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Sample records for stroke patients speech

  1. Altered resting-state network connectivity in stroke patients with and without apraxia of speech.

    Science.gov (United States)

    New, Anneliese B; Robin, Donald A; Parkinson, Amy L; Duffy, Joseph R; McNeil, Malcom R; Piguet, Olivier; Hornberger, Michael; Price, Cathy J; Eickhoff, Simon B; Ballard, Kirrie J

    2015-01-01

    Motor speech disorders, including apraxia of speech (AOS), account for over 50% of the communication disorders following stroke. Given its prevalence and impact, and the need to understand its neural mechanisms, we used resting state functional MRI to examine functional connectivity within a network of regions previously hypothesized as being associated with AOS (bilateral anterior insula (aINS), inferior frontal gyrus (IFG), and ventral premotor cortex (PM)) in a group of 32 left hemisphere stroke patients and 18 healthy, age-matched controls. Two expert clinicians rated severity of AOS, dysarthria and nonverbal oral apraxia of the patients. Fifteen individuals were categorized as AOS and 17 were AOS-absent. Comparison of connectivity in patients with and without AOS demonstrated that AOS patients had reduced connectivity between bilateral PM, and this reduction correlated with the severity of AOS impairment. In addition, AOS patients had negative connectivity between the left PM and right aINS and this effect decreased with increasing severity of non-verbal oral apraxia. These results highlight left PM involvement in AOS, begin to differentiate its neural mechanisms from those of other motor impairments following stroke, and help inform us of the neural mechanisms driving differences in speech motor planning and programming impairment following stroke.

  2. Altered resting-state network connectivity in stroke patients with and without apraxia of speech

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    Anneliese B. New

    2015-01-01

    Full Text Available Motor speech disorders, including apraxia of speech (AOS, account for over 50% of the communication disorders following stroke. Given its prevalence and impact, and the need to understand its neural mechanisms, we used resting state functional MRI to examine functional connectivity within a network of regions previously hypothesized as being associated with AOS (bilateral anterior insula (aINS, inferior frontal gyrus (IFG, and ventral premotor cortex (PM in a group of 32 left hemisphere stroke patients and 18 healthy, age-matched controls. Two expert clinicians rated severity of AOS, dysarthria and nonverbal oral apraxia of the patients. Fifteen individuals were categorized as AOS and 17 were AOS-absent. Comparison of connectivity in patients with and without AOS demonstrated that AOS patients had reduced connectivity between bilateral PM, and this reduction correlated with the severity of AOS impairment. In addition, AOS patients had negative connectivity between the left PM and right aINS and this effect decreased with increasing severity of non-verbal oral apraxia. These results highlight left PM involvement in AOS, begin to differentiate its neural mechanisms from those of other motor impairments following stroke, and help inform us of the neural mechanisms driving differences in speech motor planning and programming impairment following stroke.

  3. Effects of Speech Therapy in Hospitalized Patients with Post-Stroke Dysphagia: A Systematic Review of Observational Studies

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    Joice Santos Andrade

    2017-12-01

    Conclusion: Speech therapy in hospital bed in post-stroke hospitalized patients with dysphagia seems to bring satisfactory results in the short-term, revealing the importance of diagnosis and early intervention in these cases.

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

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

    2013-08-01

    To investigate the therapeutic effect of neurologic music therapy (NMT) and speech language therapy (SLT) through improvement of the aphasia quotient (AQ) in post-stroke aphasic patients. Twenty-one post-stroke, nonfluent aphasia patients who had ischemic/hemorrhagic stroke on radiologic evaluation were divided into the NMT and SLT groups. They received NMT and SLT for 1 month. Language function was assessed by Korean version-Western Aphasia Battery before and after therapy. NMT consisted of therapeutic singing and melodic intonation therapy, and SLT consisted of language-oriented therapy. Significant improvements were revealed in AQ, repetition, and naming after therapy in the NMT group and improvements in repetition in the SLT group of chronic stroke patients (ptherapies are effective treatments in the chronic stage of stroke and NMT is effective in subacute post-stroke aphasic patients.

  5. Study of accent-based music speech protocol development for improving voice problems in stroke patients with mixed dysarthria.

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    Kim, Soo Ji; Jo, Uiri

    2013-01-01

    Based on the anatomical and functional commonality between singing and speech, various types of musical elements have been employed in music therapy research for speech rehabilitation. This study was to develop an accent-based music speech protocol to address voice problems of stroke patients with mixed dysarthria. Subjects were 6 stroke patients with mixed dysarthria and they received individual music therapy sessions. Each session was conducted for 30 minutes and 12 sessions including pre- and post-test were administered for each patient. For examining the protocol efficacy, the measures of maximum phonation time (MPT), fundamental frequency (F0), average intensity (dB), jitter, shimmer, noise to harmonics ratio (NHR), and diadochokinesis (DDK) were compared between pre and post-test and analyzed with a paired sample t-test. The results showed that the measures of MPT, F0, dB, and sequential motion rates (SMR) were significantly increased after administering the protocol. Also, there were statistically significant differences in the measures of shimmer, and alternating motion rates (AMR) of the syllable /K$\\inve$/ between pre- and post-test. The results indicated that the accent-based music speech protocol may improve speech motor coordination including respiration, phonation, articulation, resonance, and prosody of patients with dysarthria. This suggests the possibility of utilizing the music speech protocol to maximize immediate treatment effects in the course of a long-term treatment for patients with dysarthria.

  6. Altered resting-state network connectivity in stroke patients with and without apraxia of speech

    OpenAIRE

    New, Anneliese B.; Robin, Donald A.; Parkinson, Amy L.; Duffy, Joseph R.; McNeil, Malcom R.; Piguet, Olivier; Hornberger, Michael; Price, Cathy J.; Eickhoff, Simon B.; Ballard, Kirrie J.

    2015-01-01

    Motor speech disorders, including apraxia of speech (AOS), account for over 50% of the communication disorders following stroke. Given its prevalence and impact, and the need to understand its neural mechanisms, we used resting state functional MRI to examine functional connectivity within a network of regions previously hypothesized as being associated with AOS (bilateral anterior insula (aINS), inferior frontal gyrus (IFG), and ventral premotor cortex (PM)) in a group of 32 left hemisphere ...

  7. Ability to solve riddles in patients with speech and language impairments after stroke

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    Savić Goran

    2016-01-01

    Full Text Available Introduction. Successful riddle solving requires recognition of the meaning of words, attention, concentration, memory, connectivity and analysis of riddle content, and sufficiently developed associative thinking. Objective. The aim of the study was to determine the ability to solve riddles in stroke patients who do or do not have speech and language disorders (SLDs, to determine the presence of SLDs in relation to the lesion localization, as well as to define the relationship between riddle-solving and functional impairment of a body side. Methods. The sample consisted of 88 patients. The data used included age, sex, educational level, time of stroke onset, presence of an SLD, lesion localization, and functional damage of the body side. The patients were presented with a task of solving 10 riddles. Results. A significant SLD was present in 38.60% of the patients. Brain lesions were found distributed at 46 different brain sites. Patients with different lesion localization had different success in solving riddles. Patients with perisylvian cortex brain lesions, or patients with Wernicke and global aphasia, had the poorest results. The group with SLDs had an average success of solved riddles of 26.76% (p = 0.000. The group with right-sided functional impairments had average success of 37.14%, and the group with functional impairments of the left side of the body 56.88% (p = 0.002. Conclusion. Most patients with SLDs had a low ability of solving riddles. Most of the patients with left brain lesions and perisylvian cortex damage demonstrated lower ability in solving riddles in relation to patients with right hemisphere lesions.

  8. Speech and language therapy for aphasia following subacute stroke.

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    Koyuncu, Engin; Çam, Pınar; Altınok, Nermin; Çallı, Duygu Ekinci; Duman, Tuba Yarbay; Özgirgin, Neşe

    2016-10-01

    The aim of this study was to investigate the time window, duration and intensity of optimal speech and language therapy applied to aphasic patients with subacute stroke in our hospital. The study consisted of 33 patients being hospitalized for stroke rehabilitation in our hospital with first stroke but without previous history of speech and language therapy. Sixteen sessions of impairment-based speech and language therapy were applied to the patients, 30-60 minutes per day, 2 days a week, for 8 successive weeks. Aphasia assessment in stroke patients was performed with Gülhane Aphasia Test-2 before and after treatment. Compared with before treatment, fluency of speech, listening comprehension, reading comprehension, oral motor evaluation, automatic speech, repetition and naming were improved after treatment. This suggests that 16 seesions of speech and language therapy, 30-60 minutes per day, 2 days a week, for 8 successive weeks, are effective in the treatment of aphasic patients with subacute stroke.

  9. Analysis of the Level of Dysphagia, Anxiety, and Nutritional Status Before and After Speech Therapy in Patients with Stroke

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    Drozdz, Daniela

    2014-03-01

    Full Text Available Introduction: The rehabilitation in oropharyngeal dysphagia evidence-based implies the relationship between the interventions and their results. Objective: Analyze level of dysphagia, oral ingestion, anxiety levels and nutritional status of patients with stroke diagnosis, before and after speech therapy. Method: Clinical assessment of dysphagia partially using the Protocol of Risk Assessment for Dysphagia (PARD, applying the scale Functional Oral Intake Scale for Dysphagia in Stroke Patients (FOIS, Beck Anxiety Inventory (BAI and the Mini Nutritional Assessment MNA®. The sample consisted of 12 patients, mean age of 64.6 years, with a medical diagnosis of hemorrhagic and ischemic stroke and without cognitive disorders. All tests were applied before and after speech therapy (15 sessions. Statistical analysis was performed using the chi-square test or Fisher's exact test, McNemar's test, Bowker's symmetry test and Wilcoxon's test. Results: During the pre-speech therapy assessments, 33.3% of patients had mild to moderate dysphagia, 88.2% did not receive food orally, 47.1% of the patients showed malnutrition and 35.3% of patients had mild anxiety level. After the therapy sessions, it was found that 33.3% of patients had mild dysphagia, 16.7% were malnourished and 50% of patients had minimal level of anxiety. Conclusion:  There were statistically significant evolution of the level of dysphagia (p = 0.017 and oral intake (p = 0.003 post-speech therapy. Although not statistically significant, there was considerable progress in relation to the level of anxiety and nutritional status.

  10. Speech and Language Therapy for Aphasia following Subacute Stroke

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    Koyuncu, E.; Çam, P.; Altinok, N.; Çalli, D.E.; Yarbay Duman, T.; Özgirgin, N.

    2016-01-01

    The aim of this study was to investigate the time window, duration and intensity of optimal speech and language therapy applied to aphasic patients with subacute stroke in our hospital. The study consisted of 33 patients being hospitalized for stroke rehabilitation in our hospital with first stroke

  11. A Randomized Controlled Trial on Very Early Speech and Language Therapy in Acute Stroke Patients with Aphasia

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    A.C. Laska

    2011-07-01

    Full Text Available Background: Aphasia affects one third of acute stroke patients. There is a considerable spontaneous recovery in aphasia, but impaired communication ability remains a great problem. Communication difficulties are an impediment to rehabilitation. Early treatment of the language deficits leading to increased communication ability would improve rehabilitation. The aim of this study is to elucidate the efficacy of very early speech and language therapy (SLT in acute stroke patients with aphasia. Methods: A prospective, open, randomized, controlled trial was carried out with blinded endpoint evaluation of SLT, starting within 2 days of stroke onset and lasting for 21 days. 123 consecutive patients with acute, first-ever ischemic stroke and aphasia were randomized. The SLT treatment was Language Enrichment Therapy, and the aphasia tests used were the Norsk grunntest for afasi (NGA and the Amsterdam-Nijmegen everyday language test (ANELT, both performed by speech pathologists, blinded for randomization. Results: The primary outcome, as measured by ANELT at day 21, was 1.3 in the actively treated patient group and 1.2 among controls. NGA led to similar results in both groups. Patients with a higher level of education (>12 years improved more on ANELT by day 21 than those with Conclusions: Very early intensive SLT with the Language Enrichment Therapy program over 21 days had no effect on the degree of aphasia in unselected acute aphasic stroke patients. In aphasic patients with more fluency, SLT resulted in a significant improvement as compared to controls. A higher educational level of >12 years was beneficial.

  12. Cohesive and coherent connected speech deficits in mild stroke.

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    Barker, Megan S; Young, Breanne; Robinson, Gail A

    2017-05-01

    Spoken language production theories and lesion studies highlight several important prelinguistic conceptual preparation processes involved in the production of cohesive and coherent connected speech. Cohesion and coherence broadly connect sentences with preceding ideas and the overall topic. Broader cognitive mechanisms may mediate these processes. This study aims to investigate (1) whether stroke patients without aphasia exhibit impairments in cohesion and coherence in connected speech, and (2) the role of attention and executive functions in the production of connected speech. Eighteen stroke patients (8 right hemisphere stroke [RHS]; 6 left [LHS]) and 21 healthy controls completed two self-generated narrative tasks to elicit connected speech. A multi-level analysis of within and between-sentence processing ability was conducted. Cohesion and coherence impairments were found in the stroke group, particularly RHS patients, relative to controls. In the whole stroke group, better performance on the Hayling Test of executive function, which taps verbal initiation/suppression, was related to fewer propositional repetitions and global coherence errors. Better performance on attention tasks was related to fewer propositional repetitions, and decreased global coherence errors. In the RHS group, aspects of cohesive and coherent speech were associated with better performance on attention tasks. Better Hayling Test scores were related to more cohesive and coherent speech in RHS patients, and more coherent speech in LHS patients. Thus, we documented connected speech deficits in a heterogeneous stroke group without prominent aphasia. Our results suggest that broader cognitive processes may play a role in producing connected speech at the early conceptual preparation stage. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Application of the Trail Making Test in the assessment of cognitive flexibility in patients with speech disorders after ischaemic cerebral stroke

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    Anna Rajtar-Zembaty

    2015-04-01

    Full Text Available The main aim of this study was to evaluate the level of cognitive flexibility in patients with speech disorders after ischaemic cerebral stroke. The study was conducted in a group of 43 patients (18 women and 25 men who had experienced cerebral ischaemic stroke. The patients under study were divided into groups based on the type of speech disorders, i.e.: aphasia, lack of speech disorders and dysarthria. A Mini-Mental State Examination (MMSE and a Clock Drawing Test (CDT were applied for the general evaluation of the efficiency of cognitive functions. Cognitive flexibility – a component of executive functions, was evaluated with the use of a Trail Making Test (TMT. The results obtained prove that patients with aphasia show the lowest level of cognitive flexibility. Disorders of executive functions can be related to the dysfunction of the prefrontal cortex which has been damaged as a result of ischaemic cerebral stroke. Presumably, there are common functional neuroanatomical circuits for both language skills and components of executive functions. In the case of damage to the structures that are of key importance for both skills, language and executive dysfunctions can therefore occur in parallel. The presence of executive dysfunctions in patients with aphasia can additionally impede the functioning of the patient, and also negatively influence the process of rehabilitation the aim of which is to improve the efficiency of communication.

  14. The left superior temporal gyrus is a shared substrate for auditory short-term memory and speech comprehension: evidence from 210 patients with stroke

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    Leff, Alexander P.; Schofield, Thomas M.; Crinion, Jennifer T.; Seghier, Mohamed L.; Grogan, Alice; Green, David W.; Price, Cathy J.

    2009-01-01

    Competing theories of short-term memory function make specific predictions about the functional anatomy of auditory short-term memory and its role in language comprehension. We analysed high-resolution structural magnetic resonance images from 210 stroke patients and employed a novel voxel based analysis to test the relationship between auditory short-term memory and speech comprehension. Using digit span as an index of auditory short-term memory capacity we found that the structural integrit...

  15. 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.

  16. The role of the speech language pathologist in acute stroke

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    Dilworth Cindy

    2008-01-01

    Full Text Available Dysphagia and communication impairment are common consequences of stroke. Stroke survivors with either or both of these impairments are likely to have poorer long-term outcomes than those who do not have them. Speech-language pathologists (SLP play a significant role in the screening, formal assessment, management, and rehabilitation of stroke survivors who present with dysphagia and/or communication impairment. Early diagnosis and referral is critical, as is intensive intervention as soon as the patient is able to participate. The SLP is also responsible for educating carers and staff in strategies that can support the patient and for making appropriate environmental modifications (e.g. altering diet consistencies or providing information in an aphasia-friendly format to optimize the stroke survivor′s participation, initially, in the rehabilitation program and, subsequently, within the community.

  17. Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting.

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    Breitenstein, Caterina; Grewe, Tanja; Flöel, Agnes; Ziegler, Wolfram; Springer, Luise; Martus, Peter; Huber, Walter; Willmes, Klaus; Ringelstein, E Bernd; Haeusler, Karl Georg; Abel, Stefanie; Glindemann, Ralf; Domahs, Frank; Regenbrecht, Frank; Schlenck, Klaus-Jürgen; Thomas, Marion; Obrig, Hellmuth; de Langen, Ernst; Rocker, Roman; Wigbers, Franziska; Rühmkorf, Christina; Hempen, Indra; List, Jonathan; Baumgaertner, Annette

    2017-04-15

    Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam-Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (-0·03 points [4·04]; -0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had

  18. Propositional speech in unselected stroke: The effect of genre and external support.

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    Law, Bonnie; Young, Breanne; Pinsker, Donna; Robinson, Gail A

    2015-01-01

    Distinguished from nominal language, propositional language generation refers to the spontaneous and voluntary aspect of language that introduces novel concepts to a specific context. Propositional language can be impaired in a range of neurological disorders, including stroke, despite well-preserved nominal language. Although external support can increase speech rate in patients with reduced propositional speech, no specific investigation of propositional speech has been carried out in unselected stroke patients. The current study investigated propositional language in an unselected post-acute stroke group (N = 18) with mild cognitive impairment and prominent executive dysfunction, but without significant aphasia. Specifically, we investigated whether genre or external support affected the number of words, sentences, and novel ideas produced, compared to healthy controls (N = 27). Results showed that discourse genre was not associated with differential performances. By contrast, speech quantity increased without external support although, for stroke patients, speech novelty decreased. Overall, the novelty deficit in unselected stroke patients highlights the importance of assessing cognition and propositional speech. Our findings suggest that for stroke patients with mild cognitive deficits, including executive dysfunction, introducing external support improved speech quality but not quantity. Implications for both assessment and rehabilitation of social communication are discussed.

  19. Long-term use benefits of personal frequency-modulated systems for speech in noise perception in patients with stroke with auditory processing deficits: a non-randomised controlled trial study.

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    Koohi, Nehzat; Vickers, Deborah; Warren, Jason; Werring, David; Bamiou, Doris-Eva

    2017-04-07

    Approximately one in five stroke survivors suffer from difficulties with speech reception in noise, despite normal audiometry. These deficits are treatable with personal frequency-modulated systems (FMs). This study aimed to evaluate long-term benefits in speech reception in noise, after daily 10-week use of personal FMs, in non-aphasic patients with stroke with auditory processing deficits. This was a prospective non-randomised controlled trial study. Patients were allocated to an intervention care group or standard care subjects group according to their willingness to use the intervention or not. Tertiary care setting. Nine non-aphasic subjects with ischaemic stroke, normal/near-normal audiometry and auditory processing deficits and with reported difficulties understanding speech in background noise were recruited in the subacute stroke stage (3-12 months after stroke). Four patients (intervention care subjects) used the FMs in their daily life over 10 weeks. Five patients (standard care subjects) received standard care. All subjects were tested at baseline (visit 1) and 10 weeks later (visit 2) on a sentences in noise test with the FMs (aided) and without the FMs (unaided). Speech reception thresholds showed clinically and statistically significant improvements in intervention but not in standard care subjects at 10 weeks in aided and unaided conditions. 10-week use of FMs by adult patients with stroke may lead to benefits in unaided speech in noise perception. Our findings may indicate auditory plasticity type changes and require further investigation. Pre-results; NCT02889107. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  20. The left superior temporal gyrus is a shared substrate for auditory short-term memory and speech comprehension: evidence from 210 patients with stroke.

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    Leff, Alexander P; Schofield, Thomas M; Crinion, Jennifer T; Seghier, Mohamed L; Grogan, Alice; Green, David W; Price, Cathy J

    2009-12-01

    Competing theories of short-term memory function make specific predictions about the functional anatomy of auditory short-term memory and its role in language comprehension. We analysed high-resolution structural magnetic resonance images from 210 stroke patients and employed a novel voxel based analysis to test the relationship between auditory short-term memory and speech comprehension. Using digit span as an index of auditory short-term memory capacity we found that the structural integrity of a posterior region of the superior temporal gyrus and sulcus predicted auditory short-term memory capacity, even when performance on a range of other measures was factored out. We show that the integrity of this region also predicts the ability to comprehend spoken sentences. Our results therefore support cognitive models that posit a shared substrate between auditory short-term memory capacity and speech comprehension ability. The method applied here will be particularly useful for modelling structure-function relationships within other complex cognitive domains.

  1. Patterns of Post-Stroke Brain Damage that Predict Speech Production Errors in Apraxia of Speech and Aphasia Dissociate

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    Basilakos, Alexandra; Rorden, Chris; Bonilha, Leonardo; Moser, Dana; Fridriksson, Julius

    2015-01-01

    Background and Purpose Acquired apraxia of speech (AOS) is a motor speech disorder caused by brain damage. AOS often co-occurs with aphasia, a language disorder in which patients may also demonstrate speech production errors. The overlap of speech production deficits in both disorders has raised questions regarding if AOS emerges from a unique pattern of brain damage or as a sub-element of the aphasic syndrome. The purpose of this study was to determine whether speech production errors in AOS and aphasia are associated with distinctive patterns of brain injury. Methods Forty-three patients with history of a single left-hemisphere stroke underwent comprehensive speech and language testing. The Apraxia of Speech Rating Scale was used to rate speech errors specific to AOS versus speech errors that can also be associated with AOS and/or aphasia. Localized brain damage was identified using structural MRI, and voxel-based lesion-impairment mapping was used to evaluate the relationship between speech errors specific to AOS, those that can occur in AOS and/or aphasia, and brain damage. Results The pattern of brain damage associated with AOS was most strongly associated with damage to cortical motor regions, with additional involvement of somatosensory areas. Speech production deficits that could be attributed to AOS and/or aphasia were associated with damage to the temporal lobe and the inferior pre-central frontal regions. Conclusion AOS likely occurs in conjunction with aphasia due to the proximity of the brain areas supporting speech and language, but the neurobiological substrate for each disorder differs. PMID:25908457

  2. Speech and language therapy for aphasia following stroke.

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    Brady, Marian C; Kelly, Helen; Godwin, Jon; Enderby, Pam; Campbell, Pauline

    2016-06-01

    Aphasia is an acquired language impairment following brain damage that affects some or all language modalities: expression and understanding of speech, reading, and writing. Approximately one third of people who have a stroke experience aphasia. To assess the effects of speech and language therapy (SLT) for aphasia following stroke. We searched the Cochrane Stroke Group Trials Register (last searched 9 September 2015), CENTRAL (2015, Issue 5) and other Cochrane Library Databases (CDSR, DARE, HTA, to 22 September 2015), MEDLINE (1946 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), AMED (1985 to September 2015), LLBA (1973 to September 2015), and SpeechBITE (2008 to September 2015). We also searched major trials registers for ongoing trials including ClinicalTrials.gov (to 21 September 2015), the Stroke Trials Registry (to 21 September 2015), Current Controlled Trials (to 22 September 2015), and WHO ICTRP (to 22 September 2015). In an effort to identify further published, unpublished, and ongoing trials we also handsearched the International Journal of Language and Communication Disorders (1969 to 2005) and reference lists of relevant articles, and we contacted academic institutions and other researchers. There were no language restrictions. Randomised controlled trials (RCTs) comparing SLT (a formal intervention that aims to improve language and communication abilities, activity and participation) versus no SLT; social support or stimulation (an intervention that provides social support and communication stimulation but does not include targeted therapeutic interventions); or another SLT intervention (differing in duration, intensity, frequency, intervention methodology or theoretical approach). We independently extracted the data and assessed the quality of included trials. We sought missing data from investigators. We included 57 RCTs (74 randomised comparisons) involving 3002 participants in this review (some appearing in

  3. Automatic speech recognition (ASR) based approach for speech therapy of aphasic patients: A review

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    Jamal, Norezmi; Shanta, Shahnoor; Mahmud, Farhanahani; Sha'abani, MNAH

    2017-09-01

    This paper reviews the state-of-the-art an automatic speech recognition (ASR) based approach for speech therapy of aphasic patients. Aphasia is a condition in which the affected person suffers from speech and language disorder resulting from a stroke or brain injury. Since there is a growing body of evidence indicating the possibility of improving the symptoms at an early stage, ASR based solutions are increasingly being researched for speech and language therapy. ASR is a technology that transfers human speech into transcript text by matching with the system's library. This is particularly useful in speech rehabilitation therapies as they provide accurate, real-time evaluation for speech input from an individual with speech disorder. ASR based approaches for speech therapy recognize the speech input from the aphasic patient and provide real-time feedback response to their mistakes. However, the accuracy of ASR is dependent on many factors such as, phoneme recognition, speech continuity, speaker and environmental differences as well as our depth of knowledge on human language understanding. Hence, the review examines recent development of ASR technologies and its performance for individuals with speech and language disorders.

  4. Post-stroke pure apraxia of speech - A rare experience.

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    Polanowska, Katarzyna Ewa; Pietrzyk-Krawczyk, Iwona

    Apraxia of speech (AOS) is a motor speech disorder, most typically caused by stroke, which in its "pure" form (without other speech-language deficits) is very rare in clinical practice. Because some observable characteristics of AOS overlap with more common verbal communication neurologic syndromes (i.e. aphasia, dysarthria) distinguishing them may be difficult. The present study describes AOS in a 49-year-old right-handed male after left-hemispheric stroke. Analysis of his articulatory and prosodic abnormalities in the context of intact communicative abilities as well as description of symptoms dynamics over time provides valuable information for clinical diagnosis of this specific disorder and prognosis for its recovery. This in turn is the basis for the selection of appropriate rehabilitative interventions. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  5. Rehabilitation of a patient with stroke

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    Apurba Barman

    2013-01-01

    Full Text Available Stroke is a significant cause of long-term disability world-wide. The post-stroke disabilities are due to loss of locomotion, activity of daily living, cognition and communication skills. Rehabilitation is an integral part of medical management and continues longitudinally through acute care, post-acute care and community reintegration. The objectives of stroke rehabilitation are to maximize the functional independence, minimize the disabilities, reintegrate back into the home and community and improve the self-esteem of patient. A comprehensive stroke rehabilitation service should provide early assessment of impairments and disabilities, management and prevention of complications and well-organized rehabilitation program in both in-patient and out-patient settings. A multidisciplinary or interdisciplinary team approach is necessary to reduce the post-stroke disabilities. It has many members, including physicians, physical therapists, occupational therapists, speech and language pathologists, orthotist, psychotherapists, social workers, vocational rehabilitation therapists, rehabilitation nurse, patients, families and other caregivers. Physicians caring for patients with stroke during rehabilitation must be aware of potential medical complications, as well as a number of special problems that may complicate recovery, including cognitive deficits, aphasia, dysphagia, urinary incontinence, shoulder pain, spasticity, falls and depression. Involvement of patient and caregivers in the rehabilitation process is essential. This article outlines the salient features of the early comprehensive rehabilitation after stroke.

  6. Non-fluent speech following stroke is caused by impaired efference copy.

    Science.gov (United States)

    Feenaughty, Lynda; Basilakos, Alexandra; Bonilha, Leonardo; den Ouden, Dirk-Bart; Rorden, Chris; Stark, Brielle; Fridriksson, Julius

    2017-09-01

    Efference copy is a cognitive mechanism argued to be critical for initiating and monitoring speech: however, the extent to which breakdown of efference copy mechanisms impact speech production is unclear. This study examined the best mechanistic predictors of non-fluent speech among 88 stroke survivors. Objective speech fluency measures were subjected to a principal component analysis (PCA). The primary PCA factor was then entered into a multiple stepwise linear regression analysis as the dependent variable, with a set of independent mechanistic variables. Participants' ability to mimic audio-visual speech ("speech entrainment response") was the best independent predictor of non-fluent speech. We suggest that this "speech entrainment" factor reflects integrity of internal monitoring (i.e., efference copy) of speech production, which affects speech initiation and maintenance. Results support models of normal speech production and suggest that therapy focused on speech initiation and maintenance may improve speech fluency for individuals with chronic non-fluent aphasia post stroke.

  7. VERBAL CHOICE IN ISCHEMIC STROKE PATIENTS WITH ANOMIC APHASIA.

    Directory of Open Access Journals (Sweden)

    Мaya P. Danovska

    2014-03-01

    Full Text Available Background and purposes: Anomic aphasia is common in patients with left hemispheric strokes. The purpose of this study was to explore the verbal production of ischemic stroke patients with anomic aphasia. Contingent and methods: Fifty ischemic stroke patients admitted to the Neurology Clinic of University Hospital Pleven were studied by neuropsychological battery and CT scan of the brain. Verbal productivity changes found were analyzed in relation to the speech recovery education. Results: All the patients showed lower scores at all nominative and reproductive speech subtests. Discussion: Among the ischemic stroke patients with mild anomic aphasia comparatively great was the percentage of low frequency word actualization and verbal fluency impairment. The usage of nominatives in speech expression of ischemic stroke patients is less as compared with that one of predicatives. Actualization of particles, unions, prepositions and interjections was comparatively high thus compensating the difficulty in choice of a definite lexical number. Conclusion: Future studies on testing of verbal choice in ischemic stroke patients should confirm its practical significance for the assessment of speech disorders concerning a special speech- recovery education.

  8. [Clinical study of post-stroke speech apraxia treated with scalp electric acupuncture under anatomic orientation and rehabilitation training].

    Science.gov (United States)

    Jiang, Yujuan; Yang, Yuxia; Xiang, Rong; Chang, E; Zhang, Yanchun; Zuo, Bingfang; Zhang, Qianwei

    2015-07-01

    To compare the differences in the clinical efficacy on post-stroke speech disorder between scalp electric acupuncture (EA) under anatomic orientation combined with rehabilitation training and simple rehabilitation training. Sixty patients of post-stroke speech apraxia were randomized into an observation group and a control group, 30 cases in each one. In the observation group, under anatomic orientation, the scalp EA was adopted to the dominant hemisphere Broca area on the left cerebrum. Additionally, the speech rehabilitation training was combined. In the control group, the speech rehabilitation training was simply,used. The treatment lasted for 4 weeks totally. The speech movement program module in the psychological language assessment and treatment system of Chinese aphasia was used for the evident of efficacy assessment. The scores of counting, singing scale, repeating phonetic alphabet, repeating monosyllable and repeating disyllable were observed in the patients of the two groups. The assessment was done separately on the day of grouping and 4 weeks after treatment. In 4 weeks of treatment, the scores of counting, singing scale, repeating phonetic alphabet, repeating monosyllable and repeating disyllable were all improved as compared with those before treatment in the two groups (all Pspeech rehabilitation training obviously improves speech apraxia in stroke patients so that the speech disorder cani be relieved. The efficacy is better than that in simple rehabilitation training.

  9. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin

    2018-01-01

    AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...

  10. Damage to the Left Precentral Gyrus Is Associated With Apraxia of Speech in Acute Stroke.

    Science.gov (United States)

    Itabashi, Ryo; Nishio, Yoshiyuki; Kataoka, Yuka; Yazawa, Yukako; Furui, Eisuke; Matsuda, Minoru; Mori, Etsuro

    2016-01-01

    Apraxia of speech (AOS) is a motor speech disorder, which is clinically characterized by the combination of phonemic segmental changes and articulatory distortions. AOS has been believed to arise from impairment in motor speech planning/programming and differentiated from both aphasia and dysarthria. The brain regions associated with AOS are still a matter of debate. The aim of this study was to address this issue in a large number of consecutive acute ischemic stroke patients. We retrospectively studied 136 patients with isolated nonlacunar infarcts in the left middle cerebral artery territory (70.5±12.9 years old, 79 males). In accordance with speech and language assessments, the patients were classified into the following groups: pure form of AOS (pure AOS), AOS with aphasia (AOS-aphasia), and without AOS (non-AOS). Voxel-based lesion-symptom mapping analysis was performed on T2-weighted images or fluid-attenuated inversion recovery images. Using the Liebermeister method, group-wise comparisons were made between the all AOS (pure AOS plus AOS-aphasia) and non-AOS, pure AOS and non-AOS, AOS-aphasia and non-AOS, and pure AOS and AOS-aphasia groups. Of the 136 patients, 22 patients were diagnosed with AOS (7 patients with pure AOS and 15 patients with AOS-aphasia). The voxel-based lesion-symptom mapping analysis demonstrated that the brain regions associated with AOS were centered on the left precentral gyrus. Damage to the left precentral gyrus is associated with AOS in acute to subacute stroke patients, suggesting a role of this brain region in motor speech production. © 2015 American Heart Association, Inc.

  11. Perception of stroke among patients with stroke | Ajayi | Nigerian ...

    African Journals Online (AJOL)

    The perception of patients to stroke is variable. The aim of this study was to determine the perception of stroke among stroke patients. The study was carried out between January 2004 - December 2004 on all the patients presenting with features of stroke at the Federal Medical Center Ido, Nigeria. Data were collected by ...

  12. Communication activity in stroke patients with aphasia.

    Science.gov (United States)

    Mazaux, Jean-Michel; Lagadec, Tiphaine; de Sèze, Mathieu Panchoa; Zongo, Drissa; Asselineau, Julien; Douce, Emmanuelle; Trias, Joel; Delair, Marie-France; Darrigrand, Bénédicte

    2013-04-01

    To study communication disability in stroke patients with aphasia. Prospective, multicentric cohort study of patients with aphasia, consecutively included after a first stroke, and examined 1 year later at home. Assessment included a stroke severity scale, the Barthel Index, the boston diagnostic aphasia examination, a communication questionnaire, and the aphasia depression rating scale. A total of 164 patients were included. Among the 100 survivors assessed at follow-up, 24% had severe aphasia, 12% moderate aphasia and 64% mild aphasia according to the Boston diagnostic aphasia examination severity score. Patients mainly reported difficulties in conversation with strangers and/or on abstract topics, using a phone, reading and writing administrative documents, dealing with money and outdoor communication activities. Communication was strongly related to aphasia severity. Age, gender, education level, residence status and type of stroke had no influence on communication activity. On multivariate analysis, severity of stroke and severity of aphasia on inclusion were found to account for 58% of variance and were independent predictors of the communication questionnaire score at follow-up. Documenting the most impaired communication skills may help to set priority goals for speech and language therapy in aphasia.

  13. Separate neural systems support representations for actions and objects during narrative speech in post-stroke aphasia

    Directory of Open Access Journals (Sweden)

    Ezequiel Gleichgerrcht

    2016-01-01

    Conclusions: The finding that the two major grammatical classes in human speech rely on two dissociable networks has both important theoretical implications for the neurobiology of language and clinical implications for the assessment and potential rehabilitation and treatment of patients with chronic aphasia due to stroke.

  14. Family History in Young Patients With Stroke.

    Science.gov (United States)

    Thijs, Vincent; Grittner, Ulrike; Dichgans, Martin; Enzinger, Christian; Fazekas, Franz; Giese, Anne-Katrin; Kessler, Christof; Kolodny, Edwin; Kropp, Peter; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Rothwell, Peter M; Schmidt, Reinhold; Tanislav, Christian; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt

    2015-07-01

    Family history of stroke is an established risk factor for stroke. We evaluated whether family history of stroke predisposed to certain stroke subtypes and whether it differed by sex in young patients with stroke. We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young patients (aged stroke in whom cardiovascular risk factors and family history of stroke were obtained and detailed stroke subtyping was performed. A family history of stroke was present in 1578 of 4232 transient ischemic attack and ischemic stroke patients (37.3%). Female patients more often had a history of stroke in the maternal lineage (P=0.027) than in the paternal lineage. There was no association with stroke subtype according to Trial of Org 10172 in Acute Stroke Treatment nor with the presence of white matter disease on brain imaging. Patients with dissection less frequently reported a family history of stroke (30.4% versus 36.3%; P=0.018). Patients with a parental history of stroke more commonly had siblings with stroke (3.6% versus 2.6%; P=0.047). Although present in about a third of patients, a family history of stroke is not specifically related to stroke pathogenic subtypes in patients with young stroke. Young women with stroke more often report stroke in the maternal lineage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  15. Measurement of speech parameters in casual speech of dementia patients

    NARCIS (Netherlands)

    Ossewaarde, Roelant; Jonkers, Roel; Jalvingh, Fedor; Bastiaanse, Yvonne

    Measurement of speech parameters in casual speech of dementia patients Roelant Adriaan Ossewaarde1,2, Roel Jonkers1, Fedor Jalvingh1,3, Roelien Bastiaanse1 1CLCG, University of Groningen (NL); 2HU University of Applied Sciences Utrecht (NL); 33St. Marienhospital - Vechta, Geriatric Clinic Vechta

  16. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic.

    Science.gov (United States)

    Aroor, Sushanth; Singh, Rajpreet; Goldstein, Larry B

    2017-02-01

    The FAST algorithm (Face, Arm, Speech, Time) helps identify persons having an acute stroke. We determined the proportion of patients with acute ischemic stroke not captured by FAST and evaluated a revised mnemonic. Records of all patients admitted to the University of Kentucky Stroke Center between January and December 2014 with a discharge International Classification of Diseases, Ninth Revision, Clinical Modification code for acute ischemic stroke were reviewed. Those misclassified, having missing National Institutes of Health Stroke Scale data, or were comatose or intubated were excluded. Presenting symptoms, demographics, and examination findings based on the National Institutes of Health Stroke Scale data were abstracted. Of 858 consecutive records identified, 736 met inclusion criteria; 14.1% did not have any FAST symptoms at presentation. Of these, 42% had gait imbalance or leg weakness, 40% visual symptoms, and 70% either symptom. With their addition, the proportion of stroke patients not identified was reduced to 4.4% (P<0.0001). In a sensitivity analysis, if face weakness, arm weakness, or speech impairment on admission examination were considered in addition to a history of FAST symptoms, the proportion missed was reduced to 9.9% (P=0.0010). The proportion of stroke patients not identified was also reduced (2.6%) with the addition of a history of gait imbalance/leg weakness or visual symptoms (P<0.0001). Of patients with ischemic stroke with deficits potentially amenable to acute intervention, 14% are not identified using FAST. The inclusion of gait/leg and visual symptoms leads to a reduction in missed strokes. If validated in a prospective study, a revision of public educational programs may be warranted. © 2017 American Heart Association, Inc.

  17. Music and speech listening enhance the recovery of early sensory processing after stroke.

    Science.gov (United States)

    Särkämö, Teppo; Pihko, Elina; Laitinen, Sari; Forsblom, Anita; Soinila, Seppo; Mikkonen, Mikko; Autti, Taina; Silvennoinen, Heli M; Erkkilä, Jaakko; Laine, Matti; Peretz, Isabelle; Hietanen, Marja; Tervaniemi, Mari

    2010-12-01

    Our surrounding auditory environment has a dramatic influence on the development of basic auditory and cognitive skills, but little is known about how it influences the recovery of these skills after neural damage. Here, we studied the long-term effects of daily music and speech listening on auditory sensory memory after middle cerebral artery (MCA) stroke. In the acute recovery phase, 60 patients who had middle cerebral artery stroke were randomly assigned to a music listening group, an audio book listening group, or a control group. Auditory sensory memory, as indexed by the magnetic MMN (MMNm) response to changes in sound frequency and duration, was measured 1 week (baseline), 3 months, and 6 months after the stroke with whole-head magnetoencephalography recordings. Fifty-four patients completed the study. Results showed that the amplitude of the frequency MMNm increased significantly more in both music and audio book groups than in the control group during the 6-month poststroke period. In contrast, the duration MMNm amplitude increased more in the audio book group than in the other groups. Moreover, changes in the frequency MMNm amplitude correlated significantly with the behavioral improvement of verbal memory and focused attention induced by music listening. These findings demonstrate that merely listening to music and speech after neural damage can induce long-term plastic changes in early sensory processing, which, in turn, may facilitate the recovery of higher cognitive functions. The neural mechanisms potentially underlying this effect are discussed.

  18. Rehabilitative Games for Stroke Patients

    Directory of Open Access Journals (Sweden)

    A. Pyae

    2015-07-01

    Full Text Available Stroke is one of the major problems in medical and healthcare that can cause severe disability and death of patients especially for older population. Rehabilitation plays an important role in stroke therapy. However, most of the rehabilitative exercises are monotonous and tiring for the patients. For a particular time, they can easily get bored in doing these exercises. The role of patient’s motivation in rehabilitation is vital. Motivation and rehabilitative outcomes are strongly related. Digital games promise to help stroke patients to feel motivated and more engaged in rehabilitative training through motivational gameplay. Most of the commercial games available in the market are not well-designed for stroke patients and their motivational needs in rehabilitation. This study aims at understanding the motivational requirements of stroke patients in doing rehabilitative exercises and living in a post-stroke life. Based on the findings from the literature review, we report factors that can influence the stroke patients’ level of motivation such as social functioning, patient-therapist relationship, goal-setting, and music. These findings are insightful and useful for ideating and designing interactive motivation-driven games for stroke patients. The motivational factors of stroke patients in rehabilitation may help the game designers to design motivation-driven game contexts, contents, and gameplay. Moreover, these findings may also help healthcare professionals who concern stroke patient’s motivation in rehabilitative context. In this paper, we reported our Virtual Nursing Home (VNH concept and the games that we are currently developing and re-designing. Based on this literature review, we will present and test out the ideas how we can integrate these motivational factors in our future game design, development, and enhancement.

  19. Communication in conversation in stroke patients.

    Science.gov (United States)

    Rousseaux, Marc; Daveluy, Walter; Kozlowski, Odile

    2010-07-01

    In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication difficulties at the rehabilitation phase (1-6 months) post-stroke, in order to define the main mechanisms of verbal and non-verbal communication (VC, NVC) disorders and their relationship with aphasic disorders. Sixty-three patients were recruited, who belonged to six groups, with left or right cortico-sub-cortical (L-CSC, R-CSC) or sub-cortical (L-SC, R-SC), frontal (Fro) or posterior fossa (PF) lesions. They were compared with an equivalent control group (gender, age, education level). We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). We also used the Functional Communication Profile and the Boston Diagnostic Aphasia Examination (BDAE). Decrease in participation was found in L-CSC, R-CSC and Fro patients. Verbal communication was essentially disrupted in L-SCS and L-SC groups, including by verbal pragmatic disorders, and to a lesser degree in frontal patients. Nonverbal communication was mainly affected in R-CSC patients, especially by pragmatic difficulties. L-CSC patients showed an increase in gesture production, compensating for aphasia. In conclusion, communication disorders were relatively complex and could not be summarised by syntactical and lexical difficulties in left stroke and pragmatic problems in right stroke. The former also showed severe

  20. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

    Science.gov (United States)

    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.

  1. Short-term prognosis for speech and language in first stroke patients Prognóstico em curto prazo para fala e linguagem em pacientes acometidos de infarto cerebral único

    Directory of Open Access Journals (Sweden)

    Fabricio F. Oliveira

    2009-09-01

    Full Text Available OBJECTIVE: To evaluate the factors that can influence evolution of communication after a first stroke. METHOD: Thirty-seven adult patients were evaluated for speech and language within 72 hours after a single first-ever ischemic brain injury and later on. Patients who were comatose, with decompensated systemic diseases, or history of chronic alcoholism or illicit drug use were not included. Brain CT and/or 2T-MR exams were solicited for topographic correlation. Size of infarct was classified as large or small according to the TOAST classification. RESULTS: Patients who survived had lesser chances of presenting with aphasia or dysarthria 3 months after the stroke if the infarct size was small (p=0.017. Gender, age, schooling, aphasia subtype, infarct side and topography were non-significant in our sample. Subjects with global aphasia or lone cortical dysarthria had a slower evolution. CONCLUSION: Brain injury size was the most influential factor for neurological outcome at 3 months post-stroke.OBJETIVO: Avaliar os fatores que podem influenciar o desempenho neurolinguístico após um primeiro acidente vascular cerebral isquêmico. MÉTODO: Foram avaliados 37 pacientes quanto a fala e linguagem dentro de 72 horas após um primeiro infarto cerebral e posteriormente. Pacientes comatosos, com doenças sistêmicas descompensadas, história de etilismo crônico ou uso de drogas ilícitas não foram incluídos. TC e/ou RMN-2T cerebrais foram solicitadas para correlação topográfica. Utilizou-se a classificação TOAST para o tamanho do infarto (grande ou pequeno. RESULTADOS: Sobreviventes tiveram menores chances de apresentarem-se afásicos ou disártricos 3 meses após o evento agudo caso o infarto fosse pequeno (p=0.017. Gênero, idade, escolaridade, subtipo de afasia, lado e topografia da lesão cerebral não foram fatores estatisticamente significativos. Pacientes portadores de afasia global ou disartria cortical isolada evoluíram mais lentamente

  2. OF STROKE PATIENTS IN IBADAN.

    African Journals Online (AJOL)

    206 patients clinically diagnosed as stroke/cerebrovascular accidents(CVA) were investigated using computerized tomography. (CT) scan. 19 patients (9%) had normal scan, While 20(9.7%) patients had other lesions including atrophy and tumours. Of the l67(l8.l%) patients proven to have suffered a cerebro~vascular ...

  3. [The rehabilitation treatment of patients with motor and cognitive disorders after stroke].

    Science.gov (United States)

    Sakharov, V Iu; Isanova, V A

    2014-01-01

    Objective. To study the possibility of using the rehabilitative pneumatic suit "Atlant" in stroke outpatients. Material and methods. We studied 11 stroke patients who wore the pneumatic suit in the early rehabilitation period. A comparison group included 13 patients. The high effectiveness of complex treatment with using the suit "Atlant" was shown. The motor activity was improved in 71.4% of patients, the recovery of speech was found in 33.3% patients. Conclusion. Continuity of rehabilitation in outpatients with stroke promotes the recovery of functional activity, motor, cognitive and speech functions and positively impacts on the emotional state of the patient.

  4. Integrated oral health care for stroke patients - a scoping review.

    Science.gov (United States)

    Ajwani, Shilpi; Jayanti, Sumedh; Burkolter, Nadia; Anderson, Craig; Bhole, Sameer; Itaoui, Rhonda; George, Ajesh

    2017-04-01

    To identify current evidence on the role of nurses and allied health professionals in the oral health management of stroke patients, detailing their current knowledge, attitudes and practices and the potential benefits of an integrated oral care programme. Stroke has disabling oral health effects, such as dysphagia and hindered brushing due to upper limb hemiparesis. Together, these can increase bacterial load, increasing risk of pneumonia. In general management of stroke, nurses play a key role in early identification, assessment and referral, while occupational therapists, dieticians and speech pathologists are important in rehabilitation. While this should logically apply to the oral care of stroke patients, there is currently limited information, especially in Australia. Scoping review. A literature search was conducted using multiple databases regarding the oral health management of stroke patients by nondental professionals, and 26 articles were reviewed. The Australian National Clinical Guidelines for Stroke accentuate the need for oral care following stroke and suggest how hospital staff need to be involved. Currently, there are no Australian studies. However, international literature suggests that lack of oral health knowledge by nurses and poor patient attitude are reflected in infrequent assistance with stroke patient oral hygiene. There is limited information regarding the benefits of nursing-driven oral hygiene programme in reducing pneumonia incidence, and only few studies show that involving nurses in assisted oral care reduces plaque. There are some suggestions that involving nurses and speech pathologists in oral rehabilitation can improve dysphagia outcomes. Managing oral health poststroke is vital, and there is a need for an appropriate integrated oral care service in Australia. Nondental professionals, especially nurses, can play a key role in the poststroke oral health management of stroke patients to reduce complications, especially pneumonia

  5. Stroke Patients Communicating Their Healthcare Needs in Hospital: A Study within the ICF Framework

    Science.gov (United States)

    O'Halloran, Robyn; Worrall, Linda; Hickson, Louise

    2012-01-01

    Background: Previous research has identified that many patients admitted into acute hospital stroke units have communication-related impairments such as hearing, vision, speech, language and/or cognitive communicative impairment. However, no research has identified how many patients in acute hospital stroke units have difficulty actually…

  6. Protein consumptions in stroke patients

    Directory of Open Access Journals (Sweden)

    Zahra Maghsoudi

    2013-01-01

    Full Text Available Background : Stroke is one of the most common causes of disabilities and death all over the world. The mortality rate of stroke is predicted to be doubled by 2030 in the Middle East countries. Nutrition is an effective strategy in prevention and management of stroke. This study assessed the relationship between various protein types and stroke risk. Materials and Methods: This hospital-based case-control study was performed in a University hospital. The data regarding consumption of usual food intake of 69 cases (46 men and 23 women and 60 controls (30 men and 30 women was collected with a food frequency questionnaire (FFQ. The mean consumption of red and white meat and vegetable and processed proteins consumption were compared between two groups. Results: The percent of total of daily protein intake were lower in patients with stroke in both sexes (25.92% vs 30.55% in men and 30.7% vs 31.14% in women. Conclusion: Lower protein consumption may be observed in patients with stroke patients in both sex.

  7. A systematic review of nursing rehabilitation of stroke patients with aphasia.

    Science.gov (United States)

    Poslawsky, Irina E; Schuurmans, Marieke J; Lindeman, Eline; Hafsteinsdóttir, Thóra B

    2010-01-01

    To explore the evidence on rehabilitation of stroke patients with aphasia in relation to nursing care, focusing on the following themes: (1) the identification of aphasia, (2) the effectiveness of speech-language interventions. Patients with poststroke aphasia have higher mortality rates and worse functional outcome than patients without aphasia. Nurses are well aware of aphasia and the associated problems for patients with stroke because they have daily contact with them. The challenge is to provide evidence-based care directed at the aphasia. Although rehabilitation stroke guidelines are available, they do not address the caregiving of nurses to patients with aphasia. Systematic review. Published studies were reviewed, focusing on identification and treatment of aphasic patients after stroke in terms of the consequences for nursing care. Also, data concerning effective speech-language interventions were extrapolated into nursing practice with respect to the classification of nursing interventions. Intensive speech-language therapy, which was initiated in the acute stage post stroke, showed the best rehabilitation outcomes. Trained persons other than speech-language therapists provided effective speech-language interventions. Speech-language therapy included several types of intervention that met nursing intervention classifications. The contribution of nursing to the rehabilitation of patients with aphasia is relevant. The use of screening instruments by nurses can increase early detection of aphasia, a precondition for initiating timely speech-language therapy. Collaboration between speech-language therapists and nurses is of the utmost importance for increasing the intensity and functionality of speech-language exercises, which may enhance the quality of treatment. The findings of this study can be used to develop nursing rehabilitation guidelines for stroke patients with aphasia. Further research is necessary to explore the feasibility of using such guidelines

  8. Fatigue after Stroke: The Patient's Perspective

    Directory of Open Access Journals (Sweden)

    Victoria Louise Barbour

    2012-01-01

    Full Text Available Background. Fatigue after stroke is common and distressing to patients. Aims. Our aims were to explore patients' perceptions of post-stroke fatigue, including the causes of fatigue and the factors that alleviate fatigue, in a mixed methods study. Results. We interviewed 15 patients who had had a stroke and were inpatients on stroke rehabilitation wards. A substantial proportion of patients reported that their fatigue started at the time of their stroke. Various different factors were reported to improve fatigue, including exercise, good sleep, rehabilitation and rest. Fatigue influences patients' sense of “control” after their stroke. Conclusion. Our results are consistent with the possibility that poststroke fatigue might be triggered by factors that occur at the time of the stroke (e.g., the stroke lesion itself, or admission to hospital and then exacerbated by poor sleep and boredom. These factors should be considered when developing complex interventions to improve post-stroke fatigue.

  9. FASTER (Face, Arm, Speech, Time, Emergency Response): experience of Central Coast Stroke Services implementation of a pre-hospital notification system for expedient management of acute stroke.

    Science.gov (United States)

    O'Brien, W; Crimmins, D; Donaldson, W; Risti, R; Clarke, T A; Whyte, S; Sturm, J

    2012-02-01

    Despite benefit in acute ischaemic stroke, less than 3% of patients receive tissue plasminogen activator (tPA) in Australia. The FASTER (Face, Arm, Speech, Time, Emergency Response) protocol was constructed to reduce pre-hospital and Emergency Department (ED) delays and improve access to thrombolysis. This study aimed to determine if introduction of the FASTER protocol increases use of tPA using a prospective pre- and post-intervention cohort design in a metropolitan hospital. A pre-hospital assessment tool was used by ambulance services to screen potential tPA candidates. The acute stroke team was contacted, hospital bypass allowed, triage and CT radiology alerted, and the patient rapidly assessed on arrival to ED. Data were collected prospectively during the first 6 months of the new pathway and compared to a 6-month period 12 months prior to protocol initiation. In the 6 months following protocol introduction, 115 patients presented within 24 hours of onset of an ischaemic stroke: 22 (19%) received thrombolysis, significantly greater than five (7%) of 67 patients over the control period, p=0.03. Overall, 42 patients were referred via the FASTER pathway, with 21 of these receiving tPA (50%). One inpatient stroke was also treated. Only two referrals (patients involving the ambulance services and streamlined hospital assessment is effective and efficient in improving patient access to thrombolysis. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  10. Stroke

    Science.gov (United States)

    ... adjust your treatment as needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, ... may have trouble communicating after a stroke. You may not be able to find the ...

  11. Ischemic Stroke and Cancer: Stroke Severely Impacts Cancer Patients, While Cancer Increases the Number of Strokes

    OpenAIRE

    Bang, Oh Young; Seok, Jin Myoung; Kim, Seon Gyeong; Hong, Ji Man; Kim, Hahn Young; Lee, Jun; Chung, Pil-Wook; Park, Kwang-Yeol; Kim, Gyeong-Moon; Chung, Chin-Sang; Lee, Kwang Ho

    2011-01-01

    Background Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke. Main Contents This revi...

  12. Sexual function in post-stroke patients: considerations for rehabilitation.

    Science.gov (United States)

    Rosenbaum, Talli; Vadas, Dor; Kalichman, Leonid

    2014-01-01

    While the rehabilitation goals of post-stroke patients include improving quality of life and returning to functional activities, the extent to which sexual activity is addressed as part of the standard rehabilitation process is unknown. Moreover, the specific sexual concerns of stroke patients, including the effect of stroke on intimate relationships and sexuality of the partner, the ability to physically engage in sex, and the effect of psychological components such as role identity, depression, and anxiety on sexuality, all warrant examination by rehabilitation professionals. The aim of this study is to examine the existing literature on sexuality and stroke patients in order to better understand how the sexual lives of stroke patients and their partners are affected and to provide recommendations to rehabilitation professionals for addressing sexuality as part of treatment. Narrative review, PubMed, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2012) were searched for the key words "stroke," "sexual dysfunction," "sexuality," "quality of life," and their combination. All relevant articles in English and secondary references were reviewed. We report the results of the literature review. Sexual dysfunction and decreased sexual satisfaction are common in the post-stroke population and are related to physical, psychosocial, and relational factors. However, they are not adequately addressed in post-stroke rehabilitation. As sexual function is an important component to quality of life and activities of daily living, physicians and rehabilitation specialists, including physical, occupational, and speech therapists, should receive training in addressing sexuality in the treatment of post-stroke patients. Sexologists and sex therapists should be an integral part of the rehabilitation team. © 2013 International Society for Sexual Medicine.

  13. Speech profile of patients undergoing primary palatoplasty.

    Science.gov (United States)

    Menegueti, Katia Ignacio; Mangilli, Laura Davison; Alonso, Nivaldo; Andrade, Claudia Regina Furquim de

    2017-10-26

    To characterize the profile and speech characteristics of patients undergoing primary palatoplasty in a Brazilian university hospital, considering the time of intervention (early, before two years of age; late, after two years of age). Participants were 97 patients of both genders with cleft palate and/or cleft and lip palate, assigned to the Speech-language Pathology Department, who had been submitted to primary palatoplasty and presented no prior history of speech-language therapy. Patients were divided into two groups: early intervention group (EIG) - 43 patients undergoing primary palatoplasty before 2 years of age and late intervention group (LIG) - 54 patients undergoing primary palatoplasty after 2 years of age. All patients underwent speech-language pathology assessment. The following parameters were assessed: resonance classification, presence of nasal turbulence, presence of weak intraoral air pressure, presence of audible nasal air emission, speech understandability, and compensatory articulation disorder (CAD). At statistical significance level of 5% (p≤0.05), no significant difference was observed between the groups in the following parameters: resonance classification (p=0.067); level of hypernasality (p=0.113), presence of nasal turbulence (p=0.179); presence of weak intraoral air pressure (p=0.152); presence of nasal air emission (p=0.369), and speech understandability (p=0.113). The groups differed with respect to presence of compensatory articulation disorders (p=0.020), with the LIG presenting higher occurrence of altered phonemes. It was possible to assess the general profile and speech characteristics of the study participants. Patients submitted to early primary palatoplasty present better speech profile.

  14. A multimedia PDA/PC speech and language therapy tool for patients with aphasia.

    Science.gov (United States)

    Reeves, Nina; Jefferies, Laura; Cunningham, Sally-Jo; Harris, Catherine

    2007-01-01

    Aphasia is a speech disorder usually caused by stroke or head injury and may involve a variety of communication difficulties. As 30% of stroke sufferers have a persisting speech and language disorder and therapy resources are low, there is clear scope for the development of technology to support patients between therapy sessions. This paper reports on an empirical study which evaluated SoundHelper, a multimedia application to demonstrate how to pronounce target speech sounds. Two prototypes, involving either video or animation, were developed and evaluated with 20 Speech and Language Therapists. Participants responded positively to both, with the video being preferred because of the perceived extra information provided. The potential for the use on portable devices, since internet access is limited in hospitals, is explored in the light of opinions of Augmented and Alternative Communication (AAC) device users in the UK nd Europe who have expressed a strong desire for more use of internet services.

  15. WARFARIN IN PATIENTS WITH CARDIOEMBOLIC STROKE

    Directory of Open Access Journals (Sweden)

    E. N. Dankovtseva

    2012-01-01

    Full Text Available Analysis of the current literature data on the use of warfarin in patients with cardioembolic stroke is presented. Cardioembolic stroke pathology and particularities of this condition therapywith antithrombotic medications are shown in details. Possibility to apply thrombolysis during warfarin treatment and the use of anticoagulants after cardioembolic stroke is discussed.

  16. Do Stroke Patients Know Their Risk Factors?

    Science.gov (United States)

    Soomann, Maarja; Vibo, Riina; Kõrv, Janika

    2016-03-01

    Risk factor management is the key to stroke prevention. Although several studies have assessed the awareness of different risk factors in the general public, there are limited data available on how well acute stroke patients know their own risk factors. The aim of this study was to assess stroke patients' informedness of their own stroke risk factors. All consecutive eligible acute stroke and transient ischemic attack patients hospitalized at the Tartu University Hospital, Department of Neurology, during 9 months in 2010 were interviewed about different stroke risk factors within 72 hours from hospitalization. The respective information was also retrieved from medical records. Of the 341 patients admitted during the study period, 195 were eligible for the interview. Diabetes was the best known risk factor (89%) followed by hypertension (80%), atrial fibrillation (78%), previous stroke (77%), and heart failure and/or ischemic heart disease (66%). We found that acute stroke patients are best informed of their diabetes and worst informed of their ischemic heart disease and/or heart failure. There is, however, room for amelioration in the awareness of all of the studied risk factors. More attention should be addressed to explaining the risks and treatment options to patients at risk of stroke and the general population. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. The knowledge and attitudes of occupational therapy, physiotherapy and speech-language therapy students, regarding the speech-language therapist's role in the hospital stroke rehabilitation team.

    Science.gov (United States)

    Felsher, L; Ross, E

    1994-01-01

    The purpose of the present study was to survey and compare the knowledge and attitudes of final year occupational therapy, physiotherapy and speech-language therapy students, concerning the role of the speech-language therapist as a member of the stroke rehabilitation team in the hospital setting. In order to achieve this aim, a questionnaire was administered to final year students in these three disciplines, and included questions on most areas of stroke rehabilitation with which the speech-language therapist might be involved, as well as the concepts of rehabilitation and teamwork in relation to stroke rehabilitation. Results suggested a fairly good understanding of the concepts of rehabilitation and teamwork. Students appeared to have a greater understanding of those disorders following a stroke, with which the speech-language therapist is commonly involved, such as Aphasia, Dysarthria, Verbal Apraxia and Dysphagia. However, students appeared to show less understanding of those disorders post-stroke, for which the speech-language therapist's role is less well defined, such as Agraphia, Alexia and Amnesia. In addition, a high percentage of role duplication/overlapping in several aspects of stroke rehabilitation, such as family and social support, was found. Several implications for facilitating communication, collaboration and understanding between paramedical professions, as well as for further research are also provided.

  18. Features of self-esteem in patients with various speech disorders

    OpenAIRE

    Anastasia E. Vishneva

    2016-01-01

    The paper presents the results of the self-assessment study in patients with aphasia and dysarthria after stroke or traumatic brain injury. All the patients were neurorehabilitation course. Self-esteem is considered as important parameter in the study of the psychological status of patients. This article describes the differences in the quantitative and qualitative parameters of self-esteem in patients with various speech defect (motor aphasia, temporal aphasia, dysarthria). The actual self-e...

  19. Music and Stroke Rehabilitation: A Narrative Synthesis of the Music-Based Treatments used to Rehabilitate Disorders of Speech and Language following Left-Hemispheric Stroke

    OpenAIRE

    Kevin Draper

    2016-01-01

    Stroke is a leading cause of long-term disability. A stroke can damage areas of the brain associated with communication, resulting in speech and language disorders. Such disorders are frequently acquired impairments from left-hemispheric stroke. Music-based treatments have been implemented, and researched in practice, for the past thirty years; however, the number of published reports reviewing these treatments is limited. This paper uses the four elements of the narrative synthesis framework...

  20. Dysarthria following stroke: the patient's perspective on management and rehabilitation.

    Science.gov (United States)

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

    2011-10-01

    To explore the perceptions of people with stroke-related dysarthria in relation to the management and rehabilitation of dysarthria. Qualitative semi-structured interviews. Community setting Subjects: Twenty-four people with an acquired dysarthria as a result of a stroke in the previous three years. All were living at home at the time of the interview. None exhibited a co-existing impairment (for example, aphasia, apraxia or cognitive impairment) that might have contributed to their communicative experiences. Participants described the considerable efforts they made to maximize their communicative effectiveness prior to, and during, communicative interactions. Activities described included careful articulation and vocal projection as well as more inconspicuous strategies including pre-planning interactions, focused, effortful speech and word substitution. Communication was facilitated by a range of strategies including drafting, rehearsal, manoeuvring and ongoing monitoring and repair. Self-led speech rehabilitation activities were functionally based and often undertaken regularly. Some novel reading-aloud and speaking-aloud activities were described. The quantity and nature of inconspicuous, internalized, cognitive activities people with dysarthria engage in to maximize their communicative effectiveness should be considered in evaluating the impact of dysarthria following stroke. Focusing upon externally observable characteristics alone is insufficient. Challenging, functionally relevant, patient-focused activities, materials and targets are more likely to be perceived by the patient as relevant and worthwhile and are thus more likely to ensure adherence to recommended rehabilitation activities.

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

    Science.gov (United States)

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

    2014-01-01

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

  2. Incidence of constipation in stroke patients

    Science.gov (United States)

    Li, Jianxiang; Yuan, Mengguo; Liu, Yunfang; Zhao, Yang; Wang, Jingqing; Guo, Weifeng

    2017-01-01

    Abstract There is growing awareness of a link between the gut and cardiovascular disease. Constipation is common among individuals who have had a stroke, and it negatively affects social functioning and quality of life. However, no systematic study on the incidence of constipation in stroke patients has been reported. We selected studies included in Medline, Embase, Cochrane database, and Web of Science. Studies were included if they reported the incidence in stroke patients. Two authors selected the studies, extracted the data independently, and assessed these. Subgroup analyses were conducted according to the stroke subtype and stage of stroke. After detailed evaluations, 8 studies (n  =  1385 participants) were found that contained data that were suitable for meta-analytic synthesis. A forest plot showed that the incidence of constipation was 48% (95% confidence interval [CI]  =  33%–63%). In the analysis of the type of stroke subgroup, the incidence of constipation in patients who had had a hemorrhagic stroke (66% [95% CI  =  40–91%]) was higher than that in patients who had experienced an ischemic stroke (51% [95% CI  =  27%–75%]). The incidence in the acute stage (45% [95% CI  =  36%–54%]) was lower than that in the rehabilitation stage (48% [95% CI  =  23%–73%]). Constipation after a stroke event occurs frequently. This finding may raise awareness about bowel complications to allow correct evaluation and proper management. PMID:28640117

  3. Three-dimensional patterns of speech-induced cerebral and cerebellar activation in healthy volunteers and in aphasic stroke patients studied by positron emission tomography of 2(18F)-fluorodeoxyglucose

    International Nuclear Information System (INIS)

    Pawlik, G.; Heiss, W.D.; Beil, C.; Gruenewald, G.; Herholz, K.; Wienhard, K.; Wagner, R.

    1987-01-01

    Eight healthy male volunteers and eight moderately aphasic patients with a single cerebral infarctions in the postacute stage, were studied by dynamic positron emission tomography (PET) using the 2(18F)-fluoro-2-deoxy-D-glucose method and a 7-slice positron camera. Because hemispheric speech dominance is commonly thought to be closely related to handedness, subjects were tested by the Oldfield and Bryden questionnaires; the volunteers also had a tracking and pin-sort test. PET studies were performed in random order, both at rest and during spontaneous speech of rather abstract and some biographic content, with a time interval of 2 to 7 days between measurements of the same individual. Data was analyzed by means of weighted, repeated measures of analysis of variance (ANOVA). 11 refs.; 2 figs

  4. [Nutrition for elderly acute stroke patients].

    Science.gov (United States)

    Ha, Lisa; Iversen, Per Ole; Hauge, Truls

    2008-09-11

    Elderly people have an increased risk of malnutrition due to biological and physiological changes and underlying disease. Almost 90% of the stroke patients are older than 65 years, and the consequences of acute stroke may lead to additional nutritional problems. This paper reviews nutritional therapy for stroke patients. PubMed was searched (non-systematically) for prospective cohort studies of occurrence, diagnostics and consequences of undernutrition in stroke patients. Randomized trials were examined to identify clinical effects of oral protein and energy supplements or tube feeding on nutritional status and intake, functional status, infections, length of stay, quality of life and mortality. 8-35% of stroke patients are undernourished. Body weight is one of the most important parameters for assessment of nutritional status. Dysphagia occurs in up to 80% of patients with acute stroke and increases the risk of undernutrition, which again leads to prolonged length of stay, reduced functional status and poorer survival. Early nasogastric tube feeding does not increase the risk of pneumonia and may improve survival after six months. Oral supplements lead to a significantly improved nutritional intake in undernourished stroke patients, as well as improved nutritional status and survival in undernourished elderly. Nutritional treatment can improve the clinical outcome after an acute stroke, provided that there are good procedures for follow-up and monitoring of the treatment.

  5. A predictive model for diagnosing stroke-related apraxia of speech.

    Science.gov (United States)

    Ballard, Kirrie J; Azizi, Lamiae; Duffy, Joseph R; McNeil, Malcolm R; Halaki, Mark; O'Dwyer, Nicholas; Layfield, Claire; Scholl, Dominique I; Vogel, Adam P; Robin, Donald A

    2016-01-29

    Diagnosis of the speech motor planning/programming disorder, apraxia of speech (AOS), has proven challenging, largely due to its common co-occurrence with the language-based impairment of aphasia. Currently, diagnosis is based on perceptually identifying and rating the severity of several speech features. It is not known whether all, or a subset of the features, are required for a positive diagnosis. The purpose of this study was to assess predictor variables for the presence of AOS after left-hemisphere stroke, with the goal of increasing diagnostic objectivity and efficiency. This population-based case-control study involved a sample of 72 cases, using the outcome measure of expert judgment on presence of AOS and including a large number of independently collected candidate predictors representing behavioral measures of linguistic, cognitive, nonspeech oral motor, and speech motor ability. We constructed a predictive model using multiple imputation to deal with missing data; the Least Absolute Shrinkage and Selection Operator (Lasso) technique for variable selection to define the most relevant predictors, and bootstrapping to check the model stability and quantify the optimism of the developed model. Two measures were sufficient to distinguish between participants with AOS plus aphasia and those with aphasia alone, (1) a measure of speech errors with words of increasing length and (2) a measure of relative vowel duration in three-syllable words with weak-strong stress pattern (e.g., banana, potato). The model has high discriminative ability to distinguish between cases with and without AOS (c-index=0.93) and good agreement between observed and predicted probabilities (calibration slope=0.94). Some caution is warranted, given the relatively small sample specific to left-hemisphere stroke, and the limitations of imputing missing data. These two speech measures are straightforward to collect and analyse, facilitating use in research and clinical settings. Copyright

  6. Factors associated with delayed presentation in patients with TIA and minor stroke in China: analysis of data from the China National Stroke Registry (CNSR).

    Science.gov (United States)

    Wang, Linyu; Chao, Yangyun; Zhao, Xingquan; Liu, Liping; Wang, Chunxue; Wang, David Z; Meng, Xia; Wang, Anxin; Wang, Yongjun; Xu, Yuming

    2013-06-01

    We aimed to evaluate the management of patients with transient ischemic attack (TIA) and minor stroke in China. Data from the China National Stroke Registry (CNSR) were used to identify patients who were admitted to 132 urban hospitals across China with TIA or minor stroke. Factors associated with delayed presentation to hospital were evaluated. Univariate and multivariate analyses were performed to analyze relationships between patient characteristics and time of presentation. Of the 7467 patients entered into the CNSR (1204 with TIA, 6263 with minor stroke), 780 patients (64·78%) with TIA and 3467 patients (55·36%) with minor stroke had delayed presentation to hospital (>24 hours). In both groups, factors associated with early presentation (≤24 hours) included transportation by ambulance and direct presentation to the emergency room. In patients with minor stroke, early presentation was associated with older age (65-80 years), motor and sensory symptoms, speech impairment, atrial fibrillation, previous TIA, and living in central or eastern China; and delayed presentation was associated with female sex, cognitive dysfunction, and diabetes. In patients with TIA, early presentation was associated with motor symptoms, and delayed presentation was associated with headache or vertigo. In China, many patients with TIA and minor stroke do not seek medical treatment immediately. Further education is needed to teach members of the public about the warning signs and symptoms of TIA and minor stroke, and encourage the use of ambulance transportation after TIA or stroke.

  7. Speech entrainment enables patients with Broca’s aphasia to produce fluent speech

    Science.gov (United States)

    Hubbard, H. Isabel; Hudspeth, Sarah Grace; Holland, Audrey L.; Bonilha, Leonardo; Fromm, Davida; Rorden, Chris

    2012-01-01

    A distinguishing feature of Broca’s aphasia is non-fluent halting speech typically involving one to three words per utterance. Yet, despite such profound impairments, some patients can mimic audio-visual speech stimuli enabling them to produce fluent speech in real time. We call this effect ‘speech entrainment’ and reveal its neural mechanism as well as explore its usefulness as a treatment for speech production in Broca’s aphasia. In Experiment 1, 13 patients with Broca’s aphasia were tested in three conditions: (i) speech entrainment with audio-visual feedback where they attempted to mimic a speaker whose mouth was seen on an iPod screen; (ii) speech entrainment with audio-only feedback where patients mimicked heard speech; and (iii) spontaneous speech where patients spoke freely about assigned topics. The patients produced a greater variety of words using audio-visual feedback compared with audio-only feedback and spontaneous speech. No difference was found between audio-only feedback and spontaneous speech. In Experiment 2, 10 of the 13 patients included in Experiment 1 and 20 control subjects underwent functional magnetic resonance imaging to determine the neural mechanism that supports speech entrainment. Group results with patients and controls revealed greater bilateral cortical activation for speech produced during speech entrainment compared with spontaneous speech at the junction of the anterior insula and Brodmann area 47, in Brodmann area 37, and unilaterally in the left middle temporal gyrus and the dorsal portion of Broca’s area. Probabilistic white matter tracts constructed for these regions in the normal subjects revealed a structural network connected via the corpus callosum and ventral fibres through the extreme capsule. Unilateral areas were connected via the arcuate fasciculus. In Experiment 3, all patients included in Experiment 1 participated in a 6-week treatment phase using speech entrainment to improve speech production

  8. [Potential analysis of research on speech therapy-led communication training in aphasia following stroke].

    Science.gov (United States)

    Kempf, Sabrina; Lauer, Norina; Corsten, Sabine; Voigt-Radloff, Sebastian

    2014-01-01

    In Germany, about 100,000 people currently suffer from aphasia. This speech disorder occurs as a result of neurologic events such as stroke or traumatic brain injury. Aphasia causes major limitations in social participation and quality of life and can be associated with unemployability and social isolation. For affected persons, it is essential to regain and maintain autonomy in daily life, both at work and with family and friends. The loss of autonomy is perceived much more dramatically than the loss of speech. Clients wish to minimise this loss of autonomy in daily life. As full recovery is not achievable in chronic aphasia, treatment must focus on improved compensatory approaches and on supporting the clients' coping strategies. Based on eight randomised comparisons including 347 participants, a recent Cochrane review (Brady et al., 2012) revealed that speech therapy - as compared with no treatment - had positive effects on functional communication in clients suffering from aphasia (0.30 SMD; 95% CI[0.08 to 0.52]). There was no evidence suggesting that one type of training was superior to the others. However, quality of life and social participation were not evaluated as outcomes. Recent studies found that speech therapy-led training for communication and self-efficacy and the integration of communication partners may have a positive impact on these client-centred outcomes. Speech therapy-led training for communication within a group setting should be manualised and pilot-tested with respect to feasibility and acceptance in a German sample of people with aphasia and their communication partners. Instruments measuring quality of life and social participation can be validated within the scope of this feasibility study. These research efforts are necessary to prepare a large-scale comparative effectiveness research trial comparing the effects of both usual speech therapy and speech therapy-led group communication training on quality of life and social participation

  9. Default Mode Network Connectivity in Stroke Patients.

    Science.gov (United States)

    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.

  10. Motor Imagery Impairment in Postacute Stroke Patients

    Directory of Open Access Journals (Sweden)

    Niclas Braun

    2017-01-01

    Full Text Available Not much is known about how well stroke patients are able to perform motor imagery (MI and which MI abilities are preserved after stroke. We therefore applied three different MI tasks (one mental chronometry task, one mental rotation task, and one EEG-based neurofeedback task to a sample of postacute stroke patients (n=20 and age-matched healthy controls (n=20 for addressing the following questions: First, which of the MI tasks indicate impairment in stroke patients and are impairments restricted to the paretic side? Second, is there a relationship between MI impairment and sensory loss or paresis severity? And third, do the results of the different MI tasks converge? Significant differences between the stroke and control groups were found in all three MI tasks. However, only the mental chronometry task and EEG analysis revealed paresis side-specific effects. Moreover, sensitivity loss contributed to a performance drop in the mental rotation task. The findings indicate that although MI abilities may be impaired after stroke, most patients retain their ability for MI EEG-based neurofeedback. Interestingly, performance in the different MI measures did not strongly correlate, neither in stroke patients nor in healthy controls. We conclude that one MI measure is not sufficient to fully assess an individual’s MI abilities.

  11. Physical Activity in Hospitalised Stroke Patients

    Directory of Open Access Journals (Sweden)

    Tanya West

    2012-01-01

    Full Text Available The aim of this paper was to examine the amount and type of physical activity engaged in by people hospitalised after stroke. Method. We systematically reviewed the literature for observational studies describing the physical activity of stroke patients. Results. Behavioural mapping, video recording and therapist report are used to monitor activity levels in hospitalised stroke patients in the 24 included studies. Most of the patient day is spent inactive (median 48.1%, IQR 39.6%–69.3%, alone (median 53.7%, IQR 44.2%–60.6% and in their bedroom (median 56.5%, IQR 45.2%–72.5%. Approximately one hour per day is spent in physiotherapy (median 63.2 minutes, IQR 36.0–79.5 and occupational therapy (median 57.0 minutes, IQR 25.1–58.5. Even in formal therapy sessions limited time is spent in moderate to high level physical activity. Low levels of physical activity appear more common in patients within 14 days post-stroke and those admitted to conventional care. Conclusions. Physical activity levels are low in hospitalised stroke patients. Improving the description and classification of post stroke physical activity would enhance our ability to pool data across observational studies. The importance of increasing activity levels and the effectiveness of interventions to increase physical activity after stroke need to be tested further.

  12. Aspirin resistant patients with recent ischemic stroke.

    Science.gov (United States)

    Castilla-Guerra, L; Navas-Alcántara, M S; Fernández-Moreno, M C

    2014-04-01

    Some patients with a recent ischemic stroke who are being treated with aspirin as an antiaggregant suffer a new ischemic stroke. These patients (15-25%) have been called unresponsive to aspirin or aspirin resistant. The aspirin-resistant patients have a four-time greater risk of suffering a stroke. Furthermore, these strokes are generally more severe, with increased infarct volume and greater risk of recurrence. There is currently no ideal laboratory test to detect the resistance to the antiaggregant effect of aspirin. The study of resistance to aspirin would only be indicated in selected cases. In these patients, one should first rule out any "pseudo-resistance" to aspirin (lack of compliance, concomitant treatments that interfere with the action of the aspirin). Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. Hypercholesterolemia in patients of ischemic stroke

    International Nuclear Information System (INIS)

    Saeed, E.; Ali, R.; Din, M.J.U.; Saeed, A.; Jadoon, R.J.

    2015-01-01

    Background: Stroke is a common neurological disease that results in significant mortality and morbidity globally. Several risk factors have been identified for stroke among which hyperlipidaemia is one of the modifiable risk factors. Recent clinical trials have shown a reduction in ischemic stroke for patients taking lipid lowering medications. Therefore, the aim of this study was to find out the frequency of hypercholesterolemia in patients of ischemic stroke in Hazara region. Method: This cross sectional study was carried out in the Medical Department of Ayub Teaching Hospital, Abbottabad. Ninety patients of stroke confirmed as ischemic by CT scan brain were enrolled in the study after informed consent. The frequency of hypercholesterolemia in patients was recorded. Results: There were 55 (61.1 percentage) males. The mean age of patients was 64.4±11.5 years. The mean serum cholesterol in all patients was 4.16±1.1 mmol/l. The mean serum cholesterol of male patients was 4.3±1.2 mmol/l and 4.0±10.9 mmol/l in the case of females. Conclusions: Hypercholesterolemia could not be established as a major risk factor for stroke in our setup through this study that allude to the fact that other risk factors might be contributing more to the incidence of cerebrovascular accident in our population. (author)

  14. Epidemiology of stroke patients in Tikur Anbessa Specialized Hospital

    African Journals Online (AJOL)

    unhcc

    2013-09-20

    Sep 20, 2013 ... stroke are not well identified in Ethiopia. Methods: A retrospective chart review of all stroke patients who presented from December 2010 to December ... In developed nations, ischemic stroke accounts for 85. % of the stroke types (1,5-6), but in ..... Emphasis on Stroke in the Young. EthiopJHealth. Dev. 2002 ...

  15. Program to Diagnose Probability of Aspiration Pneumonia in Patients with Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Pinto, Gisele

    2014-05-01

    Full Text Available Introduction Stroke is a major cause of death and disability worldwide, with a strong economic and social impact. Approximately 40% of patients show motor, language, and swallowing disorders after stroke. Objective To evaluate the use of software to infer the probability of pneumonia in patients with ischemic stroke. Methods Prospective and cross-sectional study conducted in a university hospital from March 2010 to August 2012. After confirmation of ischemic stroke by computed axial tomography, a clinical and flexible endoscopic evaluation of swallowing was performed within 72 hours of onset of symptoms. All patients received speech therapy poststroke, and the data were subsequently analyzed by the software. The patients were given medical treatment and speech therapy for 3 months. Results The study examined 52 patients with a mean age of 62.05 ± 13.88 years, with 23 (44.2% women. Of the 52 patients, only 3 (5.7% had a probability of pneumonia between 80 and 100% as identified by the software. Of all patients, 32 (61.7% had pneumonia probability between 0 and 19%, 5 (9.5% between 20 and 49%, 3 (5.8% between 50 and 79%, and 12 (23.0% between 80 and 100%. Conclusion The computer program indicates the probability of patient having aspiration pneumonia after ischemic stroke.

  16. Hemiplegic limb synergies in stroke patients.

    Science.gov (United States)

    Welmer, Anna-Karin; Holmqvist, Lotta Widén; Sommerfeld, Disa K

    2006-02-01

    To describe the extent to which the voluntary movements of hemiparetic stroke patients are restricted to the hemiplegic limb synergies (which are marked by the inability to master individual joint movements) described by Brunnström. The study also aimed to describe the extent to which the synergies are related to functioning. In a prospective observational study design, 64 consecutive hemiparetic stroke patients were assessed with Brunnström's hemiplegic limb synergies, the modified Ashworth scale for spasticity, the Rivermead mobility index, and the Barthel ADL index. Three months after stroke, 8 of the 64 patients were moving completely or partly within the synergies. All patients whose movements were restricted to the synergies also exhibited spasticity. Hemiparetic patients whose movements were restricted to the synergies had significantly worse functioning scores than hemiparetic patients whose movements were not restricted to the synergies although severe disabilities were seen in both groups. Three months after stroke, the voluntary movements of only 13% of hemiparetic stroke patients were restricted to the synergies. The synergies were associated with spasticity and activity limitations. The use of the synergies might only be suitable for a small fraction of hemiparetic patients-namely, those displaying spasticity.

  17. MEMORY SONGS DECREASE DEPRESSION FOR STROKE PATIENTS

    Directory of Open Access Journals (Sweden)

    Harmayetty Harmayetty

    2017-07-01

    Full Text Available Introduction: Biological, physical and phsycosocial changes in stroke patient could be a stressor that induced a depression state. There would be an emotional disturbance in stroke patient and stroke attack would be recurrent, if it was not treated. One of the alternative techniques to reduce depression is musical therapy especially memory songs. Method: This study was used a quasy experimental pre-post test purposive sampling design. The population was stroke patients who treated in Neurological Ward A and Stroke Unit Dr Soetomo Hospital Surabaya. There were 12 respondents divided into 6 respondents for treatment group and 6 respondents for control group. The independent variable was music (memory song and dependent variable was depression. Data were collected by using questionnaire which adapted from Hamilton Depression Rating Scale and Geriatric Depression Rating Scale, then analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U Test with significance level α≤0.05. Result: The result showed that there was a difference between pre test and post test in depression (p=0.0196 and there was a difference in the depression between treatment group and control group (p=0.002. Discussion: It can be concluded that music (memory songs has an effect to the depression of stroke patient. Further studies are needed to concerning other factors that may affect the relaxation technique especially in listening music.

  18. Respiratory Changes in Patients with Stroke

    Directory of Open Access Journals (Sweden)

    Rita Ocko

    2014-05-01

    Full Text Available This study aimed to review published literature concerning the major changes that occur in the respiratory system after stroke, and also the impact of respiratory muscle training in these patients. The literature search was conducted through electronic databases (PubMed, SciELO and Pedro in Portuguese and English languages on themes related to changes in the respiratory system and methods of assessment and rehabilitation of respiratory muscle strength in individuals affected by stroke. There is scientific evidence that individuals affected by stroke may show decreased inspiratory and expiratory muscle strength. Studies suggest that respiratory muscle training through threshold load can bring benefits by improving respiratory function and respiratory muscle strength. However, more studies should be conducted to deepen the knowledge about the benefits and long-term effects of pulmonary rehabilitation in patients with stroke.

  19. Malnutrition in Patients with Acute Stroke

    Directory of Open Access Journals (Sweden)

    Stella D. Bouziana

    2011-01-01

    Full Text Available Stroke is a devastating event that carries a potential for long-term disability. Malnutrition is frequently observed in patients with stroke, and dysphagia contributes to malnutrition risk. During both the acute phase of stroke and rehabilitation, specific nutritional interventions in the context of a multidisciplinary team effort can enhance the recovery of neurocognitive function. Early identification and management of malnutrition with dietary modifications or specific therapeutic strategies to ensure adequate nutritional intake should receive more attention, since poor nutritional status appears to exacerbate brain damage and to contribute to adverse outcome. The main purpose of nutritional intervention should be the prevention or treatment of complications resulting from energy-protein deficit. This paper reviews the evaluation and management of malnutrition and the use of specialized nutrition support in patients with stroke. Emphasis is given to enteral tube and oral feeding and to strategies to wean from tube feeding.

  20. Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

    Directory of Open Access Journals (Sweden)

    Chao-jin-zi Li

    2016-01-01

    Full Text Available Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6% was the primary stroke type found in the young group, while ischemic stroke (60.0% was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

  1. SPEECH AND LANGUAGE DISORDERS IN PATIENTS WITH CVA COMPARISON WITH CT SCAN

    Directory of Open Access Journals (Sweden)

    A CHIT SAZ

    2001-09-01

    Full Text Available Introduction. Stroke is a sudden onset of neurologic signs as a result of the ischemic or intracranial hemmorhage because of the cerebrovascular disease that stands for at least 24 hours. Cerebrovascular disease is one of the most important factors that causes speech disorder. The aim of this study is to show the characteristics of speech and language related to the various parts of the brain lesion. Methods. In this study 64 patients with CVA and speech disorders were tested. Lesions in 36 patients were ischemic, 17 patients were hemmorhagic. 11 patients had no any significant lesion on CT-scan. The test unndertaken included "Farsi Aphasia Test" written by Dr. Nilipoor. Results. Fifty percent of patients were in 61-70 years old group. 70.3 percent were male and 29.7 percent were female. In aspect of the hemisphere involved 50 percent were left hemisphere and 28.1 percent Right hemisphere and 4.7 percent with both hemisphers involvement. Discussion. In CVA patient with speech disorders the temporal lobe of the left hemisphere is mostly involved, and in respect to oral speech disorders in CVA, most of the problems were seen in non verbal fluency and the least problems were seen in repetition.

  2. Obstructive sleep apnea in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Aliye Tosun

    2008-01-01

    Full Text Available OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started.

  3. [Language and swallowing disorders in acute stroke patients: tools and early management].

    Science.gov (United States)

    Flamand-Roze, C; Roze, E; Denier, C

    2012-05-01

    The contribution of stroke units to improve morbidity, mortality and recovery in stroke victims is clearly demonstrated. However, acute management of language disorders in these specialized units is controversial and little standardization is seen for the management of swallowing disorders. The recently validated French scale for rapid screening for language disorders (LAST) in acute stroke patients should enable optimal detection and early management. A standardized protocol should be used to screen for and manage swallowing disorders. This protocol should include daily evaluations, individually tailored rehabilitation sessions, adaptation of food textures, patient education for adequate eating position, team training, and information for families. These protocols imply co-operation and coordination between the medical and allied profession teams and the daily presence of a speech and language therapist. This presence is crucial for patients in stroke units to achieve the full benefits of the management scheme proposed in this paper. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  4. Polymorphonuclear leukocyte elastase in patients with stroke.

    Science.gov (United States)

    Vila, N; Elena, M; Deulofeu, R; Chamorro, A

    1999-12-01

    Polymorphonuclear leukocytes (PMNL) are involved in the pathogenesis of acute cerebral ischemia and atherosclerosis. Elastase is one of the proteolytic enzymes released by activated PMNL. We evaluated whether plasma levels of elastase-inhibitor complexes (EIC) are related to acute cerebral damage or with extension of carotid atherosclerosis in patients with stroke. Plasma levels of EIC were determined in 44 patients during acute and chronic phases of stroke. We recorded in all patients vascular risk factors, clinical severity on admission, infarct volume, and extension of carotid atherosclerosis using B-mode ultrasound exam. EIC levels were not different between acute and chronic phases of stroke. Eleven patients (25%) had increased values of EIC. On multiple regression analysis diabetes, dislipemia, and coronary disease were predictors of abnormal EIC levels. EIC levels were not related to neurological severity on admission, infarct volume, or carotid atherosclerosis. EIC levels in stroke patients are associated to the presence of vascular risk factors and may reflect cellular inflammatory aspects of chronic vessel disease. However, whether elastase contributes to the development of carotid atherosclerosis in patients with stroke remains unknown.

  5. Acupuncture therapy for stroke patients.

    Science.gov (United States)

    Li, Xin; Wang, Qiang

    2013-01-01

    Acupuncture is one of the most important parts of Traditional Chinese Medicine, has been used for more than 3000 years as prevention and treatment for various diseases in China as well as in adjacent regions, and is widely accepted in western countries in recent years. More and more clinical trials revealed that acupuncture shows positive effect in stroke, not only as a complementary and alternative medicine for poststroke rehabilitation but also as a preventive strategy which could induce cerebral ischemic tolerance, especially when combined with modern electrotherapy. Acupuncture has some unique characteristics, which include acupoint specificity and parameter-dependent effect. It also involves complicated mechanism to exert the beneficial effect on stroke. Series of clinical trials have shown that acupuncture primarily regulates the release of neurochemicals, hemorheology, cerebral microcirculation, metabolism, neuronal activity, and the function of specific brain region. Animal studies showed that the effects of acupuncture therapy on stroke were possibly via inhibition of postischemic inflammatory reaction, stimulation of neurogenesis and angiogenesis, and influence on neural plasticity. Mechanisms for its preconditioning effect include activity enhancement of antioxidant, regulation of the endocannabinoid system, and inhibition of apoptosis. Although being controversial, acupuncture is a promising preventive and treatment strategy for stroke, but further high-quality clinical trials would be needed to provide more confirmative evidence. © 2013 Elsevier Inc. All rights reserved.

  6. Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke.

    Science.gov (United States)

    Zhao, Lu; Wang, Ruihao; Song, Bo; Tan, Song; Gao, Yuan; Fang, Hui; Lu, Jie; Xu, Yuming

    2015-07-01

    The association between atherogenic dyslipidemia and stroke recurrence remains unclear, and may be influenced by different subtypes of ischemic stroke. We aimed to investigate whether atherogenic dyslipidemia contributed to stroke recurrence in ischemic stroke patients and in those with certain subtypes of ischemic stroke. We conducted a prospective hospital-based study enrolling patients with acute ischemic stroke. Atherogenic dyslipidemia was defined as high-density lipoprotein cholesterol dyslipidemia and stroke recurrence was analyzed by using multivariable Cox regression model. In the 510 ischemic stroke patients, 64 patients (12·5%) had atherogenic dyslipidemia, and 66 patients (12·9%) experienced stroke recurrence events within 24 months. Kaplan-Meier analysis revealed that stroke recurrence rate was significantly higher in patients with atherogenic dyslipidemia than those without in all the stroke patients (20·3% vs. 11·9%; P = 0·048), and more evident in those of large-artery atherosclerosis subtype (31·0% vs. 14·1%; P = 0·014), but not in the other subtypes. Multivariable Cox regression analysis revealed that atherogenic dyslipidemia was associated with higher stroke recurrence risk among stroke patients of large-artery atherosclerosis subtype (hazard ratio, 2·79; 95% confidence interval, 1·24-6·28), but not significant in all the stroke patients (hazard ratio, 1·69; 95% confidence interval, 0·85-3·37). Atherogenic dyslipidemia is associated with higher risk of stroke recurrence in ischemic stroke patients. Such association might be more pronounced in large-artery atherosclerosis subtype and needs further investigation to establish such relationship. © 2015 World Stroke Organization.

  7. Characteristics of Dysphagia in Severe Traumatic Brain Injury Patients: A Comparison With Stroke Patients.

    Science.gov (United States)

    Lee, Won Kyung; Yeom, Jiwoon; Lee, Woo Hyung; Seo, Han Gil; Oh, Byung-Mo; Han, Tai Ryoon

    2016-06-01

    To compare the swallowing characteristics of dysphagic patients with traumatic brain injury (TBI) with those of dysphagic stroke patients. Forty-one patients with TBI were selected from medical records (between December 2004 to March 2013) and matched to patients with stroke (n=41) based on age, sex, and disease duration. Patients' swallowing characteristics were analyzed retrospectively using a videofluoroscopic swallowing study (VFSS) and compared between both groups. Following thorough review of medical records, patients who had a history of diseases that could affect swallowing function at the time of the study were excluded. Dysphagia characteristics and severity were evaluated using the American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale, clinical dysphagia scale, and the videofluoroscopic dysphagia scale. There was a significant difference in radiological lesion location (p=0.024) between the two groups. The most common VFSS finding was aspiration or penetration, followed by decreased laryngeal elevation and reduced epiglottis inversion. Swallowing function, VFSS findings, or quantified dysphagia severity showed no significant differences between the groups. In a subgroup analysis of TBI patients, the incidence of tube feeding was higher in patients with surgical intervention than in those without (p=0.011). The swallowing characteristics of dysphagic patients after TBI were comparable to those of dysphagic stroke patients. Common VFSS findings comprised aspiration or penetration, decreased laryngeal elevation, and reduced epiglottis inversion. Patients who underwent surgical intervention after TBI were at high risk of tube feeding requirement.

  8. National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014.

    Science.gov (United States)

    Lecoffre, Camille; de Peretti, Christine; Gabet, Amélie; Grimaud, Olivier; Woimant, France; Giroud, Maurice; Béjot, Yannick; Olié, Valérie

    2017-11-01

    Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management. © 2017 American Heart Association, Inc.

  9. Clues to occult cancer in patients with ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Suk Jae Kim

    Full Text Available BACKGROUND: We hypothesized that hidden malignancy could be detected in patients with cryptogenic stroke without active cancer when they showed the distinctive characteristics of cancer-related stroke. METHODS AND FINDINGS: Among 2,562 consecutive patients with acute ischemic stroke, patients with cryptogenic stroke were analyzed and categorized into two groups according to the presence of active cancer: cryptogenic stroke with active cancer (cancer-related stroke, CA-stroke group and without active cancer (CR-stroke group. Patients with active lung cancer without stroke were also recruited for comparison purposes (CA-control. Clinical factors, lesion patterns on diffusion-weighted MRI (DWI, and laboratory findings were analyzed among groups. A total of 348 patients with cryptogenic stroke were enrolled in this study. Among them, 71 (20.4% patients had active cancer at the time of stroke. The D-dimer levels were significantly higher in patients with CA-stroke than those with CR-stroke or CA-control (both p<0.001. Regarding lesion patterns, patients with CA-stroke mostly had multiple lesions in multiple vascular territories, while more than 80% of patients with CR-stroke had single/multiple lesions in a single vascular territory (P<0.001. D-dimer levels (OR 1.11 per 1 µg/mL increase; 95% CI 1.06-1.15; P<0.001 and DWI lesion patterns (OR 7.13; 95% CI 3.42-14.87; P<0.001 were independently associated with CA-stroke. Workup for hidden malignancy was performed during hospitalization in 10 patients who showed elevated D-dimer levels and multiple infarcts involving multiple vascular territories but had no known cancer, and it revealed hidden malignancies in all the patients. CONCLUSION: Patients with CA-stroke have distinctive D-dimer levels and lesion patterns. These characteristics can serve as clues to occult cancer in patients with cryptogenic stroke.

  10. Polysomnographic indicators of mortality in stroke patients

    DEFF Research Database (Denmark)

    Ponsaing, Laura B; Iversen, Helle K; Jennum, Poul

    2017-01-01

    PURPOSE: The purpose of the study was to assess polysomnographic indicators of increased mortality risk in patients with stroke or a transient ischemic attack (TIA). METHODS: We performed polysomnographies in 63 acute stroke/TIA patients. Mortality data were collected from a national database after...... a 19-37-month follow-up period. RESULTS: Of the 57 stroke and 6 TIA patients, 9 stroke patients died during follow-up. All nine had moderate or severe sleep-related breathing disorders (SRBDs). Binarily divided, the group with the highest apnea hypopnea index (AHI) had an almost 10-fold higher...... mortality risk (hazard ratio (HR) 9.71; 95 % confidence interval (CI) 1.20-78.29; p = 0.033) compared to the patients with the lowest AHI. The patients with the longest versus shortest nocturnal wake time had a higher mortality (HR 8.78; 95 % CI 1.1-71.8; p = 0.0428). Lung disease increased mortality (HR 9...

  11. Intensive therapy induces contralateral white matter changes in chronic stroke patients with Broca's aphasia.

    Science.gov (United States)

    Wan, Catherine Y; Zheng, Xin; Marchina, Sarah; Norton, Andrea; Schlaug, Gottfried

    2014-09-01

    Using a pre-post design, eleven chronic stroke patients with large left hemisphere lesions and nonfluent aphasia underwent diffusion tensor imaging and language testing before and after receiving 15 weeks of an intensive intonation-based speech therapy. This treated patient group was compared to an untreated patient group (n=9) scanned twice over a similar time period. Our results showed that the treated group, but not the untreated group, had reductions in fractional anisotropy in the white matter underlying the right inferior frontal gyrus (IFG, pars opercularis and pars triangularis), the right posterior superior temporal gyrus, and the right posterior cingulum. Furthermore, we found that greater improvements in speech production were associated with greater reductions in FA in the right IFG (pars opercularis). Thus, our findings showed that an intensive rehabilitation program for patients with nonfluent aphasia led to structural changes in the right hemisphere, which correlated with improvements in speech production. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Intensive therapy induces contralateral white matter changes in chronic stroke patients with Broca’s aphasia

    Science.gov (United States)

    Marchina, Sarah; Norton, Andrea; Schlaug, Gottfried

    2015-01-01

    Using a pre-post design, eleven chronic stroke patients with large left hemisphere lesions and nonfluent aphasia underwent diffusion tensor imaging and language testing before and after receiving 15 weeks of an intensive intonation-based speech therapy. This treated patient group was compared to an untreated patient group (n=9) scanned twice over a similar time period. Our results showed that the treated group, but not the untreated group, had reductions in fractional anisotropy in the white matter underlying the right inferior frontal gyrus (IFG, pars opercularis and pars triangularis), the right posterior superior temporal gyrus, and in the right posterior cingulum. Furthermore, we found that greater improvements in speech production were associated with greater reductions in FA in the right IFG (pars opercularis). Thus, our findings showed that an intensive rehabilitation program for patients with non-fluent aphasia led to structural changes in the right hemisphere, which correlated with improvements in speech production. PMID:25041868

  13. Evaluating a community-based stroke nursing education and rehabilitation programme for patients with mild stroke.

    Science.gov (United States)

    Wang, Lee; Chen, Chiu-Mei; Liao, Wen-Chun; Hsiao, Chun-Yin

    2013-06-01

    This study evaluated whether mild stroke patients who received a community-based stroke nursing intervention had better stroke knowledge, behaviour and self-efficacy than those who were exposed to traditional education programmes. The intervention group consisted of sixty five stroke patients randomly selected from seven communities who received three 2-hour stroke interventions per week for 8 weeks. The normal care group consisted of sixty two stroke patients randomly selected from a medical centre who received a general stroke education programme. The stroke patients in two groups were assessed at baseline, after intervention and at the 6-month follow-up. At the 6-month follow-up, the intervention group demonstrated an improvement in the knowledge of stroke risk factors compared with the normal care group. Three months after education, the intervention group exhibited changes in the knowledge of stroke, social participation and self-efficacy compared with those at baseline. Also, self-efficacy was correlated with the knowledge of stroke risk factors after intervention and at the 6-month follow-up; self-efficacy was correlated with social participation after the 6-month follow-up. A community-based stroke nursing intervention might have effects on changes in the knowledge of stroke risk factors, social participation and self-efficacy. © 2013 Wiley Publishing Asia Pty Ltd.

  14. Risk Factors and Biomarkers of Ischemic Stroke in Cancer Patients

    OpenAIRE

    Kim, Kwangsoo; Lee, Ji-Hun

    2014-01-01

    Background and Purpose Stroke is common among cancer patients. However, risk factors and biomarkers of stroke in cancer patients are not well established. This study aimed to investigate risk factors and biomarkers as well as etiology of ischemic stroke in cancer patients. Methods A retrospective review was conducted in cancer patients with ischemic stroke who were admitted to a general hospital in Busan, Korea, between January 2003 and December 2012. The risk factors and biomarkers for strok...

  15. Improving oral hygiene for stroke patients

    OpenAIRE

    Woon, Caroline

    2017-01-01

    In stroke nursing, oral hygiene is fundamental and should be a priority. Patients are more dependent on the nursing staff due to problems with cognition, arm weakness, a reduced conscious level, dysphagia or aphasia. Patients rely on nurses for oral care and are at a higher risk of xerostomia (dry mouth). Effective oral care removes plaque and prevents complications such as pneumonia which would increase patient length of stay. A lack of knowledge exists amongst nursing staff in the area of o...

  16. Cognitive impairment and stroke in elderly patients

    Directory of Open Access Journals (Sweden)

    Lo Coco D

    2016-03-01

    Full Text Available Daniele Lo Coco,1 Gianluca Lopez,1 Salvatore Corrao,2,31Neurology and Stroke Unit, 2Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, 3Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M., Di.Bi.M.I.S., University of Palermo, Palermo, Italy Abstract: We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the

  17. Current Australian speech-language pathology practice in addressing psychological well-being in people with aphasia after stroke.

    Science.gov (United States)

    Sekhon, Jasvinder K; Douglas, Jacinta; Rose, Miranda L

    2015-06-01

    Psychological well-being is essential to overall health; however, there is a paucity of research on how to address psychological well-being in stroke survivors with aphasia. This study describes the current beliefs, attitudes and practices of Australian speech-language pathologists in addressing psychological well-being in people with aphasia after stroke. A 26-item web-based survey consisting of open and closed questions was distributed to Australian speech-language pathologists through four electronic databases. Australian speech-language pathologists (n = 111) utilized counselling and clinical approaches to address psychological well-being in people with post-stroke aphasia. The majority of speech-language pathologists did not feel comfortable with addressing psychological well-being in people with aphasia and sought support from other health professionals in this practice. Self-perception of being under-skilled was the main barrier identified to adequate practice in this domain, followed by inadequate time, inadequate staffing and people with aphasia declining referral to counselling. The main facilitators reported by speech-language pathologists to address psychological well-being included personal interest, personal and professional experience and availability of counselling health professionals for people with aphasia. There were small-to-medium statistically significant correlations between speech-language pathologists reporting additional training in counselling and perceived knowledge of, confidence in and satisfaction with managing psychological well-being in people with aphasia. This study identifies factors requiring attention in order to enable speech-language pathologists to facilitate improved psychological well-being in people with aphasia.

  18. Partially Overlapping Sensorimotor Networks Underlie Speech Praxis and Verbal Short-Term Memory: Evidence from Apraxia of Speech Following Acute Stroke

    Directory of Open Access Journals (Sweden)

    Gregory eHickok

    2014-08-01

    Full Text Available We tested the hypothesis that motor planning and programming of speech articulation and verbal short-term memory (vSTM depend on partially overlapping networks of neural regions. We evaluated this proposal by testing 76 individuals with acute ischemic stroke for impairment in motor planning of speech articulation (apraxia of speech; AOS and vSTM in the first day of stroke, before the opportunity for recovery or reorganization of structure-function relationships. We also evaluate areas of both infarct and low blood flow that might have contributed to AOS or impaired vSTM in each person. We found that AOS was associated with tissue dysfunction in motor-related areas (posterior primary motor cortex, pars opercularis; premotor cortex, insula and sensory-related areas (primary somatosensory cortex, secondary somatosensory cortex, parietal operculum/auditory cortex; while impaired vSTM was associated with primarily motor-related areas (pars opercularis and pars triangularis, premotor cortex, and primary motor cortex. These results are consistent with the hypothesis, also supported by functional imaging data, that both speech praxis and vSTM rely on partially overlapping networks of brain regions.

  19. Risk factors for falls of hospitalized stroke patients

    NARCIS (Netherlands)

    Tutuarima, J. A.; van der Meulen, J. H.; de Haan, R. J.; van Straten, A.; Limburg, M.

    1997-01-01

    Patients with stroke are at a high risk for falling. We assessed the fall incidence and risk factors for patients hospitalized as the result of an acute stroke. We studied a cohort of 720 stroke patients from 23 hospitals in The Netherlands. The data were abstracted from the medical and nursing

  20. Speech and language therapists' perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post-stroke.

    Science.gov (United States)

    Lawton, Michelle; Sage, Karen; Haddock, Gillian; Conroy, Paul; Serrant, Laura

    2018-01-18

    Therapeutic alliance refers to the interactional and relational processes operating during therapeutic interventions. It has been shown to be a strong determinant of treatment efficacy in psychotherapy, and evidence is emerging from a range of healthcare and medical disciplines to suggest that the construct of therapeutic alliance may in fact be a variable component of treatment outcome, engagement and satisfaction. Although this construct appears to be highly relevant to aphasia rehabilitation, no research to date has attempted to explore this phenomenon and thus consider its potential utility as a mechanism for change. To explore speech and language therapists' perceptions and experiences of developing and maintaining therapeutic alliances in aphasia rehabilitation post-stroke. Twenty-two, in-depth, semi-structured interviews were conducted with speech and language therapists working with people with aphasia post-stroke. Qualitative data were analysed using inductive thematic analysis. Analysis resulted in the emergence of three overarching themes: laying the groundwork; augmenting cohesion; and contextual shapers. Recognizing personhood, developing shared expectations of therapy and establishing therapeutic ownership were central to laying the groundwork for therapeutic delivery. Augmenting cohesion was perceived to be dependent on the therapists' responsiveness and ability to resolve both conflict and resistance, as part of an ongoing active process. These processes were further moulded by contextual shapers such as the patient's family, relational continuity and organizational drivers. The findings suggest that therapists used multiple, complex, relational strategies to establish and manage alliances with people with aphasia, which were reliant on a fluid interplay of verbal and non-verbal skills. The data highlight the need for further training to support therapists to forge purposive alliances. Training should develop: therapeutic reflexivity; inclusivity in

  1. White matter changes in stroke patients. Relationship with stroke subtype and outcome

    DEFF Research Database (Denmark)

    Leys, D; Englund, E; Del Ser, T

    1999-01-01

    or white matter lesions or leukoencephalopathy or leukoaraiosis' and 'stroke or cerebral infarct or cerebral hemorrhage or cerebrovascular disease or transient ischemic attack (TIA)'. WMC, as defined radiologically, are present in up to 44% of patients with stroke or TIA and in 50% of patients...... of death or dependency, recurrent stroke of any type, cerebral bleeding under anticoagulation, myocardial infarction, and poststroke dementia. WMC in stroke patients are often associated with small-vessel disease and lead to a higher risk of death, and poor cardiac and neurological outcome. However......White matter changes (WMC), detected by imaging techniques, are frequent in stroke patients. The aim of the study was to determine how WMC relate to stroke subtypes and to stroke outcome. We made a systematic Medline search for articles appearing with two of the following key words: either 'WMC...

  2. Copeptin Levels in Patients With Acute Ischemic Stroke and Stroke Mimics.

    Science.gov (United States)

    Wendt, Matthias; Ebinger, Martin; Kunz, Alexander; Rozanski, Michal; Waldschmidt, Carolin; Weber, Joachim E; Winter, Benjamin; Koch, Peter M; Nolte, Christian H; Hertel, Sabine; Ziera, Tim; Audebert, Heinrich J

    2015-09-01

    Copeptin levels are increased in patients diagnosed with stroke and other vascular diseases. Copeptin elevation is associated with adverse outcome, predicts re-events in patients with transient ischemic attack and is used in ruling-out acute myocardial infarction. We evaluated whether copeptin can also be used as a diagnostic marker in the prehospital stroke setting. We prospectively examined patients with suspected stroke on the Stroke Emergency Mobile-an ambulance that is equipped with computed tomography and point-of-care laboratory. A blood sample was taken from patients immediately after arrival. We analyzed copeptin levels in patients with final hospital-based diagnosis of stroke or stroke mimics as well as in vascular or nonvascular patients. In addition, we examined the associations of symptom onset with copeptin levels and the prognostic value of copeptin in patients with stroke. Blood samples of 561 patients were analyzed. No significant differences were seen neither between cerebrovascular (n=383) and other neurological (stroke mimic; n=90) patients (P=0.15) nor between vascular (n=391) and nonvascular patients (n=170; P=0.57). We could not detect a relationship between copeptin levels and time from onset to blood draw. Three-month survival status was available in 159 patients with ischemic stroke. Copeptin levels in nonsurviving patients (n=8: median [interquartile range], 27.4 [20.2-54.7] pmol/L) were significantly higher than in surviving patients (n=151: median [interquartile range], 11.7 [5.2-30.9] pmol/L; P=0.024). In the prehospital setting, copeptin is neither appropriate to discriminate between stroke and stroke mimic patients nor between vascular and nonvascular patients. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01382862. The Pre-Hospital Acute Neurological Therapy and Optimization of Medical Care in Stroke Patients study (PHANTOM-S) was registered (NCT01382862). This sub-study was observational and not registered separately

  3. Stroke patients communicating their healthcare needs in hospital: a study within the ICF framework.

    Science.gov (United States)

    O'Halloran, Robyn; Worrall, Linda; Hickson, Louise

    2012-01-01

    Previous research has identified that many patients admitted into acute hospital stroke units have communication-related impairments such as hearing, vision, speech, language and/or cognitive communicative impairment. However, no research has identified how many patients in acute hospital stroke units have difficulty actually communicating their healthcare needs. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) conceptualizes difficulty communicating about healthcare needs as a type of activity limitation, within the Activity and Participation component. The ICF proposes that activity limitation can be measured in four different ways. The first aim of this research was to measure a patient's difficulty communicating his or her healthcare needs, that is, activity limitation, in two of the four ways suggested by the ICF when interacting with healthcare providers. The second aim was to investigate whether communication-related impairments in hearing, vision, speech, language and/or cognitive communicative impairment predict difficulty communicating healthcare needs, measured in these ways. A total of 65 patients consecutively admitted into two acute hospital stroke units in Melbourne, Australia, who consented to this research participated in this study. Early in their admission participants were screened for hearing, vision, speech, language and cognitive communicative impairment. Participants were also assessed for difficulty communicating about healthcare needs in two ways proposed by the ICF: 'capacity with assistance' and 'performance'. Relationships between communication-related impairment and both capacity with assistance and performance were explored through Spearman's correlations and binary logistic regression. A total of 87% of patients had one or more communication-related impairments. Half of the patients (51%) had difficulty communicating their healthcare needs when assessed in terms of capacity with

  4. Hypertensive patients using thiazide diuretics as primary stroke prevention make better functional outcome after ischemic stroke.

    Science.gov (United States)

    Shih, Hong-Mo; Lin, Wei Chun; Wang, Cheng-Hsien; Lin, Leng-Chieh

    2014-10-01

    Thiazides have been used for the control of blood pressure and primary prevention of ischemic stroke. No previous studies have assessed the influence of thiazides on functional prognosis after ischemic stroke. Demographics, prestroke conditions, poststroke National Institutes of Health Stroke Scale score, and clinical and laboratory parameters were prospectively registered in 216 Taiwanese patients. One hundred forty patients who completed follow-up 3 months after experiencing ischemic stroke were assessed with the modified Rankin scale as functional prognoses. Twenty-one patients used thiazide to control hypertension before experiencing ischemic stroke. No differences of stroke subtypes and comorbidities before stroke were observed between the 2 groups. The emergency department National Institutes of Health Stroke Scale was lesser among thiazide users (4 [2-7] versus 6 [4-16], P = .02). Among 140 patients who completed follow-up in 90 days, thiazide users had more favorable functional status (modified Rankin scale ≤2: 42.4% versus 26.9%, P = .02, odds ratio 3.34, 95%, confidence interval .130-.862). Hypertensive patients treated with thiazides long term had a lesser severity of stroke and better functional outcomes after ischemic stroke. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Magnitude of stroke and associated factors among patients who ...

    African Journals Online (AJOL)

    unhcc

    study was aimed to assess the magnitude of stroke and associated factors among patients attended the medical department of ... Methods: An institution based cross sectional study was conducted among 427 adult (≥30 years old) stroke patient records in June ... risk of mortality, about 85% of all strokes are ischemic. (1-3).

  6. Stroke Risk Factors among Patients in a Nigerian Teaching Hospital ...

    African Journals Online (AJOL)

    ... aim of this study was to describe the risk factors in stroke patients admitted in a Nigerian teaching hospital. Methods: This is a prospective study carried out in the Jos University Teaching Hospital in Nigeria. The participants were 120 patients admitted into the hospital with stroke. Stroke was defined by the WHO definition.

  7. Characterization of Hospitalized Ischemic Stroke Patients in Palestine

    African Journals Online (AJOL)

    Objective: Stroke is a major health problem, yet no studies on stroke have been reported from Palestine. This one-year, hospital-based study was conducted to determine the prevalence of risk factors and the in-hospital mortality rate in patients with ischemic stroke. Method: All patients admitted to Al-Watani government ...

  8. Rehabilitation of stroke patients needs a family-centred approach

    NARCIS (Netherlands)

    Visser-Meily, Anne; Post, Marcel; Gorter, Jan Willem; Berlekom, Steven Berdenis V.; van den Bos, Trudi; Lindeman, Eline

    2006-01-01

    To highlight the importance of the spouse in stroke rehabilitation. Stroke not only affects the patients, but also their families, but rehabilitation practice is still primarily focused on the patient only. Analysis of the position of the spouse and possible consequences of stroke for the spouse,

  9. Early Dysphagia Screening by Trained Nurses Reduces Pneumonia Rate in Stroke Patients: A Clinical Intervention Study.

    Science.gov (United States)

    Palli, Christoph; Fandler, Simon; Doppelhofer, Kathrin; Niederkorn, Kurt; Enzinger, Christian; Vetta, Christian; Trampusch, Esther; Schmidt, Reinhold; Fazekas, Franz; Gattringer, Thomas

    2017-09-01

    Dysphagia is a common stroke symptom and leads to serious complications such as aspiration and pneumonia. Early dysphagia screening can reduce these complications. In many hospitals, dysphagia screening is performed by speech-language therapists who are often not available on weekends/holidays, which results in delayed dysphagia assessment. We trained the nurses of our neurological department to perform formal dysphagia screening in every acute stroke patient by using the Gugging Swallowing Screen. The impact of a 24/7 dysphagia screening (intervention) over swallowing assessment by speech-language therapists during regular working hours only was compared in two 5-month periods with time to dysphagia screening, pneumonia rate, and length of hospitalization as outcome variables. Overall, 384 patients (mean age, 72.3±13.7 years; median National Institutes of Health Stroke Scale score of 3) were included in the study. Both groups (pre-intervention, n=198 versus post-intervention, n=186) were comparable regarding age, sex, and stroke severity. Time to dysphagia screening was significantly reduced in the intervention group (median, 7 hours; range, 1-69 hours) compared with the control group (median, 20 hours; range, 1-183; P =0.001). Patients in the intervention group had a lower rate of pneumonia (3.8% versus 11.6%; P =0.004) and also a reduced length of hospital stay (median, 8 days; range, 2-40 versus median, 9 days; range, 1-61 days; P =0.033). 24/7 dysphagia screening can be effectively performed by nurses and leads to reduced pneumonia rates. Therefore, empowering nurses to do a formal bedside screening for swallowing dysfunction in stroke patients timely after admission is warranted whenever speech-language therapists are not available. © 2017 American Heart Association, Inc.

  10. Improving stroke care for patients at Cavan hospital [poster

    LENUS (Irish Health Repository)

    Murugasu, G Dr.

    2013-07-01

    Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

  11. E-learning-based speech therapy: a web application for speech training.

    NARCIS (Netherlands)

    Beijer, L.J.; Rietveld, T.C.; Beers, M.M. van; Slangen, R.M.; Heuvel, H. van den; Swart, B.J.M. de; Geurts, A.C.H.

    2010-01-01

    Abstract In The Netherlands, a web application for speech training, E-learning-based speech therapy (EST), has been developed for patients with dysarthria, a speech disorder resulting from acquired neurological impairments such as stroke or Parkinson's disease. In this report, the EST infrastructure

  12. Stroke Risk Perception in Atrial Fibrillation Patients is not Associated with Clinical Stroke Risk.

    Science.gov (United States)

    Fournaise, Anders; Skov, Jane; Bladbjerg, Else-Marie; Leppin, Anja

    2015-11-01

    Clinical risk stratification models, such as the CHA2DS2-VASc, are used to assess stroke risk in atrial fibrillation (AF) patients. No study has yet investigated whether and to which extent these patients have a realistic perception of their personal stroke risk. The purpose of this study was to investigate and describe the association between AF patients' stroke risk perception and clinical stroke risk. In an observational cross-sectional study design, we surveyed 178 AF patients with a mean age of 70.6 years (SD 8.3) in stable anticoagulant treatment (65% treatment duration >12 months). Clinical stroke risk was scored through the CHA2DS2-VASc, and patients rated their perceived personal stroke risk on a 7-point Likert scale. There was no significant association between clinical stroke risk assessment and patients' stroke risk perception (rho = .025; P = .741). Approximately 60% of the high-risk patients had an unrealistic perception of their own stroke risk, and there was no significant increase in risk perception from those with a lower compared with a higher risk factor load (χ(2) = .010; P = .522). Considering possible negative implications in terms of lack of motivation for lifestyle behavior change and adequate adherence to the treatment and monitoring of vitamin K antagonist, the apparent underestimation of risk by large subgroups warrants attention and needs further investigation with regard to possible behavioral consequences. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. [Evaluation of the effectiveness of rehabilitation in patients after stroke with executive dysfunction].

    Science.gov (United States)

    Jankowska, Agnieszka; Klimkiewiaz, Robert; Krekora, Katarzyna; Klimkiewiaz, Paulina; Woldańska-Okońska, Marta

    2013-01-01

    Executive dysfunction (DES) in the form of disturbances of conscious and flexible programming, organization and control of their own actions as part of the clinical picture of stroke. impairment of the executive mechanism may reduce the efficacy of treatment of patient. The aim of this study was to assess the impact of rehabilitation on improving executive functions in patients after stroke. The study involved 90 patients after a stroke. The study group comprised 45 patients, resident in the Department of Rehabilitation and Physical Medicine USK of Medical University in Lodz, which was implemented in 5 week rehabilitation program including: kinesiotherapy, physiotherapy, speech therapy classes and psychological consultation and psychotherapy. The control group consisted of patients waiting for admission to the Department of Rehabilitation. The study was conducted twice: the first time, before the start of rehabilitation, the second time at the end of five weeks of the rehabilitation process. Executive functions were assessed by means of: Test of Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT-A, TMT-B), Verbal Fluency Test (VFT). In patients after stroke rehabilitation in the hospital was significantly greater improvement in executive function compared to those rehabilitated in environmental conditions. Comprehensive rehabilitation in the hospital has a significant impact on improving executive functions in patients after stroke.

  14. Location of the ischemic focus in rehabilitated stroke patients with impairment of executive functions.

    Science.gov (United States)

    Jankowska, Agnieszka M; Klimkiewicz, Robert; Kubsik, Anna; Klimkiewicz, Paulina; Śmigielski, Janusz; Woldańska-Okońska, Marta

    2017-08-01

    Executive dysfunctions are part of the clinical symptoms of a stroke and can inhibit the process of rehabilitation. Patients with impaired executive functions may manifest aggression, impulsiveness, impaired thinking and planning. The aim of this study was to assess the effect of the ischemic focus location on the effectiveness of physiotherapy in improving the executive functions in patients after stroke. Ninety patients after unilateral ischemic cerebral stroke were studied. We studied 45 patients treated at the Department of Rehabilitation and Physical Medicine of the WAM University Hospital of Lodz for 5 weeks. The rehabilitation program included: kinesitherapy, physiotherapy, speech therapy, psychological consultations and psychotherapy. The control group consisted of patients who were waiting for admission to the Department of Rehabilitation. The patients in both groups were divided into three subgroups with different locations of stroke: front, back and subcortical. Executive functions were measured by the Wisconsin Card Sorting Test (WCST), the trail making test (TMT - A, TMT - B), the verbal fluency test (VFT). Patients rehabilitated in the hospital with the front and subcortical lesion location reported improvement in executive functions in terms of a greater number of the analyzed indicators of the Wisconsin Card Sorting Test (WCST) than those with the back lesion location. Patients rehabilitated at home with the subcortical lesion location did not experience a significant improvement in executive functions in any of the analyzed indicators of the Wisconsin Card Sorting Test (WCST). Most of the indicators, with the exception of the total errors of Wisconsin Card Sorting Test (WCST) and TMT B, have not been modified by the location of stroke. Executive dysfunction occurs not only in patients with an anterior location of the stroke, but also in the posterior and subcortical locations. Patients with a subcortical location of the stroke require more

  15. Renal Function Predicts Outcomes in Patients with Ischaemic Stroke and Haemorrhagic Stroke.

    Science.gov (United States)

    Snarska, Katarzyna; Kapica-Topczewska, Katarzyna; Bachórzewska-Gajewska, Hanna; Małyszko, Jolanta

    2016-01-01

    We evaluated renal function and the impact of renal function on in-hospital outcomes in patients with ischaemic and haemorrhagic stroke. We collected data from 766 patients with stroke; 637 (83.2 %) with ischaemic and 129 with haemorrhagic one. The mean serum creatinine on admission in patients with both types of stroke, who died, was significantly higher than in those who survived. Multivariate analysis showed that independent predictors of mortality in patients with ischaemic stroke were: ischemic heart disease or prior myocardial infarction, diabetes, admission glucose and eGFR on admission. Also, multivariate analysis showed that independent predictors of mortality in patients with haemorrhagic stroke were: age and admission glucose. Patients with haemorrhagic stroke, in particular with acute kidney injury during hospitalisation had significantly worse outcomes than patients with ischaemic stroke. Assessment of kidney function is prerequisite to employ the necessary measures to decrease the risk of in-hospital mortality among patients with acute stroke. Appropriate approach to patients with renal dysfunction (adequate hydration, avoidance of nephrotoxic drugs, drug dose adjustment etc) should be considered as preventive and therapeutic strategies in the management of acute stroke. © 2016 The Author(s) Published by S. Karger AG, Basel.

  16. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Krarup, L-H; Sandset, E C; Sandset, P M

    2011-01-01

    Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation are at in......Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation.......96), and the combined endpoint of stroke progression, recurrent stroke, and death (D-dimer: 991 ng/ml vs 970 ng/ml, P = 0.91). Multivariable analyses did not alter the results. Conclusion -  D-dimer and other markers of hemostatic activation were not associated with stroke progression, recurrent stroke, or death...

  17. Pre-stroke apathy symptoms are associated with an increased risk of delirium in stroke patients.

    Science.gov (United States)

    Klimiec, Elzbieta; Kowalska, Katarzyna; Pasinska, Paulina; Klimkowicz-Mrowiec, Aleksandra; Szyper, Aleksandra; Pera, Joanna; Slowik, Agnieszka; Dziedzic, Tomasz

    2017-08-09

    Neuropsychiatric symptoms can be interrelated to delirium. We aimed to investigate an association between pre-stroke neuropsychiatric symptoms and the risk of delirium in stroke patients. We included 606 patients (median age: 73, 53% female) with stroke or transient ischemic attack admitted within 48 hours from symptoms onset. We assessed delirium on a daily basis during the first 7 days of hospitalization. To make diagnosis of delirium we used DSM-5 criteria. We used Neuropsychiatric Inventory to assess neuropsychiatric symptoms occurring within 4 weeks prior to stroke. We diagnosed delirium in 28.2% of patients. On univariate analysis, higher score of pre-stroke depression (OR: 1.58, 95% CI: 1.04-2.40, P = 0.03), apathy (OR: 2.23, 95% CI: 1.44-3.45, P delirium. On multivariate analysis adjusted for age, atrial fibrillation, diabetes mellitus, stroke severity, right hemisphere lesion, pre-stroke cognitive decline, pre-stroke disability and infections, higher apathy score (OR: 2.03, 95% CI: 1.17-3.50, P = 0.01), but no other neuropsychiatric symptoms, remained independent predictor of delirium. We conclude that pre-stroke apathy symptoms are associated with increased risk of delirium in stroke patients.

  18. Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit

    Directory of Open Access Journals (Sweden)

    Tanya West

    2013-01-01

    Full Text Available Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25 of the day in some form of physical activity and received 58 (SD 34 minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32 hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care.

  19. Speech intelligibility of laryngectomized patients who use different types of vocal communication

    OpenAIRE

    Šehović Ivana; Petrović-Lazić Mirjana

    2016-01-01

    Modern methods of speech rehabilitation after a total laryngectomy have come to a great success by giving the patients a possibility to establish an intelligible and functional speech after an adequate rehabilitation treatment. The aim of this paper was to examine speech intelligibility of laryngectomized patients who use different types of vocal communication: esophageal speech, speech with tracheoesophageal prosthesis and speech with electronic laringeal prosthesis. The research was conduct...

  20. Stroke prevalence amongst sickle cell disease patients in Nigeria: a ...

    African Journals Online (AJOL)

    Background: Stroke is a life-changing, debilitating complication of sickle cell disease (SCD). Previous studies had recorded high stroke prevalence amongst this group of patients. Nigeria has a large population of people affected by this condition and this study aims to assess the stroke prevalence in this large population.

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

    African Journals Online (AJOL)

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

  2. Admission Blood Pressure of Stroke Patients and Its Relationship to ...

    African Journals Online (AJOL)

    Background: High blood pressure is often said to be associated with poor outcome in stroke. However, there remains some uncertainly about the relationship of blood pressure to mortality in stroke. Objective: This study seeks to determine the influence of admission blood pressure on early mortality of stroke patients at the ...

  3. An oral hygiene protocol improves oral health for patients in inpatient stroke rehabilitation.

    Science.gov (United States)

    Murray, Joanne; Scholten, Ingrid

    2018-03-01

    To determine whether a simple oral hygiene protocol improves the oral health of inpatients in stroke rehabilitation. Poor oral health can lead to serious complications, such as pneumonia. The comorbidities associated with stroke, such as dysphagia, hemiparesis and cognitive impairment, can further impede independent oral care. International stroke guidelines recommend routine oral care but stop short of detailing specific regimes. The oral health assessment tool (OHAT) was conducted by speech-language pathologists with 100 patients with and without dysphagia in three metropolitan inpatient stroke rehabilitation facilities. A simple nurse-led oral hygiene regime was then implemented with all participants, which included twice daily tooth brushing and mouth rinsing after lunch, and oral health was measured again one week later. Initially, dysphagia was negatively associated with OHAT scores, and independence for oral hygiene was positively associated with oral health. After one week of a simple oral hygiene regime, the OHAT scores available for 89 participants indicated an improvement on average for all participants. In particular, 59% of participants with dysphagia had an improvement of 1 or more points. None of the participants developed pneumonia. A simple, inexpensive oral hygiene regime resulted in positive outcomes for patients with and without dysphagia in inpatient stroke rehabilitation settings. Oral health assessments and oral hygiene regimes that are simple to implement by the interdisciplinary team can be incorporated into standard stroke care with positive effect. © 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  4. 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

    , 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...... variables was 31 (35 %) at 1 week and was reduced to 20 (22 %) at 6 months. CONCLUSION: 35 % of elderly patients with ischemic stroke admitted to a geriatric rehabilitation unit were malnourished 1 week after stroke. Particularly serum proteins and body fat were affected. Follow-up of nutritional variables......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...

  5. Social work after stroke: identifying demand for support by recording stroke patients' and carers' needs in different phases after stroke.

    Science.gov (United States)

    Padberg, Inken; Knispel, Petra; Zöllner, Susanne; Sieveking, Meike; Schneider, Alice; Steinbrink, Jens; Heuschmann, Peter U; Wellwood, Ian; Meisel, Andreas

    2016-07-20

    Previous studies examining social work interventions in stroke often lack information on content, methods and timing over different phases of care including acute hospital, rehabilitation and out-patient care. This limits our ability to evaluate the impact of social work in multidisciplinary stroke care. We aimed to quantify social-work-related support in stroke patients and their carers in terms of timing and content, depending on the different phases of stroke care. We prospectively collected and evaluated data derived from a specialized "Stroke-Service-Point" (SSP); a "drop in" center and non-medical stroke assistance service, staffed by social workers and available to all stroke patients, their carers and members of the public in the metropolitan region of Berlin, Germany. Enquiries from 257 consenting participants consulting the SSP between March 2010 and April 2012 related to out-patient and in-patient services, therapeutic services, medical questions, medical rehabilitation, self-help groups and questions around obtaining benefits. Frequency of enquiries for different topics depended on whether patients were located in an in-patient or out-patient setting. The majority of contacts involved information provision. While the proportion of male and female patients with stroke was similar, about two thirds of the carers contacting the SSP were female. The social-work-related services provided by a specialized center in a German metropolitan area were diverse in terms of topic and timing depending on the phase of stroke care. Targeting the timing of interventions might be important to increase the impact of social work on patient's outcome.

  6. Comparison of two approaches to screen for dysphagia among acute ischemic stroke patients: nursing admission screening tool versus National Institutes of Health stroke scale.

    Science.gov (United States)

    Bravata, Dawn M; Daggett, Virginia S; Woodward-Hagg, Heather; Damush, Teresa; Plue, Laurie; Russell, Scott; Allen, George; Williams, Linda S; Harezlak, Jaroslaw; Chumbler, Neale R

    2009-01-01

    This study assessed the positive and negative predictive values and the sensitivity and specificity of a nursing dysphagia screening tool and the National Institutes of Health Stroke Scale (NIHSS) for the identification of dysphagia for veterans hospitalized with ischemic stroke.A secondary objective of this study was to evaluate the speech-language pathology consult rate before and after the nursing admission dysphagia screening tool. This retrospective cohort study evaluated veterans admitted to one Department of Veterans Affairs medical center with ischemic stroke during the 6 months both before and after the implementation of a nursing dysphagia screening tool, which was part of the admission nursing template. Stroke severity was measured with the use of the retrospective NIHSS. Dysphagia diagnosis was based on speech-language pathology evaluations.Dysphagia was present in 38 of 101 patients (38%) with ischemic stroke. The nursing dysphagia screening tool had a positive predictive value of 50% and a negative predictive value of 68%, with a sensitivity of 29% and specificity of 84%. The use of the NIHSS to identify dysphagia risk had a positive predictive value of 60% and a negative predictive value of 84%.The NIHSS had better test characteristics in predicting dysphagia than the nursing dysphagia screening tool. Future research should evaluate the use of the NIHSS as a screening tool for dysphagia.

  7. Patent Foramen Ovale and Cryptogenic Strokes in the Stroke in Young Fabry Patients Study.

    Science.gov (United States)

    Huber, Roman; Grittner, Ulrike; Weidemann, Frank; Thijs, Vincent; Tanislav, Christian; Enzinger, Christian; Fazekas, Franz; Wolf, Markus; Hennerici, Michael G; McCabe, Dominick J H; Putaala, Jukaa; Tatlisumak, Turgut; Kessler, Christoph; von Sarnowski, Bettina; Martus, Peter; Kolodny, Edwin; Norrving, Bo; Rolfs, Arndt

    2017-01-01

    A patent foramen ovale (PFO) is disproportionately prevalent in patients with cryptogenic stroke. Without alternative explanations, it is frequently considered to be causative. A detailed stratification of these patients may improve the identification of incidental PFO. We investigated the PFO prevalence in 3497 transient ischemic attack and ischemic stroke patients aged 18 to 55 years in the prospective multicenter SIFAP1 study (Stroke in Young Fabry Patients 1) using the ASCO classification. Patients without an obvious cause for transient ischemic attack/stroke (ASCO 0) were divided into subgroups with and without vascular risk factors (ASCO 0+ and 0-). In addition, we looked for PFO-related magnetic resonance imaging lesion patterns. PFO was identified in 25% of patients. Twenty percent of patients with a definite or probable cause of transient ischemic attack/stroke (≥1 grade 1 or 2 ASCO criterion; n=1769) had a PFO compared with 29% of cryptogenic stroke patients (ASCO 0 and 3; n=1728; Pstrokes revealed a PFO in 24% of 978 ASCO 3 patients (n.s. versus ASCO 1 and 2) and a higher prevalence of 36% in 750 ASCO 0 cases (Pstroke patients demonstrate a heterogeneous PFO prevalence. Even in case of less conclusive diseases like nonstenotic arteriosclerosis, patients should preferentially be considered to have a non-PFO-mediated stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2016 American Heart Association, Inc.

  8. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Jørgensen, H S; Reith, J

    2004-01-01

    stroke onset. By way of multiple logistic regression and survival analyses very old age was independently related to short- and long-term mortality and nursing home placement independent of other clinical characteristics. RESULTS: 16% of patients were 85 years or older at the time of stroke onset. More...... stroke very old age predicted mortality or nursing home placement (OR 3.9; 95% CI 2.1-7.3), and long-term mortality (HR 2.0; 95% CI 1.6-2.5). However, other factors such as onset stroke severity, pre-existing disability and atrial fibrillation were also significant independent predictors of prognosis......BACKGROUND AND PURPOSE: The very old are expected to become a growing part of the stroke population in the industrialised part of the world. The aims of this study were to evaluate clinical characteristics of patients aged 85 years or more at stroke onset and to investigate very old age...

  9. Incidence and types of sleep disorders in patients with stroke.

    Science.gov (United States)

    Pasic, Zejneba; Smajlovic, Dzevdet; Dostovic, Zikrija; Kojic, Biljana; Selmanovic, Senada

    2011-01-01

    Sleep disorders (SD) after stroke (stroke) are common occurrences, and most often in sleep apnea, insomnia and daytime sleepiness. GOALS. Research goals were to determine the types of SD and their frequency in patients with stroke in relation to the type of stroke and side of lesion. The study analyzed 200 patients with acute stroke hospitalized in the Clinic of Neurology, University Clinical Centre Tuzla in the period from 1st August 2007 to 1st June 2008. All patients have confirmed the existence of stroke by computerized tomography. SD was verified according to the General Curriculum of sleep, the Berlin questionnaire and Epvort scale. Stroke, by type, were divided into hemorrhagic and ischemic, and the localization of the stroke to right and left cerebral hemispheres. Of the total number of respondents, 78% had SD. Very serious level of SD had 42% of respondents, 20% moderate, and 16% of medium-severe degree. There was no statistically significant differences in the frequency of SD among patients with ischemic and hemorrhagic stroke (76.8%: 82.5%, p = 0.58). In relation to the side of lesion there was more patient with SD and stroke in the right cerebral hemisphere, but there were no statistically significant differences (39.5%: 33%, p = 0.1). According Epvort scale sleep apnea and snoring was present in 86%, daytime sleepiness in 49.5% and narcolepsy 0.5%. Sleep disturbance as a neuropsychological disorder has a significant incidence in the acute phase of stroke. SD is slightly more common in hemorrhagic stroke and stroke in the right hemisphere. Sleep Apnea and snoring are the most common types of SD in patients with stroke.

  10. Stroke outcome in clinical trial patients deriving from different countries.

    Science.gov (United States)

    Ali, Myzoon; Atula, Sari; Bath, Philip M W; Grotta, James; Hacke, Werner; Lyden, Patrick; Marler, John R; Sacco, Ralph L; Lees, Kennedy R

    2009-01-01

    Stroke incidence and outcome vary widely within and across geographical locations. We examined whether differences in index stroke severity, stroke risk factors, mortality, and stroke outcome across geographical locations remain after adjusting for case mix. We analyzed 3284 patients from the Virtual International Stroke Trials Archive (VISTA). We used logistic regression to examine the incidence of mild index stroke, functional, and neurological outcomes after accounting for age, medical history, year of trial recruitment, and initial stroke severity in the functional and neurological outcome analyses. We examined mortality between geographical regions using a Cox proportional hazards model, accounting for age, initial stroke severity, medical history, and year of trial recruitment. Patients enrolled in the USA and Canada had the most severe index strokes. Those recruited in Austria and Switzerland had the best functional and neurological outcomes at 90 days (P<0.05), whereas those enrolled in Germany had the worst functional outcome at 90 days (P=0.013). Patients enrolled in Austria, Switzerland, Belgium, Netherlands, Finland, Germany, Greece, Israel, Spain, and Portugal had a significantly better survival rate when compared with those enrolled in USA and Canada. Patients enrolled in trials after 1998 had more severe index strokes, with no significant difference in outcome compared with those enrolled before 1998. We identified regional variations in index stroke severity, outcome, and mortality for patients enrolled in ischemic stroke clinical trials over the past 13 years that were not fully explained by case mix. Index stroke severity was greater in patients enrolled after 1998, with no significant improvement in outcomes compared to those enrolled before 1998.

  11. Increased stroke risk in Bell's palsy patients without steroid treatment.

    Science.gov (United States)

    Lee, C-C; Su, Y-C; Chien, S-H; Ho, H-C; Hung, S-K; Lee, M-S; Chou, P; Chiu, B C-H; Huang, Y-S

    2013-04-01

    To investigate the risk of stroke development following a diagnosis of Bell's palsy in a nationwide follow-up study. Information on Bell's palsy and other factors relevant for stroke was obtained for 433218 eligible subjects without previous stroke who had ambulatory visit in 2004. Of those, 897 patients with Bell's palsy were identified. Over a median 2.9 years of follow-up, 4581 incident strokes were identified. We estimated hazard ratios (HR) and 95% confidence intervals [CI] with Cox proportional hazard models adjusting for age, sex, co-morbidities, and important risk factors. Standardized incidence ratio of stroke amongst patients with Bell's palsy was analyzed. Compared with non-Bell's palsy patients, patients with Bell's palsy had a 2.02-times (95% CI, 1.42-2.86) higher risk of stroke. The adjusted HR of developing stroke for patients with Bell's palsy treated with and without systemic steroid were 1.67 (95% CI, 0.69-4) and 2.10 (95%, 1.40-3.07), respectively. Patients with Bell's palsy carry a higher risk of stroke than the general population. Our data suggest that these patients might benefit from a more intensive stroke prevention therapy and regular follow-up after initial diagnosis. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  12. Perioperative care of a patient with stroke

    Directory of Open Access Journals (Sweden)

    Veenith Tonny V

    2010-11-01

    Full Text Available Abstract Strokes and TIAs, with their high cumulative mortality and morbidity rates, are occurring with increasing frequency in western population 14. As such, it is vital for clinicians to provide optimal medical management in the perioperative period for those patients with this common neurological problem. This review aims to highlight the importance of the perioperative period and the stages of pre-optimization that can be taken by the multi-disciplinary team to aid this 171819. The evidence suggests that there are significant physiological advantages to early invasive monitoring and high dependency care in these complex patients. These cohort of patients are at increased risk of development of respiratory, gastrointestinal, nutritional and electrolyte disturbances so a constant vigil should be exercised in early recognition and treatment.

  13. Respiratory function and functional capacity in chronic stroke patients 1

    OpenAIRE

    Machado, Anna Cláudia Martinez; Silva, Nathália Grasielle Marinho; Diniz, Gisele do Carmo Leite; Pessoa, Bruno Porto; Scalzo, Paula Luciana

    2016-01-01

    Abstract Introduction: Cerebrovascular accident (CVA) or stroke results in weakness of the trunk muscles and physical unfitness. Objectives: To evaluate respiratory changes caused by stroke and correlate them with the functional capacity of chronic stroke patients who were treated at the Clinical Center of Physical Therapy of the Pontifical Catholic University of Minas Gerais, Betim. Methods: Fifteen patients were recruited for assessment of respiratory function and functional capacity. W...

  14. The prognostic significance of ABPM in patients with acute stroke

    OpenAIRE

    Ewa Trzmielewska; Marta Jurdziak

    2016-01-01

    Hypertension is present in about 77% of patients with a first episode of stroke. Unlike the established benefit of lowering blood pressure for the primary and secondary prevention of stroke, the management of hypertension in patients with acute stroke remains controversial. ABPM is a diagnostic tool that has been proposed as a method of obtaining a more reliable assessment of patients’ blood pressure in comparison with OBPM. ABPM provides precise information about the BP values during the dai...

  15. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Jørgensen, H S; Reith, J

    2004-01-01

    BACKGROUND AND PURPOSE: The very old are expected to become a growing part of the stroke population in the industrialised part of the world. The aims of this study were to evaluate clinical characteristics of patients aged 85 years or more at stroke onset and to investigate very old age as an ind...

  16. Emergency Medical Services Support for Acute Ischemic Stroke Patients Receiving Thrombolysis at a Primary Stroke Center

    Directory of Open Access Journals (Sweden)

    Byron R. Spencer

    2009-01-01

    Full Text Available Background Emergency Medical Services (EMS is a vital link in the overall chain of stroke survival. A Primary Stroke Center (PSC relies heavily on the 9-1-1 response system along with the ability of EMS personnel to accurately diagnose acute stroke. Other critical elements include identifying time of symptom onset, providing pre-hospital care, selecting a destination PSC, and communicating estimated time of arrival (ETA. Purpose Our purpose was to evaluate the EMS component of thrombolysed acute ischemic stroke patient care at our PSC. Methods In a retrospective manner we retrieved electronic copies of the EMS incident reports for every thrombolysed ischemic stroke patient treated at our PSC from September 2001 to August 2005. The following data elements were extracted: location of victim, EMS agency, times of dispatch, scene, departure, emergency department (ED arrival, recordings of time of stroke onset, blood pressure (BP, heart rate (HR, cardiac rhythm, blood glucose (BG, Glasgow Coma Scale (GCS, Cincinnati Stroke Scale (CSS elements, emergency medical personnel field assessment, and transport decision making. Results Eighty acute ischemic stroke patients received thrombolysis during the study interval. Eighty-one percent arrived by EMS. Two EMS agencies transported to our PSC. Mean dispatch-to-scene time was 6 min, on-scene time was 16 min, transport time was 10 min. Stroke onset time was recorded in 68%, BP, HR, and cardiac rhythm each in 100%, BG in 81%, GCS in 100%, CSS in 100%, and acute stroke diagnosis was made in 88%. Various diagnostic terms were employed: cerebrovascular accident in 40%, unilateral weakness or numbness in 20%, loss of consciousness in 16%, stroke in 8%, other stroke terms in 4%. In 87% of incident reports there was documentation of decision-making to transport to the nearest PSC in conjunction with pre-notification. Conclusion The EMS component of thrombolysed acute ischemic stroke patients care at our PSC appeared

  17. Speech rehabilitation of maxillectomy patients with hollow bulb obturator

    Directory of Open Access Journals (Sweden)

    Pravesh Kumar

    2012-01-01

    Full Text Available Aim: To evaluate the effect of hollow bulb obturator prosthesis on articulation and nasalance in maxillectomy patients. Materials and Methods: A total of 10 patients, who were to undergo maxillectomy, falling under Aramany classes I and II, with normal speech and hearing pattern were selected for the study. They were provided with definitive maxillary obturators after complete healing of the defect. The patients were asked to wear the obturator for six weeks and speech analysis was done to measure changes in articulation and nasalance at four different stages of treatment, namely, preoperative, postoperative (after complete healing, that is, 3-4 months after surgery, after 24 hours, and after six weeks of providing the obturators. Articulation was measured objectively for distortion, addition, substitution, and omission by a speech pathologist, and nasalance was measured by Dr. Speech software. Results: The statistical comparison of preoperative and six weeks post rehabilitation levels showed insignificance in articulation and nasalance. Comparison of post surgery complete healing with six weeks after rehabilitation showed significant differences in both nasalance and articulation. Conclusion: Providing an obturator improves the speech closer to presurgical levels of articulation and there is improvement in nasality also.

  18. Increase of Meningitis Risk in Stroke Patients in Taiwan

    Directory of Open Access Journals (Sweden)

    Chie-Hong Wang

    2018-03-01

    Full Text Available Background and purposeThe blood–brain barrier (BBB not only provides a physical obstruction but also recruits and activates neutrophils in cases of infection. Hemorrhagic or ischemic stroke reportedly induces the disruption of the BBB. However, few studies have reported a correlation between the incidence of meningitis in patients with a history of stroke. This study tested the hypothesis that patients with a history of stroke may be more vulnerable to meningitis.MethodsStroke and age-matched comparison (n = 29,436 and 87,951, respectively cohorts were recruited from the Taiwan National Health Insurance database (2000–2011. Correlations between the two cohorts were evaluated by Cox proportional hazard regression model, Kaplan–Meier curve, and log-rank tests.ResultsThe incidence of meningitis was higher in the stroke cohort compared to that in the comparison cohort [hazard ratio (HR, 2.89; 95% confidence interval (CI, 2.23–3.74, p < 0.001]. After adjusting for age, sex, and comorbidities, the estimated HR in the stroke cohort was 2.55-fold higher than that in the comparison cohort (CI, 1.94–3.37; p < 0.001. Notably, patients who had experienced hemorrhagic stroke had a higher incidence rate of meningitis than those with a history of ischemic stroke, except for patients older than 75 years (incidence rates in hemorrhagic/ischemic stroke patients, 3.14/1.48 in patients younger than 45 years, 1.52/0.41 in 45- to 64-year group, 1.15/0.90 in 65- to 74-year group, 0.74/0.93 in patients older than 75 years. Moreover, stroke patients who had undergone head surgery had the highest meningitis risk (adjusted HR, 8.66; 95% CI, 5.55–13.5; p < 0.001 followed by stroke patients who had not undergone head surgery (adjusted HR, 2.11; 95% CI, 1.57–2.82; p < 0.001.ConclusionOur results indicated that stroke patients have higher risks of meningitis. Compromised BBB integrity in stroke patients may lead to increased

  19. Functional recovery differs between ischaemic and haemorrhagic stroke patients

    NARCIS (Netherlands)

    Schepers, V.P.; Ketelaar, M.; Visser-Meily, A.J.; de Groot, V.; Twisk, J.W.R.; Lindeman, E.

    2008-01-01

    Objective: To determine whether there is a difference between patients with a cerebral infarction and those with an intracerebral haemorrhage with respect to the development of independence in activities of daily living over the first year post-stroke. Methods: Patients after first-ever stroke who

  20. Functional recovery differs between ischaemic and haemorrhagic stroke patients

    NARCIS (Netherlands)

    Schepers, Vera P. M.; Ketelaar, Marjoliin; Visser-Meily, Anne J. M.; de Groot, Vincent; Twisk, Jos W. R.; Lindeman, Eline

    Objective: To determine whether there is a difference between patients with a cerebral infarction and those with an intracerebral haemorrhage with respect to the development of independence in activities of daily living over the first year post-stroke. Methods: Patients after first-ever stroke who

  1. Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients

    Science.gov (United States)

    Wintermark, Max; Sanelli, Pina C.; Albers, Gregory W.; Bello, Jacqueline A.; Derdeyn, Colin P.; Hetts, Steven W.; Johnson, Michele H.; Kidwell, Chelsea S.; Lev, Michael H.; Liebeskind, David S.; Rowley, Howard A.; Schaefer, Pamela W.; Sunshine, Jeffrey L.; Zaharchuk, Greg; Meltzer, Carolyn C.

    2014-01-01

    In the article entitled “Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients: A Joint Statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery”, we are proposing a simple, pragmatic approach that will allow the reader to develop an optimal imaging algorithm for stroke patients at their institution. PMID:23948676

  2. Stroke at a tertiary medical institution in Northern Nigeria: Patients ...

    African Journals Online (AJOL)

    Background: Little is known about the burden of stroke in the northern part of Nigeria as most studies in the country have been in the southern part. The objective of this study was to study the profile of stroke patients and predictors of outcome in a tertiary health centre in Katsina, North-Western Nigeria.. Patients and Method: ...

  3. Frequency Of Hyperthermia In Acute Ischemic Stroke Patients Visiting A Tertiary Care Hospital

    International Nuclear Information System (INIS)

    Maheshwari, A. K.; Kumar, P.; Alam, M. T.; Aurangzeb, M.; Imran, K.; Masroor, M.; Parkash, J.

    2016-01-01

    Objective: To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country. Study Design: Cross-sectional, observational study. Place and Duration of Study: Medical Wards of Civil Hospital, Karachi, from January to June 2013. Methodology: Patients aged = 18 years of either gender with acute ischemic stroke presenting within 24 hours of onset of symptoms were included. Written informed consent was obtained from all participants as well as approval of ethical review committee of the institute. Axillary temperature by mercury thermometer was monitored at the time of admission and after every 6 hours for 3 days. The data was analyzed using SPSS version 17.0 (SPSS Inc., IL, Chicago, USA). Result: A total of 106 patients of ischemic stroke were included. The mean age of enrolled participants was 60.1 ±9.5 years. Among these, 61 (57.5 percentage) were males and 45 (42.5 percentage) females. Among all patients, 51.9 percentage presented with loss of consciousness, 30.2 percentage with slurred speech, 77.4 percentage with limb weakness, and 9.4 percentage with decrease vision. A total of 17 (16 percentage) patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of < 60 years of age, 26 percentage developed hyperthermia compared to 7.1 percentage in patients of = 60 years of age (p=0.008). On gender stratification, among male patients, 14.8 percentage developed hyperthermia compared to 17.8 percentage in female patients (p=0.43). Conclusion: It is concluded from this study that the frequency of hyperthermia in ischemic stroke was 16 percentage and it should be looked for as it has significant impact on the outcome. The hyperthermia was significantly more common in younger adults as compared to older adults. However, gender had no influence on the prevalence rate of hyperthermia. (author)

  4. Health, function and disability in stroke patients in the community

    Directory of Open Access Journals (Sweden)

    Bárbara P. B. Carvalho-Pinto

    2016-01-01

    Full Text Available ABSTRACT Background Stroke patients commonly have impairments associated with reduction in functionality. Among these impairments, the motor impairments are the most prevalent. The functional profile of these patients living in the community who are users of the primary health-care services in Brazil has not yet been established Objective To describe the functional profile of stroke patients who are users of the primary health-care services in Brazil, looking at one health-care unit in the city of Belo Horizonte, Brazil. Method From medical records and home visits, data were collected regarding health status, assistance received following the stroke, personal and environmental contextual factors, function and disability, organized according to the conceptual framework of the International Classification of Functioning, Disability and Health (ICF. Test and instruments commonly applied in the assessment of stroke patients were used. Results Demographic data from all stroke patients who were users of the health-care unit (n=44, age: 69.23±13.12 years and 67±66.52 months since the stroke participated of this study. Most subjects presented with disabilities, as changes in emotional function, muscle strength, and mobility, risks of falling during functional activities, negative self-perception of quality of life, and perception of the environment factors were perceived as obstacles. The majority of the patients used the health-care unit to renew drug prescriptions, and did not receive any information on stroke from health professionals, even though patients believed it was important for patients to receive information and to provide clarifications. Conclusion Stroke patients who used primary health-care services in Brazil have chronic disabilities and health needs that require continuous health attention from rehabilitation professionals. All of these health needs should be considered by health professionals to provide better management as part of

  5. Risk factors for swallowing dysfunction in stroke patients

    Directory of Open Access Journals (Sweden)

    Anna Flávia Ferraz Barros Baroni

    2012-06-01

    Full Text Available CONTEXT: Stroke is a frequent cause of dysphagia. OBJECTIVE: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. METHODS: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. RESULTS: It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. CONCLUSIONS: Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death.

  6. Thrombolysis outcomes in acute ischemic stroke patients with prior stroke and diabetes mellitus

    DEFF Research Database (Denmark)

    Mishra, N K; Ahmed, N; Davalos, A

    2011-01-01

    BACKGROUND: Patients with concomitant diabetes mellitus (DM) and prior stroke (PS) were excluded from European approval of alteplase in stroke. We examined the influence of DM and PS on the outcomes of patients who received thrombolytic therapy (T; data from Safe Implementation of Thrombolysis......,986), or concomitant DM and PS (OR 1.23 [0.996-1.52], p = 0.05, n = 1,136), all CMH p treatment (tissue...

  7. Stroke prevention strategies in North American patients with atrial fibrillation

    DEFF Research Database (Denmark)

    McIntyre, William F; Conen, David; Olshansky, Brian

    2018-01-01

    BACKGROUND: Antithrombotic prophylaxis with oral anticoagulation (OAC) substantially reduces stroke and mortality in patients with atrial fibrillation (AF). HYPOTHESIS: Analysis of data in GLORIA-AF, an international, observational registry of patients with newly-diagnosed AF, can identify factor...

  8. Obstructive sleep apnea exaggerates cognitive dysfunction in stroke patients.

    Science.gov (United States)

    Zhang, Yan; Wang, Wanhua; Cai, Sijie; Sheng, Qi; Pan, Shenggui; Shen, Fang; Tang, Qing; Liu, Yang

    2017-05-01

    Obstructive sleep apnea (OSA) is very common in stroke survivors. It potentially worsens the cognitive dysfunction and inhibits their functional recovery. However, whether OSA independently damages the cognitive function in stroke patients is unclear. A simple method for evaluating OSA-induced cognitive impairment is also missing. Forty-four stroke patients six weeks after onset and 24 non-stroke patients with snoring were recruited for the polysomnographic study of OSA and sleep architecture. Their cognitive status was evaluated with a validated Chinese version of Cambridge Prospective Memory Test. The relationship between memory deficits and respiratory, sleeping, and dementia-related clinical variables were analyzed with correlation and multiple linear regression tests. OSA significantly and independently damaged time- and event-based prospective memory in stroke patients, although it had less power than the stroke itself. The impairment of prospective memory was correlated with increased apnea-hypopnea index, decreased minimal and mean levels of peripheral oxygen saturation, and disrupted sleeping continuity (reduced sleep efficiency and increased microarousal index). The further regression analysis identified minimal levels of peripheral oxygen saturation and sleep efficiency to be the two most important predictors for the decreased time-based prospective memory in stroke patients. OSA independently contributes to the cognitive dysfunction in stroke patients, potentially through OSA-caused hypoxemia and sleeping discontinuity. The prospective memory test is a simple but sensitive method to detect OSA-induced cognitive impairment in stroke patients. Proper therapies of OSA might improve the cognitive function and increase the life quality of stroke patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Explicit memory and implicit memory in occipital lobe stroke patients.

    Science.gov (United States)

    Gong, Liang; Wang, JiHua; Feng, Lei; Wang, MeiHong; Li, Xiu; Hu, JiaYun; Wang, Kai

    2015-03-01

    Occipital stroke patients mainly showed cortical blindness and unilateral vision loss; memory is generally reserved. Recent reports from neuroimaging show the occipital lobe may be involved in the processing of implicit memory (IM), especially the perception type of IM processing. In this study, we explored the explicit memory (EM) and IM damage in occipital lobe stroke patients. A total of 25 occipital strokes and 29 years of age, educational level equivalent healthy controls (HCs), evaluated by using immediate recall, delayed recall, recognition for EM tasks, picture identification, and category exemplar generation for IM tasks. There was no significant difference between occipital stroke patients and HCs in EM tasks and category exemplar generation task. In the picture identification task, occipital lobe stroke group score was poorer than HC group, the results were statistically significant, but in the pictures identify rate, occipital stroke patients and normal control group had no significant difference. The occipital stroke patients may have IM damage, primarily damage the perception type of IM priming effects, which was unrelated with their cortical blindness. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Management of arterial hypertension in patients with acute stroke.

    Science.gov (United States)

    Adeoye, Opeolu; Jauch, Edward C

    2006-11-01

    Management of arterial hypertension in the hyperacute period immediately after stroke ictus remains controversial. Extremes of blood pressure (BP) are associated with poor outcomes in all stroke subtypes. Severely hypertensive patients likely benefit from modest BP reductions, but aggressive BP reduction may worsen outcome. Although little evidence is currently available to definitively establish guideline recommendations for optimal BP goals at stroke presentation, recently published research is shedding some light on how to approach management of BP after stroke. Antihypertensive treatment should probably be deferred in ischemic stroke patients except in cases of severe hypertension or when thrombolytic therapy is warranted and the patient's BP is above acceptable levels. Hypertensive hemorrhagic stroke patients may benefit from modest BP reductions. Relative hypotension causing regional hypoperfusion is an increasingly understood concept immediately following ischemic or hemorrhagic stroke, emphasizing the need for careful titration of appropriate medications to minimize fluctuations in BP for treated patients. Ongoing trials will improve our current knowledge regarding BP management after ischemic and hemorrhagic stroke.

  11. Dissociated Crossed Speech Areas in a Tumour Patient

    Directory of Open Access Journals (Sweden)

    Jörg Mauler

    2017-05-01

    Full Text Available In the past, the eloquent areas could be deliberately localised by the invasive Wada test. The very rare cases of dissociated crossed speech areas were accidentally found based on the clinical symptomatology. Today functional magnetic resonance imaging (fMRI-based imaging can be employed to non-invasively localise the eloquent areas in brain tumour patients for therapy planning. A 41-year-old, left-handed man with a low-grade glioma in the left frontal operculum extending to the insular cortex, tension headaches, and anomic aphasia over 5 months underwent a pre-operative speech area localisation fMRI measurement, which revealed the evidence of the transhemispheric disposition, where the dominant Wernicke speech area is located on the left and the Broca’s area is strongly lateralised to the right hemisphere. The outcome of the Wada test and the intraoperative cortico-subcortical stimulation mapping were congruent with this finding. After tumour removal, language area function was fully preserved. Upon the occurrence of brain tumours with a risk of impaired speech function, the rare dissociate crossed speech areas disposition may gain a clinically relevant meaning by allowing for more extended tumour removal. Hence, for its identification, diagnostics which take into account both brain hemispheres, such as fMRI, are recommended.

  12. Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes.

    Science.gov (United States)

    Al-Khaled, Mohamed; Matthis, Christine; Binder, Andreas; Mudter, Jonas; Schattschneider, Joern; Pulkowski, Ulrich; Strohmaier, Tim; Niehoff, Torsten; Zybur, Roland; Eggers, Juergen; Valdueza, Jose M; Royl, Georg

    2016-01-01

    Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to 72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability. © 2016 S. Karger AG, Basel.

  13. Unipolar and continuous cortical stimulation to enhance motor and language deficit in patients with chronic stroke: report of 2 cases.

    Science.gov (United States)

    Kim, Hyoung-Ihl; Shin, Yong-Il; Moon, Seong-Keun; Chung, Gyung-Ho; Lee, Min-Cheol; Kim, Hyun-Gi

    2008-01-01

    Stroke often leads to permanent neurological deficit despite extensive therapeutic and rehabilitative efforts; and in chronic stages, it is difficult to restore neurological function. Recently, bipolar and intermittent cortical stimulation combined with rehabilitation has been reported to be effective in chronic hemiparetic stroke. However, optimal parameters of cortical stimulation for chronic stroke have not been determined to restore neurological function in chronic stages of stroke. We report 2 cases of chronic stroke whose neurological functions were improved by continuous, unipolar cortical stimulation combined with rehabilitation. Patient 1 presented motor and language deficit associated with cortical infarct in the left middle cerebral artery territory, which occurred 18 months before admission. Patient 2 presented motor deficit associated with subcortical infarct in the internal capsule 8 months before admission. Unipolar electrodes were implanted epidurally to cover the contralateral premotor and motor cortex in both cases, and an additional electrode was implanted over the Broca area in patient 1. Follow-up evaluation after 4 months of stimulation and concurrent rehabilitation showed improvement of Fugl-Meyer and FIM scores in both patients, and of speech and articulation in patient 1, whose electrode covered the Broca area. No adverse effects were observed during the period of treatment. Unipolar and continuous cortical stimulation with rehabilitation is beneficial for improving neurological deficit in selected cases of chronic stroke.

  14. Kinesthetic taping improves walking function in patients with stroke

    DEFF Research Database (Denmark)

    Boeskov, Birgitte; Carver, Line Tornehøj; von Essen-Leise, Anders

    2014-01-01

    BACKGROUND: Stroke is an important cause of severe disability and impaired motor function. Treatment modalities that improve motor function in patients with stroke are needed. The objective of this study was to investigate the effect of kinesthetic taping of the anterior thigh and knee on maximal...... walking speed and clinical indices of spasticity in patients with stroke. METHODS: Thirty-two patients (9 women) receiving rehabilitation after stroke (average, 50 days since stroke) who had impaired walking ability were recruited. Primary outcome was maximal walking speed measured by the 10-meter walk...... test. Secondary outcomes were number of steps taken during the test and clinical signs of spasticity measured by the Tardieu Scale. Tests were conducted before and immediately after application of kinesthetic tape to the anterior thigh and knee of the paretic lower limb. RESULTS: After application...

  15. Determinants of Length of Stay in Stroke Patients: A Geriatric Rehabilitation Unit Experience

    Science.gov (United States)

    Atalay, Ayce; Turhan, Nur

    2009-01-01

    The objective was to identify the predictors of length of stay--the impact of age, comorbidity, and stroke subtype--on the outcome of geriatric stroke patients. One hundred and seventy stroke patients (129 first-ever ischemic, 25 hemorrhagic, and 16 ischemic second strokes) were included in the study. The Oxfordshire Community Stroke Project…

  16. Occupational therapy for stroke patients - A systematic review

    NARCIS (Netherlands)

    Steultjens, E.M.J.; Dekker, J.; Bouter, L.M.; van de Nes, J.C.M.; Cup, E.H.C.; van den Ende, C.H.M.

    2003-01-01

    Background and Purpose - Occupational therapy (OT) is an important aspect of stroke rehabilitation. The objective of this study was to determine from the available literature whether OT interventions improve outcome for stroke patients. Methods - An extensive search in MEDLINE, CINAHL, EMBASE, AMED,

  17. Multidisciplinary rehabilitation outcomes of stroke patients in the ...

    African Journals Online (AJOL)

    Multidisciplinary rehabilitation can be implemented to address disability post stroke. The aim of this study was to determine outcomes of stroke patients managed by a multidisciplinary team at a step-down facility in the Western Cape. A longitudinal observational study was used to measure outcomes at baseline and ...

  18. Clinical characteristics and outcomes of patients with stroke ...

    African Journals Online (AJOL)

    Background: Epidemiological data on stroke in Zimbabwe are scarce and few clinical studies have been performed to date. Methods: A retrospective review of the medical records of patients admitted for stroke during the year 2012 was performed at three tertiary hospitals. Sociodemographic data were recorded alongside ...

  19. Ischemic Stroke among the Patients with End-Stage Renal Disease Who Were Undergoing Maintenance Dialysis

    OpenAIRE

    Jung, San; Kwon, Seok-Beom; Hwang, Sung-Hee; Noh, Jung Woo; Lee, Young-Ki

    2012-01-01

    Purpose In spite of higher incidence of stroke in end-stage renal disease (ESRD) patients compared to general population, the risk factor for stroke which is specific to ESRD is not fully understood. The ESRD patients who develop stroke may have certain additional risk factors compared to ESRD patients without stroke. We used registered data of Hallym Stroke Registry to elucidate the factors which affect development of ischemic stroke among the dialysis patients. Materials and Methods We recr...

  20. Stroke occurring in patients with cognitive impairment or dementia

    Directory of Open Access Journals (Sweden)

    Solène Moulin

    Full Text Available ABSTRACT One in six patients admitted for stroke was previously demented. These patients have less access to appropriate stroke care, although little is known about their optimal management. Objective To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods Literature search. Results (i A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others. Conclusion Patients with cognitive impairment who develop a stroke have worse outcomes, but should be treated like others.

  1. Inpatient rehabilitation outcomes of patients with apraxia after stroke.

    Science.gov (United States)

    Wu, Andy J; Burgard, Emily; Radel, Jeff

    2014-01-01

    Stroke-induced paresis commands much attention during rehabilitation; other stroke-related consequences receive less consideration. Apraxia is a stroke disorder that may have important implications for rehabilitation and recovery. To investigate association of apraxia with stroke rehabilitation outcomes during inpatient rehabilitation. This cohort study compared patients with and without apraxia after a first left hemispheric stroke. All study patients received standard of care. Clinical measures were the Functional Independence Measure (FIM) and the upper extremity section of the Fugl-Meyer Assessment (FMA) administered upon admission and at discharge. Length of stay was also documented. Florida Apraxia Battery subtests were used to classify patients with apraxia. Fifteen patients were included in this study, 10 of whom had apraxia. Data analysis revealed that patients with apraxia exhibited improvement from admission to discharge in clinical measures; however, admission FIM score was significantly lower compared to patients without apraxia. There was no statistically significant difference between groups on FMA score, length of stay, or amount of change on clinical measures. This study of acute patients found those with apraxia to be significantly less independent upon admission to inpatient rehabilitation compared to patients without apraxia. Although both groups improved a similar amount during rehabilitation, patients with apraxia discharged at a level of independence comparable to patients without apraxia upon admission. Such disparity in independence is of concern, and apraxia as a factor in stroke rehabilitation and recovery deserves further attention.

  2. Pattern of hospitalized-stroke patients in ASEAN countries an ASNA stroke epidemiological study

    Directory of Open Access Journals (Sweden)

    Jusuf Misbach

    2001-03-01

    Full Text Available To better understanding the demographic characteristics, admission time, clinical pattern, risk factors, stroke type, length of stay, and discharge outcome of hospitalized acute stroke patients in ASEAN member countries, ASEAN   Neurological Association (ASNA formed a Standing Commiltee for Stroke in 1996 and this is the first ASNA Stroke Epidemiological Study using the same stroke protocol. This prospective hospital based study was conducted in seven ASEAN countries (Brunei, Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam by participating neurologists from October 1996 to March 1997. Of the 3723 consecutive hospitalized stroke patients (2030 males and 1660 females from 44 participating hospitals in this study ie Brunei (n=53, Indonesia (n=2065, Malaysia (n=300,Philippines (n=545,Singapore (n=232, Thailand (n=244 and Vietnam (n=284, the mean age was 59.0 ± 13,8 years 16% of patients were younger than 45 years and 37% of patients were older than 65 years. There were no significant differences in age at onset among stroke subjects except in Vietnam (younger and Singapore (older. The sex distribution showed a slight higher prevalence of women in Singapore and in the age group > 64 years. The mean adrnission time was 41.5 ± 87.0 hours, 19% of patients were admitted within 3 hours, 29% within 6 hours and 66% more than 6 hours (delayed admission especially in Malaysia and Singapore (80% and 77% respectively. Motor disability was the most prevalent clinical feature in all countries and carotid bruit was the rarest (1%. Hypertension was the most common risk factor (68% in all countries, followed by TIA (35%, smoking, diabetes mellitus, ischnemic heart disease and hypercholesterolemia. CT scan was performed on 76% of subjects. The diagnostic classification was non lacunar anterior circulation (32%, lacunar infarction (14%, hemorrhagic stroke (26%, SAH (4%. Mean length of stay was 11.4 ± 11.8 days. Most of the patients

  3. Thrombophilia testing in young patients with ischemic stroke.

    Science.gov (United States)

    Pahus, Sidse Høst; Hansen, Anette Tarp; Hvas, Anne-Mette

    2016-01-01

    The possible significance of thrombophilia in ischemic stroke remains controversial. We aimed to study inherited and acquired thrombophilias as risk factors for ischemic stroke, transient ischemic attack (TIA) and amaurosis fugax in young patients. We included patients aged 18 to 50 years with ischemic stroke, TIA or amaurosis fugax referred to thrombophilia investigation at Aarhus University Hospital, Denmark from 1 January 2004 to 31 December 2012 (N=685). Clinical information was obtained from the Danish Stroke Registry and medical records. Thrombophilia investigation results were obtained from the laboratory information system. Absolute thrombophilia prevalences and associated odds ratios (OR) with 95% confidence intervals (95% CI) were reported for ischemic stroke (N=377) and TIA or amaurosis fugax (N=308). Thrombophilia prevalences for the general population were obtained from published data. No strong associations were found between thrombophilia and ischemic stroke, but patients with persistent presence of lupus anticoagulant (3%) had an OR at 2.66 (95% CI 0.84-9.15) for ischemic stroke. A significantly higher risk of TIA/amaurosis fugax was found for factor V Leiden heterozygote (12%) (OR: 1.99 (95% CI 1.14-3.28)). No other inherited or acquired thrombophilia was associated with ischemic stroke, TIA or amaurosis fugax. In young patients, thrombophilia did not infer an increased risk of ischemic stroke. Only factor V Leiden heterozygote patients had an increased risk of TIA/amaurosis fugax, and persistent presence of lupus anticoagulant was likely associated with ischemic stroke. We suggest the testing restricted to investigation of persistent presence of lupus anticoagulant. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Variations in Kinematics during Clinical Gait Analysis in Stroke Patients

    OpenAIRE

    Boudarham, Julien; Roche, Nicolas; Pradon, Didier; Bonnyaud, C?line; Bensmail, Djamel; Zory, Raphael

    2013-01-01

    In addition to changes in spatio-temporal and kinematic parameters, patients with stroke exhibit fear of falling as well as fatigability during gait. These changes could compromise interpretation of data from gait analysis. The aim of this study was to determine if the gait of hemiplegic patients changes significantly over successive gait trials. Forty two stroke patients and twenty healthy subjects performed 9 gait trials during a gait analysis session. The mean and variability of spatio-tem...

  5. Transthyretin Concentrations in Acute Stroke Patients Predict Convalescent Rehabilitation.

    Science.gov (United States)

    Isono, Naofumi; Imamura, Yuki; Ohmura, Keiko; Ueda, Norihide; Kawabata, Shinji; Furuse, Motomasa; Kuroiwa, Toshihiko

    2017-06-01

    For stroke patients, intensive nutritional management is an important and effective component of inpatient rehabilitation. Accordingly, acute care hospitals must detect and prevent malnutrition at an early stage. Blood transthyretin levels are widely used as a nutritional monitoring index in critically ill patients. Here, we had analyzed the relationship between the transthyretin levels during the acute phase and Functional Independence Measure in stroke patients undergoing convalescent rehabilitation. We investigated 117 patients who were admitted to our hospital with acute ischemic or hemorrhagic stroke from February 2013 to October 2015 and subsequently transferred to convalescent hospitals after receiving acute treatment. Transthyretin concentrations were evaluated at 3 time points as follows: at admission, and 5 and 10 days after admission. After categorizing patients into 3 groups according to the minimum transthyretin level, we analyzed the association between transthyretin and Functional Independence Measure. In our patients, transthyretin levels decreased during the first 5 days after admission and recovered slightly during the subsequent 5 days. Notably, Functional Independence Measure efficiency was significantly associated with the decrease in transthyretin levels during the 5 days after admission. Patients with lower transthyretin levels had poorer Functional Independence Measure outcomes and tended not to be discharged to their own homes. A minimal transthyretin concentration (stroke patients undergoing convalescent rehabilitation. In particular, an early decrease in transthyretin levels suggests restricted rehabilitation efficiency. Accordingly, transthyretin levels should be monitored in acute stroke patients to indicate mid-term rehabilitation prospects. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  6. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    Directory of Open Access Journals (Sweden)

    Koopmanschap Marc A

    2003-02-01

    Full Text Available Abstract Background Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses patient costs after stroke and compares costs between regular and stroke service care. Methods Costs were calculated within the framework of the evaluation of three experiments with stroke services in the Netherlands. Cost calculations are base on medical consumption data and actual costs. Results 598 patients were consecutively admitted to hospital after stroke. The average total costs of care per patient for the 6 month follow-up are estimated at €16,000. Costs are dominated by institutional and accommodation costs. Patients who die after stroke incur less costs. For patients that survive the acute phase, the most important determinants of costs are disability status and having a partner – as they influence patients' stroke careers. These determinants also interact. The most efficient stroke service experiment was most successful in co-ordinating patient flow from hospital to (nursing home, through capacity planning and efficient discharge procedures. In this region the costs of stroke service care are the same as for regular stroke care. The other experiments suffered from waiting lists for nursing homes and home care, leading to "blocked beds" in hospitals and nursing homes and higher costs of care. Costs of co-ordination are estimated at about 3% of total costs of care. Conclusion This paper demonstrates that by organising care for stroke patients in a stroke service, better health effects can be achieved with the same budget. In addition, it provides insight in need, predisposing and enabling factors that determine costs of care after stroke.

  7. Diagnostic value of prehospital ECG in acute stroke patients.

    Science.gov (United States)

    Bobinger, Tobias; Kallmünzer, Bernd; Kopp, Markus; Kurka, Natalia; Arnold, Martin; Heider, Stefan; Schwab, Stefan; Köhrmann, Martin

    2017-05-16

    To investigate the diagnostic yield of prehospital ECG monitoring provided by emergency medical services in the case of suspected stroke. Consecutive patients with acute stroke admitted to our tertiary stroke center via emergency medical services and with available prehospital ECG were prospectively included during a 12-month study period. We assessed prehospital ECG recordings and compared the results to regular 12-lead ECG on admission and after continuous ECG monitoring at the stroke unit. Overall, 259 patients with prehospital ECG recording were included in the study (90.3% ischemic stroke, 9.7% intracerebral hemorrhage). Atrial fibrillation (AF) was detected in 25.1% of patients, second-degree or greater atrioventricular block in 5.4%, significant ST-segment elevation in 5.0%, and ventricular ectopy in 9.7%. In 18 patients, a diagnosis of new-onset AF with direct clinical consequences for the evaluation and secondary prevention of stroke was established by the prehospital recordings. In 2 patients, the AF episodes were limited to the prehospital period and were not detected by ECG on admission or during subsequent monitoring at the stroke unit. Of 126 patients (48.6%) with relevant abnormalities in the prehospital ECG, 16.7% received medical antiarrhythmic therapy during transport to the hospital, and 6.4% were transferred to a cardiology unit within the first 24 hours in the hospital. In a selected cohort of patients with stroke, the in-field recordings of the ECG detected a relevant rate of cardiac arrhythmia. The results can add to the in-hospital evaluation and should be considered in prehospital care of acute stroke. © 2017 American Academy of Neurology.

  8. Stroke rehabilitation and patients with multimorbidity: a scoping review protocol

    Directory of Open Access Journals (Sweden)

    Michelle L.A. Nelson

    2015-02-01

    Full Text Available Stroke care presents unique challenges for clinicians, as most strokes occur in the context of other medical diagnoses. An assessment of capacity for implementing “best practice” stroke care found clinicians reporting a strong need for training specific to patient/system complexity and multimorbidity. With mounting patient complexity, there is pressure to implement new models of healthcare delivery for both quality and financial sustainability. Policy makers and administrators are turning to clinical practice guidelines to support decision-making and resource allocation. Stroke rehabilitation programs across Canada are being transformed to better align with the Canadian Stroke Strategy’s Stroke Best Practice Recommendations. The recommendations provide a framework to facilitate the adoption of evidence-based best practices in stroke across the continuum of care. However, given the increasing and emerging complexity of patients with stroke in terms of multimorbidity, the evidence supporting clinical practice guidelines may not align with the current patient population. To evaluate this, electronic databases and gray literature will be searched, including published or unpublished studies of quantitative, qualitative or mixed-methods research designs. Team members will screen the literature and abstract the data. Results will present a numerical account of the amount, type, and distribution of the studies included and a thematic analysis and concept map of the results. This review represents the first attempt to map the available literature on stroke rehabilitation and multimorbidity, and identify gaps in the existing research. The results will be relevant for knowledge users concerned with stroke rehabilitation by expanding the understanding of the current evidence.

  9. Care for post-stroke patients at Malaysian public health centres: self-reported practices of family medicine specialists

    Science.gov (United States)

    2014-01-01

    Background Provision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services. Methods A semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached. Results Response rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on ‘as needed’ basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS’ perceived 4 important ‘needs’ in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family

  10. Computed tomography scan in the evaluation of patients with stroke

    Directory of Open Access Journals (Sweden)

    PK Chhetri

    2012-09-01

    Full Text Available Cerebrovascular accident is a frequent cause of death and disability in most parts of the globe. The incidence of cerebrovascular diseases increases with age and the number of strokes is projected to increase as the elderly population grows. This study was undertaken to determine the type of stroke and also to relate the risks factors associated with stroke. Hundred consecutive patients presenting with stroke in the emergency department / neurology clinic were subjected to computed tomography scan of the brain. Sixty – four patients had ischemic infarct and 36 had intracranial hemorrhage which included 2 patients with subarachnoid hemorrhage and 1 with underlying cavernous angioma. Ischemic stroke was thus commoner than hemorrhagic stroke. Previous infarct or lacunes were noted in 25 % of the patients presenting with stroke. Risk factors were present in most (77 % of the patients presenting with stroke. Among the various risk factors, the single most common was smoking seen in 38 cases, followed by hypertension in 28 cases, obesity in 8 cases and diabetes in 3 cases. Twenty- one patients had multiple combinations of the above risk factors. Among the multiple risk factors, combination of alcohol and smoking was the commonest seen in 11 cases, followed by hypertension and obesity in 8 cases and alcohol with obesity in 2 cases. Change in lifestyle and eating habits may thus help reduce the incidence of stroke. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 24-31 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6834

  11. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients.

    Science.gov (United States)

    Chen, Jia-Ching; Shaw, Fu-Zen

    2014-08-16

    Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotics-aided systems, virtual reality, intermittent compression, partial body weight supported treadmill training and thermal stimulation, are being developed and incorporated into conventional rehabilitation programs. The concept of combining valuable rehabilitative procedures into "a training package", based on the patient's functional status during different recovery phases after stroke is proposed. Integrated sensorimotor rehabilitation programs with appropriate temporal arrangements might provide great functional benefits for stroke patients.

  12. Anticoagulant treatment in patients with atrial fibrillation and ischemic stroke

    DEFF Research Database (Denmark)

    Brunner-Frandsen, Nicole; Dammann Andersen, Andreas; Ashournia, Hamoun

    2015-01-01

    BACKGROUND: Atrial fibrillation (AF) is the most common cardiac dysrhythmia, with a lifetime risk of 25%, and it is a well-known independent risk factor for ischemic stroke. Over the last 15 years, efforts have been made to initiate relevant treatment in patients with AF. A retrospective study...... was observed. An explanation could be an increase in the prevalence of AF in the general population, leaving the proportion of patients admitted with ischemic stroke unchanged. Other risk factors have been sought reduced as well with the implementation of national guidelines regarding hypertension...... was set up to clarify whether this effort has resulted in a decreased proportion of patients with known AF experiencing an ischemic stroke. METHODS: Patients admitted to the Department of Neurology, Vejle Hospital, Denmark, with ischemic stroke from January 1997 to December 2012 were included in the study...

  13. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, P K; Damsgaard, Else Marie; Husted, Steen

    2007-01-01

    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...... 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...... and 6 months. Nutritional status was evaluated by body weight, body mass index (BMI), mid upper arm circumference (MAC), triceps skinfold thickness (TSF) and serum concentrations of albumin and transferrin. Malnutrition was defined if the patients had 2 or more abnormal nutritional variables. RESULTS...

  14. Dabigatran Therapy in Acute Ischemic Stroke Patients Without Atrial Fibrillation.

    Science.gov (United States)

    Kate, Mahesh; Gioia, Laura; Buck, Brian; Sivakumar, Leka; Jeerakathil, Thomas; Shuaib, Ashfaq; Butcher, Kenneth

    2015-09-01

    Acute ischemic stroke patients are at risk of early recurrence. We tested the feasibility and safety of initiating dabigatran in patients, within 24 hours of minor stroke in patients without atrial fibrillation. Minor stroke patients (National Institutes of Health Stroke Scale score ≤3) without atrial fibrillation and evidence of acute infarction on magnetic resonance imaging were treated with dabigatran. Treatment began within 24 hours of onset and was continued for 30 days. The primary end point was symptomatic hemorrhagic transformation. A total of 53 patients with median (interquartile range) age of 68 (57-77) years and National Institutes of Health Stroke Scale score of 1 (0-2) were enrolled. Baseline diffusion-weighted imaging volume was 0.8 (0.3-2.4) mL. No patients experienced symptomatic hemorrhagic transformation. Three patients had evidence of asymptomatic petechial hemorrhagic transformation on day 7, which remained stable at day 30, while continuing dabigatran. Dabigatran treatment within 24 hours of minor stroke is feasible. A larger randomized trial is required to confirm the safety and efficacy of this treatment approach. URL: http://www.clinicaltrials.gov. Unique identifier: NCT 01769703. © 2015 American Heart Association, Inc.

  15. Identification of stroke during the emergency call: a descriptive study of callers' presentation of stroke.

    Science.gov (United States)

    Berglund, Annika; von Euler, Mia; Schenck-Gustafsson, Karin; Castrén, Maaret; Bohm, Katarina

    2015-04-28

    To evaluate symptoms presented by the caller during emergency calls regarding stroke, and to assess if symptoms in the Face-Arm-Speech-Time Test (FAST) are related to identification of stroke. Emergency calls to the Emergency Medical Communication Center (EMCC) concerning patients discharged with stroke diagnosis in a large teaching hospital in Stockholm, Sweden, in January-June 2011. The emergency calls of 179 patients who arrived at hospital by ambulance, and who were discharged with a stroke diagnosis and consented to participate were included in the study. Frequencies of stroke symptoms presented and a comparison of symptoms presented in calls with dispatch code stroke or other dispatch code. Of the 179 emergency calls analysed, 64% were dispatched as 'Stroke'. FAST symptoms, that is, facial or arm weakness or speech disturbances, were presented in 64% of the calls and were spontaneously revealed in 90%. Speech disturbance was the most common problem (54%) in all calls, followed by fall/lying position (38%) and altered mental status (27%). For patients with dispatch codes other than stroke, the dominating problem presented was a fall or being in a lying position (66%), followed by speech disturbance (31%) and altered mental status (25%). Stroke-specific symptoms were more common in patients dispatched as stroke. FAST symptoms were reported in 80% of patients dispatched as stroke compared with 35% in those dispatched as something else. This study implicates that fall/lying position and altered mental status could be considered as possible symptoms of stroke during an emergency call. Checking for FAST symptoms in these patients might uncover stroke symptoms. Future studies are needed to evaluate if actively asking for FAST symptoms in emergency calls presenting falls or a lying position can improve the identification of stroke. Stroke2010/703-31/2. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  16. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    M.A. Koopmanschap (Marc); W.J.M. Scholte op Reimer (Wilma); J.D.H. van Wijngaarden (Jeroen); N.J.A. van Exel (Job)

    2003-01-01

    textabstractBACKGROUND: Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients.

  17. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    N.J.A. van Exel (Job); M.A. Koopmanschap (Marc); J.D.H. van Wijngaarden (Jeroen); W.J.M. Scholte op Reimer (Wilma)

    2003-01-01

    textabstractBackground. Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses

  18. Hearing Characteristics of Stroke Patients: Prevalence and Characteristics of Hearing Impairment and Auditory Processing Disorders in Stroke Patients.

    Science.gov (United States)

    Koohi, Nehzat; Vickers, Deborah A; Lakshmanan, Rahul; Chandrashekar, Hoskote; Werring, David J; Warren, Jason D; Bamiou, Doris-Eva

    2017-06-01

    Stroke survivors may suffer from a range of hearing impairments that may restrict their participation in postacute rehabilitation programs. Hearing impairment may have a significant impact on listening, linguistic skills, and overall communication of the affected stroke patient. However, no studies sought to systematically characterize auditory function of stroke patients in detail, to establish the different types of hearing impairments in this cohort of patients. Such information would be clinically useful in understanding and addressing the hearing needs of stroke survivors. The present study aimed to characterize and classify the hearing impairments, using a detailed audiological assessment test battery, in order to determine the level of clinical need and inform appropriate rehabilitation for this patient population. A case-control study. Forty-two recruited stroke patients who were discharged from a stroke unit and 40 control participants matched for age. All participants underwent pure-tone audiometry and immittance measurements including acoustic reflex threshold, transient-evoked otoacoustic emissions, auditory-evoked brainstem response, and a central auditory processing assessment battery, performed in a single session. Hearing impairments were classified as peripheral hearing loss (cochlear and neural type), central auditory processing disorder (CAPD), and as a combination of CAPD and peripheral hearing loss. Overall mean hearing thresholds were not significantly different between the control and stroke groups. The most common type of hearing impairment in stroke patients was the combination type, "peripheral and CAPD," in the 61- to 80-yr-old subgroup (in 55%), and auditory processing deficits in 18- to 60-yr-olds (in 40%), which were both significantly higher than in controls. This is the first study to examine hearing function in detail in stroke patients. Given the importance of hearing for the efficiency of communication, it is essential to identify

  19. Facilities available in European hospitals treating stroke patients.

    Science.gov (United States)

    Leys, Didier; Ringelstein, E Bernd; Kaste, Markku; Hacke, Werner

    2007-11-01

    Stroke units decrease mortality and need for institutional care, but they are not widely available. The objective of the study was to determine, among European hospitals admitting acute stroke patients, how many are able to provide an appropriate level of care. Method- We randomly selected 886 hospitals in 25 countries. We used definitions derived from a European expert survey for comprehensive stroke centers (CSC), primary stroke centers (PSC), and minimum level required for any hospital ward (AHW) admitting stroke patients. We determined the proportion of hospitals meeting criteria for each category, and which facilities were not available. Participating hospitals treated approximately one-third of all strokes supposed to have occurred in these countries in 2005. Forty-three (4.9%) met criteria for CSC, 32 (3.6%) for PSC, 356 (40.2%) for AHW, and 455 (51.4%) provided a lower level of care. In 2005, hospitals meeting criteria for CSC, PSC, AHW, and none of them admitted 27 644 (8.3%), 17 365 (5.2%), 146 175 (44.1%), and 140 306 (42.3%) patients. There was no 24-hour availability for brain CT scan in 25% of hospitals not meeting criteria for AHW. Of 448 hospitals admitting at least 1 stroke per day, 51 (11.4%) met criteria for PSC or CSC, and 227 (50.7%) for AHW. Less than 10% of European hospitals admitting acute stroke patients have optimal facilities, and in 40% even the minimum level is not available. Because the availability of facilities does not grant their use, our study suggests that only few acute stroke patients are treated in appropriate centers in Europe.

  20. Inhibitory non-invasive brain stimulation to homologous language regions as an adjunct to speech and language therapy in post-stroke aphasia: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Begonya eOtal

    2015-04-01

    Full Text Available Chronic communication impairment is common after stroke, and conventional speech and language therapy (SLT strategies have limited effectiveness in post-stroke aphasia. Neurorehabilitation with non-invasive brain stimulation techniques (NIBS ‒ particularly repetitive transcranial magnetic stimulation (rTMS or transcranial direct current stimulation (tDCS ‒ may enhance the effects of SLT in selected patients. Applying inhibitory NIBS to specific homologous language regions may induce neural reorganization and reduce interhemispheric competition. This mini review highlights randomized controlled trials (RCTs and randomized cross-over trials using low-frequency rTMS or cathodal tDCS over the non-lesioned non-language dominant hemisphere and performs an exploratory meta-analysis of those trials considered combinable. Using a random-effects model, a meta-analysis of nine eligible trials involving 215 participants showed a significant mean effect size of 0.51 (95% CI = 0.24 to 0.79 for the main outcome accuracy of naming in language assessment. No heterogeneity was observed (I2 = 0%. More multicenter RCTs with larger populations and homogenous intervention protocols are required to confirm these and the longer-term effects.

  1. Glucose and lipid assessment in patients with acute stroke.

    Science.gov (United States)

    Ogbera, Anthonia O; Oshinaike, Olajumoke O; Dada, Olusola; Brodie-Mends, Ayodeji; Ekpebegh, Chukwuma

    2014-01-01

    Stroke is a major health issue in Nigeria and it is also a common cause of emergency admissions. Stroke often results in increased morbidity, mortality and reduced quality of life in people thus affected. The risk factors for stroke include metabolic abnormalities such as dyslipidaemia and diabetes mellitus (DM). The stress of an acute stroke may present with hyperglycaemia and in persons without a prior history of DM, may be a pointer to stress hyperglycaemia or undiagnosed DM. This was a cross sectional study carried out over a period of one year in a teaching hospital in Lagos, Nigeria. Patients with acute stroke admitted to the hospital within three days of the episode of stroke and who met other inclusion criteria for the Study were consecutively recruited. Clinically relevant data was documented and biochemical assessments were carried out within three days of hospitalization. Tests for lipid profile, glycosylated haemoglobin(HbA1c), and blood glucose at presentation were carried out. The presence of past history of DM, undiagnosed DM, stress hyperglycaemia and abnormal lipid profile were noted. Students t test and Chi square were the statistical tests employed. A total of 137 persons with stroke were recruited of which 107 (76%) met the defining criteria for ischaemic stroke. The mean age and age range of the Study subjects were 62.2 (11.7) and 26-89 years respectively. The Study subjects were classified according to their glycaemic status into the following categories viz; stress hyperglycaemia, euglycaemia, DM and previously undiagnosed DM. Stress hyperglycaemia occurred commonly in the fifth decade of life and its incidence was comparable between those with cerebral and haemorrhagic stroke. The commonly occurring lipid abnormalities were elevated LDL-C and low HDL. The detection of abnormal metabolic milieu is a window of opportunity for aggressive management in persons with stroke as this will improve outcome. Routine screening for hyperglycaemia in

  2. Prevalence of risk factors for ischaemic stroke and their treatment among a cohort of stroke patients in Dublin.

    LENUS (Irish Health Repository)

    McDonnell, R

    2000-10-01

    The majority of strokes are due to ischaemia. Risk factors include atrial fibrillation, hypertension and smoking. The incidence can be reduced by addressing these risk factors. This study examines the prevalence of risk factors and their treatment in a cohort of patients with ischaemic stroke registered on a Dublin stroke database.

  3. The Importance of Patient Involvement in Stroke Rehabilitation

    Science.gov (United States)

    2016-01-01

    Objective To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. Method Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. Results The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. Conclusions The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health

  4. Hypertension unawareness among Chinese patients with first-ever stroke

    Directory of Open Access Journals (Sweden)

    Qinqin Cao

    2016-02-01

    Full Text Available Abstract Background The low rates of hypertension treatment and control, partly due to its unawareness, are the main causes of the high stroke incidence in China. The purpose of this study was to evaluate hypertension unawareness amongst patients with first-ever stroke and to detect factors associated with its unawareness. Methods We selected those diagnosed with hypertension from patients with first-ever stroke registered in the Nanjing Stroke Registry Program between 2004 and 2014. These hypertensives were divided as being aware or unaware of their hypertension by using a brief questionnaire conducted shortly after the stroke. Multivariate logistic regression analysis was performed to identify potential factors associated with hypertension unawareness. Results Of the 5309 patients with first-ever stroke, 3732 (70.3 % were diagnosed with hypertension. Among which, 593 (15.9 % were unaware of their hypertension at the time of stroke onset. Lower-level of education (primary school or illiteracy and smoking were associated positively with hypertension unawareness; while advanced age, overweight, diabetes mellitus, heart diseases and family history of stroke were associated negatively with hypertension unawareness. Annual data analyzed indicated that the rate of hypertension awareness increased during the past 11 years (r = 0.613, P = 0.045 for trends. Conclusions A substantial proportion (15.9 % of Chinese patients with hypertension had not been aware of this covert risk until an overt stroke occurred. Hypertension unawareness was associated with lower educational levels and smoking, which address the importance of health education especially in these individuals.

  5. Transthoracic echocardiography in Thai patients with acute ischemic stroke.

    Science.gov (United States)

    Piriyapong, Tapawas; Dharmasaroja, Pompatr A; Muengtaweepongsa, Sombat; Piyayotai, Dilok; Hutayanon, Pisit

    2012-01-01

    Transthoracic echocardiography (TTE) is routinely performed to look for the cardiac sources of emboli in many Western stroke centers. Due to a limitation of resources in Thailand, echocardiography is done in only some patients with acute ischemic stroke. The purpose of this study is to evaluate the need for cardiac investigations, especially TTE, in Thai patients with acute ischemic stroke. Two-hundred and seven patients with acute ischemic stroke or transient ischemic attack (TIA), who had TTE results during August 2006 to November 2008, were studied. Patients were divided into 2 groups by the risk of cardioembolism: low- versus high-risk groups. All echocardiography results were reviewed and classified by the need for management change following the echocardiography. Abnormal TTE results indicating a need for change in management were found in 4% (4/102) and 18% (18/105) in low- and high- risk patients, respectively The results of ECG alone led to change in management in 17% (36 patients). Atrial fibrillation was the most common cause of cardioembolism, which was found in 35 patients (17%). Because of limited resources in Thailand, ECG should be routinely performed on all ischemic stroke patients and TTE in patients with high risk for cardioembolism. However larger studies are still needed to clarify the benefits of echocardiography in low-risk patients.

  6. Is air transport of stroke patients faster than ground transport?

    DEFF Research Database (Denmark)

    Hesselfeldt, Rasmus; Gyllenborg, Jesper; Steinmetz, Jacob

    2014-01-01

    BACKGROUND: Helicopters are widely used for interhospital transfers of stroke patients, but the benefit is sparsely documented. We hypothesised that helicopter transport would reduce system delay to thrombolytic treatment at the regional stroke centre. METHODS: In this prospective controlled...... observational study, we included patients referred to a stroke centre if their ground transport time exceeded 30 min, or they were transported by a secondarily dispatched, physician-staffed helicopter. The primary endpoint was time from telephone contact to triaging neurologist to arrival in the stroke centre....... Secondary endpoints included modified Rankin Scale at 3 months, 30-day and 1-year mortality. RESULTS: A total of 330 patients were included; 265 with ground transport and 65 with helicopter, of which 87 (33%) and 22 (34%), received thrombolysis, respectively (p=0.88). Time from contact to triaging...

  7. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients

    Science.gov (United States)

    Chen, Jia-Ching; Shaw, Fu-Zen

    2014-01-01

    Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotics-aided systems, virtual reality, intermittent compression, partial body weight supported treadmill training and thermal stimulation, are being developed and incorporated into conventional rehabilitation programs. The concept of combining valuable rehabilitative procedures into “a training package”, based on the patient’s functional status during different recovery phases after stroke is proposed. Integrated sensorimotor rehabilitation programs with appropriate temporal arrangements might provide great functional benefits for stroke patients. PMID:25133141

  8. Time use of stroke patients with stroke admitted for rehabilitation in Skilled Nursing Facilities.

    Science.gov (United States)

    Vermeulen, Chantal J A H R; Buijck, Bianca I; van der Stegen, John C G H; van Eijk, Monica Spruit-; Koopmans, Raymond T C M; Hafsteinsdóttir, Thóra B

    2013-01-01

    To describe the time use of patients with stroke in five Skilled Nursing Facilities (SNFs) in the Netherlands, focusing on the time spent on therapeutic activities, nontherapeutic activities, interaction with others, and the location where the activities took place. Evidence suggest that task-oriented interventions are the most effective for patients with stroke and that some of these interventions are relevant and feasible for use by nurses. The question arises to what extent elderly patients who had a stroke and rehabilitate in a SNF receive therapeutic training and engage in therapeutic activities. Descriptive, observational design. Therapeutic and nontherapeutic activities of patients were observed at 10-minute intervals during one weekday (8 a.m.-4:30 p.m.) using behavioral mapping. Forty-two patients with stroke with a mean age of 76 years participated in the study. The patients spent 56% of the day on therapeutic activities, whereas 44% of the day was spent on nontherapeutic activities. Most therapeutic time was spent on nursing care (9%) and physical therapy (4%). Patients stayed an average 41% of the day in their own room and were alone 49% of the day. Therapeutic time use was significantly related to improved functional status, patients with higher functional status spent more time on therapeutic activities. Patients spent more than half of the day on therapeutic activities. Nurses are faced with the challenge of activating patients with stroke and to assist them to engage in purposeful task-oriented exercises including daily activities. Thereby better rehabilitation results and recovery of patients may be reached. © 2013 Association of Rehabilitation Nurses.

  9. Clinical and Anatomical Correlates of Apraxia of Speech

    Science.gov (United States)

    Ogar, Jennifer; Willock, Sharon; Baldo, Juliana; Wilkins, David; Ludy, Carl; Dronkers, Nina

    2006-01-01

    In a previous study (Dronkers, 1996), stroke patients identified as having apraxia of speech (AOS), an articulatory disorder, were found to have damage to the left superior precentral gyrus of the insula (SPGI). The present study sought (1) to characterize the performance of patients with AOS on a classic motor speech evaluation, and (2) to…

  10. The Influence of Visual and Auditory Information on the Perception of Speech and Non-Speech Oral Movements in Patients with Left Hemisphere Lesions

    Science.gov (United States)

    Schmid, Gabriele; Thielmann, Anke; Ziegler, Wolfram

    2009-01-01

    Patients with lesions of the left hemisphere often suffer from oral-facial apraxia, apraxia of speech, and aphasia. In these patients, visual features often play a critical role in speech and language therapy, when pictured lip shapes or the therapist's visible mouth movements are used to facilitate speech production and articulation. This demands…

  11. Comparing language outcomes in monolingual and bilingual stroke patients

    Science.gov (United States)

    Parker Jones, ‘Ōiwi; Grogan, Alice; Crinion, Jenny; Rae, Johanna; Ruffle, Louise; Leff, Alex P.; Seghier, Mohamed L.; Price, Cathy J.; Green, David W.

    2015-01-01

    Post-stroke prognoses are usually inductive, generalizing trends learned from one group of patients, whose outcomes are known, to make predictions for new patients. Research into the recovery of language function is almost exclusively focused on monolingual stroke patients, but bilingualism is the norm in many parts of the world. If bilingual language recruits qualitatively different networks in the brain, prognostic models developed for monolinguals might not generalize well to bilingual stroke patients. Here, we sought to establish how applicable post-stroke prognostic models, trained with monolingual patient data, are to bilingual stroke patients who had been ordinarily resident in the UK for many years. We used an algorithm to extract binary lesion images for each stroke patient, and assessed their language with a standard tool. We used feature selection and cross-validation to find ‘good’ prognostic models for each of 22 different language skills, using monolingual data only (174 patients; 112 males and 62 females; age at stroke: mean = 53.0 years, standard deviation = 12.2 years, range = 17.2–80.1 years; time post-stroke: mean = 55.6 months, standard deviation = 62.6 months, range = 3.1–431.9 months), then made predictions for both monolinguals and bilinguals (33 patients; 18 males and 15 females; age at stroke: mean = 49.0 years, standard deviation = 13.2 years, range = 23.1–77.0 years; time post-stroke: mean = 49.2 months, standard deviation = 55.8 months, range = 3.9–219.9 months) separately, after training with monolingual data only. We measured group differences by comparing prediction error distributions, and used a Bayesian test to search for group differences in terms of lesion-deficit associations in the brain. Our models distinguish better outcomes from worse outcomes equally well within each group, but tended to be over-optimistic when predicting bilingual language outcomes: our bilingual patients tended to have poorer language skills

  12. Parkinsonian patients reduce their stroke size with increased processing demands.

    Science.gov (United States)

    Van Gemmert, A W; Teulings, H L; Stelmach, G E

    2001-12-01

    Parkinson's disease (PD) patients often show reductions in writing size (micrographia) as the length of the text they produce increases. The cause for these reductions in stroke size are not well understood. Reductions in stroke size could be associated with either concurrent processing demands that result from the coordination and control of fingers, wrist, and arm during writing and the processing of future words or increased extension of the wrist joint as the execution of the writing progresses to the right across the page, resulting in increased stiffness in the pen-limb system. Parkinson's patients and elderly controls wrote phrases of different lengths with target patterns in various serial positions. When the number of words to be written increased, PD patients reduced their stroke size of the initial target pattern, while the elderly controls did not reduce their stroke size. There was no systematic change in stroke size of the second pattern as function of serial position. This result suggests that PD patients reduce the size of their handwriting strokes when concurrent processing load increases. Copyright 2001 Elsevier Science.

  13. Women Sex Importance in Stroke Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cemile Handan Mısırlı

    2014-08-01

    Full Text Available OBJECTIVE: It was shown the differences in age, risk factors and treatment between women and men in stroke patients with atrial fibrillation METHODS: The stroke patients with atrial fibrillation who were hospitalized in our department at the last 2 years were seperated into 2 groups of aged above 75 and below 75, investigated with CHADS2 and CHA2DS2VASc scores and looked at the sex differences of women and men. RESULTS: Stroke ratio according to sex was statistically meaningful especially in women above the age of 75. Risc factors also were founded in elderly women and CHA2DS2VASc scores were higher in women than men so more anticoagulan treatment were begun. No differences were shown between sexes at lone atrial fibrillation and no treatment were begun. CONCLUSION: Women with atrial fibrillation had more risk factors, higher stroke rate and higher anticoagulation treatment.

  14. Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals.

    Science.gov (United States)

    Dimitrov, Nikolay; Koenig, William; Bosson, Nichole; Song, Sarah; Saver, Jeffrey L; Mack, William J; Sanossian, Nerses

    2015-09-01

    Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Each county's local emergency medical services agency (LEMSA) was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45%) had stroke routing protocols, covering 23 counties (40%) and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile). In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources.

  15. Age-related rehabilitation outcome in stroke patients.

    Science.gov (United States)

    Manimmanakorn, Nuttaset; Arrayawichanon, Preeda; Wattanapun, Pattra; Nuntharuksa, Chompilai; Kuptniratsaikul, Vilai

    2008-03-01

    Patients who survive a stroke usually have residual neurological deficits. Consequently, a rehabilitation program is valuable for improving their quality of life (QOL). However, age is a known factor that needs qualification vis-à-vis rehabilitation outcomes among Thai patients. To study the functional and psychological outcomes and the QOL before and after rehabilitation program among three age groups of Thai stroke patients ( or = 65 years of age). Prospective, analytical study. Three hundred and twenty seven stroke patients were measured using the Barthel index, the Hospital Anxiety and Depression scale (HADS) and the WHO QOL BREF questionnaire before and after undergoing an in-patient rehabilitation program. Data were collected from nine sites around Thailand. Functional and psychological outcomes and the quality of life score improved after the rehabilitation program. The youngest group of stroke victims showed the greatest improvement in functional outcome and QOL score in both the physical and social domains. No significant difference was found regarding anxiety and depression among the three groups. An in-patient rehabilitation program was of benefit to Thai stroke patients but age significantly determined rehabilitation outcomes.

  16. Use of biomarkers in triage of patients with suspected stroke.

    Science.gov (United States)

    Vanni, Simone; Polidori, Gianluca; Pepe, Giuseppe; Chiarlone, Melisenda; Albani, Alberto; Pagnanelli, Adolfo; Grifoni, Stefano

    2011-05-01

    The absence of a rapidly available and sensitive diagnostic test represents an important limitation in the triage of patients with suspected stroke. The aim of the present study was to investigate the triage accuracy of a novel test that measures blood-borne biomarkers (triage stroke panel, TSP) and to compare its accuracy with that of the Cincinnati Prehospital Stroke Scale (CPSS). Consecutive patients with suspected stroke presenting to the Emergency Departments of three Italian hospitals underwent triage by a trained nurse according to the CPSS and had blood drawn for TSP testing. The TSP simultaneously measures four markers (B-type natriuretic peptide, D-dimer, matrix metalloproteinase-9, and S100β) presenting a single composite result, the Multimarker Index (MMX). Stroke diagnosis was established by an expert committee blinded to MMX and CPSS results. There were 155 patients enrolled, 87 (56%) of whom had a final diagnosis of stroke. The area under the receiver operating characteristic (ROC) curve for CPSS was 0.77 (95% confidence interval [CI] 0.70-0.84) and that of MMX was 0.74 (95% CI 0.66-0.82) (p = 0.285). Thus, both tests, when used alone, failed to recognize approximately 25% of strokes. The area under the ROC curve of the combination of the two tests (0.86, 95% CI 0.79-0.91) was significantly greater than that of either single test (p = 0.01 vs. CPSS and p vs. TSP). In an emergency care setting, a panel test using multiple biochemical markers showed triage accuracy similar to that of CPSS. Further studies are needed before biomarkers can be introduced in the clinical work-up of patients with suspected stroke. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

    Directory of Open Access Journals (Sweden)

    Jittima Saengsuwan

    2017-01-01

    Full Text Available Stroke is a global burden. It is not known whether patients who are most at risk of stroke (recurrent stroke or recurrent transient ischaemic attack have enough knowledge of stroke risk factors and warning signs. The aim of this study was to assess the knowledge of stroke risk factors and warning signs in this high-risk population. We performed a cross-sectional questionnaire-based study of patients with recurrent stroke or recurrent TIA admitted to Srinagarind Hospital and Khon Kaen Hospital, Thailand. A total of 140 patients were included in the study (age 65.6±11.3 years [mean ± SD], 62 females. Using an open-ended questionnaire, nearly one-third of patients (31.4% could not name any risk factors for stroke. The most commonly recognized risk factors were hypertension (35%, dyslipidemia (28.6%, and diabetes (22.9%. Regarding stroke warning signs, the most commonly recognized warning signs were sudden unilateral weakness (61.4%, sudden trouble with speaking (25.7%, and sudden trouble with walking, loss of balance, or dizziness (21.4%. Nineteen patients (13.6% could not identify any warning signs. The results showed that knowledge of stroke obtained from open-ended questionnaires is still unsatisfactory. The healthcare provider should provide structured interventions to increase knowledge and awareness of stroke in these patients.

  18. Ischaemic stroke in patients treated with oral anticoagulants.

    Science.gov (United States)

    Cano, L M; Cardona, P; Quesada, H; Lara, B; Rubio, F

    2016-01-01

    Cardioembolic stroke is associated with poorer outcomes. Prevention is based on oral anticoagulant (OAC) therapy. Haemorrhage is the main complication of OACs, which are sometimes ineffective. We retrospectively reviewed 1014 consecutive patients who suffered an ischaemic stroke between 2011 and 2013, analysing those who were receiving OAC treatment at stroke onset (107 patients in total) with special attention to aetiology, outcomes, and INR value in the acute phase. The mean age (SD) was 71.9 (10) years. Patients had been treated with OACs for 5.9 (5.5) years; 98.1% of them were being treated for heart disease. INR was strokes were cardioembolic and 1.9% were atherothrombotic. Anticoagulation therapy was discontinued in 48 patients (44.9%) due to haemorrhagic transformation (24 patients), extensive infarction (23), or endarterectomy (1). Therapy was resumed in 24 patients (50%) after a mean lapse of 36 days. This was not possible in the remaining patients because of death or severe sequelae. New OACs (NOACs) were prescribed to 9 patients (18.7% of all potential candidates). At 3 months, patients with INR>1.7 in the acute phase exhibited better outcomes than patients with INR≤1.7 (mRS 0-2 in 62% vs 30.8%; death in 10% vs 38.4%; P=.0004). Some patients taking OACs suffer ischaemic strokes that are usually cardioembolic, especially if INR is below the therapeutic range. OACs can be resumed without complications, and NOACs are still underused. Despite cases in which treatment is ineffective, outcomes are better when INR is above 1.7 at stroke onset. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Increased Risk of Ischemic Stroke in Young Nasopharyngeal Carcinoma Patients

    International Nuclear Information System (INIS)

    Lee, Ching-Chih; Su, Yu-Chieh; Ho, Hsu-Chueh; Hung, Shih-Kai; Lee, Moon-Sing; Chiou, Wen-Yen; Chou, Pesus; Huang, Yung-Sung

    2011-01-01

    Purpose: Radiation/chemoradiotherapy-induced carotid stenosis and cerebrovascular events in patients with nasopharyngeal carcinoma (NPC) can cause severe disability and even death. This study aimed to estimate the risk of ischemic stroke in this patient population over more than 10 years of follow-up. Methods and Materials: The study cohorts consisted of all patients hospitalized with a principal diagnosis of NPC (n = 1094), whereas patients hospitalized for an appendectomy during 1997 and 1998 (n = 4376) acted as the control group and surrogate for the general population. Cox proportional hazard model was performed as a means of comparing the stroke-free survival rate between the two cohorts after adjusting for possible confounding and risk factors. Results: Of the 292 patients with ischemic strokes, 62 (5.7%) were from the NPC cohort and 230 (5.3%) were from the control group. NPC patients ages 35–54 had a 1.66 times (95% CI, 1.16–2.86; p = 0.009) higher risk of ischemic stroke after adjusting for patient characteristics, comorbidities, geographic region, urbanization level of residence, and socioeconomic status. There was no statistical difference in ischemic stroke risk between the NPC patients and appendectomy patients ages 55–64 years (hazard ratio = 0.87; 95% CI, 0.56–1.33; p = 0.524) after adjusting for other factors. Conclusions: Young NPC patients carry a higher risk for ischemic stroke than the general population. Besides regular examinations of carotid duplex, different irradiation strategies or using new technique of radiotherapy, such as intensity modulated radiation therapy or volumetric modulated arc therapy, should be considered in young NPC patients.

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

    Science.gov (United States)

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

    2016-08-01

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

  1. Dietary patterns in stroke patients in Northwest India.

    Science.gov (United States)

    Mangat, Arshi; Grewal, Dilpreet; Kaur, Paramdeep; Jyotsna, Rashmi; Singh, Ruma; Pandian, Jeyaraj Durai

    2013-11-01

    Little is known about the dietary patterns among stroke patients in India. We explored the dietary patterns in stroke patients and attempted to correlate the dietary patterns with stroke characteristics. This hospital-based study was carried out in a tertiary referral centre in Northwest India from March 2008 to September 2009. All first ever stroke (ischaemic and hemorrhagic) patients were interviewed by the dietician using an oral diet questionnaire. The demographic information and risk factors were noted and outcome was assessed after 30 days using modified Rankin scale (≤2 = good outcome). A total of 210 stroke patients were enrolled. The mean age was 60 ± 14 years and 126 (60%) patients were men. Hypertension (167 (79.5%)) was the major risk factor. All patients consumed cereals and beverages. Consumption of other food items in the diet were as follows: milk and milk products (203 (96.7%)), saturated fats (butter, butter oil, cream) (133 (63.3%)), bakery items (139 (66.2%)), fried snacks (116 (55.2%)), fruits (96 (45.7%)), and juices (20 (9.5%)). Large proportion of the patients (112 (53.6%)) consumed more food calories than recommended. Use of fried snacks was significant in patients who consumed alcohol (P = 0.03) and patients who had diabetes mellitus were more likely to use saturated fats (P = 0.01). Majority of the patients consumed milk and milk products. Fruits and juices were consumed by a small proportion of patients. Our results provide opportunities for stroke prevention by diet modification.

  2. The cardiovascular status of the black stroke patient

    International Nuclear Information System (INIS)

    Joubert, J.; Van Gelder, A.L.; Pilloy, W.J.; Darazs, B.

    1989-01-01

    The cardiac status of 102 consecutive black stroke patients entered to the Medunsa Stroke Databank was determined. Cardiological examination, echocardiography and a gated blood pool scan revealed structural and/or functional cardiac abnormalities in 73,6% of patients. Rheumatic heart disease was diagnosed in 15,6%, mitral valve prolapse in 5,8% and mitral annulus calcification in 4,9% of cases. 'Possible' cardiac sources of cerebral embolism were detected in 22,5% and 'definite' sources in 23,5% of patients. Hypertensive heart disease was diagnosed in 35,2% and cardiomyopathy in 13,7% of the study population. Ischaemic heart disease was present in 6,86%. Ultrasonography revealed ventricular bands in 29,4% of patients. The high incidence of structural cardiac abnormalities detected by non-invasive means is in keeping with recent studies in white stroke patients. 32 refs., 11 tabs., 2 figs

  3. Mortality and use of psychotropic medication in patients with stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Baandrup, Lone; Iversen, Helle K

    2016-01-01

    OBJECTIVES: The study sought to describe whether psychotropic medication may have long-term side effects in patients with stroke compared with controls. SETTING: Use of national register data from healthcare services were identified from the Danish National Patient Registry in Denmark. Information...... about psychotropic medication use was obtained from the Danish Register of Medicinal Product Statistics. OBJECTIVES: We aimed to evaluate all-cause mortality in relation to the use of benzodiazepines, antidepressants and antipsychotics in patients with stroke and matched controls. PARTICIPANTS: Patients...... with a diagnosis of stroke and either no drug use or preindex use of psychotropic medication (n=49,968) and compared with control subjects (n=86,100) matched on age, gender, marital status and community location. PRIMARY OUTCOME MEASURE: All-cause mortality. RESULTS: All-cause mortality was higher in patients...

  4. Epidemiology of Stroke in Costa Rica: A 7-Year Hospital-Based Acute Stroke Registry of 1319 Consecutive Patients.

    Science.gov (United States)

    Torrealba-Acosta, Gabriel; Carazo-Céspedes, Kenneth; Chiou, Sy Han; O'Brien, Anthony Terrence; Fernández-Morales, Huberth

    2017-12-25

    Limited data on stroke exist for Costa Rica. Therefore, we created a stroke registry out of patients with stroke seen in the Acute Stroke Unit of the Hospital Calderon Guardia. We analyzed 1319 patients enrolled over a 7-year period, which incorporated demographic, clinical, laboratory, and neuroimaging data. The mean age of patients with stroke was 68.0 ± 15.5 years. Seven hundred twenty-five were men and the age range was 13-104 years. The most prevalent risk factors were hypertension (78.8%), dyslipidemia (36.3%), and diabetes (31.9%). Fifteen percent had atrial fibrillation and 24.7% had a previous stroke or transient ischemic attack. Prevalence of hypertension and atrial fibrillation increased with age; however, younger patients were more associated with thrombophilia. We documented 962 (72.9%) ischemic and 270 (20.5%) hemorrhagic strokes. Of the ischemic strokes, 174 (18.1%) were considered secondary to large-artery atherothrombosis, 175 (18.2%) were due to cardiac embolism, 19 (2.0%) were due to lacunar infarcts, and 25 (2.6%) were due to other determined causes. Five hundred sixty-nine (59.1%) remained undetermined. Atherothrombotic strokes were mostly associated with dyslipidemia, diabetes, metabolic syndrome, and obesity, whereas lacunar infarcts were associated with hypertension, smoking, sedentary lifestyle, and previous stroke or transient ischemic attack. Of our patients, 69.9% scored between 0 and 9 in the initial National Institutes of Health Stroke Scale (NIHSS). We found differences in sociodemographic features, risk factors, and stroke severity among stroke subtypes. Risk factor prevalence was similar to other registries involving Hispanic populations. Copyright © 2017 National Stroke Association. All rights reserved.

  5. Immune Dysfunction in HIV infected stroke patients: Role of low CD ...

    African Journals Online (AJOL)

    Whether or not low CD4 count directly contributes to stroke among HIV infected stroke patients is yet to be elucidated. This study aimed to ascertain the role of low CD4 count in the pathophysiology of stroke in HIV infection. This was a hospital-based, case-control study. Sixty five (65) consecutive stroke patients (36 males ...

  6. Trial participants' experiences of early enhanced speech and language therapy after stroke compared with employed visitor support: a qualitative study nested within a randomized controlled trial.

    Science.gov (United States)

    Young, Alys; Gomersall, Timothy; Bowen, Audrey

    2013-02-01

    To explore trial participants' experiences of the process and outcomes of early, enhanced speech and language therapy after stroke with support from an employed visitor. Qualitative study nested within a randomized controlled trial. Twney-two people who, after stroke, had a diagnosis of aphasia (12), dysarthria (5) or both (5) and who participated in the ACT NoW study. Eight English NHS usual care settings. Individual interviews. Thematic content analysis assisted by a bespoke data transformation protocol for incorporating non-verbal and semantically ambiguous data. Participants highly regarded regular and sustained contact with someone outside of immediate family/friends who engaged them in deliberate activities/communication in the early months after stroke. Participants identified differences in the process of intervention between speech and language therapists and employed visitors. But no major discriminations were made between the impact or value of this contact according to whether provided by a speech and language therapist or employed visitor. Participant-defined criteria for effectiveness of contact included: impact on mood and confidence, self-recognition of progress and the meeting of individual needs. As in the randomized controlled trial, participants reported no evidence of added benefit of early communication therapy beyond that from attention control. The findings do not imply that regular contact with any non-professional can have beneficial effects for someone with aphasia or dysarthria in the early weeks following a stroke. The study points to specific conditions that would have to be met for contact to have a positive effect.

  7. Audiovisual Integration of Speech in a Patient with Broca’s Aphasia

    DEFF Research Database (Denmark)

    Andersen, Tobias; Starrfelt, Randi

    2015-01-01

    Lesions to Broca's area cause aphasia characterized by a severe impairment of the ability to speak, with comparatively intact speech perception. However, some studies have found effects on speech perception under adverse listening conditions, indicating that Broca's area is also involved in speech...... perception. While these studies have focused on auditory speech perception other studies have shown that Broca's area is activated by visual speech perception. Furthermore, one preliminary report found that a patient with Broca's aphasia did not experience the McGurk illusion suggesting that an intact Broca......'s area is necessary for audiovisual integration of speech. Here we describe a patient with Broca's aphasia who experienced the McGurk illusion. This indicates that an intact Broca's area is not necessary for audiovisual integration of speech. The McGurk illusions this patient experienced were atypical...

  8. Stroke in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Greve, Anders Møller; Dalsgaard, Morten; Bang, Casper N

    2014-01-01

    , and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex (CHA2DS2-VASc...

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

    Science.gov (United States)

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

    2017-02-01

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

  10. Neuromuscular Electrical Stimulation and Anabolic Signaling in Patients with Stroke.

    Science.gov (United States)

    Mettler, Joni A; Bennett, Sydney M; Doucet, Barbara M; Magee, Dillon M

    2017-12-01

    Stroke results in limited ability to produce voluntary muscle contraction and movement on one side of the body, leading to further muscle wasting and weakness. Neuromuscular electrical stimulation is often used to facilitate involuntary muscle contraction; however, the effect of neuromuscular electrical stimulation on muscle growth and strengthening processes in hemiparetic muscle is not clear. This study examined the skeletal muscle anabolic response of an acute bout of neuromuscular electrical stimulation in individuals with chronic stroke and healthy older adults. Eleven individuals (59.8 ± 2.7 years old) were divided into a chronic stroke group (n = 5) and a healthy older adult control group (n = 6). Muscle biopsies were obtained before and after stimulation from the vastus lateralis of the hemiparetic leg for the stroke group and the right leg for the control group. The neuromuscular electrical stimulation protocol consisted of a 60-minute, intermittent stimulation train at 60 Hz. Phosphorylation of mammalian target of rapamycin and ribosomal protein S6 kinase beta-1 were analyzed by Western blot. An acute bout of neuromuscular electrical stimulation increased phosphorylation of mammalian target of rapamycin (stroke: 56.0%; control: 51.4%; P = .002) and ribosomal protein S6 kinase beta-1 (stroke: 131.2%; control: 156.3%; P = .002) from resting levels to post-neuromuscular electrical stimulation treatment, respectively. Phosphorylated protein content was similar between stroke and control groups at both time points. Findings suggest that paretic muscles of patients with chronic stroke may maintain ability to stimulate protein synthesis machinery in response to neuromuscular electrical stimulation. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Time use of stroke patients with stroke admitted for rehabilitation in skilled nursing facilities

    NARCIS (Netherlands)

    Vermeulen, C.J.; Buijck, B.I.; Stegen, J.C. van der; Eijk, M.S. van; Koopmans, R.T.C.M.; Hafsteinsdottir, T.B.

    2013-01-01

    PURPOSE: To describe the time use of patients with stroke in five Skilled Nursing Facilities (SNFs) in the Netherlands, focusing on the time spent on therapeutic activities, nontherapeutic activities, interaction with others, and the location where the activities took place. Evidence suggest that

  12. The balance effect of acupuncture therapy among stroke patients.

    Science.gov (United States)

    Huang, Shih-Wei; Wang, Wei-Te; Yang, Tsung-Hsien; Liou, Tsan-Hon; Chen, Guan-Yu; Lin, Li-Fong

    2014-08-01

    To analyze how acupuncture therapy affects balance in patients experiencing their first stroke and to identify the stroke group with greatest improvement in balance after acupuncture intervention. Retrospective case-control study. Ward of a medical university hospital. A total of 629 stroke patients were enrolled initially; 345 patients met the study criteria and 132 were analyzed (66 each in the study and control groups). The study group received physiotherapy combined with acupuncture and the control group received only physiotherapy. The Postural Assessment Scale for Stroke patients (PASS) was used to evaluate balance. This balance scale system can be subdivided into static balance (PASS-MP, maintain posture) and dynamic balance (PASS-CP, change posture). This study revealed no statistically significant improvement of balance in the study group (t test). When patients with high Brunnstrom stage (Br stage) and low Br stage were analyzed separately, once again no statistical difference was detected between the study and control groups of those with high Br stage. However, among low-Br stage patients, the study group showed significant improvement in static balance (mean PASS-MP score±standard deviation: 4.7±3.7) compared with the control group (PASS-MP score: 2.8±2.7) (pacupuncture therapy can improve static balance during rehabilitation. However, the effect on balance was limited among high-Br stage patients. This study provides information valuable to patients with hemiplegic stroke because it suggests that acupuncture can be used to improve balance. A prospective double-blind, randomized, controlled study design is recommended for future studies in patients with hemiplegic stroke.

  13. Highly sensitive troponin T in patients with acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, J K; Ueland, T; Aukrust, P

    2012-01-01

    in decedents than in survivors. After adjustment for stroke severity, C-reactive protein, age, NT-proBNP and prior heart and/or renal failure, hsTnT levels were not a significant predictor of long-term all-cause or cardiovascular mortality. Conclusion: Elevated levels of hsTnT are frequently present......Background: Newly developed troponin assays have superior diagnostic and prognostic performance in acute coronary syndrome (ACS), when compared to conventional troponin assays; however, highly sensitive troponin has not been evaluated in patients with acute ischemic stroke. Methods: Highly...... sensitive troponin T (hsTnT) was measured daily during the first 4 days in 193 consecutive patients with acute ischemic stroke without overt ACS or atrial fibrillation. The patients were previously tested normal with a fourth-generation TnT assay. The patients were followed for 47 months, with all...

  14. Speech and Communication Disorders

    Science.gov (United States)

    ... Speech problems like stuttering Developmental disabilities Learning disorders Autism spectrum disorder Brain injury Stroke Some speech and communication problems may be genetic. Often, no one knows the causes. By first grade, about 5 percent of children ...

  15. Patients' perspectives on aerobic exercise early after stroke.

    Science.gov (United States)

    Prout, Erik C; Mansfield, Avril; McIlroy, William E; Brooks, Dina

    2017-04-01

    To describe patient perspectives of aerobic exercise during inpatient stroke rehabilitation, including their self-efficacy and beliefs towards exercise, as well as their perceptions of barriers. A survey was conducted at three Canadian rehabilitation centres to evaluate individuals' (N = 33) self-efficacy and outcome expectations for exercise. In addition, patient perceptions of other people recovering from stroke, social support, and aerobic exercise as part of rehabilitation were assessed. Thirty-two people completed the survey. Of these, 97% were willing to participate in aerobic exercise 5.9 ± 8.8 days after admission to inpatient rehabilitation. While outcome expectations for exercise were high, participants reported lower self-efficacy for exercise. Patients reported barriers related to the ability to perform exercise (other health problems (i.e., arthritis), not being able to follow instructions and physical impairments) more often than safety concerns (fear of falling). The lack of support from a spouse and family were commonly identified, as was a lack of information on how to perform aerobic exercise. Patients with stroke are willing to participate in aerobic exercise within a week after admission to inpatient rehabilitation. However, they perceive a lack of ability to perform aerobic exercise, social support from family and information as barriers. Implications for rehabilitation Aerobic exercise is recognized as part of comprehensive stroke rehabilitation. There is a need to better understand patient perspectives to develop and implement more effective interventions early after stroke. Patients lack confidence in their ability to overcome barriers early after stroke. Patients are concerned with their ability to perform exercise, fall risk, lack of support from a spouse and family, and limited information on aerobic exercise. There is a need to reinforce education with practical experience in structured aerobic exercise programs that show

  16. Hyponatremia And Disability, Prevalence And Prognosis In Babol Stroke Patients.

    Directory of Open Access Journals (Sweden)

    Alijan Ahmadi Ahangar

    2017-02-01

    Full Text Available Background: Stroke is the leading cause of serious long-term disability. In recent studies hyponatremia as a risk factor for stroke. Methods: This cross-sectional descriptive study was to evaluate serum zinc level in serum sodium over the first 24 hours after the onset of stroke. Different intensities were determined on Stroke Scale NIH (National Institute of Health (mild 4-1 and (average moderate 15-5 and (moderate to severe 20-16 and (extreme severe 42- 21. Determination intensity of stroke after admission and discharge with Modified Rankin Scale and Barthel index. Blood serum concentrations of sodium 0.5 mL of venous blood were taken and sodium serum level was performed with Latex particle agglutination test in Ayatollah Rouhani Hospital. That normal range was defined 136-146 meq / L Findings: 125 patients were entered into this study; the prevalence of hyponatremia in female was 70% vs 60% in male. Of stroke patients included in this study 66% of them had hyponatremia and the frequency of hyponatremia in ischemic and hemorrhagic was 82% and 63%, respectively. Increase in hyponatremia with disability period of admission had statistically significant (10(12 mild vs 40(32 moderate, 32(25.6 severe, p=0.01 also with disability before discharge (24(19.2 mild, 26(20.8 moderate, 32(25.6 severe, p=0.03. Conclusions: Hyponatremia can effect on severity of the stroke and can be considered as a predictor of increased stroke severity and disability at admission and discharge.

  17. A causal test of the motor theory of speech perception: a case of impaired speech production and spared speech perception.

    Science.gov (United States)

    Stasenko, Alena; Bonn, Cory; Teghipco, Alex; Garcea, Frank E; Sweet, Catherine; Dombovy, Mary; McDonough, Joyce; Mahon, Bradford Z

    2015-01-01

    The debate about the causal role of the motor system in speech perception has been reignited by demonstrations that motor processes are engaged during the processing of speech sounds. Here, we evaluate which aspects of auditory speech processing are affected, and which are not, in a stroke patient with dysfunction of the speech motor system. We found that the patient showed a normal phonemic categorical boundary when discriminating two non-words that differ by a minimal pair (e.g., ADA-AGA). However, using the same stimuli, the patient was unable to identify or label the non-word stimuli (using a button-press response). A control task showed that he could identify speech sounds by speaker gender, ruling out a general labelling impairment. These data suggest that while the motor system is not causally involved in perception of the speech signal, it may be used when other cues (e.g., meaning, context) are not available.

  18. New standardized nursing cooperation workflow to reduce stroke thrombolysis delays in patients with acute ischemic stroke.

    Science.gov (United States)

    Zhou, Yan; Xu, Zhuojun; Liao, Jiali; Feng, Fangming; Men, Lai; Xu, Li; He, Yanan; Li, Gang

    2017-01-01

    We assessed the effectiveness of a new standardized nursing cooperation workflow in patients with acute ischemic stroke (AIS) to reduce stroke thrombolysis delays. AIS patients receiving conventional thrombolysis treatment from March to September 2015 were included in the control group, referred to as T0. The intervention group, referred to as T1 group, consisted of AIS patients receiving a new standardized nursing cooperation workflow for intravenous thrombolysis (IVT) at the emergency department of Shanghai East Hospital (Shanghai, People's Republic of China) from October 2015 to March 2016. Information was collected on the following therapeutic techniques used: application or not of thrombolysis, computed tomography (CT) time, and door-to-needle (DTN) time. A nursing coordinator who helped patients fulfill the medical examinations and diagnosis was appointed to T1 group. In addition, a nurse was sent immediately from the stroke unit to the emergency department to aid the thrombolysis treatment. The average value of the door-to-CT initiation time was 38.67±5.21 min in the T0 group, whereas it was 14.39±4.35 min in the T1 group; the average values of CT completion-to-needle time were 55.06±4.82 and 30.26±3.66 min; the average values of DTN time were 100.43±6.05 and 55.68±3.62 min, respectively; thrombolysis time was improved from 12.8% (88/689) in the T0 group to 32.5% (231/712) in the T1 group (all P nursing cooperation workflow decreased the National Institutes of Health Stroke Scale (NIHSS) scores at 24 h ( P nursing cooperation workflow reduced stroke thrombolysis delays in patients with AIS.

  19. Dysphagia Therapy in Stroke: A Survey of Speech and Language Ttherapists

    Science.gov (United States)

    Archer, S. K.; Wellwood, I.; Smith, C. H.; Newham, D. J.

    2013-01-01

    Background: Dysphagia is common after stroke, leading to adverse outcome. There is a paucity of high-quality evidence for dysphagia therapy, thus making it difficult to determine the best approaches to treatment. Clinical decisions are often based on usual practice, however no formal method of monitoring practice patterns exists. Aims: To…

  20. Ultrasonographic Findings in Hemiplegic Knees of Stroke Patients

    Directory of Open Access Journals (Sweden)

    Chao-Pin Yang

    2005-02-01

    Full Text Available Clinical and radiologic asymmetric arthritic differences between paralyzed and nonparalyzed limbs of stroke patients have been reported. Arthritic pathology aggravates motor dysfunction and compromises rehabilitation. Musculoskeletal ultrasonography plays an important role in showing soft tissue and the articular cartilage of the knee. Fifty-nine patients with either ischemic or hemorrhagic stroke-induced right or left hemiplegia were recruited to evaluate soft-tissue and intra-articular cartilage changes in hemiplegic knees of stroke patients using ultrasonography. An additional 15 subjects (30 knees without knee disease or a history of knee trauma or surgery were used as controls. There were significant differences in suprapatellar effusion and patellar tendinitis between hemiplegic and nonhemiplegic knees. Suprapatellar effusion and pes anserinus tendinitis were correlated with Brunnstrom stage. The length of time since stroke onset was not significantly correlated with positive ultrasonographic findings in hemiplegic knees. In conclusion, ultrasonography is useful for detecting periarticular soft-tissue changes and intra-articular lesions in hemiplegic knees of stroke patients.

  1. Seizures, electroencephalographic abnormalities, and outcome of ischemic stroke patients.

    Science.gov (United States)

    Bentes, Carla; Peralta, Ana Rita; Martins, Hugo; Casimiro, Carlos; Morgado, Carlos; Franco, Ana Catarina; Viana, Pedro; Fonseca, Ana Catarina; Geraldes, Ruth; Canhão, Patrícia; Pinho E Melo, Teresa; Paiva, Teresa; Ferro, José M

    2017-12-01

    Seizures and electroencephalographic (EEG) abnormalities have been associated with unfavorable stroke functional outcome. However, this association may depend on clinical and imaging stroke severity. We set out to analyze whether epileptic seizures and early EEG abnormalities are predictors of stroke outcome after adjustment for age and clinical/imaging infarct severity. A prospective study was made on consecutive and previously independent acute stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 on admission and an acute anterior circulation ischemic lesion on brain imaging. All patients underwent standardized clinical and diagnostic assessment during admission and after discharge, and were followed for 12 months. Video-EEG (<60 min) was performed in the first 72 h. The Alberta Stroke Program Early CT Score quantified middle cerebral artery infarct size. The outcomes in this study were an unfavorable functional outcome (modified Rankin Scale [mRS] ≥ 3) and death (mRS = 6) at discharge and 12 months after stroke. Unfavorable outcome at discharge was independently associated with NIHSS score (p = 0.001), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Unfavorable outcome 1 year after stroke was independently associated with age (p = 0.001), NIHSS score (p < 0.001), remote symptomatic seizures (p = 0.046), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Death in the first year after stroke was independently associated with age (p = 0.028), NIHSS score (p = 0.001), acute symptomatic seizures (p = 0.015), and EEG suppression (p = 0.019). Acute symptomatic seizures were independent predictors of vital outcome and remote symptomatic seizures of functional outcome in the first year after stroke. Therefore, their recognition and prevention strategies may be clinically relevant. Early EEG abnormalities were independent predictors and comparable to age and early

  2. [Speech discrimination through telephone in patients implanted with a Combi 40+].

    Science.gov (United States)

    Castro, A; Lassaletta, L; Bastarrica, M; Prim, M P; de Sarriá, M J; Gavilán, J

    2005-01-01

    To assess speech discrimination through line and mobile telephone in cochlear implanted patients. Eighteen patients implanted with a Combi 40+ went through different speech discrimination tests with a line telephone and three mobile telephones, in quiet and noisy environment. Mean scores for telephonic speech discrimination were 84-92% using CID sentences, 27-58% using bisyllabic words in quiet environment and 15-41% using bisyllabic words in noisy environment. Among the mobile telephones tested, the Siemens M55 reached the best scores. Telephonic speech discrimination is achieved by a significant number of cochlear implanted patients. Certain mobile telephone models appear to be more advisable for these patients.

  3. A novel speech prosthesis for mandibular guidance therapy in hemimandibulectomy patient: A clinical report

    Directory of Open Access Journals (Sweden)

    Raghavendra Adaki

    2016-01-01

    Full Text Available Treating diverse maxillofacial patients poses a challenge to the maxillofacial prosthodontist. Rehabilitation of hemimandibulectomy patients must aim at restoring mastication and other functions such as intelligible speech, swallowing, and esthetics. Prosthetic methods such as palatal ramp and mandibular guiding flange reposition the deviated mandible. Such prosthesis can also be used to restore speech in case of patients with debilitating speech following surgical resection. This clinical report gives detail of a hemimandibulectomy patient provided with an interim removable dental speech prosthesis with composite resin flange for mandibular guidance therapy.

  4. Cervicocranial fibromuscular dysplasia in Taiwanese ischemic stroke patients.

    Science.gov (United States)

    Liu, Chi-Hung; Wu, Dean; Chin, Shy-Chyi; Fu, Ser-Chen; Wu, Tai-Cheng; Chang, Chien-Hung; Peng, Tsung-I; Chang, Yeu-Jhy; Lee, Tsong-Hai

    2012-01-01

    Clinical research of cervicocranial fibromuscular dysplasia (FMD) is rare in Asian populations. Our study reviewed Taiwanese ischemic stroke patients with cervicocranial FMD and compared them with previous reports. Between 2000 and 2011, we collected 19 consecutive cervicocranial FMD patients who received demographic registration, a blood test for excluding vasculitis, and comprehensive angiography. Cerebral ultrasound, vascular images and clinical outcomes (Barthel index, modified Rankin scale, recurrent stroke, or death) were monitored during follow-up. Of the 19 patients, 16 (84%) had carotid FMD, while 7 (37%) had vertebral FMD. Only 2 investigated patients (13%) had renal FMD and 1 (5%) had cerebral aneurysm. 14 (74%) presented acute arterial dissection. All patients received medical treatment and had neither recurrent stroke nor dissection during follow-up. In the literature review of 225 FMD patients, 3.6% had recurrent stroke during follow-up, and some reported surgical procedure or angioplasty could give a good clinical outcome in progressing ischemia irrelevant to the cause of stenosis. In Taiwanese cervicocranial FMD patients, arterial dissection was one of the most common clinical presentations. Most of our patients had isolated involvement of the cervicocranial artery and carried a favorable outcome under medical treatment. Copyright © 2012 S. Karger AG, Basel.

  5. Patient-specific prediction of functional recovery after stroke.

    Science.gov (United States)

    Douiri, Abdel; Grace, Justin; Sarker, Shah-Jalal; Tilling, Kate; McKevitt, Christopher; Wolfe, Charles DA; Rudd, Anthony G

    2017-07-01

    Background and aims Clinical predictive models for stroke recovery could offer the opportunity of targeted early intervention and more specific information for patients and carers. In this study, we developed and validated a patient-specific prognostic model for monitoring recovery after stroke and assessed its clinical utility. Methods Four hundred and ninety-five patients from the population-based South London Stroke Register were included in a substudy between 2002 and 2004. Activities of daily living were assessed using Barthel Index) at one, two, three, four, six, eight, 12, 26, and 52 weeks after stroke. Penalized linear mixed models were developed to predict patients' functional recovery trajectories. An external validation cohort included 1049 newly registered stroke patients between 2005 and 2011. Prediction errors on discrimination and calibration were assessed. The potential clinical utility was evaluated using prognostic accuracy measurements and decision curve analysis. Results Predictive recovery curves showed good accuracy, with root mean squared deviation of 3 Barthel Index points and a R 2 of 83% up to one year after stroke in the external cohort. The negative predictive values of the risk of poor recovery (Barthel Index <8) at three and 12 months were also excellent, 96% (95% CI [93.6-97.4]) and 93% [90.8-95.3], respectively, with a potential clinical utility measured by likelihood ratios (LR+:17 [10.8-26.8] at three months and LR+:11 [6.5-17.2] at 12 months). Decision curve analysis showed an increased clinical benefit, particularly at threshold probabilities of above 5% for predictive risk of poor outcomes. Conclusions A recovery curves tool seems to accurately predict progression of functional recovery in poststroke patients.

  6. Chronic kidney disease in patients with ischemic stroke.

    Science.gov (United States)

    Tsukamoto, Yuuko; Takahashi, Wakoh; Takizawa, Shunya; Kawada, Shiaki; Takagi, Shigeharu

    2012-10-01

    To examine the significance of renal dysfunction in patients who have sustained ischemic stroke, we examined the relationship between the renal function evaluated in terms of estimated glomerular filtration rate (eGFR) and the subtype of brain infarction (BI) in patients with ischemic stroke. A total of 639 patients with BI were enrolled in this study, with 314 subjects without stroke or transient ischemic attack registered as age-matched controls. eGFR was calculated according to the equation 194 × Cr(-1.094) × Age(-0.287) (-0.739 if female), where Cr is serum creatinine concentration, and was classified into four stages: stage I, eGFR ≥ 90 mL/min/1.73 m(2); stage II, eGFR 60 ~ 89 mL/min/1.73 m(2); stage III, eGFR 30 ~ 59 mL/min/1.73 m(2); and stage IV, eGFR stroke is frequently associated with renal dysfunction. Chronic kidney disease might be independent risk factor for infarction, especially for cardiogenic and atherosclerotic types. Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Silent stroke in patients with transient ischemic attack or minor ischemic stroke. The Dutch TIA Trial Study Group

    NARCIS (Netherlands)

    Herderscheê, D.; Hijdra, A.; Algra, A.; Koudstaal, P. J.; Kappelle, L. J.; van Gijn, J.

    1992-01-01

    BACKGROUND AND PURPOSE: We studied silent stroke (i.e., infarcts on computed tomographic scan not related to later symptoms) in patients after transient ischemic attack or minor ischemic stroke. METHODS: Ours is a cross-sectional study of 2,329 patients who were randomized in a secondary prevention

  8. Preventive Ceftriaxone in Patients with Stroke Treated with Intravenous Thrombolysis: Post Hoc Analysis of the Preventive Antibiotics in Stroke Study

    NARCIS (Netherlands)

    Vermeij, Jan-Dirk; Westendorp, Willeke F.; Roos, Yvo B.; Brouwer, Matthijs C.; van de Beek, Diederik; Nederkoorn, Paul J.

    2016-01-01

    The Preventive Antibiotics in Stroke Study (PASS), a randomized open-label masked endpoint trial, showed that preventive ceftriaxone did not improve functional outcome at 3 months in patients with acute stroke (adjusted common OR 0.95; 95% CI 0.82-1.09). Post-hoc analyses showed that among patients

  9. Ischemic Stroke Due to Cardiac Involvement: Emery Dreifuss Patient

    Directory of Open Access Journals (Sweden)

    Ersin Kasım Ulusoy

    2015-08-01

    Full Text Available Emery-Dreifuss muscular dystrophy (EDMD is a hereditary disease. It is characterized by early-onset contractures, slowly progressive weakness, fatigue related to skapulo-humero-peroneal muscle weakness, cardiomyopathy which develops in adulthood and cardiac conduction system block. Cardiac involvement has a prognostic significance in patients with EDMD and even sudden cardiac death may be the first clinical presentation. In this article, an EDMD patient with ischemic stroke clinic who didn’t have regular cardiac follow-up was reported and the importance of the treatment of cardiac diseases which could play a role in ischemic stroke etiology and the implantation of pace-maker was mentioned.

  10. An associative Brain-Computer-Interface for acute stroke patients

    DEFF Research Database (Denmark)

    Mrachacz-Kersting, Natalie; Stevenson, Andrew James Thomas; Aliakbaryhosseinabadi, Susan

    2016-01-01

    An efficient innovative Brain-Computer-Interface system that empowers chronic stroke patients to control an artificial activation of their lower limb muscle through task specific motor intent has been tested in the past. In the current study it was applied to acute stroke patients. The system...... (tibialis anterior). This activation is precisely and individually timed such that the sensory signal arising from the stimulation reaches the motor cortex during its maximum activation due to the intention. The output of the motor cortical area representing the dorsiflexor muscles was significantly...

  11. Augmentative And Alternative Communication Systems For Post-Stroke Patients With Severe Communication And Motor Impairment

    Directory of Open Access Journals (Sweden)

    Talieh Zarifian

    2017-02-01

    Full Text Available Background and aims: Adults with acquired neurological disorders (stroke, Traumatic Brain Injury ... develop their verbal communication and literacy capabilities as typical speakers and writers. They use these skills to participate academically, vocationally, recreationally, and socially. Depending upon their neurological condition, they gradually or suddenly lose their speech or language capabilities and are required to rely on Augmentative and Alternative Communication (AAC systems to meet their communication needs. In addition to the loss of their spoken communication, the impact of their neurological condition on their participation patterns is potentially profound with reduced ability to care for themselves, a reduction or loss of employment, and usually a sudden or gradual restriction of their social networks. AAC is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. During the past five decades, AAC technologies have been developed to compensate for these natural communication losses.      Stroke is one of the main causes of disability in the world. About 20% of stroke patients experience aphasia, with 20-30% of these individuals exhibiting severe communication deficits for at least a portion of their recovery period. Augmentative and Alternative Communication (AAC encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production of spoken or written language.  Specifically designed Human Computer Interfaces (HCI, as an assistive technology, provides new channels of communication for patients with aphasia, dysarthria, and dyspraxia, when accompanied by movement impairments.       In this workshop after stating a science review of the following types of issues: AAC acceptance (individually, culturally; AAC availability

  12. Strategies of Daily Living Rehabilitative Activities for Post Stroke Patients at Minia University Hospital

    Science.gov (United States)

    Zaky, Hend Elham Mohamed; EL-Lateef Mohammad, Zienab Abd; EL-Labban, Abdou Saad Taha; Ahmed, Gahen

    2015-01-01

    Background: Stroke is a leading cause of disability. Rehabilitation aims to hasten and maximize recovery from stroke by treating the disabilities caused by the stroke. Therefore, the aim of this study determine the post stroke patients' knowledge and practices in relation to disease and activities of daily living before the implementation of…

  13. Persistent Q fever and ischaemic stroke in elderly patients.

    Science.gov (United States)

    González-Quijada, S; Salazar-Thieroldt, E; Mora-Simón, M J

    2015-04-01

    Whether persistent or chronic Q fever may act as a risk factor for stroke is unknown. A case-control study was conducted in the Hospital Universitario de Burgos (Spain) between February 2011 and December 2012. A total of 803 samples from 634 consecutive hospitalized patients ≥65 years old were tested, of whom 111 were cases (patients with prevalent or incident ischaemic stroke and/or transient ischaemic attack) and 523 were controls (patients without ischaemic stroke and/or transient ischaemic attack). Immunoglobulin G (IgG) antibody titres phase I and II against Q fever, and IgG antibodies levels against Chlamydia pneumoniae and cytomegalovirus (CMV), were determined using immunofluorescence assay and ELISA methods, respectively. Phase I IgG titres against Coxiella burnetii ≥1:256 (compatible with chronic or persistent Q fever) were detected in 16 of 110 (14.5%) cases and in 32 of 524 (6.1%) controls; P = .004, odds ratio (OR) 2.6, 95% confidence interval (CI) 1.3 to 4.9. This ratio was maintained after adjusting for age, sex, hypertension, dyslipidaemia, cardioembolic focus, smoking, diabetes, other cardiovascular diseases, C-reactive protein, and leukocyte count (OR 2.6, 95% CI 1.3 to 5.3). High-titre IgG antibodies (top quartile) against CMV (OR 2.1, 95% CI 1.3 to 3.5), but not against C. pneumoniae (OR 0.9, 95% CI 0.5 to 1.6), also were associated with ischaemic stroke after adjustment for risk factors. In conclusion, serology compatible with persistent or chronic Q fever is associated with ischaemic stroke in elderly patients. High levels of IgG antibodies against CMV, but not against C. pneumoniae, also are associated with ischaemic stroke in these patients. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  14. Five-Year Outcome in Stroke Patients Submitted to Thrombolysis.

    Science.gov (United States)

    Machado, Célia; Pinho, João; Alves, José Nuno; Santos, Ana Filipa; Ferreira, Maria do Céu; Abreu, Maria João; Oliveira, Liliana; Mota, João; Fontes, João Ramalho; Ferreira, Carla

    2015-08-01

    Little is known on long-term follow-up after thrombolysis in ischemic stroke patients because the majority of studies evaluated outcome at 3 to 12 months. We aimed to assess 5-year outcome after intravenous thrombolysis (IVT). Cohort study based on the prospective registry of all consecutive ischemic stroke patients submitted to IVT in our Stroke Unit. Five-year outcome, including living settings, functional outcome, stroke recurrence, and mortality, was ascertained by telephonic interviews and additional review of clinical records. Multivariate analyses were performed to identify predictors of outcome and mortality. Excellent outcome was defined as modified Rankin scale 0 to 1. Five-year outcome was available for 155/164 patients submitted to IVT. At 5 years, 32.9% of patients had an excellent outcome (95% confidence interval (CI) =25.5-43.3) and mortality was 43.9% (95%CI=36.1-51.7). Increasing age (odds ratio =0.93, 95% CI =0.90-0.97) and increasing National Institute of Health Stroke Scale (NIHSS) 24 h after thrombolysis (odds ratio =0.81, 95% CI =0.74-0.90) were independently associated with a lower likelihood of an excellent 5-year outcome. Age (hazards ratio =1.07, 95% CI =1.03-1.11) and excellent functional outcome 3 months after thrombolysis (hazards ratio =0.28, 95%CI=0.12-0.66) were independently associated with mortality during follow-up. One third of ischemic stroke patients have excellent 5-year outcome after IVT. Younger age, lower NIHSS 24 h after IVT, and excellent 3-month functional outcome are independent predictors of excellent 5-year outcome. © 2015 American Heart Association, Inc.

  15. Help seeking behavior and onset-to-alarm time in patients with acute stroke: sub-study of the preventive antibiotics in stroke study

    NARCIS (Netherlands)

    Zock, E.; Kerkhoff, H.; Kleyweg, R. P.; van Bavel-Ta, T. B. V.; Scott, S.; Kruyt, N. D.; Nederkoorn, P. J.; van de Beek, D.

    2016-01-01

    Patients with acute stroke often do not seek immediate medical help, which is assumed to be driven by lack of knowledge of stroke symptoms. We explored the process of help seeking behavior in patients with acute stroke, evaluating knowledge about stroke symptoms, socio-demographic and clinical

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

    Directory of Open Access Journals (Sweden)

    Nou-Ying Tang

    2012-04-01

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

  17. Cognitive Profile of Elderly Patients with Mild Stroke

    Directory of Open Access Journals (Sweden)

    Arne Gramstad

    2011-11-01

    Full Text Available Background: A pattern characterizing cognitive deficits in mild stroke could help in differential diagnosis and rehabilitation planning. Methods: Fifty patients with mild stroke (modified Rankin scale ≤2 at discharge aged >60 years were given the Mini Mental State Examination (MMSE, the Hopkins Verbal Learning Test-Revised (HVLT-R and the Stroop test. Results: On HVLT-R, significant impairments were found in learning and recall, but not in delayed recall. The Stroop test revealed significant impairments in reading speed, but not in color-word interference. Using the MMSE, significant deficits were only found in the youngest age group. Conclusion: Elderly patients with mild stroke show deficits in verbal learning/recall and in reading speed, but not in the MMSE, delayed recall or color-word interference. The deficits are consistent with a mild-to-moderate brain dysfunction, with relative sparing of medial brain structures.

  18. Speech-language pathologists' preferences for patient-centeredness.

    Science.gov (United States)

    Bellon-Harn, Monica L; Azios, Jamie Hartwell; Dockens, Ashley L; Manchaiah, Vinaya

    2017-07-01

    Preferences for patient-centeredness is an important indicator in healthcare service delivery. However, it remains largely unexplored in the field of communication science and disorders. This study investigated speech-language pathologists' (SLPs) preferences for patient-centeredness METHOD: The study involved a cross-sectional survey design. SLPs (n = 102) fully completed the modified Patient-Practitioner Orientation Scale (PPOS; Krupat et al, 2000) and also provided demographic details. Data were analyzed using descriptive statistics, correlation, and linear regression methods. Mean PPOS scores indicated that SLPs value patient-centeredness. There was a strong positive correlation among sharing and caring subscales with the full-scale. Results from the linear regression modeling suggested no relationship between demographic factors and preferences for patient-centeredness. SLPs value patient-centeredness, although there may be regional and cultural variations. Qualitative investigations may help uncover dimensions of patient-centeredness that were not captured in the PPOS scale. In addition, further research should explore congruence in preferences for patient-centeredness among SLPs and patients. Published by Elsevier Inc.

  19. Modern Tools in Patient-Centred Speech Therapy for Romanian Language

    Directory of Open Access Journals (Sweden)

    Mirela Danubianu

    2016-03-01

    Full Text Available The most common way to communicate with those around us is speech. Suffering from a speech disorder can have negative social effects: from leaving the individuals with low confidence and moral to problems with social interaction and the ability to live independently like adults. The speech therapy intervention is a complex process having particular objectives such as: discovery and identification of speech disorder and directing the therapy to correction, recovery, compensation, adaptation and social integration of patients. Computer-based Speech Therapy systems are a real help for therapists by creating a special learning environment. The Romanian language is a phonetic one, with special linguistic particularities. This paper aims to present a few computer-based speech therapy systems developed for the treatment of various speech disorders specific to Romanian language.

  20. Language-specific dysgraphia in Korean stroke patients.

    Science.gov (United States)

    Yoon, Ji Hye; Suh, Mee Kyung; Kim, HyangHee

    2010-12-01

    We investigated how changes in the writing of 14 Korean stroke patients reflect the unique features of the Korean writing system. The Korean writing system, Han-geul, has both linguistic and visuospatial/constructive characteristics. In the visuospatial construction of a syllable, the component consonant(s) and vowel(s) must be arranged from top-to-bottom and/or left-to-right within the form of a square. This syllabic organization, unique to Korean writing, may distinguish dysgraphia in Korean patients from the disorder in other languages, and reveal the effects of stroke on visuospatial/constructive abilities. We compared 2 groups of patients affected by stroke, 1 group with left hemisphere (LH) lesions and the other with right hemisphere (RH) lesions. We instructed them to write from a dictation of 90 monosyllabic stimuli, each presented with a real word cue. Patients had to repeat a target syllable and a word cue, and then to write the target syllable only. Patients with LH and RH lesions produced qualitatively different error patterns. While the LH lesion group produced primarily linguistic errors, visuospatial/constructive errors predominated in the group with RH lesions. With regard to language-specific features, these Korean patients with RH lesions produced diverse visuospatial/constructive errors not commonly observed in dysgraphia of the English language. Language-specific writing errors by Korean stroke patients reflect the unique characteristics of Korean writing, which include the arrangement of strokes and graphemes within a square syllabic form by dimensional and spatial rules. These findings support the notion that the Korean writing system possesses a language-specific nature with both linguistic and visuospatial/constructive processes. Distinctive patterns of dysgraphia in the Korean language also suggest interactivity between linguistic and visuospatial/constructive levels of processing. This study is noteworthy for its systematic description of

  1. Geriatric rehabilitation of stroke patients in nursing homes : a study protocol

    NARCIS (Netherlands)

    Spruit-van Eijk, M.; Buijck, B.I.; Zuidema, S.U.; Voncken, F.L.M.; Geurts, A.C.H.; Koopmans, R.T.C.M.

    2010-01-01

    BACKGROUND: Geriatric patients are typically underrepresented in studies on the functional outcome of rehabilitation after stroke. Moreover, most geriatric stroke patients do probably not participate in intensive rehabilitation programs as offered by rehabilitation centers. As a result, very few

  2. Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers: An Urban Population-Based Study.

    Science.gov (United States)

    Katz, Brian S; Adeoye, Opeolu; Sucharew, Heidi; Broderick, Joseph P; McMullan, Jason; Khatri, Pooja; Widener, Michael; Alwell, Kathleen S; Moomaw, Charles J; Kissela, Brett M; Flaherty, Matthew L; Woo, Daniel; Ferioli, Simona; Mackey, Jason; Martini, Sharyl; De Los Rios la Rosa, Felipe; Kleindorfer, Dawn O

    2017-08-01

    The American Stroke Association recommends that Emergency Medical Service bypass acute stroke-ready hospital (ASRH)/primary stroke center (PSC) for comprehensive stroke centers (CSCs) when transporting appropriate stroke patients, if the additional travel time is ≤15 minutes. However, data on additional transport time and the effect on hospital census remain unknown. Stroke patients ≥20 years old who were transported from home to an ASRH/PSC or CSC via Emergency Medical Service in 2010 were identified in the Greater Cincinnati area population of 1.3 million. Addresses of all patients' residences and hospitals were geocoded, and estimated travel times were calculated. We estimated the mean differences between the travel time for patients taken to an ASRH/PSC and the theoretical time had they been transported directly to the region's CSC. Of 929 patients with geocoded addresses, 806 were transported via Emergency Medical Service directly to an ASRH/PSC. Mean additional travel time of direct transport to the CSC, compared with transport to an ASRH/PSC, was 7.9±6.8 minutes; 85% would have ≤15 minutes added transport time. Triage of all stroke patients to the CSC would have added 727 patients to the CSC's census in 2010. Limiting triage to the CSC to patients with National Institutes of Health Stroke Scale score of ≥10 within 6 hours of onset would have added 116 patients (2.2 per week) to the CSC's annual census. Emergency Medical Service triage to CSCs based on stroke severity and symptom duration may be feasible. The impact on stroke systems of care and patient outcomes remains to be determined and requires prospective evaluation. © 2017 American Heart Association, Inc.

  3. Resistant hypertension, patient characteristics, and risk of stroke.

    Directory of Open Access Journals (Sweden)

    Chen-Ying Hung

    Full Text Available Little is known about the prognosis of resistant hypertension (RH in Asian population. This study aimed to evaluate the impacts of RH in Taiwanese patients with hypertension, and to ascertain whether patient characteristics influence the association of RH with adverse outcomes.Patients aged ≥45 years with hypertension were identified from the National Health Insurance Research Database. Medical records of 111,986 patients were reviewed in this study, and 16,402 (14.6% patients were recognized as having RH (continuously concomitant use of ≥3 anti-hypertensive medications, including a diuretic, for ≥2 years. Risk of major adverse cardiovascular events (MACE, a composite of all-cause mortality, acute coronary syndrome, and stroke [included both fatal and nonfatal events] in patients with RH and non-RH was analyzed. A total of 11,856 patients experienced MACE in the follow-up period (average 7.1±3.0 years. There was a higher proportion of females in the RH group, they were older than the non-RH (63.1 vs. 60.5 years patients, and had a higher prevalence of cardiovascular co-morbidities. Overall, patients with RH had higher risks of MACE (adjusted HR 1.17; 95%CI 1.09-1.26; p<0.001. Significantly elevated risks of stroke (10,211 events; adjusted HR 1.17; 95%CI 1.08-1.27; p<0.001, especially ischemic stroke (6,235 events; adjusted HR 1.34; 95%CI 1.20-1.48; p<0.001, but not all-cause mortality (4,594 events; adjusted HR 1.06; 95%CI 0.95-1.19; p = 0.312 or acute coronary syndrome (2,145 events; adjusted HR 1.17; 95%CI 0.99-1.39; p = 0.070 were noted in patients with RH compared to those with non-RH. Subgroup analysis showed that RH increased the risks of stroke in female and elderly patients. However, no significant influence was noted in young or male patients.Patients with RH were associated with higher risks of MACE and stroke, especially ischemic stroke. The risks were greater in female and elderly patients than in male or young

  4. Brain perfusion-CT in acute stroke patients

    International Nuclear Information System (INIS)

    Andreev, T.; Totsev, N.; Tzvetanov, P.

    2013-01-01

    Since 1979 when Grodfrey Hounsfield and Allan Corman introduced the computed tomography new generations of CT were developed that improved the special resolution and time of acquisition. The role of neuro-imaging in the evaluation of acute stroke has changed dramatically in the past decade. Previously, neuro-imaging was used in this set-ting to provide anatomic imaging that indicated the presence or absence of acute cerebral ischemia and excluded lesions that produce symptoms or signs mimicking those of stroke, such as hemorrhage and neoplasms. More recently, the introduction of thrombolysis has changed the goals of neuro-imaging from providing solely anatomic information to providing physiologic information that could help to determine which patients might benefit from therapy. In particular, significant emphasis has been placed on the delineation of the ischemic penumbra, also called tissue at risk. Modem CT survey, consisting of three indissociable elements; noncontrast CT (NCT) of course, perfusion-CT (PCT) and CT-angiography (CTA), fulfill all the requirements for hyperacute stroke imaging. CTA can define the occlusion site, depict arterial dissection, grade collateral blood flow, and characterize atherosclerotic disease, whereas PCT accurately defines the infarct core and the ischemic penumbra. CT offers a number of practical advantages over other cerebral perfusion imaging methods, including its wide availability. Using PCT and CTA to define new individualized strategies for acute reperfusion will allow more acute stroke patients to benefit from thrombolytic therapy. Key words: Stroke. Penumbra. Computed Tomography. Perfusion-CT. CT Angiography. Outcome

  5. How is nursing care for stroke patients organised? Nurses' views on best praactices

    DEFF Research Database (Denmark)

    Lind, Jette; Struwe, Jytte Holm; Baernholdt, Marianne

    2013-01-01

    In the developed world, stroke is the third leading cause of death (DSFA 2009) In Denmark there are 12400 new patients every year and 30000 - 40000 people living with long-term after stroke. This group consists mainly of people aged 80 years and older. When these patients have a stroke their biol......In the developed world, stroke is the third leading cause of death (DSFA 2009) In Denmark there are 12400 new patients every year and 30000 - 40000 people living with long-term after stroke. This group consists mainly of people aged 80 years and older. When these patients have a stroke...

  6. Use of functional bandages in patients with stroke

    Directory of Open Access Journals (Sweden)

    Dreyzialle Vila Nova Mota

    Full Text Available Introduction Functional bandages have been used in physiotherapeutic practice with the purpose of minimizing disabilities and favoring functional improvement. However, there is still a shortage of research regarding the use of these devices in patients with neurological sequelae, especially those resulting from stroke. Objective To report the motor evolution of patients living with sequelae of stroke, who have been submitted to the use of functional bandages associated with conventional physical therapy. Materials and methods We assessed the active range of motion, strength and degree of spasticity in the flexor and extensor muscles of the wrist and elbow joints, and functionality of the upper limb during the performance of daily activities at the first and the twentieth session of conventional physical therapy associated with the use of functional bandages. Results There was an increase in range of motion and muscle strength of patients, and reduction in spasticity of the wrist and elbow flexor muscles. Conversely, the functionality scores remained similar before and after treatment. Conclusion The subjects of this study showed a good evolution in the aspects studied. Thus, the use of functional bandages associated with conventional physical therapy seems to contribute to the rehabilitation of patients with stroke sequelae. Further research needs to be conducted in order to increase the scientific evidence regarding the effectiveness of functional bandages in the treatment of patients with stroke sequelae.

  7. Stroke patients who regain urinary continence in the first week after acute first-ever stroke have better prognosis than patients with persistent lower urinary tract dysfunction.

    Science.gov (United States)

    Rotar, Melita; Blagus, Rok; Jeromel, Miran; Skrbec, Miha; Tršinar, Bojan; Vodušek, David B

    2011-09-01

    Urinary incontinence (UI) is a predictor of greater mortality and poor functional recovery; however published studies failed to evaluate lower urinary tract (LUT) function immediately after stroke. The aim of our study was to evaluate the course of LUT function in the first week after stroke, and its impact on prognosis. We included 100 consecutively admitted patients suffering first-ever stroke and evaluated them within 72 hours after stroke, after 7 days, 6 months, and 12 months. For LUT function assessment we used ultrasound measurement. The patients were divided into three groups: (i) patients who remained continent after stroke, (ii) patients who had LUT dysfunction in the acute phase but regained continence in the first week, and (iii) patients who did not regain normal LUT control in the first week. We assessed the influence of variables on death using the multiple logistic regression model. Immediately after stroke 58 patients had LUT dysfunction. The odds of dying in group with LUT dysfunction were significantly larger than odds in group without LUT dysfunction. Odds for death for patients who regained LUT function in 1 week after stroke were comparable to patients without LUT dysfunction. We confirmed that post-stroke UI is a predictor of greater mortality at 1 week, 6 months and 12 months after stroke. However, patients who regain normal bladder control in the first week have a comparable prognosis as the patients who do not have micturition disturbances following stroke. Copyright © 2011 Wiley-Liss, Inc.

  8. Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the patient-driven research paradigm to aid decision making in stroke care.

    Science.gov (United States)

    Xian, Ying; O'Brien, Emily C; Fonarow, Gregg C; Olson, DaiWai M; Schwamm, Lee H; Hannah, Deidre; Lindholm, Brianna; Maisch, Lesley; Lytle, Barbara L; Greiner, Melissa A; Wu, Jingjing; Peterson, Eric D; Pencina, Michael J; Hernandez, Adrian F

    2015-07-01

    Stroke is common and costly, annually depriving the lives and well-being of 800,000 Americans. Despite demonstrated efficacy in clinical trials, questions remain about the safety and clinical effectiveness of various treatment options given patient characteristics, conditions, preferences, and their desired outcomes. The Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-sponsored project designed to help patients, physicians, and other stakeholders make informed decisions regarding stroke care and improve outcomes through patient-centered comparative effectiveness research. The primary outcomes identified and prioritized by stroke patients are "home time" (time spent alive and outside a hospital) and major adverse cardiovascular events. With inputs from stroke patients themselves, a series of comparative safety and effectiveness analyses will be performed across 3 prioritized therapeutic areas identified as important by stroke survivors: oral anticoagulants, statin therapy, and antidepressants. We obtained data from Get With the Guidelines-Stroke linked with Medicare claims and follow-up telephone interviews. Our combined retrospective and prospective research strategy allows the evaluation of the safety and effectiveness of various treatment options and patient-centered longitudinal outcomes. To ensure the rapid translation of findings into clinical practice, results will be disseminated to stroke survivors, caregivers, and health care providers through traditional and social media, including an online decision aid tool. PROSPER is a patient-centered outcome research study guided by patients, caregivers, and the broader health care community. By addressing knowledge gaps in treatment uncertainties through comparative effectiveness research, PROSPER has the potential to improve decision making in stroke care and patient outcomes reflecting individual patient

  9. Nursing care for stroke patients: A survey of current practice in 11 European countries.

    Science.gov (United States)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin; Jönsson, Ann-Cathrin

    2018-02-01

    To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies 2006 and to examine to what extent the European Stroke Strategies have been implemented in stroke care nursing in Europe. Stroke is a leading cause of death and disability globally. Optimal organisation of interdisciplinary stroke care is expected to ameliorate outcome after stroke. Consequently, universal access to stroke care based on evidence-based guidelines is a priority. This study is a descriptive cross-sectional survey. A questionnaire comprising 61 questions based on the European Stroke Strategies and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: organisation of stroke services, management of acute stroke and prevention including basic care and nursing, and secondary prevention. Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hr after stroke onset, 95% monitor patients regularly, 94% start mobilisation after 24 hr when patients are stable, and 89% assess patients' ability to swallow. Change of position for immobile patients is followed by 73%, and postvoid residual urine volume is measured by 85%. Some aspects needed improvement, for example, staff education (70%), education for patients/families/carers (55%) and individual care plans in secondary prevention (62%). The participating European countries comply well with the European Stroke Strategies guidelines, particularly in the acute stroke care, but not all stroke units have reached optimal development in all aspects of stroke care nursing. Our study may provide clinical administrators and nurses in stroke care with information that may contribute to improved compliance with the European Stroke Strategies and evidence

  10. Discharge Disposition After Stroke in Patients With Liver Disease.

    Science.gov (United States)

    Parikh, Neal S; Merkler, Alexander E; Schneider, Yecheskel; Navi, Babak B; Kamel, Hooman

    2017-02-01

    Liver disease is associated with both hemorrhagic and thrombotic processes, including an elevated risk of intracranial hemorrhage. We sought to assess the relationship between liver disease and outcomes after stroke, as measured by discharge disposition. Using administrative claims data, we identified a cohort of patients hospitalized with stroke in California, Florida, and New York from 2005 to 2013. The predictor variable was liver disease. All diagnoses were defined using validated diagnosis codes. Ordinal logistic regression was used to analyze the association between liver disease and worsening discharge disposition: home, nursing/rehabilitation facility, or death. Secondarily, multiple logistic regression was used to analyze the association between liver disease and in-hospital mortality. Models were adjusted for demographics, vascular risk factors, and comorbidities. We identified 121 428 patients with intracerebral hemorrhage and 703 918 with ischemic stroke. Liver disease was documented in 13 584 patients (1.7%). Liver disease was associated with worse discharge disposition after both intracerebral hemorrhage (global odds ratio, 1.28; 95% confidence interval, 1.19-1.38) and ischemic stroke (odds ratio, 1.23; 95% confidence interval, 1.17-1.29). Similarly, liver disease was associated with in-hospital death after both intracerebral hemorrhage (odds ratio, 1.33; 95% confidence interval, 1.23-1.44) and ischemic stroke (odds ratio, 1.60; 95% confidence interval, 1.51-1.71). Liver disease was associated with worse hospital discharge disposition and in-hospital mortality after stroke, suggesting worse functional outcomes. © 2016 American Heart Association, Inc.

  11. The risk of ischaemic stroke in primary antiphospholipid syndrome patients

    DEFF Research Database (Denmark)

    Radin, M; Schreiber, K; Cecchi, I

    2018-01-01

    BACKGROUND AND PURPOSE: The most common neurological manifestation of antiphospholipid syndrome (APS) is ischaemic stroke. Identifying patients with APS at high risk for developing any thrombotic event remains a major challenge. In this study, the aim was to identify predictive factors of ischaemic...

  12. NDT-competence of nurses caring for patients with stroke

    NARCIS (Netherlands)

    M.H.F. Grypdonck; Thóra Hafsteinsdóttir

    2004-01-01

    NeuroDevelopmental Treatment (NDT) is the most used rehabilitation approach in the treatment of patients with stroke in the Western world today, despite the lack of evidence for its efficacy. The aim of this study was to conduct an intervention check and measure the nurses' competence, in

  13. Review of nutrition support and evaluation in stroke patients

    Directory of Open Access Journals (Sweden)

    Zhuo-li WU

    2015-04-01

    Full Text Available Malnutrition is common after stroke, usually caused by cognitive disorder, dysphagia, paralysis, sensorimotor disability and visual field defect. Many researches indicate that the initiation of early enteral nutrition in stroke patients would own enormous clinical benefits, including a decrease in the risk of death and infectious diseases, shorter hospital stay and lower health expenditure. However, irregular nutrition management could increase the incidence of hypostatic pneumonia and urinary tract infection. Therefore, both European Society for Parenteral and Enteral Nutrition (ESPEN and American Society for Parenteral and Enteral Nutrition (ASPEN recommended that nutrition screening and assessment and nutrition support be initiated as soon as possible, preferably within 24 h of hospital admission, to improve clinical outcomes. Chinese neurologists and patients have accepted this concept and have done many worthful studies in the past few years. This paper summarized the common methods of nutrition assessment and measurement of interstinal barrier function, in order to monitor the nutritional status of stroke patients, and push the establishment and improvement of nutrition support system for stroke patients in China. DOI: 10.3969/j.issn.1672-6731.2015.04.004

  14. Length of hospital stay and discharge delays in stroke patients

    NARCIS (Netherlands)

    van Straten, A.; van der Meulen, J. H.; van den Bos, G. A.; Limburg, M.

    1997-01-01

    In The Netherlands, many stroke patients stay in the hospital for some time merely waiting for discharge placement. This indicates an inefficient use of hospital resources, as well as a possible deficiency in the quality of care, because hospitals are not adequately equipped to care for these

  15. Towards evidence-based physiotherapy for patients with stroke

    NARCIS (Netherlands)

    van Peppen, R.P.S.

    2008-01-01

    The first aim of the thesis was to collect and review systematically, and to appraise critically the available evidence stemming from physiotherapy and physiotherapy-related studies in patients with stroke. It can be concluded that the application of physiotherapy improves performance to execute

  16. Recovery of Motor Imagery Ability in Stroke Patients

    Directory of Open Access Journals (Sweden)

    Sjoerd de Vries

    2011-01-01

    Full Text Available Objective. To investigate whether motor imagery ability recovers in stroke patients and to see what the relationship is between different types of imagery and motor functioning after stroke. Methods. 12 unilateral stroke patients were measured at 3 and 6 weeks poststroke on 3 mental imagery tasks. Arm-hand function was evaluated using the Utrecht Arm-Hand task and the Brunnström Fugl-Meyer Scale. Age-matched healthy individuals (N=10 were included as controls. Results. Implicit motor imagery ability and visual motor imagery ability improved significantly at 6 weeks compared to 3 weeks poststroke. Conclusion. Our study shows that motor imagery can recover in the first weeks after stroke. This indicates that a group of patients who might not be initially selected for mental practice can, still later in the rehabilitation process, participate in mental practice programs. Moreover, our study shows that mental imagery modalities can be differently affected in individual patients and over time.

  17. Long-term use of antiplatelet drugs by stroke patients

    DEFF Research Database (Denmark)

    Ostergaard, Kamilla; Hallas, Jesper; Bak, Søren

    2012-01-01

    in a cohort of stroke patients discharged from a Danish neurology department. The antiplatelet drugs comprised acetylsalicylic acid (ASA), clopidogrel and dipyridamole (if combined with ASA use). Non-persistence was defined as failure to present a prescription for antiplatelet drugs within 180 days after...

  18. Stroke

    Science.gov (United States)

    ... as independent as possible. It may include physical therapy, occupational therapy, speech therapy, and swallowing therapy. Your doctor will ... Prevention and Wellness Staying Healthy Healthy Living Travel Occupational ... Sex and Sexuality Birth Control Family Health Infants and Toddlers Kids ...

  19. Prosodic analysis of neutral, stress-modified and rhymed speech in patients with Parkinson's disease.

    Science.gov (United States)

    Galaz, Zoltan; Mekyska, Jiri; Mzourek, Zdenek; Smekal, Zdenek; Rektorova, Irena; Eliasova, Ilona; Kostalova, Milena; Mrackova, Martina; Berankova, Dagmar

    2016-04-01

    Hypokinetic dysarthria (HD) is a frequent speech disorder associated with idiopathic Parkinson's disease (PD). It affects all dimensions of speech production. One of the most common features of HD is dysprosody that is characterized by alterations of rhythm and speech rate, flat speech melody, and impairment of speech intensity control. Dysprosody has a detrimental impact on speech naturalness and intelligibility. This paper deals with quantitative prosodic analysis of neutral, stress-modified and rhymed speech in patients with PD. The analysis of prosody is based on quantification of monopitch, monoloudness, and speech rate abnormalities. Experimental dataset consists of 98 patients with PD and 51 healthy speakers. For the purpose of HD identification, sequential floating feature selection algorithm and random forests classifier is used. In this paper, we also introduce a concept of permutation test applied in the field of acoustic analysis of dysarthric speech. Prosodic features obtained from stress-modified reading task provided higher classification accuracies compared to the ones extracted from reading task with neutral emotion demonstrating the importance of stress in speech prosody. Features calculated from poem recitation task outperformed both reading tasks in the case of gender-undifferentiated analysis showing that rhythmical demands can in general lead to more precise identification of HD. Additionally, some gender-related patterns of dysprosody has been observed. This paper confirms reduced variation of fundamental frequency in PD patients with HD. Interestingly, increased variability of speech intensity compared to healthy speakers has been detected. Regarding speech rate disturbances, our results does not report any particular pattern. We conclude further development of prosodic features quantifying the relationship between monopitch, monoloudness and speech rate disruptions in HD can have a great potential in future PD analysis. Copyright © 2016

  20. Ocular disorders in stroke patients in a tertiary hospital in Nigeria ...

    African Journals Online (AJOL)

    Visual complaints following stroke were documented in 9.6% of the patients. Conclusion: Ocular abnormalities are present in patients with stroke, mostly due to predisposing risk factors for stroke, and age‑related changes. Routine ophthalmic evaluation is suggested in the management of patients with cerebrovascular ...

  1. Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe.

    Science.gov (United States)

    Ghoreishi, Mehrdad; Foster, Nate; Pasrija, Chetan; Shah, Aakash; Watkins, A Claire; Evans, Charlie F; Maghami, Sam; Quinn, Rachael; Wehman, Brody; Taylor, Bradley S; Dawood, Murtaza Y; Griffith, Bartley P; Gammie, James S

    2018-01-01

    To determine if preoperative embolic stroke is associated with an increased risk of postoperative stroke among patients undergoing early operation for mitral valve (MV) infective endocarditis (IE), we compared outcomes among patients presenting with and without acute stroke. From 2003 to 2015, 243 consecutive patients underwent surgery for active MV IE. Patients were categorized into 2 groups: 72% (174 of 243 patients) with no preoperative acute stroke (clinical, radiographic or both) and 28% (69 of 243 patients) with stroke. Both preoperative and postoperative strokes were confirmed in all patients with brain computed tomography or magnetic resonance imaging and comprehensive examination by a neurologist. Among patients presenting with stroke, 33% (23 of 69 patients) were asymptomatic and had only positive imaging findings. The median time from admission to operation was 5 days. The overall rate of new postoperative stroke was 4% (10 of 243 patients). The rate of postoperative stroke was not different between the 2 groups: 4% (7 of 174 patients) among patients with no preoperative stroke and 4% (3 of 69 patients) with stroke (p = 0.9). One patient developed a hemorrhagic conversion of an acute infarct. Operative mortality was 7% (13 of 174 patients) among patients with no preoperative stroke and 7% (5 of 69 patients) among patients with stroke (p = 0.9). MV surgery for IE and acute stroke can be performed early with a low risk of postoperative neurologic complications. When indicated, surgical intervention for MV IE complicated by acute stroke should not be delayed. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Evaluation of patients with stroke monitored by home care programs

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

    2013-10-01

    Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.

  3. Risk Factors and Etiology of Young Ischemic Stroke Patients in Estonia

    Directory of Open Access Journals (Sweden)

    Siim Schneider

    2017-01-01

    Full Text Available Objectives. Reports on young patients with ischemic stroke from Eastern Europe have been scarce. This study aimed to assess risk factors and etiology of first-ever and recurrent stroke among young Estonian patients. Methods. We performed a retrospective study of consecutive ischemic stroke patients aged 18–54 years who were treated in our two hospitals from 2003 to 2012. Results. We identified 741 patients with first-ever stroke and 96 patients with recurrent stroke. Among first-time patients, men predominated in all age groups. The prevalence of well-documented risk factors in first-time stroke patients was 83% and in the recurrent group 91%. The most frequent risk factors were hypertension (53%, dyslipidemia (46%, and smoking (35%. Recurrent stroke patients had fewer less well-documented risk factors compared to first-time stroke patients (19.8 versus 30.0%, P=0.036. Atrial fibrillation was the most common cause of cardioembolic strokes (48% and large-artery atherosclerosis (LAA was the cause in 8% among those aged <35 years. Compared to first-time strokes, recurrent ones were more frequently caused by LAA (14.3 versus 24.0%, P=0.01 and less often by other definite etiology (8.5 versus 1.0%, P=0.01. Conclusions. The prevalence of vascular risk factors among Estonian young stroke patients is high. Premature atherosclerosis is a cause in a substantial part of very young stroke patients.

  4. Heart rate as a predictor of stroke in high-risk, hypertensive patients with previous stroke or transient ischemic attack.

    Science.gov (United States)

    Sandset, Else Charlotte; Berge, Eivind; Kjeldsen, Sverre E; Julius, Stevo; Holzhauer, Björn; Krarup, Lars-Henrik; Hua, Tsushung A

    2014-01-01

    Risk factors for first stroke are well established, but less is known about risk factors for recurrent stroke. In the present analysis, we aimed to assess the effect of heart rate and other possible predictors of stroke in a hypertensive population with previous stroke or transient ischemic attack (TIA). The Valsartan Antihypertensive Long-Term Use Evaluation trial was a multicentre, double-masked, randomized controlled, parallel group trial comparing the effects of an angiotensin receptor blocker (valsartan) and a calcium channel blocker (amlodipine) in patients with hypertension and high cardiovascular risk. We used Cox proportional hazard models to investigate the effect of baseline variables on the risk of stroke. Quadratic terms of the continuous variables were entered in the models to test for linearity. Of 15,245 patients included in the trial, 3014 had a previous stroke or TIA at baseline and were included in the present analysis. Stroke recurrence occurred in 239 patients (7.9%) during a median of 4.5 years of follow-up. Resting heart rate (per 10 beats per minute; hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.18-6.58) and diabetes mellitus at baseline (HR, 1.47; 95% CI, 1.03-2.10) were significantly associated with an increased risk of stroke recurrence in the multivariable analysis. In high-risk, hypertensive patients with previous stroke or TIA, resting heart rate was the strongest predictor of recurrent stroke. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. 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.

  6. Stroke in a patient with tuberculous meningitis and HIV infection

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    Maria Bruna Pasticci

    2013-02-01

    Full Text Available Abstract. Tuberculous meningitis (TBM is a devastating disease. TBM occurs more commonly in HIV infected patients. The influence of HIV co-infection on clinical manifestations and outcome of TBM is not well defined. Yet, some differences have been observed and stroke has been recorded to occur more frequently. This study reports on an HIV infected Caucasian female with lung, meningeal tuberculosis and stroke due to a cortical sub-cortical ischemic lesion.TBM was documented in the absence of neurologic symptoms. At the same time, miliary lung TB caused by multi-susceptible Mycobacterium tuberculosis was diagnosed. Anti-TB therapy consisting of a combination of four drugs was administered. The patient improved and was discharged five weeks later. In conclusion, TBM and multiple underling pathologies including HIV infection, as well as other risk factors can lead to a greater risk of stroke. Moreover, drug interactions and their side effects add levels of complexity. TBM must be included in the differential diagnosis of HIV infected patients with stroke and TBM treatment needs be started as soon as possible before the onset of vasculopathy.

  7. Early warning score predicts acute mortality in stroke patients

    DEFF Research Database (Denmark)

    Liljehult, J; Christensen, Thomas

    2016-01-01

    OBJECTIVES: Clinical deterioration and death among patients with acute stroke are often preceded by detrimental changes in physiological parameters. Systematic and effective tools to identify patients at risk of deterioration early enough to intervene are therefore needed. The aim of the study...... was calculated. Death within 30 days was used as outcome. Area under the receiver operating characteristics curve (AUROC) and a Kaplan-Meier curve were computed to examine the prognostic validity of EWS. RESULTS: A total of 24 patients (8.8%) died within 30 days. The prognostic performance was high for both...... tool for identifying patients at risk of dying after acute stroke. Readily available physiological parameters are converted to a single score, which can guide both nurses and physicians in clinical decision making and resource allocation....

  8. Methods to improve patient recruitment and retention in stroke trials

    DEFF Research Database (Denmark)

    Berge, Eivind; Stapf, Christian; Al-Shahi Salman, Rustam

    2016-01-01

    by health services only when delivered within clinical trials. The literature review revealed that few methods have been formally evaluated. The top five priorities for evaluation identified in the workshop were as follows: short and illustrated patient information leaflets, nonwritten consent......Background: The success of randomized-controlled stroke trials is dependent on the recruitment and retention of a sufficient number of patients, but fewer than half of all trials meet their target number of patients. Methods: We performed a search and review of the literature, and conducted...... a survey and workshop among 56 European stroke trialists, to identify barriers, suggest methods to improve recruitment and retention, and make a priority list of interventions that merit further evaluation. Results: The survey and workshop identified a number of barriers to patient recruitment...

  9. The effects of temporary hyperglycemia on the prognosis of stroke in patients with acute ischaemıc stroke

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    Soner Kılıc

    2012-12-01

    Full Text Available OBJECTIVE: In this study, frequency of temporary hyperglycemia and effects of the hyperglycemia on the severity and prognosis of stroke were examined in patients with acute ischaemic stroke. MATERIAL and METHODS: One hundred patients, who applied for acute ischaemic stroke and met the inclusion criteria, were included in the study. Patients were diveded into three groups: normoglycemic, temporary hyperglycemic and diabetes mellitus (DM, according to the baseline blood glucose, fasting blood glucose, oral glucose tolerance test (OGTT test and HbA1c value. These groups’ National Institue of Stroke Scale (NIHSS, Fugl–Meyer (FM and Functional Independence Measure (FIM scores were measured at baseline and at the 3rd month of the follow up; then, these data were compared in terms of the severity and prognosis of stroke. In addition, according to the fasting blood glucose, hyperglycemic and normoglycemic patients becoming permanent diabetics were evaluated. ANOVA, Paired t test and Mann-Whitney U tests were used in the statistical analyses. RESULTS: Of the patients 52 were normoglycemic, 21 were hyperglycemic and 27 were diabetic. At the 3rd month of the follow up, 28 patients died. Three patients with temporary hyperglycemia became permanent DM. At baseline, severity of stroke as measured by NIHSS, FM and FIM scores was lower, which was statistically significant (p0.05. Each of the three groups showed significant improvements at the 3rd month after stroke (p<0.05. Normoglycemia group showed the more improvement than diabetic group. CONCLUSION: In this study, it was concluded that temporary hyperglycemia was not infrequent in patients with ischaemic stroke, and that all forms of hyperglycemia played negative role in the severity and prognosis of stroke. It was determined that follow up of temporary hyperglycemia was important for secondary care of these patients.

  10. Audiovisual Integration of Speech in a Patient with Broca’s Aphasia

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    Tobias Søren Andersen

    2015-04-01

    Full Text Available Lesions to Broca’s area cause aphasia characterised by a severe impairment of the ability to speak, with comparatively intact speech perception. However, some studies have found effects on speech perception under adverse listening conditions, indicating that Broca’s area is also involved in speech perception. While these studies have focused on auditory speech perception other studies have shown that Broca’s area is activated by visual speech perception. Furthermore, one preliminary report found that a patient with Broca’s aphasia did not experience the McGurk illusion suggesting that an intact Broca’s area is necessary for audiovisual integration of speech. Here we describe a patient with Broca’s aphasia who experienced the McGurk illusion. This indicates that an intact Broca’s area is not necessary for audiovisual integration of speech. The McGurk illusions this patient experienced were atypical, which could be due to Broca’s area having a more subtle role in audiovisual integration of speech. The McGurk illusions of a control subject with Wernicke’s aphasia were, however, also atypical. This indicates that the atypical McGurk illusions were due to deficits in speech processing that are not specific to Broca’s aphasia.

  11. Suicidal ideation and attempts in patients with stroke: a population-based study.

    Science.gov (United States)

    Chung, Jae Ho; Kim, Jung Bin; Kim, Ji Hyun

    2016-10-01

    Stroke is known to be associated with an increase in the risk for suicide. However, there are very few population-based studies investigating the risk of suicidal ideation and attempts in patients with stroke. The purpose of this study was to compare the risk of suicidal ideation and attempts between patients with stroke and population without stroke using nationwide survey data. Individual-level data were obtained from 228,735 participants (4560 with stroke and 224,175 without stroke) of the 2013 Korean Community Health Survey. Demographic characteristics, socioeconomic status, physical health status, and mental health status were compared between patients with stroke and population without stroke. Multivariable logistic regression was performed to investigate the independent effects of the stroke on suicidal ideation and attempts. Stroke patients had more depressive mood (12.6 %) than population without stroke (5.7 %, p suicidal ideation (24.4 %) and attempts (1.3 %) than population without stroke (9.8 and 0.4 %, respectively; both p suicidal ideation (OR 1.65, 95 % CI 1.52-1.79) and suicidal attempts (OR 1.64, 95 % CI 1.21-2.22), adjusting for demographics, socioeconomic factors, and physical health and mental health factors. We found that stroke increased the risk for suicidal ideation and attempts, independent of other factors that are known to be associated with suicidality, suggesting that stroke per se may be an independent risk factor for suicidality.

  12. Bringing the hospital to the patient: first treatment of stroke patients at the emergency site.

    Directory of Open Access Journals (Sweden)

    Silke Walter

    2010-10-01

    Full Text Available Early treatment with rt-PA is critical for favorable outcome of acute stroke. However, only a very small proportion of stroke patients receive this treatment, as most arrive at hospital too late to be eligible for rt-PA therapy.We developed a "Mobile Stroke Unit", consisting of an ambulance equipped with computed tomography, a point-of-care laboratory system for complete stroke laboratory work-up, and telemedicine capabilities for contact with hospital experts, to achieve delivery of etiology-specific and guideline-adherent stroke treatment at the site of the emergency, well before arrival at the hospital. In a departure from current practice, stroke patients could be differentially treated according to their ischemic or hemorrhagic etiology even in the prehospital phase of stroke management. Immediate diagnosis of cerebral ischemia and exclusion of thrombolysis contraindications enabled us to perform prehospital rt-PA thrombolysis as bridging to later intra-arterial recanalization in one patient. In a complementary patient with cerebral hemorrhage, prehospital diagnosis allowed immediate initiation of hemorrhage-specific blood pressure management and telemedicine consultation regarding surgery. Call-to-therapy-decision times were 35 minutes.This preliminary study proves the feasibility of guideline-adherent, etiology-specific and causal treatment of acute stroke directly at the emergency site.

  13. The influence of early speech rehabilitation with voice prostheses on the psychological state of laryngectomized patients.

    Science.gov (United States)

    de Maddalena, Harry

    2002-01-01

    This survey assessed how early speech rehabilitation influences the emotional state and psychological adjustment of 43 male laryngectomy patients, at three different chronological stages. The first assessment occurred 2-3 days before the operation. The patients filled out a stress questionnaire (SVF) which assessed coping strategies. Exactly 2 weeks after the operation the patients were given a list of adjectives (EWL) which measured their actual emotional state. One day before leaving the hospital the patients were given the Post-laryngectomy Telephone Test (PLTT) which ascertained the quality of speech intelligibility. In addition, patients filled out a questionnaire on postoperative stress and anticipated stigmatisation with regard to their changed voice. Results demonstrated that patients who had early speech rehabilitation felt significantly more active and, in general, felt considerably better than patients who had not received speech rehabilitation training. Patients assessed voice loss as extremely distressing. The postoperative stress and the anticipated stigmatisation on the basis of the changed voice was significantly higher in those patients with good speech intelligibility than in patients with poor speech articulation at hospital discharge. The coping strategies "Giving up and resignation" and "Need for social support" correlated positively with postoperative stress and anticipated stigmatisation. Results show that early speech rehabilitation with voice prostheses had a positive effect on the emotional state of laryngectomy patients. However, the early speech rehabilitation leads to distress in the initial phase in laryngectomy patients. Moreover, patients who habitually tend towards resignation, or need lots of social support should receive psychological support during the early phase of speech rehabilitation training.

  14. Helicopter Scene Response for Stroke Patients: A 5-Year Experience.

    Science.gov (United States)

    Hawk, Andrew; Marco, Catherine; Huang, Matt; Chow, Bonnie

    The purpose of this study was to examine the usefulness of an emergency medical service (EMS)-requested air medical helicopter response directly to the scene for a patient with clinical evidence of an ischemic cerebrovascular accident (CVA) and transport to a regional comprehensive CVA center. CareFlight, an air medical critical care transportation service, is based in Dayton, OH. The 3 CareFlight helicopters are geographically located and provided transport to all CVA scene patients in this study. A retrospective chart review was completed for all CareFlight CVA scene flights for 5 years (2011-2015). A total of 136 adult patients were transported. EMS criteria included CVA symptom presence for less than 3 hours or awoke abnormal, nonhypoglycemia, and a significantly positive Cincinnati Prehospital Stroke Scale. The majority of patients (75%) met all 3 EMS CVA scene criteria; 27.5% of these patients received peripheral tissue plasminogen activator, and 9.8% underwent a neurointerventional procedure. Using a 3-step EMS triage for acute CVA, air medical transport from the scene to a comprehensive stroke center allowed for the timely administration of tissue plasminogen activator and/or a neurointerventional procedure in a substantive percentage of patients. Further investigation into air medical scene response for acute stroke is warranted. Copyright © 2016 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  15. Quantitative measures of spasticity in post-stroke patients.

    Science.gov (United States)

    Pisano, F; Miscio, G; Del Conte, C; Pianca, D; Candeloro, E; Colombo, R

    2000-06-01

    Quantitative evaluation of muscle tone in post-stroke patients; correlation of biomechanical indices with conventional clinical scales and neurophysiological measures; characterization of passive and neural components of muscle tone. Mechanical stretches of the wrist flexor muscles of 53 post-stroke patients were imposed by means of a torque motor at constant speed. Patients were clinically studied using the Ashworth scale for spasticity and the Medical Research Council score for residual muscle strength. The neurophysiological measures were Hoffmann reflex latency, Hmax/Mmax ratio, stretch reflex threshold speed (SRTS), stretch reflex (SR) latency and area, passive (ISI) and total (TSI) stiffness indices. Hmax/Mmax ratio, SR area, ISI and TSI values were significantly higher in patients, while SRTS was significantly lower. TSI, SRTS and SR area were highly correlated to the Ashworth score. This EMG-biomechanical technique allows an objective evaluation of changes in muscle tone in post-stroke patients, providing easily measurable, quantitative indices of muscle stiffness. The linear distribution of these measures is particularly indicated for monitoring changes induced by treatment. The apparatus seems suitable to characterize neural stiffness, while difficulties were found in isolating the passive components, because of the occurrence of tonic EMG activity in most spastic patients.

  16. Variations in Kinematics during Clinical Gait Analysis in Stroke Patients

    Science.gov (United States)

    Boudarham, Julien; Roche, Nicolas; Pradon, Didier; Bonnyaud, Céline; Bensmail, Djamel; Zory, Raphael

    2013-01-01

    In addition to changes in spatio-temporal and kinematic parameters, patients with stroke exhibit fear of falling as well as fatigability during gait. These changes could compromise interpretation of data from gait analysis. The aim of this study was to determine if the gait of hemiplegic patients changes significantly over successive gait trials. Forty two stroke patients and twenty healthy subjects performed 9 gait trials during a gait analysis session. The mean and variability of spatio-temporal and kinematic joint parameters were analyzed during 3 groups of consecutive gait trials (1–3, 4–6 and 7–9). Principal component analysis was used to reduce the number of variables from the joint kinematic waveforms and to identify the parts of the gait cycle which changed during the gait analysis session. The results showed that i) spontaneous gait velocity and the other spatio-temporal parameters significantly increased, and ii) gait variability decreased, over the last 6 gait trials compared to the first 3, for hemiplegic patients but not healthy subjects. Principal component analysis revealed changes in the sagittal waveforms of the hip, knee and ankle for hemiplegic patients after the first 3 gait trials. These results suggest that at the beginning of the gait analysis session, stroke patients exhibited phase of adaptation,characterized by a “cautious gait” but no fatigue was observed. PMID:23799100

  17. Management of swallowing in thrombolysed stroke patients: Implementation of a new protocol.

    Science.gov (United States)

    Schwarz, Maria; Coccetti, Anne; Cardell, Elizabeth; Murdoch, Allison; Davis, Jennifer

    2017-12-01

    There is a paucity of evidence regarding dysphagia management post-thrombolysis. The aim of this case-control study was to evaluate the impact of a dysphagia management protocol on patient outcomes. Thrombolysis has been completed at our metropolitan hospital since 2011 and a dysphagia management protocol was developed in 2012. Chart auditing was completed for 83 participants in three groups: pre-protocol (n = 12) (2011), post-protocol (n = 28) (2012-2014), and non-thrombolysed stroke patients (n = 43). Following the implementation of this clinical protocol, the average time patient remained nil by mouth reduced by 9.5 h, the percentage of patients who were malnourished or at risk reduced by 24% and the number of patients who developed aspiration pneumonia reduced by 11%. The cost of hospital stay reduced by $1505. Service compliance with best practice in dysphagia management in thrombolysed patients increased from 67% to 96% in the thrombolysed patient groups. The outcomes suggest that a clinical protocol for dysphagia management in thrombolysed patients has the potential to improve service outcomes, reduce complications from dysphagia, have financial benefits for the hospital and increase service compliance. Furthermore, the results lend support for speech pathology services to manage dysphagia on weekends.

  18. Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

    Science.gov (United States)

    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.

  19. Stroke subtypes and comorbidity among ischemic stroke patients in Brasilia and Cuenca: a Brazilian-Spanish cross-cultural study.

    Science.gov (United States)

    Carod-Artal, Francisco Javier; Casanova Lanchipa, Jardiel Omar; Cruz Ramírez, Luis Miguel; Pérez, Noelia Sánchez; Siacara Aguayo, Fátima M; Moreno, Isabel Gómez; Romero, Lourdes Gómez; Coral, Luciene Ferreira; Trizotto, Daniele Stieven; Moreira, Clarissa Menezes

    2014-01-01

    With the increase in life expectancy worldwide, changes in stroke subtypes and burden of stroke population are expected in both developing and developed countries. Prevalence of stroke subtypes and comorbidity in ischemic stroke patients was assessed in Brasilia, Brazil, and Cuenca, Spain. This was an international (Brazilian-Spanish) cross-sectional study. Stroke subtypes were assessed by means of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Modified Rankin scale was used to measure functional recovery and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was used to assess comorbidity. A total of 500 patients (mean age 66.2 ± 16.4 years; 48% female; 48.2% Spanish) were included in the study. Spanish patients were significantly older than Brazilian ones (76.4 ± 11.2 versus 56.7 ± 14.6 years; P < .0001). Prevalence of ischemic cardiopathy (20.3% versus 6.2%) and atrial fibrillation (25.7% versus 6.6%) was significantly higher in Spanish stroke patients, whereas they less frequently used tobacco (28.3% versus 52.9%); P less than .0001. Prevalence of stroke subtypes in Spanish and Brazilian stroke patients was: stroke of undetermined etiology (58.1% versus 32.4%), cardioembolism (24.5% versus 11.6%), lacunar infarct (11.6% versus 25.5%), atherothrombotic (3.7% versus 19.7%), and other causes (2.1% versus 10.8%); P less than .0001. The Spanish sample had a significantly higher frequency of comorbidities. The CIRS-G total score and CIRS-G mean number of affected organs significantly increased with age, and correlated with the level of functional dependence as measured by Rankin scale (rS = 0.50; P = .0005). Spanish stroke people had a higher frequency of comorbid conditions, atrial fibrillation, and cardioembolism and these facts were associated with age. Atherothrombotic and lacunar strokes were more common in the younger Brazilian stroke population. Copyright © 2014 National Stroke Association. Published by Elsevier

  20. Speech Entrainment Compensates for Broca's Area Damage

    Science.gov (United States)

    Fridriksson, Julius; Basilakos, Alexandra; Hickok, Gregory; Bonilha, Leonardo; Rorden, Chris

    2015-01-01

    Speech entrainment (SE), the online mimicking of an audiovisual speech model, has been shown to increase speech fluency in patients with Broca's aphasia. However, not all individuals with aphasia benefit from SE. The purpose of this study was to identify patterns of cortical damage that predict a positive response SE's fluency-inducing effects. Forty-four chronic patients with left hemisphere stroke (15 female) were included in this study. Participants completed two tasks: 1) spontaneous speech production, and 2) audiovisual SE. Number of different words per minute was calculated as a speech output measure for each task, with the difference between SE and spontaneous speech conditions yielding a measure of fluency improvement. Voxel-wise lesion-symptom mapping (VLSM) was used to relate the number of different words per minute for spontaneous speech, SE, and SE-related improvement to patterns of brain damage in order to predict lesion locations associated with the fluency-inducing response to speech entrainment. Individuals with Broca's aphasia demonstrated a significant increase in different words per minute during speech entrainment versus spontaneous speech. A similar pattern of improvement was not seen in patients with other types of aphasia. VLSM analysis revealed damage to the inferior frontal gyrus predicted this response. Results suggest that SE exerts its fluency-inducing effects by providing a surrogate target for speech production via internal monitoring processes. Clinically, these results add further support for the use of speech entrainment to improve speech production and may help select patients for speech entrainment treatment. PMID:25989443

  1. Speech-activated Myoclonus Mimicking Stuttering in a Patient with Myoclonus–Dystonia Syndrome

    Directory of Open Access Journals (Sweden)

    Peter Hedera

    2016-07-01

    Full Text Available Background: Acquired neurogenic stuttering has been considered a fairly uncommon clinical occurrence; speech-activated myoclonus is a rare entity that can mimic stuttering and is caused by a wide array of etiologies.Case Report: Here we report a patient with myoclonus–dystonia syndrome (MDS, due to an identified disease-causing mutation, who displayed speech-activated myoclonus mimicking stuttering.Discussion: In MDS, myoclonus has only infrequently been reported to affect speech. This case further expands the spectrum of conditions causing the rare clinical phenomenon of speech-activated myoclonus. 

  2. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Easton, J Donald; Lopes, Renato D; Bahit, M Cecilia

    2012-01-01

    In the ARISTOTLE trial, the rate of stroke or systemic embolism was reduced by apixaban compared with warfarin in patients with atrial fibrillation (AF). Patients with AF and previous stroke or transient ischaemic attack (TIA) have a high risk of stroke. We therefore aimed to assess the efficacy...

  3. Mechanism of troponin elevations in patients with acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, Jesper K.; Atar, Dan; Mickley, Hans

    2007-01-01

    Ischemic heart disease and cerebrovascular diseases frequently co-exist in the same patient, and similar risk factors are shared. For 60 years, experimental, observational, and clinical trial data have incessantly indicated that neurologically induced myocardial injury exists. Since...... the introduction of troponin in the diagnosis of acute myocardial infarction, this marker has been measured in a number of other conditions as well. One of these conditions is acute ischemic stroke, causing diagnostic dilemmas for clinicians. Because various electrocardiographic alterations have also been reported...... in these patients, it has been suggested that elevated troponin levels are somehow neurologically mediated, thus not caused by direct cardiac release. In conclusion, this review examines the available studies that systematically measured troponin in patients with acute ischemic stroke to properly interpret troponin...

  4. Transcranial Direct Current Stimulation Improves Audioverbal Memory in Stroke Patients.

    Science.gov (United States)

    Kazuta, Toshinari; Takeda, Kotaro; Osu, Rieko; Tanaka, Satoshi; Oishi, Ayako; Kondo, Kunitsugu; Liu, Meigen

    2017-08-01

    The aim of this study was to investigate whether anodal transcranial direct current stimulation over the left temporoparietal area improved audioverbal memory performance in stroke patients. Twelve stroke patients with audioverbal memory impairment participated in a single-masked, crossover, and sham-controlled experiment. The anodal or sham transcranial direct current stimulation was applied during the Rey Auditory Verbal Learning Test, which evaluates the ability to recall a list of 15 heard words over five trials. The number of correctly recalled words was compared between the anodal and sham conditions and the influence of transcranial direct current stimulation on serial position effect of the 15 words was also examined. The increase in the number of correctly recalled words from the first to the fifth trial was significantly greater in the anodal condition than in the sham condition (P patients.

  5. Ocular–visual defect and visual neglect in stroke patients – A report from Kathmandu, Nepal

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    Gauri Shankar Shrestha

    2012-01-01

    Conclusion: This study reports the relationship between ocular–visual disorders and stroke. There should be a formal screening for visual problems in stroke patients in hospital and rehabilitation settings.

  6. Relationship between Brain Lesion Location and Aphasia Type in Persian Speaking Patients with Stroke

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    Hossein Rezai

    2011-01-01

    Full Text Available Objective: It has been many years that brain lesion analysis of different aphasia Syndromes has led the foundation to investigate the language representation and organization in the brain. The aim of this study was to examine the relationship between brain lesion location and Broca's aphasia and Wernecke's aphasia in Persian speakers with stroke. Materials & Methods: In a single system design study, from 120 patients with stroke attending Emam Khomeyni and Loghman hospitals, Rofeyde, Karaj neurology, and Tabassom speech clinics and according to the Farsi Aphasia Test (FAT, syntactic comprehension subscale of Bilingual Aphasia Test (BAT, Farsi Aphasia Naming Test, and Apraxia Assessment inventory, only 9 patients with Broca’s aphasia and 2 with Wernicke’s aphasia were qualified to participate in this study. Patients’ brain lesion sites were determined by MRI. Patients with Broca’s aphasia were 5 male and 4 female Wernecke’s aphasia patients were 2 male. Results: External capsule-insula, rolandic operculum, inferior frontal gyrus, (precentral gyrus and postcentarl gyrus, and the anterior part of temporal gyrus were damaged in Broca’s aphasia patients (64±12.51 years old and the lesions of external capsule-insula, posterior part of temporal gyrus, anterior part of temporal gyrus, inferior parietal lobule were observed in Wernicke’s aphasia patients (66±8.48 years old. Conclusion: In no patient with Broca’s aphasia or Wernicke’s aphasia brain lesion confined only to Broca’s area or Wernicke’s area respectively. However, due to the limited number of participants in the present study, the extrapolation of the findings to other subjects with Broca’s or Wernicke’s aphasia would certainly be difficult.

  7. Anthropometric evaluation in diabetic patients with ischemic stroke

    Directory of Open Access Journals (Sweden)

    Holanda Maurus Marques de Almeida

    2006-01-01

    Full Text Available Strokes are one of the most common causes of mortality and long term severe disability. Risk factors for stroke include: age, gender, diabetes mellitus (DM, hypertension, and many others. OBJECTIVE: To evaluate obesity and hypertension in patients affected by acute ischemic stroke. METHOD: We compared the anthropometric variables between type II diabetic patients and non-diabetic patients. We evaluated a total of 60 patients, divided into two groups: 34 non-diabetic patients and a group of 26 type II diabetic subjects. RESULTS: The predominance of obesity, as well as hypertension, was very high among the studied groups, presenting no differences among the waist-hip ratio (WHR values of the study group compared to the ones of the control group. CONCLUSION: The predominance of obesity was very high among the studied groups and there was prevalence the android type obesity. There was no significative difference in the anthropometric evaluation by the measurement of WHR and the waist in the groups.

  8. Pilot assessment of a comfort scale in stroke patients.

    Science.gov (United States)

    Rogeau, Caroline; Beaucamp, Franck; Allart, Etienne; Daveluy, Walter; Rousseaux, Marc

    2014-04-15

    Comfort/discomfort (C/D) is an important factor of quality of life (QoL). Brain damage is a major source of discomfort. We developed a questionnaire for assessing C/D in daily living situations and for identifying the main causes of any discomfort and presented its pilot assessment in a population of stroke patients. The scale is a questionnaire of the patient or caregiver that addresses (i) comfort/discomfort in 15 situations of daily living (including getting dressed, washing, lying in bed and sitting in a chair) and (ii) the roles of physical difficulties, psychological problems and a poorly adapted environment. We analysed its metrological qualities in a group of 62 stroke patients. For the patients, the most uncomfortable activities were eating, dressing the lower body, urine and faeces elimination and walking, and the most significant factors of discomfort were motor impairments, fatigue, limb stiffness, joint pain, depression and anxiety. The reliability was fair for the overall score and for each C/D item and moderate for the impact of impairments on comfort/discomfort. We also found fair internal consistency and convergent validity against measures of functional status, QoL and burden of care. Sensitivity to change over a 6-week period was modest. The scale can help to define difficulties in daily living situations and identify opportunities for intervention in stroke patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Vancomycin Pharmacokinetic Parameters in Patients with Hemorrhagic Stroke.

    Science.gov (United States)

    Morbitzer, Kathryn A; Jordan, J Dedrick; Sullivan, Kelly A; Durr, Emily A; Olm-Shipman, Casey M; Rhoney, Denise H

    2016-10-01

    Infections are a common medical complication in hemorrhagic stroke patients, with vancomycin commonly used as empiric therapy. The purpose of this study was to evaluate the pharmacokinetic parameters of vancomycin in hemorrhagic stroke patients. This was a retrospective study of adult patients with aneurysmal subarachnoid hemorrhage (aSAH) or intracerebral hemorrhage (ICH) admitted between May 2010 and February 2015 who received vancomycin. Predicted pharmacokinetic parameters based on population data were compared with calculated pharmacokinetic parameters based on serum trough concentrations. Eighty aSAH patients and 66 ICH patients met inclusion criteria. In the aSAH group, the mean dosing regimen was 17.6 ± 4 mg/kg every 12 (8-12) h. The mean measured trough concentration was lower than the predicted trough concentration (9.9 ± 4.1 vs. 19 ± 8.7 μg/mL; p hemorrhagic stroke exhibited pharmacokinetic alterations favoring increased elimination of vancomycin when compared to predicted pharmacokinetic parameters based on population data. This may result in underexposure to vancomycin, leading to treatment failure and other medical complications.

  10. Predicting Major Bleeding in Ischemic Stroke Patients With Atrial Fibrillation.

    Science.gov (United States)

    Hilkens, Nina A; Algra, Ale; Greving, Jacoba P

    2017-11-01

    Performance of risk scores for major bleeding in patients with atrial fibrillation and a previous transient ischemic attack or ischemic stroke is not well established. We aimed to validate risk scores for major bleeding in patients with atrial fibrillation treated with oral anticoagulants after cerebral ischemia and explore the net benefit of oral anticoagulants among bleeding risk categories. We analyzed 3623 patients with a history of transient ischemic attack or stroke included in the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). We assessed performance of HEMORR 2 HAGES (hepatic or renal disease, ethanol abuse, malignancy, older age, reduced platelet count or function, hypertension [uncontrolled], anemia, genetic factors, excessive fall risk, and stroke), Shireman, HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly), ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), and ORBIT scores (older age, reduced haemoglobin/haematocrit/history of anaemia, bleeding history, insufficient kidney function, and treatment with antiplatelet) with C statistics and calibration plots. Net benefit of oral anticoagulants was explored by comparing risk reduction in ischemic stroke with risk increase in major bleedings on warfarin. During 6922 person-years of follow-up, 266 patients experienced a major bleed (3.8 per 100 person-years). C statistics ranged from 0.62 (Shireman) to 0.67 (ATRIA). Calibration was poor for ATRIA and moderate for other models. The reduction in recurrent ischemic strokes on warfarin was larger than the increase in major bleeding risk, irrespective of bleeding risk category. Performance of prediction models for major bleeding in patients with cerebral ischemia and atrial fibrillation is modest but comparable with performance in patients with only atrial fibrillation. Bleeding risk scores cannot

  11. Thrombolytic therapy for patients who wake-up with stroke.

    Science.gov (United States)

    Barreto, Andrew D; Martin-Schild, Sheryl; Hallevi, Hen; Morales, Miriam M; Abraham, Anitha T; Gonzales, Nicole R; Illoh, Kachi; Grotta, James C; Savitz, Sean I

    2009-03-01

    Approximately 25% of ischemic stroke patients awaken with their deficits. The last-seen-normal time is defined as the time the patient went to sleep, which places these patients outside the window for thrombolysis. The purpose of this study was to describe our center's experience with off-label, compassionate thrombolysis for wake-up stroke (WUS) patients. A retrospective review of our database identified 3 groups of ischemic stroke patients: (1) WUS treated with thrombolysis; (2) nontreated WUS; and (3) 0- to 3-hour intravenous tissue plasminogen activator-treated patients. Safety and clinical outcome measures were symptomatic intracerebral hemorrhage, excellent outcome (discharge modified Rankin score, 0-1), favorable outcome (modified Rankin score, 0-2), and mortality. Outcome measures were controlled for baseline NIHSS using logistic regression. Forty-six thrombolysed and 34 nonthrombolysed WUS patients were identified. Sixty-one percent (28/46) of the treated WUS patients underwent intravenous thrombolysis alone whereas 30% (14/46) were given only intra-arterial thrombolysis. Four patients received both intravenous and intra-arterial thrombolysis (9%). Two symptomatic intracerebral hemorrhages occurred in treated WUS (4.3%). Controlling for NIHSS imbalance, treated WUS had higher rates of excellent (14% vs 6%; P=0.06) and favorable outcome (28% vs 13%; P=0.006), but higher mortality (15% vs 0%) compared to nontreated WUS. A second comparison controlling for baseline NIHSS between treated WUS and 174 intravenous tissue plasminogen activator patients treated within 3 hours of symptoms showed no significant differences in safety and clinical outcomes. Thrombolysis may be safe in WUS patients. Our center's experience supports considering a prospective, randomized trial to assess the safety and outcome of thrombolysis for this specific patient population.

  12. End of Life Care for Patients Dying of Stroke: A Comparative Registry Study of Stroke and Cancer.

    Science.gov (United States)

    Eriksson, Heléne; Milberg, Anna; Hjelm, Katarina; Friedrichsen, Maria

    2016-01-01

    Although stroke is a significant public health challenge and the need for palliative care has been emphasized for these patients, there is limited data on end-of-life care for patients dying from stroke. To study the end-of-life care during the last week of life for patients who had died of stroke in terms of registered symptom, symptom management, and communication, in comparison with patients who had died of cancer. This study is a retrospective, comparative registry study. A retrospective comparative registry study was performed using data from a Swedish national quality register for end-of-life care based on WHO`s definition of Palliative care. Data from 1626 patients who had died of stroke were compared with data from 1626 patients who had died of cancer. Binary logistic analyses were used to calculate odds ratios, with 95% CI. Compared to patients who was dying of cancer, the patients who was dying of stroke had a significantly higher prevalence of having death rattles registered, but a significantly lower prevalence of, nausea, confusion, dyspnea, anxiety, and pain. In addition, the stroke group had significantly lower odds ratios for health care staff not to know whether all these six symptoms were present or not. Patients who was dying of stroke had significantly lower odds ratio of having informative communication from a physician about the transition to end-of-life care and of their family members being offered bereavement follow-up. The results indicate on differences in end-of-life care between patients dying of stroke and those dying from cancer. To improve the end-of-life care in clinical practice and ensure it has consistent quality, irrespective of diagnosis, education and implementation of palliative care principles are necessary.

  13. Patient-reported symptom questionnaires in laryngeal cancer: Voice, speech and swallowing.

    NARCIS (Netherlands)

    Rinkel, N.P.M.; Verdonck-de Leeuw, I.M.; van den Brakel, N.; de Bree, R.; Eerenstein, S.E.; Aaronson, N.K.; Leemans, C.R.

    2014-01-01

    Objectives To validate questionnaires on voice, speech, and swallowing among laryngeal cancer patients, to assess the need for and use of rehabilitation services, and to determine the association between voice, speech, and swallowing problems, and quality of life and distress. Materials and methods

  14. Patient-reported symptom questionnaires in laryngeal cancer: Voice, speech and swallowing

    NARCIS (Netherlands)

    Rinkel, R.N.P.M.; Verdonck-de Leeuw, I.M.; van den Brakel, N.; de Bree, R.; Eerenstein, S.E.J.; Aaronson, N.K.; Leemans, C.R.

    2014-01-01

    Objectives: To validate questionnaires on voice, speech, and swallowing among laryngeal cancer patients, to assess the need for and use of rehabilitation services, and to determine the association between voice, speech, and swallowing problems, and quality of life and distress. Materials and

  15. Female Caregivers and Stroke Severity Determines Caregiver Stress in Stroke Patients.

    Science.gov (United States)

    Menon, Bindu; Salini, P; Habeeba, K; Conjeevaram, Jyoti; Munisusmitha, K

    2017-01-01

    Stroke is among the major causes of short- and long-term disability. This study aimed to understand the caregivers (CGs) stress in stroke survivors. 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. 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 3/4 th 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 (χ 2 = 15.199, P = 0.002) than males (χ 2 = 11.931, P = 0.018); wives and daughters than other relations (χ 2 = 32.184, P = 0.000), (χ 2 = 35.162, P = 0.019). Our study showed that caregiving burden was predominantly shouldered by females CGs. CGs faced physical, psychological, and socioeconomic burden. The burden was more evident in female CGs and in

  16. Female caregivers and stroke severity determines caregiver stress in stroke patients

    Directory of Open Access Journals (Sweden)

    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

  17. Ischemic Stroke in a Young Patient Heralding a Left Ventricular Noncompaction Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Fanny Lestienne

    2017-08-01

    Full Text Available Strokes in young patients may be the clinical expression of many complex and extremely rare diseases. Uncommon causes constitute less than 5% of all strokes, but are present in 30% of strokes in young patients. We report the case of a young woman whose ischemic stroke led to the diagnosis of a rare embolic cardiomyopathy, left ventricular noncompaction cardiomyopathy, requiring a heart transplant.

  18. Case Study of physioterapy treatment of a patient after hemoragic stroke with left hemiparesis

    OpenAIRE

    Formánková, Dita

    2012-01-01

    Title: Case study of physioterapy treatment of a patient after hemoragic stroke with left hemiparesis. Objectives: The aim of the thesis is to obtain academic findings about stroke concerning anatomy, pathology, therapetuic approaches and methods which can be utilised in cases of stroke. The specific part focuses on the therapeutic care of a patient after hemorragic stroke which was taken during a month practice at Rehabilitation clinic Malvazinky, Medditera s.r.o. Summary: The theory of the ...

  19. Case study of physioterapy treatment of patient after hemoragic stroke with left hemiparesis

    OpenAIRE

    Waldmann, Tadeáš

    2014-01-01

    Title: Case study of physioterapy treatment of a patient after hemoragic stroke with left hemiparesis. Objectives: The aim of the thesis is to obtain academic findings about stroke concerning anatomy, pathology, therapetuic approaches and methods which can be utilised in cases of stroke. The specific part focuses on the therapeutic care of a patient after hemorragic stroke which was taken during a month practice at Regional hospital Kladno Spa Summary: The theory of the thesis discusses anato...

  20. Observational practice of incentive spirometry in stroke patients.

    Science.gov (United States)

    Lima, Íllia N D F; Fregonezi, Guilherme A F; Florêncio, Rêncio B; Campos, Tânia F; Ferreira, Gardênia H

    Stroke may lead to several health problems, but positive effects can be promoted by learning to perform physical therapy techniques correctly. To compare two different types of observational practice (video instructions and demonstration by a physical therapist) during the use of incentive spirometry (IS). A total of 20 patients with diagnosis of stroke and 20 healthy individuals (56±9.7 years) were allocated into two groups: one with observational practice with video instructions for the use of IS and the other with observational practice with demonstration by a physical therapist. Ten attempts for the correct use of IS were carried out and the number of errors and the magnitude of response were evaluated. The statistic used to compare the results was the three-way ANOVA test. The stroke subjects showed less precision when compared to the healthy individuals (mean difference 1.80±0.38) 95%CI [1.02-2.52], pstroke subjects showed more errors with the video instructions (mean difference 1.5±0.5, 95%CI [0.43-2.56] (p=0.08)) and therapist demonstration (mean difference 2.40±0.52, 95%CI [1.29-3.50] (p=0.00)) when compared to the healthy individuals. The stroke subjects had a worse performance in learning the use of volume-oriented incentive spirometry when compared to healthy individuals; however, there was no difference between the types of observational practice, suggesting that both may be used to encourage the use of learning IS in patients with stroke. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  1. A sensorimotor stimulation program for rehabilitation of chronic stroke patients.

    Science.gov (United States)

    de Diego, Cristina; Puig, Silvia; Navarro, Xavier

    2013-01-01

    The hypothesis of this study is that intensive therapy by means of a sensory and motor stimulation program of the upper limb in patients with chronic hemiparesis and severe disability due to stroke increases mobility and sensibility, and improves the use of the affected limb in activities of daily living (ADL). The program consists of 16 sessions of sensory stimulation and functional activity training in the rehabilitation center, and daily sessions of tactile stimulation, mental imaginery and practice of ADL at home, during 8 weeks. An experimental group (EG) of 12 patients followed this program, compared with a control group (CG) of 9 patients under standard rehabilitation. The efficacy of the program was evaluated by Fugl Meyer Assessment (FMA), Motor Activity Log (MAL) and Stroke Impact Scale-16 (SIS-16) scores, and a battery of sensory tests. The results show that in both groups, the motor FMA and the SIS-16 improved during the 8 weeks, this improvement being higher in the EG. Significant improvements were observed for the sensory tests in the EG. The intensive sensorimotor stimulation program for the upper extremity may be an efficacious method for improving function and use of the affected limb in ADL in chronic stroke patients.

  2. The Effect of Anemia on the Functional Outcomes of the Stroke Patients and the Efficiency of their Stroke Rehabilitation.

    Science.gov (United States)

    Chan, Tik; Ganasekaran, Ganesh

    2015-06-01

    There has been limited study focusing on the functional outcomes of stroke patients' after rehabilitation, such as functional improvement and discharge destination, length of stay (LOS), and complication rate. A retrospective study was conducted on 123 consecutive patients who were admitted to The Prince Charles Hospital Rehabilitation Unit from January 2011 to December 2012 with clinically defined stroke syndromes. Functional Independence Measure (FIM) score was used to measure the functional improvement. Anemia is defined by using the World Health Organization's criteria (hemoglobin concentration in men types of stroke were all comparable in both anemic and nonanemic groups. It was found that, when selecting only the patients with ischemic stroke for comparison (103 patients), there was a significantly higher FIM score improvement (discharge FIM - admission FIM) in nonanemic group (P = .042). FIM efficiency (FIM change/LOS) was also significantly higher in the nonanemic group (P = .027). Higher percentage of patients were discharged home in nonanemic group (94.3% versus 73.3%, P = .006). In addition, higher rate of complications was found in anemic group (60% versus 39%, P = .049). Anemia appears to have a significant effect on the functional improvement and discharge outcomes for patients who had an ischemic stroke. Anemia may also increase the complication rate and affect the efficiency of stroke rehabilitation for those patients. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  3. What happens to stroke patients after hospital discharge?

    LENUS (Irish Health Repository)

    Noone, I

    2001-05-01

    Of 231 stroke patients discharged from hospital, 34 patients (14.7%) had died when reviewed 6 months later. Of 195 survivors, 115 (58%) were independent and living in the community. The remaining 80 (42%) patients were dependent. The majority of dependent patients were in institutional care but 29 (36%) were residing in the community of whom a substantial number were not receiving physiotherapy, occupational therapy or day care. Patients who were dependent in nursing homes were less likely to have received physiotherapy (48% versus 70%) or occupational therapy (28% versus 60%) compared to disabled patients in hospital based extended nursing care. 45 patients (24%) had been re-admitted to hospital although only 48% of patients had been reviewed in hospital outpatients since discharge. 64% of patients were on anti-thrombotic treatment. This survey suggests that 6 months after hospital discharge, most stroke patients are still alive and living in the community. Many of the dependent survivors have ongoing unmet medical and rehabilitation needs.

  4. Risk Factors of Ischemic Stroke and Subsequent Outcome in Patients Receiving Hemodialysis.

    Science.gov (United States)

    Findlay, Mark D; Thomson, Peter C; Fulton, Rachael L; Solbu, Marit D; Jardine, Alan G; Patel, Rajan K; Stevens, Kathryn K; Geddes, Colin C; Dawson, Jesse; Mark, Patrick B

    2015-09-01

    End-stage renal disease (ESRD) requiring hemodialysis carries up to a 10-fold greater risk of stroke than normal renal function. Knowledge on risk factors and management strategies derived from the general population may not be applicable to those with ESRD. We studied a large ESRD population to identify risk factors and outcomes for stroke. All adult patients receiving hemodialysis for ESRD from January 1, 2007, to December 31, 2012, were extracted from the electronic patient record. Variables associated with stroke were identified by survival analysis; demographic, clinical, imaging, and dialysis-related variables were assessed, and case-fatality was determined. Follow-up was until December 31, 2013. A total of 1382 patients were identified (mean age, 60.5 years; 58.5% men). The prevalence of atrial fibrillation was 21.2%, and 59.4% were incident hemodialysis patients. One hundred and sixty patients (11.6%) experienced a stroke during 3471 patient-years of follow-up (95% ischemic). Stroke incidence was 41.5/1000 patient-years in prevalent and 50.1/1000 patient-years in incident hemodialysis patients. Factors associated with stroke on regression analysis were prior stroke, diabetes mellitus, and age at starting renal replacement therapy. Atrial fibrillation was not significantly associated with stroke, and warfarin did not affect stroke risk in warfarin-treated patients. Fatality was 18.8% at 7 days, 26.9% at 28 days, and 56.3% at 365 days after stroke. Incidence of stroke is high in patients with ESRD on hemodialysis with high case-fatality. Incident hemodialysis patients had the highest stroke incidence. Many, but not all, important risk factors commonly associated with stroke in the general population were not associated with stroke in patients receiving hemodialysis. © 2015 American Heart Association, Inc.

  5. New standardized nursing cooperation workflow to reduce stroke thrombolysis delays in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Zhou Y

    2017-05-01

    Full Text Available Yan Zhou,1 Zhuojun Xu,2 Jiali Liao,1 Fangming Feng,1 Lai Men,3 Li Xu,2 Yanan He,2 Gang Li2 1Nursing Department, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 2Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 3Paddington Dental Practice, London, UK Objective: We assessed the effectiveness of a new standardized nursing cooperation workflow in patients with acute ischemic stroke (AIS to reduce stroke thrombolysis delays.Patients and methods: AIS patients receiving conventional thrombolysis treatment from March to September 2015 were included in the control group, referred to as T0. The intervention group, referred to as T1 group, consisted of AIS patients receiving a new standardized nursing cooperation workflow for intravenous thrombolysis (IVT at the emergency department of Shanghai East Hospital (Shanghai, People’s Republic of China from October 2015 to March 2016. Information was collected on the following therapeutic techniques used: application or not of thrombolysis, computed tomography (CT time, and door-to-needle (DTN time. A nursing coordinator who helped patients fulfill the medical examinations and diagnosis was appointed to T1 group. In addition, a nurse was sent immediately from the stroke unit to the emergency department to aid the thrombolysis treatment.Results: The average value of the door-to-CT initiation time was 38.67±5.21 min in the T0 group, whereas it was 14.39±4.35 min in the T1 group; the average values of CT completion-to-needle time were 55.06±4.82 and 30.26±3.66 min; the average values of DTN time were 100.43±6.05 and 55.68±3.62 min, respectively; thrombolysis time was improved from 12.8% (88/689 in the T0 group to 32.5% (231/712 in the T1 group (all P<0.01. In addition, the new standardized nursing cooperation workflow decreased the National Institutes of Health Stroke Scale (NIHSS scores at 24 h (P<0

  6. Validation of a new language screening tool for patients with acute stroke: the Language Screening Test (LAST).

    Science.gov (United States)

    Flamand-Roze, Constance; Falissard, Bruno; Roze, Emmanuel; Maintigneux, Lisa; Beziz, Jonathan; Chacon, Audrey; Join-Lambert, Claire; Adams, David; Denier, Christian

    2011-05-01

    Standard aphasia scales such as the Boston Diagnosis Aphasia Evaluation are inappropriate for use in acute stroke. Likewise, global stroke scales do not reliably detect aphasia, and existing brief aphasia screening scales suitable for patients with stroke have several limitations. The objective of this study was to generate and validate a bedside language screening tool, the Language Screening Test, suitable for use in the emergency setting. The Language Screening Test comprises 5 subtests and a total of 15 items. To avoid retest bias, we created 2 parallel versions of the scale. We report the equivalence of the 2 versions, their internal and external validity, and their interrater reliability. We validated the scale by administering it to 300 consecutive patients within 24 hours after admission to our stroke unit and to 104 stabilized patients with and without aphasia using the Boston Diagnosis Aphasia Evaluation as a reference. The 2 versions of the Language Screening Test were equivalent with an intraclass correlation coefficient of 0.96. Internal validity was good; none of the items showed a floor or ceiling effect with no redundancy and good internal consistency (Cronbach α 0.88). External validation against the Boston Diagnosis Aphasia Evaluation showed a sensitivity of 0.98 and a specificity of 1. Interrater agreement was near perfect (intraclass correlation coefficient, 0.998). The median time to complete the Language Screening Test was approximately 2 minutes. Importantly, the Language Screening Test does not need to be administered by a speech and language therapist. This comprehensively validated language rating scale is simple and rapid, making it a useful tool for bedside evaluation of patients with acute stroke in routine clinical practice.

  7. Stroke warning campaigns: delivering better patient outcomes? A systematic review

    Directory of Open Access Journals (Sweden)

    Mellon L

    2015-02-01

    Full Text Available Lisa Mellon,1 Frank Doyle,1 Daniela Rohde,1 David Williams,2 Anne Hickey1 1Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland; 2Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland Background: Patient delay in presenting to hospital with stroke symptoms remains one of the major barriers to thrombolysis treatment, leading to its suboptimal use internationally. Educational interventions such as mass media campaigns and community initiatives aim to reduce patient delays by promoting the signs and symptoms of a stroke, but no consistent evidence exists to show that such interventions result in appropriate behavioral responses to stroke symptoms. Methods: A systematic literature search and narrative synthesis were conducted to examine whether public educational interventions were successful in the reduction of patient delay to hospital presentation with stroke symptoms. Three databases, MEDLINE, CINAHL, and PsycINFO, were searched to identify quantitative studies with measurable behavioral end points, including time to hospital presentation, thrombolysis rates, ambulance use, and emergency department (ED presentations with stroke. Results: Fifteen studies met the inclusion criteria: one randomized controlled trial, two time series analyses, three controlled before and after studies, five uncontrolled before and after studies, two retrospective observational studies, and two prospective observational studies. Studies were heterogeneous in quality; thus, meta-analysis was not feasible. Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a varied magnitude of effect. Eight studies examined thrombolysis rates, with only three studies reporting a statistically significant increase in thrombolysis administration. Five studies examined ambulance usage, and four reported a statistically significant increase in ambulance

  8. Effects of bodyposition on arterial oxygenation in acute stroke patients

    Directory of Open Access Journals (Sweden)

    Ayşe Pınar Titiz

    2008-12-01

    Full Text Available OBJECTIVE: Hypoxemia is an important factor that increases cerebral damage in acute stroke patients. In conjunction with the growing importance of stroke intensive care units, there has been an increase in studies reporting on the correlation between oxygenation and the body position in acute stroke patients with hemiparesis. This study was planned to evaluate the relationship between oxygen saturation (SaO2 and position in acute stroke patients. METHODS: : Acute stroke patients followed in the Neurology Department of Ankara Numune Hospital between July 2000 and June 2001 were included in this study. The SaO2, pulse and blood pressure values were recorded initially, and at the 15th, 30th and 60th minutes in patients lying on either their paretic or healthy side in the lateral decubitus position on the 1st, 3rd and 7th days. Characteristics of the lesions were determined on computerized tomography (CT. Clinical parameters (consciousness, degree of paresis, functional disability, coma scores, and prognosis were also recorded. RESULTS: The 50 patients (19 male, 31 female included in this study with the diagnosis of acute stroke had a mean age of 68.32±12.02. CT imaging revealed hematoma in 19 of the patients, infarct in 30 and hemorrhagic infarct in 1. Arterial oxygen saturation (SaO2 values of the subjects recorded initially and at the 15th, 30th and 60th min from the healthy side in the lateral decubitus position in the first day of stroke were found to be higher than the paretic side (p<0.05 initially; p=0.002 15th min; p=0.013 30th min; and p=0.024 60th min. In female patients, SaO2 values were found to be lower than male patients in both recumbent positions (p=0.017 and p=0.020. SaO2 values in the hematoma group were lower than in the infarct group (p=0.038. SaO2 values of patients who died were lower than of those alive on the 3rd day (p=0.013 initially; p=0.012 30th min; p=0.020 60th min. SaO2 values in the sustained recumbent position

  9. The Frequency of Fabry Disease among Young Cryptogenic Stroke Patients in the City of Sakarya.

    Science.gov (United States)

    Gündoğdu, Aslı Aksoy; Kotan, Dilcan; Alemdar, Murat

    2017-06-01

    Fabry disease (FD) is known as a rare cause of stroke. Recent studies suggested that FD is an underdiagnosed entity among young stroke patients. We aimed to investigate the frequency of FD in young cryptogenic stroke patients who lived in the City of Sakarya and to define the clinical features that help in recognizing patients with FD. Acute ischemic stroke patients aged 18-55 years who were admitted to our hospital between October 2013 and September 2016 were evaluated for inclusion. Patients with other recognized causes of stroke were excluded. The screening was performed for alpha-galactosidase A (α-Gal A) activity on dried blood spot, and DNA was sequenced for GLA mutation in patients with low plasma α-Gal A activity. Among the 484 acute ischemic stroke patients, 54 (24 male, 44.4%) young cryptogenic stroke patients were enrolled. The α-Gal A activity was detected as low in 3 patients. c.[680G > A] p.[R227Q] missense mutation was identified in 2 male patients. The frequency of FD was calculated as 3.7%. Our research is the first FD screening study in Turkish stroke patients. Our results underlined the importance of considering FD during the etiologic evaluation of young cryptogenic stroke patients as it is a rare but potentially treatable entity. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Emotional reactions in patients after frontal lobe stroke

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    Stojanović Zlatan

    2015-01-01

    Full Text Available Background/Aim. Emotional reactions have been documented after tumor lesions and the other damages of the brain. The aim of this paper was to examine the correlation between frontal lobe lesions and emotional reactions in patients with stroke. Methods. The research included 118 patients after stroke. Lesion localization was defined on computed axial tomography records, whereas the area and perimeter of lesion were measured by AutoCAD 2004 software. Examinations by means of the Hamilton Rating Scale for Anxiety and Depression (HRSA and HRSD were carried out 11-40 days after stroke. Statistic data were processed by simple linear/nonlinear regression, Cox's and the generalized linear model. Results. A higher frequency of emotional reactions, i.e. anxiety, was determined in women after stroke (p = 0.024. A negative correlation between the lesion size and the intensity of anxiety manifestations was determined (Spearman’s r = -0.297; p = 0.001. Anxiety was more frequent in patients with frontal lobe lesions in the dominant hemisphere (interaction: frontal lesion * hand dominant hemisphere, p = 0.017. Also, HRSD score values showed the tendency for lesser decline in case of greater frontal lobe lesions in relation to lesions of other regions of prosencephalon (interaction: frontal lesion * lesion area, p = 0.001. Conclusion. The results of this study indicate the correlation between evolutionary younger structures of the central nervous system and emotional reactions of man. Therefore, it is necessary to undertake proper early psychopharmacotherapy in the vulnerable group of patients.

  11. The post-stroke depression and its impact on functioning in young and adult stroke patients of a rehabilitation unit.

    Science.gov (United States)

    Amaricai, Elena; Poenaru, Dan V

    2016-01-01

    Stroke is a leading cause of disability and a major public health problem. To determine frequency and degree of post-stroke depression (PSD) and its impact on functioning in young and adult stroke patients in a rehabilitation unit. The study included 72 stroke patients (aged 29-59 years) who were attending rehabilitation. The patients were assessed for depressive symptoms by Beck Depression Inventory (BDI), and their functioning by using the Stroke Impact Scale (SIS) and the Barthel Index of Activities of Daily Living (ADL). Forty-eight patients had different degrees of depression: borderline clinical depression (13.8%), moderate depression (34.7%), severe depression (15.2%) or extreme depression (2.9%). There were no significant differences of BDI scores in 30-39, 40-49 and 50-59 years groups. Statistically significant correlations were between BDI score and SIS score, between BDI score and ADL index, and between SIS score and ADL index in men, women and total study patients. More than half of the PSD patients had a moderate degree of depression. Significant correlations were noticed between depressive symptoms and functional status evaluated both by an instrument of assessing stroke impact upon general health and an instrument for assessing the everyday activities.

  12. EFFECTIVENESS OF MIRROR THERAPY ON HANDFUNCTIONS IN SUBACUTE STROKE PATIENTS

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    Venkatanaga Prahalada Karnati

    2015-08-01

    Full Text Available Background: Mirror therapy is a relatively new therapeutic intervention that focuses on moving the unimpaired limb. In stroke patients, it involves performing movements of the unimpaired limb while watching its mirror reflection superimposed over the (unseen impaired limb, thus creating a visual illusion of enhanced movement capability of the impaired limb. The aim of this study was to evaluate the effects of mirror therapy on upper extremity motor recovery, spasticity and hand related functions of patients with sub-acute stroke. Methods: The clinical trial was conducted at the department of Physiotherapy (SIMS College of Physiotherapy, Guntur, for the duration of 6 weeks. Thirty patients divided into two groups: Group A: Experimental treated with mirror therapy along with conventional therapy and Group B: Control group treated with conventional physiotherapy only. Data analyzed using SPSS, Mean, SD and T test for independent samples used. Results: Comparison of pre-treatment and post treatment scores of experimental group of Brunnstrom stages showed extremely significant; while the control groupconsidered not significant. For Modified Ashworth Scale the pretreatment and post, treatment scores of experimental and control groupswere extremely significant. In addition, Functional Independence Measure showed extremely significant for experimental group and not significant for the control group. Conclusions: Mirror therapy shared and a predictable rehabilitation program enhanced upper-extremity motor recovery and functioning in our sub-acute stroke inpatients. It is beneficial in improving the effects and outcome on upper extremity motor recovery and function.

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

    Science.gov (United States)

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

    2017-04-01

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

  14. Changes of motor recovery in chronic stroke patients

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    Rodríguez-Lázaro, Álvaro Enrique

    2016-04-01

    Full Text Available Introduction: Few studies have evaluated changes in motor recovery during the chronic phase of stroke. Objective: To determine changes in motor function in chronic stroke survivors. Materials and methods: A retrospective-descriptive analysis was done of the records of 47 patients with motor sequelae of stroke with clinical evolution longer than 6 months (average: 8 months. Functional changes obtained between two consecutive records (average time between assessments: 6 months in scores of Fugl-Meyer Motor Scale (FM, Box and Block Test, PASS, Modified Rankin Scale (MRS, Barthel Index, Composite Functional Index, Modified Ashworth Scale were analyzed. Results: The whole group had significant changes toward functional motor recovery in all scales (p < 0.01, except for the FM in the lower limb. However, the sizes of the effect were small. In patients with evolution longer than 12 months, both the size of effects and statistical significance diminished. Conclusion: After six months of evolution, patients with motor sequelae of CVA show small changes toward functional motor recovery, which are statistically significant until twelve months.

  15. Robotic Technologies and Rehabilitation: New Tools for Stroke Patients' Therapy

    Science.gov (United States)

    Poli, Patrizia; Morone, Giovanni; Rosati, Giulio; Masiero, Stefano

    2013-01-01

    Introduction. The role of robotics in poststroke patients' rehabilitation has been investigated intensively. This paper presents the state-of-the-art and the possible future role of robotics in poststroke rehabilitation, for both upper and lower limbs. Materials and Methods. We performed a comprehensive search of PubMed, Cochrane, and PeDRO databases using as keywords “robot AND stroke AND rehabilitation.” Results and Discussion. In upper limb robotic rehabilitation, training seems to improve arm function in activities of daily living. In addition, electromechanical gait training after stroke seems to be effective. It is still unclear whether robot-assisted arm training may improve muscle strength, and which electromechanical gait-training device may be the most effective for walking training implementation. Conclusions. In the field of robotic technologies for stroke patients' rehabilitation we identified currently relevant growing points and areas timely for developing research. Among the growing points there is the development of new easily transportable, wearable devices that could improve rehabilitation also after discharge, in an outpatient or home-based setting. For developing research, efforts are being made to establish the ideal type of treatment, the length and amount of training protocol, and the patient's characteristics to be successfully enrolled to this treatment. PMID:24350244

  16. Knowledge of stroke risk factors among primary care patients with previous stroke or TIA: a questionnaire study

    Directory of Open Access Journals (Sweden)

    Strender Lars-Erik

    2010-06-01

    Full Text Available Abstract Background Survivers of stroke or transient ischaemic attacks (TIA are at risk of new vascular events. Our objective was to study primary health care patients with stroke/TIA regarding their knowledge about risk factors for having a new event of stroke/TIA, possible associations between patient characteristics and patients' knowledge about risk factors, and patients' knowledge about their preventive treatment for stroke/TIA. Methods A questionnaire was distributed to 240 patients with stroke/TIA diagnoses, and 182 patients (76% responded. We asked 13 questions about diseases/conditions and lifestyle factors known to be risk factors and four questions regarding other diseases/conditions ("distractors". The patients were also asked whether they considered each disease/condition to be one of their own. Additional questions concerned the patients' social and functional status and their drug use. The t-test was used for continuous variables, chi-square test for categorical variables, and a regression model with variables influencing patient knowledge was created. Results Hypertension, hyperlipidemia and smoking were identified as risk factors by nearly 90% of patients, and atrial fibrillation and diabetes by less than 50%. Few patients considered the distractors as stroke/TIA risk factors (3-6%. Patients with a family history of cardiovascular disease, and patients diagnosed with carotid stenosis, atrial fibrillation or diabetes, knew these were stroke/TIA risk factors to a greater extent than patients without these conditions. Atrial fibrillation or a family history of cardiovascular disease was associated with better knowledge about risk factors, and higher age, cerebral haemorrhage and living alone with poorer knowledge. Only 56% of those taking anticoagulant drugs considered this as intended for prevention, while 48% of those taking platelet aggregation inhibitors thought this was for prevention. Conclusions Knowledge about hypertension

  17. Impaired Feedforward Control and Enhanced Feedback Control of Speech in Patients with Cerebellar Degeneration.

    Science.gov (United States)

    Parrell, Benjamin; Agnew, Zarinah; Nagarajan, Srikantan; Houde, John; Ivry, Richard B

    2017-09-20

    The cerebellum has been hypothesized to form a crucial part of the speech motor control network. Evidence for this comes from patients with cerebellar damage, who exhibit a variety of speech deficits, as well as imaging studies showing cerebellar activation during speech production in healthy individuals. To date, the precise role of the cerebellum in speech motor control remains unclear, as it has been implicated in both anticipatory (feedforward) and reactive (feedback) control. Here, we assess both anticipatory and reactive aspects of speech motor control, comparing the performance of patients with cerebellar degeneration and matched controls. Experiment 1 tested feedforward control by examining speech adaptation across trials in response to a consistent perturbation of auditory feedback. Experiment 2 tested feedback control, examining online corrections in response to inconsistent perturbations of auditory feedback. Both male and female patients and controls were tested. The patients were impaired in adapting their feedforward control system relative to controls, exhibiting an attenuated anticipatory response to the perturbation. In contrast, the patients produced even larger compensatory responses than controls, suggesting an increased reliance on sensory feedback to guide speech articulation in this population. Together, these results suggest that the cerebellum is crucial for maintaining accurate feedforward control of speech, but relatively uninvolved in feedback control. SIGNIFICANCE STATEMENT Speech motor control is a complex activity that is thought to rely on both predictive, feedforward control as well as reactive, feedback control. While the cerebellum has been shown to be part of the speech motor control network, its functional contribution to feedback and feedforward control remains controversial. Here, we use real-time auditory perturbations of speech to show that patients with cerebellar degeneration are impaired in adapting feedforward control of

  18. A framework of counseling for patients with stroke in nursing: a narrative literature review.

    Science.gov (United States)

    Oikarinen, Anne; Kääriäinen, Maria; Kyngäs, Helvi

    2014-10-01

    Stroke is a major cause of death in developed countries. Its prevalence and disability burden are expected to increase in the future because of an aging population. The consequences of stroke are specific to the individual. Whereas some patients experience long-term functional and cognitive deficits, others may recover completely and be discharged quickly. Counseling is needed to help patients and their families cope with the effects of stroke after discharge. This is a systematic literature review with a narrative analysis. The purpose was to describe the content and characteristics of stroke patients' counseling. A review of studies published between January 2000 and February 2013 describing stroke patients' counseling was conducted by CINAHL and Medline databases. Studies were selected based on inclusion criteria, and the quality of the included studies was assessed. The final data (n = 33) were extracted and synthesized. Seven prominent themes were identified in the literature relating to (a) information about the disease and concerns regarding stroke, (b) the aims of counseling, (c) counseling methods, (d) interaction as a method for counseling, (e) the stroke nurse as a counselor, (f) emotional support, and (g) decision making in patients' care. The results of the review show that stroke patients' counseling is a multifaceted phenomenon with distinctive characteristics. The findings of the review can be used to develop counseling for patients with stroke and their families. In addition, the review can be used when educating stroke nurses for stroke units.

  19. Mutations of the GLA gene in young patients with stroke: the PORTYSTROKE study--screening genetic conditions in Portuguese young stroke patients.

    Science.gov (United States)

    Baptista, Miguel Viana; Ferreira, Susana; Pinho-E-Melo, Teresa; Carvalho, Marta; Cruz, Vítor T; Carmona, Cátia; Silva, Fernando A; Tuna, Assunção; Rodrigues, Miguel; Ferreira, Carla; Pinto, Ana A N; Leitão, André; Gabriel, João Paulo; Calado, Sofia; Oliveira, João Paulo; Ferro, José M

    2010-03-01

    Fabry disease is an X-linked monogenic disorder caused by mutations in the GLA gene. Recent data suggest that stroke in young adults may be associated with Fabry disease. We aimed to ascertain the prevalence of this disorder among young adult patients with stroke in Portugal by GLA genotyping. During 1 year, all patients aged 18 to 55 years with first-ever stroke, who were admitted into any of 12 neurology hospital departments in Portugal, were prospectively enrolled (n=625). Ischemic stroke was classified according to Trial of Org 10172 in Acute Stroke Treatment criteria. Alpha-galactosidase activity was further assayed in all patients with GLA mutations. Four hundred ninety-three patients (mean age, 45.4 years; 61% male) underwent genetic analyses: 364 with ischemic stroke, 89 with intracerebral hemorrhage, 26 with subarachnoid hemorrhage, and 14 with cerebral venous thrombosis. Twelve patients had missense GLA mutations: 9 with ischemic stroke (p.R118C: n=4; p.D313Y: n=5), including 5 patients with an identified cause of stroke (cardiac embolism: n=2; small vessel disease: n=2; other cause: n=1), 2 with intracerebral hemorrhage (p.R118C: n=1; p.D313Y: n=1), and one with cerebral venous thrombosis (p.R118C: n=1). Leukocyte alpha-galactosidase activity was subnormal in the hemizygous males and subnormal or low-normal in the heterozygous females. Estimated prevalence of missense GLA mutations was 2.4% (95% CI, 1.3% to 4.1%). Despite a low diagnostic yield, screening for GLA mutations should probably be considered in different types of stroke. Restricting investigation to patients with cryptogenic stroke may underestimate the true prevalence of Fabry disease in young patients with stroke.

  20. Increased risk of posterior circulation infarcts among ischemic stroke patients with cervical spondylosis

    Science.gov (United States)

    Chen, Chih-Chi; Chung, Chia-Ying; Lee, Tsong-Hai; Chang, Wei-Han; Tang, Simon FT; Pei, Yu-Cheng

    2015-01-01

    Background Cervical spondylosis is one of the extrinsic factors causing vertebral artery stenosis. Several case studies have reported compression of the vertebral artery induced by cervical osteophytes that has resulted in posterior circulation infarcts (POCI). However, to the best of our knowledge, no studies have yet analyzed differences in the risk factors and stroke subtypes between ischemic stroke patients with cervical spondylosis and those without. Purpose In the case-controlled study reported here, we analyzed the risk factors and stroke subtypes in ischemic stroke patients with and without cervical spondylosis. Characteristics in all the recruited patients with POCI and non-POCI were further compared to extract other risk factors that could predict the occurrence of POCI. Methods and patients We filtered out ischemic stroke patients with cervical spondylosis (“Stroke+C” group) by International Classification of Diseases, Ninth Revision codes. We analyzed the data of 38 subjects in the Stroke+C group and 152 sex- and age-comparable ischemic stroke patients without cervical spondylosis (“Stroke−C” group). We recorded the demographic characteristics including sex and age, and stroke risk factors, including diabetes mellitus, hypertension, heart disease, hyperlipidemia, and smoking habits. The stroke classifications were defined by the Oxford Community Stroke Project classification. All subjects were further categorized into POCI or non-POCI groups. The ultrasound findings of the vertebral arteries (extracranial and intracranial) in the Stroke+C group were also recorded. Results More patients in the Stroke+C group tended to have POCI (34.2%) than patients in the Stroke−C group (17.5%) (odds ratio [OR] =2.41, Pspondylosis (OR=2.41, Pspondylosis are more prone to POCI than those without cervical spondylosis. Hypertension is another identified risk factor for POCI in ischemic stroke patients. The occurrence of POCI should be highlighted for patients

  1. Communication impairment and activity limitation in stroke patients with severe aphasia.

    Science.gov (United States)

    Darrigrand, Benedicte; Dutheil, Sabine; Michelet, Valerie; Rereau, Stephanie; Rousseaux, Marc; Mazaux, Jean-Michel

    2011-01-01

    This study investigated how patients with severe aphasia communicated in daily living, which verbal and non-verbal communication skills were spared and which were impaired, and whether activity limitations in communication are related to verbal impairments. Twenty-seven patients with severe aphasia and 9 with moderate aphasia originating from a sample of 102 aphasic persons followed up in a French regional survey were assessed with a communication test and a communication activity limitation questionnaire 12-18 months after a first stroke. Patients with severe aphasia suffered severe activity limitations in communication, with performance 3-fold lower than that of patients with moderate aphasia, and 4-fold lower than scores attained by normals. Both aphasia severity and communication disability at follow-up were related to the initial severity of aphasia. Using a phone, credit card and a chequebook, reading and filling in administrative documents, and communication behaviours involved in social life were the most severely impaired. Non-verbal communication performance was not related to aphasia severity. We conclude that there is a great need for speech therapy research to develop new compensatory or alternative strategies for patients with severe aphasia.

  2. An Investigation of the Use of Traditional Chinese Medicine in Stroke Patients in Taiwan

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    Chien-Chang Liao

    2012-01-01

    Full Text Available Background. The use of complementary and alternative medicine in critical illness is increasing worldwide. This study investigates how traditional Chinese medicine (TCM is used in stroke patients. Methods. Using Taiwan National Health Insurance reimbursement claims, we compared the annual use of TCM between stroke patients and general population, identifying 15,330 patients with a new onset of stroke in 2000–2009. The sociodemographic status and medical comorbidities between stroke patients receiving TCM services and those without using the service were compared. Results. The use of TCM was higher in stroke patients than in the general population, 27.9% versus 25.4% in 2000 and 32.7% versus 27.8% in 2009, respectively, and grew consistently from 2000 to 2009. Among stroke patients, women, younger patients, white-collar employees, higher-income residents, and those living in areas with more TCM physicians were more likely to use TCM. Stroke patients using rehabilitation services were more likely to have more TCM visits (OR = 2.28, 95% CI = 1.96–2.66 and higher expenditure on TCM (OR = 2.67, 95% CI = 2.29–3.12 compared with stroke patients without rehabilitation. Conclusion. TCM is popular and well accepted in Taiwan. Patients with stroke have a higher TCM utilization rate than people without stroke.

  3. Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment

    DEFF Research Database (Denmark)

    Simonsen, Sofie; Andresen, Morten; Michelsen, Lene

    2014-01-01

    BackgroundEffective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during...

  4. The prevalence of HIV among patients admitted with stroke at the ...

    African Journals Online (AJOL)

    Stroke and HIV infection are both common medical problems in the day to day clinical practice. Although data from developed countries confirm HIV infection as a risk for stroke the exact underlying mechanism is still unclear. Little data exist on the magnitude of HIV among patients with stroke in Tanzania.

  5. Predicting outcome in patients with chronic stroke: findings of a 3-year follow-up study

    NARCIS (Netherlands)

    Port, I.G.L. van de

    2006-01-01

    This thesis is based on the findings of the FuPro-Stroke study (the Stroke section of the Functional Prognostification and disability study on neurological disorders), which is a multicentre, prospective cohort study among patients with stroke, who were included during inpatient rehabilitation. The

  6. Stroke in patients with diabetes mellitus: a study from North Western ...

    African Journals Online (AJOL)

    Method: Out of all stroke patients seen from June 2007 to February 2011, persons with diabetes mellitus presenting with stroke in the emergency unit of the two ... of data on the prevalence of diabetes in Nigeria. How- ever, available data ... were treated in accordance with Aminu Kano Teaching. Hospital guideline on stroke ...

  7. Case fatality of patients with stroke over a 12-month period post ...

    African Journals Online (AJOL)

    Introduction. Stroke is among the top 4 causes of death in South Africa and the top 10 leading causes of disability worldwide. There is a dearth of literature on stroke incidence, prevalence and outcome in sub-Saharan Africa. We aimed to establish the case fatality of stroke patients over a 12-month period post discharge ...

  8. Reconstruction of normal sounding speech for laryngectomy patients through a modified CELP codec.

    Science.gov (United States)

    Sharifzadeh, Hamid Reza; McLoughlin, Ian V; Ahmadi, Farzaneh

    2010-10-01

    Whispered speech can be useful for quiet and private communication, and is the primary means of unaided spoken communication for many people experiencing voice-box deficiencies. Patients who have undergone partial or full laryngectomy are typically unable to speak anything more than hoarse whispers, without the aid of prostheses or specialized speaking techniques. Each of the current prostheses and rehabilitative methods for post-laryngectomized patients (primarily oesophageal speech, tracheo-esophageal puncture, and electrolarynx) have particular disadvantages, prompting new work on nonsurgical, noninvasive alternative solutions. One such solution, described in this paper, combines whisper signal analysis with direct formant insertion and speech modification located outside the vocal tract. This approach allows laryngectomy patients to regain their ability to speak with a more natural voice than alternative methods, by whispering into an external prosthesis, which then, recreates and outputs natural-sounding speech. It relies on the observation that while the pitch-generation mechanism of laryngectomy patients is damaged or unusable, the remaining components of the speech production apparatus may be largely unaffected. This paper presents analysis and reconstruction methods designed for the prosthesis, and demonstrates their ability to obtain natural-sounding speech from the whisper-speech signal using an external analysis-by-synthesis processing framework.

  9. Blood microRNAs in Low or No Risk Ischemic Stroke Patients

    Directory of Open Access Journals (Sweden)

    Jun Rong Tan

    2013-01-01

    Full Text Available Ischemic stroke is a multi-factorial disease where some patients present themselves with little or no risk factors. Blood microRNA expression profiles are becoming useful in the diagnosis and prognosis of human diseases. We therefore investigated the blood microRNA profiles in young stroke patients who presented with minimal or absence of risk factors for stroke such as type 2 diabetes, dyslipidemia and hypertension. Blood microRNA profiles from these patients varied with stroke subtypes as well as different functional outcomes (based on modified Rankin Score. These microRNAs have been shown to target genes that are involved in stroke pathogenesis. The findings from our study suggest that molecular mechanisms in stroke pathogenesis involving low or no risk ischemic stroke patients could differ substantially from those with pre-existing risk factors.

  10. SECONDARY PREVENTION OF STROKE IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION: THE CLINICIANS’ VIEWPOINT

    Directory of Open Access Journals (Sweden)

    E. A. Drozdova

    2015-09-01

    Full Text Available Atrial fibrillation is one of the main risk factor of ischemic stroke. Current problems of the management of patients with stroke due to non-valvular atrial fibrillation and secondary stroke prevention in these patients are considered. Data of own author’s observation for patients of this type during 6 months after discharge from the hospital are presented. The problems which patients faced with are analyzed. Comparative assessment of warfarin and dabigatran therapies is given.

  11. Bipolar Disorder after Stroke in an Elderly Patient

    Directory of Open Access Journals (Sweden)

    Raquel Calvão de Melo

    2014-01-01

    Full Text Available The onset of bipolar disorder (BD secondary to a stroke event is a rare clinical entity. Although it may be related to specific regions of the brain, several other factors have been linked to its expression such as subcortical atrophy or chronic vascular burden. While precise locations and cerebral circuits involved in the bipolarity expression after stroke still need to be determined, their investigation represents an opportunity to study brain function and BD etiopathogenesis. We present a BD secondary to multiple subcortical biparietal lacunar infarctions, a lacunar infarction in left putamen and an ischemic lesion at the cerebral trunk evolving the right median portion, in a 65-year-old male patient who experienced manic, hypomanic, and depressive episodes, after 6, 10, and 16 months, respectively, of the cerebrovascular events.

  12. Trends in in-hospital mortality among patients with stroke in China.

    Directory of Open Access Journals (Sweden)

    Qian He

    Full Text Available BACKGROUND: The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China. METHODS: 109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression. RESULTS: Overall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001. The percentage of severe patients increased while odds of mortality (2010 versus 2007 decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987, intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708, and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649. In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality. CONCLUSIONS: The mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.

  13. Improvement of spontaneous language in stroke patients with chronic aphasia treated with music therapy: a randomized controlled trial.

    Science.gov (United States)

    Raglio, Alfredo; Oasi, Osmano; Gianotti, Marta; Rossi, Agnese; Goulene, Karine; Stramba-Badiale, Marco

    2016-01-01

    The aim of this research is to evaluate the effects of active music therapy (MT) based on free-improvisation (relational approach) in addition to speech language therapy (SLT) compared with SLT alone (communicative-pragmatic approach: Promoting Aphasic's Communicative Effectiveness) in stroke patients with chronic aphasia. The experimental group (n = 10) was randomized to 30 MT individual sessions over 15 weeks in addition to 30 SLT individual sessions while the control group (n = 10) was randomized to only 30 SLT sessions during the same period. Psychological and speech language assessment were made before (T0) and after (T1) the treatments. The study shows a significant improvement in spontaneous speech in the experimental group (Aachener Aphasie subtest: p = 0.020; Cohen's d = 0.35); the 50% of the experimental group showed also an improvement in vitality scores of Short Form Health Survey (chi-square test = 4.114; p = 0.043). The current trial highlights the possibility that the combined use of MT and SLT can lead to a better result in the rehabilitation of patients with aphasia than SLT alone.

  14. Tele-Rehabilitation of Upper Limb Function in Stroke Patients using Microsoft Kinect

    DEFF Research Database (Denmark)

    Simonsen, Daniel

    Stroke is a major cause of death and disability worldwide. The damage or death of brain cells caused by a stroke affects brain function and leads to deficits in sensory and/or motor function. As a consequence, a stroke can have a significantly negative impact on the patient’s ability to perform...... function training in stroke patients (Study I), delivering visual feedback to stroke patients during upper limb training (Study II), and automatization of a validated motor function test (Study III). The systems described in the three studies could be developed further in many possible ways, e.g. new...

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

    Science.gov (United States)

    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.

  16. Comparison of speech performance in labial and lingual orthodontic patients: A prospective study

    Science.gov (United States)

    Rai, Ambesh Kumar; Rozario, Joe E.; Ganeshkar, Sanjay V.

    2014-01-01

    Background: The intensity and duration of speech difficulty inherently associated with lingual therapy is a significant issue of concern in orthodontics. This study was designed to evaluate and to compare the duration of changes in speech between labial and lingual orthodontics. Materials and Methods: A prospective longitudinal clinical study was designed to assess speech of 24 patients undergoing labial or lingual orthodontic treatment. An objective spectrographic evaluation of/s/sound was done using software PRAAT version 5.0.47, a semiobjective auditive evaluation of articulation was done by four speech pathologists and a subjective assessment of speech was done by four laypersons. The tests were performed before (T1), within 24 h (T2), after 1 week (T3) and after 1 month (T4) of the start of therapy. The Mann-Whitney U-test for independent samples was used to assess the significance difference between the labial and lingual appliances. A speech alteration with P appliance systems caused a comparable speech difficulty immediately after bonding (T2). Although the speech recovered within a week in the labial group (T3), the lingual group continued to experience discomfort even after a month (T4). PMID:25540661

  17. Denial and Self-Image in Stroke, Lung Cancer, and Heart Disease Patients

    Science.gov (United States)

    Levine, Jacob; Zigler, Edward

    1975-01-01

    Stroke, lung cancer, and heart disease patients were found to employ denial, as indicated by the relatively small difference between their real and ideal selves before and after the onset of illness. The greatest amount of denial was found for stroke patients. Cancer patients displayed more denial than did heart patients. (Author)

  18. Early Home Supported Discharge of Stroke Patients:

    DEFF Research Database (Denmark)

    Larsen, Torben; Olsen, T. Skyhøj; Sørensen, Jan

    2006-01-01

    : A systematic literature search for randomized trials (RCTs) on "early supported discharge" was closed in April 2005. RCTs on EHSD without information on (i) death or institution at follow-up, (ii) change in Barthél Index, (iii) length of hospital stay, (iv) intensity of home rehabilitation, or (v) baseline...... data are excluded. Seven RCTs on EHSD with 1,108 patients followed 3-12 months after discharge are selected for statistical meta-analysis of outcomes. The costs are calculated as a function of the average number of home training sessions. Economic evaluation is organized as a test of dominance (both...... of death is not significant. Length of stay is significantly reduced by 10 days (CI, 2.6-18 days). All outcomes have a nonsignificant positive covariance. The median number of home sessions is eleven, and the average cost per EHSD is 1,340 USD. The "action mechanism" and financial barriers to EHSD...

  19. Rate and rhythm control strategies for apraxia of speech in nonfluent primary progressive aphasia.

    Science.gov (United States)

    Beber, Bárbara Costa; Berbert, Monalise Costa Batista; Grawer, Ruth Siqueira; Cardoso, Maria Cristina de Almeida Freitas

    2018-01-01

    The nonfluent/agrammatic variant of primary progressive aphasia is characterized by apraxia of speech and agrammatism. Apraxia of speech limits patients' communication due to slow speaking rate, sound substitutions, articulatory groping, false starts and restarts, segmentation of syllables, and increased difficulty with increasing utterance length. Speech and language therapy is known to benefit individuals with apraxia of speech due to stroke, but little is known about its effects in primary progressive aphasia. This is a case report of a 72-year-old, illiterate housewife, who was diagnosed with nonfluent primary progressive aphasia and received speech and language therapy for apraxia of speech. Rate and rhythm control strategies for apraxia of speech were trained to improve initiation of speech. We discuss the importance of these strategies to alleviate apraxia of speech in this condition and the future perspectives in the area.

  20. [Spontaneous speech prosody and discourse analysis in schizophrenia and Fronto Temporal Dementia (FTD) patients].

    Science.gov (United States)

    Martínez, Angela; Felizzola Donado, Carlos Alberto; Matallana Eslava, Diana Lucía

    2015-01-01

    Patients with schizophrenia and Frontotemporal Dementia (FTD) in their linguistic variants share some language characteristics such as the lexical access difficulties, disordered speech with disruptions, many pauses, interruptions and reformulations. For the schizophrenia patients it reflects a difficulty of affect expression, while for the FTD patients it reflects a linguistic issue. This study, through an analysis of a series of cases assessed Clinic both in memory and on the Mental Health Unit of HUSI-PUJ (Hospital Universitario San Ignacio), with additional language assessment (analysis speech and acoustic analysis), present distinctive features of the DFT in its linguistic variants and schizophrenia that will guide the specialist in finding early markers of a differential diagnosis. In patients with FTD language variants, in 100% of cases there is a difficulty understanding linguistic structure of complex type; and important speech fluency problems. In patients with schizophrenia, there are significant alterations in the expression of the suprasegmental elements of speech, as well as disruptions in discourse. We present how depth language assessment allows to reassess some of the rules for the speech and prosody analysis of patients with dementia and schizophrenia; we suggest how elements of speech are useful in guiding the diagnosis and correlate functional compromise in everyday psychiatrist's practice. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  1. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Jauch, Edward C; Saver, Jeffrey L; Adams, Harold P; Bruno, Askiel; Connors, J J Buddy; Demaerschalk, Bart M; Khatri, Pooja; McMullan, Paul W; Qureshi, Adnan I; Rosenfield, Kenneth; Scott, Phillip A; Summers, Debbie R; Wang, David Z; Wintermark, Max; Yonas, Howard

    2013-03-01

    The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.

  2. Speech and voice rehabilitation in selected patients fitted with a bone anchored hearing aid (BAHA).

    Science.gov (United States)

    Thomas, J

    1996-01-01

    With the Birmingham osseointegrated implant programme there have been several patients with severe pre-lingual conductive hearing loss. The majority of these have been patients with Treacher Collins syndrome. There are characteristic features of speech and voice in those with long-standing conductive hearing loss. In addition, the associated abnormalities of jaw, teeth and palate may amplify the problem. There may be spontaneous improvement in features such as voice pitch, quality and intensity following the fitting of a BAHA. However, in those with a pre-lingual hearing impairment, speech therapy may be necessary. Patients assessed as suitable for BAHA have a full assessment of communication skills including audio recording of speech and voice. Post-operative training improves auditory discrimination and perception and is followed by training in the production of the newly perceived speech sounds.

  3. Improving stroke patients' care: a patient held record is not enough

    Directory of Open Access Journals (Sweden)

    Lampe Fiona

    2001-03-01

    Full Text Available Abstract Background Stroke patients' care in hospital tends to be poorly organised, with poor communication and a lack of information being frequent sources of complaint. The purpose of this study was to evaluate whether a patient-held record (PHR would result in greater patient satisfaction and better care planning for stroke patients. Methods A time series control (6 months - intervention (8 months - control (6 months was used among London teaching hospital general medical and geriatric medicine inpatient wards. All stroke patients admitted to the wards during the intervention phase received a PHR and were instructed in its use. Demographic, stroke severity, social factors and outcomes were collected from all stroke patients during all phases of the study. Results Of 252 stroke patients aged 46 to 98 years entered into the study, by six months after admission 118 (46.8% had died. PHR and control group patients were well matched in terms of socio-demographic characteristics and pre-stroke ability. At six months after admission, 119 (97% patients responded to the questionnaire. Just over half (56%, 13 of intervention group patients recalled receiving a PHR. Of those patients, 59% reported reading the PHR, 27% had lost their PHR, and two-thirds said they had difficulties encouraging staff to write in the PHR. Half felt that possession of the PHR was more trouble than it was worth. PHR group patients were more satisfied with the recovery they had made (79% vs. 59%, p=0.04, but felt less able to talk to staff about their problems (61% vs. 82%, p=0.02. PHR group patients reported receiving fewer explanations about their condition (18% vs. 33%, p=0.12 and treatment (26% vs. 45%, p=0.07, and were more afraid of asking doctors questions (21% vs. 4%, p=0.01 than controls. PHR group patients were no better prepared for hospital discharge than control group patients, and both groups were ill-informed about services and benefits that might have helped

  4. Risk factor and etiology analysis of ischemic stroke in young adult patients.

    Science.gov (United States)

    Renna, Rosaria; Pilato, Fabio; Profice, Paolo; Della Marca, Giacomo; Broccolini, Aldobrando; Morosetti, Roberta; Frisullo, Giovanni; Rossi, Elena; De Stefano, Valerio; Di Lazzaro, Vincenzo

    2014-03-01

    Approximately 10%-14% of ischemic strokes occur in young adults. To investigate risk factors and etiologies of strokes of young adults admitted to the "stroke unit" of Policlinico "Gemelli" of Rome from December 2005 to January 2013. In all, 150 consecutive patients younger than 50 years diagnosed with ischemic stroke were enrolled. Clinical evaluation consisted of a complete neurologic examination and the National Institutes of Health Stroke Scale. Diagnostic workup consisted of anamnesis, extensive laboratory, radiologic, and cardiologic examination. Stroke etiologies were classified according to the Trial of Org 10172 in Acute Stroke Treatment. Patients' mean age was 41 ± 8.0 years. The most common risk factors were dyslipidemia (52.7%), smoking (47.3%), hypertension (39.3%), and patent foramen ovale (PFO, 32.8%). Large-artery atherosclerosis was diagnosed as the cause of stroke in 17 patients (11.3%). Cardioembolism was presumed in 36 patients (24%), most of them presented a PFO at transesophageal echocardiography. Small-vessel occlusion was diagnosed in 12 patients (8%); all of them were hypertensive and most of them presented additional risk factors. Forty-one patients (27.3%) presented a stroke of other determined etiology and 44 (29.3%) presented a stroke of undetermined etiology. The 3-year survival was 96.8% and recurrent strokes occurred in only 3 cases. Traditional vascular risk factors are also very common in young adults with ischemic stroke, but such factors increase the susceptibility to stroke dependent to other causes as atherosclerosis and small-artery occlusion represent less than 20% of cases. Prognosis quoadvitam is good, being characterized by low mortality and recurrence rate. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. British Association of Stroke Physicians: benchmarking survey of stroke services.

    Science.gov (United States)

    Rodgers, Helen; Dennis, Martin; Cohen, David; Rudd, Anthony

    2003-03-01

    the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004. to describe the organisation and staffing of specialist hospital-based stroke services in the UK. a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services. the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25. significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.

  6. Risk of epilepsy in stroke patients receiving acupuncture treatment: a nationwide retrospective matched-cohort study

    OpenAIRE

    Weng, Shu-Wen; Liao, Chien-Chang; Yeh, Chun-Chieh; Chen, Ta-Liang; Lane, Hsin-Long; Lin, Jaung-Geng; Shih, Chun-Chuan

    2016-01-01

    Objective To investigate the risk of epilepsy in stroke patients receiving and not receiving acupuncture treatment. Design Retrospective cohort study. Setting This study was based on Taiwan's National Health Insurance Research Database that included information on stroke patients hospitalised between 1 January 2000 and 31 December 2004. Participants We identified 42?040 patients hospitalised with newly diagnosed stroke who were aged 20?years and above. Primary and secondary outcome measures W...

  7. Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke: The ACROSS-China Study (Abnormal Glucose Regulation in Patients With Acute Stroke Across China).

    Science.gov (United States)

    Jing, Jing; Pan, Yuesong; Zhao, Xingquan; Zheng, Huaguang; Jia, Qian; Mi, Donghua; Chen, Weiqi; Li, Hao; Liu, Liping; Wang, Chunxue; He, Yan; Wang, David; Wang, Yilong; Wang, Yongjun

    2017-04-01

    Insulin resistance was common in patients with stroke. This study investigated the association between insulin resistance and outcomes in nondiabetic patients with first-ever acute ischemic stroke. Patients with ischemic stroke without history of diabetes mellitus in the ACROSS-China registry (Abnormal Glucose Regulation in Patients With Acute Stroke Across China) were included. Insulin resistance was defined as a homeostatis model assessment-insulin resistance (HOMA-IR) index in the top quartile (Q4). HOMA-IR was calculated as fasting insulin (μU/mL)×fasting glucose (mmol/L)/22.5. Multivariable logistic regression or Cox regression was performed to estimate the association between HOMA-IR and 1-year prognosis (mortality, stroke recurrence, poor functional outcome [modified Rankin scale score 3-6], and dependence [modified Rankin scale score 3-5]). Among the 1245 patients with acute ischemic stroke enrolled in this study, the median HOMA-IR was 1.9 (interquartile range, 1.1-3.1). Patients with insulin resistance were associated with a higher mortality risk than those without (adjusted hazard ratio, 1.68; 95% confidence interval, 1.12-2.53; P =0.01), stroke recurrence (adjusted hazard ratio, 1.57, 95% confidence interval, 1.12-2.19; P =0.008), and poor outcome (adjusted odds ratio, 1.42; 95% confidence interval, 1.03-1.95; P =0.03) but not dependence after adjustment for potential confounders. Higher HOMA-IR quartile categories were associated with a higher risk of 1-year death, stroke recurrence, and poor outcome ( P for trend =0.005, 0.005, and 0.001, respectively). Insulin resistance was associated with an increased risk of death, stroke recurrence, and poor outcome but not dependence in nondiabetic patients with acute ischemic stroke. © 2017 American Heart Association, Inc.

  8. The activity of malignancy may determine stroke pattern in cancer patients.

    Science.gov (United States)

    Karlińska, Anna G; Gromadzka, Grażyna; Karliński, Michał A; Członkowska, Anna

    2015-04-01

    It has been suggested that stroke in patients with cancer may differ from the conventional pattern. The aim of this study was to evaluate the burden of vascular risk factors, stroke etiology, and short-term outcome in patients with active and nonactive malignancy compared with patients without cancer. This is a prospective cohort study of consecutive acute stroke patients admitted to our department between September 2006 and September 2011. We distinguished between the following: (1) patients with active malignancy (AM, diagnosed not earlier than 12 months before stroke); (2) patients with nonactive malignancy (non-AM); and (3) cancer-free (CF) patients, used as a reference. Pre-existing cancer was found in 90 of 1558 patients, including 41 (2.6%) cases with AM and 49 (3.1%) cases with non-AM. Compared with CF patients, AM patients less frequently had a history of previous stroke (2.4% versus 17.9%, P = .018) and more frequently experienced ischemic strokes of undetermined etiology (62.5% versus 38.3%, P = .002). Non-AM patients did not differ in the distribution of vascular risk factors but more often experienced stroke caused by small vessel occlusion (20.0% versus 8.0%, P = .004). Inflammatory blood markers were elevated especially in patients with AM. Short-term prognosis was similar across all groups. Stroke pattern in patients with non-AM appears very similar to that observed in the CF patients. However, our findings support the thesis that cancer-specific prothrombotic mechanisms play an important role in stroke patients with AM, which may be related to active inflammatory and immune processes. Malignancy does not influence short-term prognosis of stroke. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Etiologic Subtypes, Risk Factors, and Outcomes of Acute Ischemic Stroke in Young Patients

    Directory of Open Access Journals (Sweden)

    İnci Şule Özer

    2015-04-01

    Full Text Available Objective: Stroke in people aged less than 45 years is less frequent than in older patients, but has major impacts on both the individual and society. The aim of this study was to determine the etiologic subtypes of acute ischemic stroke in the young. Materials and Methods: We reviewed the hospital records of 619 patients who were admitted with acute ischemic stroke between January 2011 and November 2014. Acute ischemic stroke in the young was defined as patients aged 45 years and under. Demographic data, the National Institutes of Health Stroke Scale (NIHSS scores at admission and detailed investigations aimed at determining etiologic cause were recorded. Etiologic stroke subtypes were determined using the automated Causative Classification System. Modified Rankin Scale (mRS scores were recorded in the follow-up. Results: There were 32 (5.2% young patients with acute ischemic stroke. The rates of hypertension, diabetes mellitus, atrial fibrillation, and coronary artery disease were significantly lower in young patients compared with patients aged more than 45 years (p<0.05. The mean NIHSS score at admission and hospital mortality was significantly lower in patients aged 45 years and under compared with those older than 45 years (p=0.006, p=0.043. Cardioaortic embolism was the most common etiologic stroke subtype in both groups. Other causes were significantly more frequent in the young acute ischemic stroke group compared with the older patients. The median follow-up mRS was significantly lower in patients aged 45 years and under compared with those older than 45 years (p<0.001. Conclusion: Young patients with ischemic stroke have different risk factors, stroke etiology, stroke severity and prognosis compared with patients older than 45 years with the same condition

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

    Directory of Open Access Journals (Sweden)

    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

  11. Mechanical thrombectomy with snare in patients with acute ischemic stroke

    International Nuclear Information System (INIS)

    Gonzalez, Alejandro; Mayol, Antonio; Martinez, Eva; Gonzalez-Marcos, Jose R.; Gil-Peralta, Alberto

    2007-01-01

    We evaluated the efficacy and safety of thrombus extraction using a microsnare in patients with acute ischemic stroke (AIS). This was a prospective, observational, cohort study in which consecutive patients with AIS (<6 hours of ischemia for anterior circulation and <24 hours for posterior circulation) who had been previously excluded from intravenous tissue plasminogen activator (tPA) thrombolysis were included and followed-up for 3 months. Mechanical embolectomy with a microsnare of 2-4 mm was undertaken as the first treatment. Low-dose intraarterial thrombolysis or angioplasty was used if needed. TIMI grade and modified Rankin stroke scale (mRSS) score were used to evaluate vessel recanalization and clinical efficacy, respectively. Nine patients (mean age 55 years, range 17-69 years) were included. Their basal mean NIHSS score was 16 (range 12-24). In seven out of the nine patients (77.8%) the clot was removed, giving a TIMI grade of 3 in four patients and TIMI grade 2 in three patients. Occlusion sites were: middle cerebral artery (four), basilar artery (two) and anterior cerebral artery plus middle cerebral artery (one). The mean time for recanalization from the start of the procedure was 50 min (range 50-75 min). At 3 months, the mRSS score was 0 in two patients and 3-4 in three patients (two patients died). According to our results, the microsnare is a safe procedure for mechanical thrombectomy with a good recanalization rate. Further studies are required to determine the role of the microsnare in the treatment of AIS. (orig.)

  12. Effect of action observation therapy on daily activities and motor recovery in stroke patients

    Directory of Open Access Journals (Sweden)

    Mei-Hong Zhu

    2015-09-01

    Conclusion: Action observation therapy significantly improves upper extremity motor function and performance of activities of daily living, and alleviates upper limb spasticity in patients with stroke.

  13. A validation study using a modified version of Postural Assessment Scale for Stroke Patients: Postural Stroke Study in Gothenburg (POSTGOT

    Directory of Open Access Journals (Sweden)

    Danielsson Anna

    2011-10-01

    Full Text Available Abstract Background A modified version of Postural Assessment Scale for Stroke Patients (PASS was created with some changes in the description of the items and clarifications in the manual (e.g. much help was defined as support from 2 persons. The aim of this validation study was to assess intrarater and interrater reliability using this modified version of PASS, at a stroke unit, for patients in the acute phase after their first event of stroke. Methods In the intrarater reliability study 114 patients and in the interrater reliability study 15 patients were examined twice with the test within one to 24 hours in the first week after stroke. Spearman's rank correlation, Kappa coefficients, Percentage Agreement and the newer rank-invariant methods; Relative Position, Relative Concentration and Relative rank Variance were used for the statistical analysis. Results For the intrarater reliability Spearman's rank correlations were 0.88-0.98 and k were 0.70-0.93 for the individual items. Small, statistically significant, differences were found for two items regarding Relative Position and for one item regarding Relative Concentration. There was no Relative rank Variance for any single item. For the interrater reliability, Spearman's rank correlations were 0.77-0.99 for individual items. For some items there was a possible, even if not proved, reliability problem regarding Relative Position and Relative Concentration. There was no Relative rank Variance for the single items, except for a small Relative rank Variance for one item. Conclusions The high intrarater and interrater reliability shown for the modified Postural Assessment Scale for Stroke Patients, the Swedish version of Postural Assessment Scale for Stroke Patients, with traditional and newer statistical analyses, particularly for assessments performed by the same rater, support the use of the Swedish version of Postural Assessment Scale for Stroke Patients, in the acute stage after stroke both

  14. Urinary incontinence nursing diagnoses in patients with stroke

    Directory of Open Access Journals (Sweden)

    Telma Alteniza Leandro

    2015-12-01

    Full Text Available Abstract OBJECTIVE Identifying the prevalence of Stress urinary incontinence (SUI, Urge urinary incontinence (UUI, Functional urinary incontinence (FUI, Overflow urinary incontinence (OUI and Reflex urinary incontinence (RUI nursing diagnoses and their defining characteristics in stroke patients. METHOD A cross-sectional study with 156 patients treated in a neurological clinic. Data were collected through interviews and forwarded to nurses for diagnostic inference. RESULTS 92.3% of the patients had at least one of the studied diagnoses; OUI showed the highest prevalence (72.4%, followed by FUI (53.2%, RUI (50.0%, UUI (41.0% and SUI (37.8%. Overdistended bladder and reports of inability to reach the toilet in time to avoid urine loss were the most prevalent defining characteristics. A statistically significant association of the defining characteristics with the studied diagnosis was verified. CONCLUSION The five incontinence diagnoses were identified in the evaluated patients, with different prevalence.

  15. A clinical study on cognitive impairment in post-ischemic stroke patients with metabolic syndrome

    Directory of Open Access Journals (Sweden)

    LI Chen

    2012-02-01

    Full Text Available Objective To explore the relation between metabolic syndrome (MetS and cognitive impairment after ischemic stroke. Methods Ninety-four cases of first ischemic stroke patients were divided into stroke without MetS group (n = 54 and stroke with MetS group (n = 40 according to the diagnostic criteria for MetS defined by Metabolic Syndrome Researching Group of Chinese Diabetes Society. All patients underwent Mini-Mental State Examination (MMSE, Clock Drawing Test (CDT, animal Verbal Fluency Test (aVFT, Trial Making Test-A (TMT-A at 2 weeks and 3 months after stroke to evaluate mental state such as verbal learning memory, and executive, attentional and visuospatial abilities. The incidence and development of cognitive impairment were also assessed. Results At 2 weeks and 3 months after stroke, the incidence of cognitive impairment were 24.47% (23/94 and 22.34% (21/94, respectively, and in the cognitive impairment patients the incidence of non-dementia were 21.28% (20/94 and 19.15% (18/94, while the incidence of dementia were 3.19% (3/94 and 3.19% (3/94, respectively. The incidence of cognitive impairment was higher in the stroke patients with MetS than the stroke patients without MetS, 37.50% (15/40 vs 14.81% (8/54 (Z = 2.500, P = 0.012 at 2 weeks after stroke and 35.00% (14/40 vs 12.96% (7/54 (Z = 2.513, P = 0.012 at 3 months after stroke. In the scores of MMSE, delay recall and CDT of the stroke patients with MetS were all lower than those without MetS at 2 weeks after stroke and at 3 months after stroke (P < 0.05, for all. The stroke patients with MetS had more cognition deterioration than the stroke patients without MetS at 3 months after stroke, the difference was significant (Z = 2.134, P = 0.033. Conclusion MetS can increase the incidence of cognitive impairment, especially non-dementia cognitive impairment in post ischemic stroke. Executive dysfunction and hypomnesis are often seen. The development of cognitive impairment in stroke patients

  16. Adapting the Home After a Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  17. Outcome and Risk Factors Presented in Old Patients Above 80 Years of Age Versus Younger Patients After Ischemic Stroke

    DEFF Research Database (Denmark)

    Bentsen, Line; Christensen, Louisa; Christensen, Anders

    2014-01-01

    patients received stroke unit care in accordance with the guidelines. The population was dichotomized into patients aged less than 80 years and 80 years of age or older. Modified Rankin Scale (mRS) score and Barthel Index (BI) were used to assess 3-month and 1-year outcome. RESULTS: Patients 80 years...... of age or older presented with significantly more severe strokes than younger patients, median Scandinavian Stroke Scale score 39 vs 42 (P = .003). Median mRS score before stroke was significantly higher in patients aged 80 years or older (P

  18. Stroke patients' experiences with Wii Sports® during inpatient rehabilitation

    DEFF Research Database (Denmark)

    Celinder, Dora; Peoples, Hanne

    2012-01-01

    INTRODUCTION: Commercial virtual reality games have been used as adjunct therapy for stroke rehabilitation, mainly after patients have been discharged. The aim of this study was to explore stroke patients' experiences with Wii Sports® as a supplement to conventional occupational therapy in a cont...... therapy services may benefit patient rehabilitation directly or provide motivation for alternative leisure activities....

  19. time of presentation of stroke patients for ct imaging in a nigerian ...

    African Journals Online (AJOL)

    morbidity worldwide leaving up to 50% of its survivors ... developing countries like Nigeria often lead to delayed presentation of stroke patients in hospitals. We sought to study the time and pattern of presentation of stroke patients for ... Conclusion: None of our patients met the time criteria for thrombolytic therapy. Ischemic ...

  20. CHARACTERISTICS OF PATIENTS WITH CEREBRAL STROKE OR TRANSIENT ISCHEMIC ATTACK, INCLUDED INTO THE LIS-2 REGISTER (LYUBERTSY STUDY OF MORTALITY IN PATIENTS AFTER STROKE

    Directory of Open Access Journals (Sweden)

    S. Yu. Martsevich

    2015-01-01

    Full Text Available Aim. To provide final data on the three-year period of the inclusion of patients; to give most accurate "portrait" of patients hospitalized with a brain stroke within the framework of the LIS-2 register (Lyubertsy study of mortality in patients after stroke.Material and methods. All patients (n=960 admitted to the Lyubertsy district hospital №2 with stroke for the period from 01.2009 to 12.2011 were included into the study.Results. Men accounted for 37.5%, women - 62.5%, mean age was 71.1±9.8 years. The history of hypertension was present in 833 patients (86.8%, atrial fibrillation in 252 (26.8% patients, 199 (20.7% patients had previously undergone stroke. In-hospital mortality was 21.6% (207 patients had died; mean age 72.9±9.8 years. Low frequency of the antihypertensive therapy (34.5%, lipid-lowering therapy (0.7%, antiplatelet agents (5.7%, anticoagulation therapy prescription in patients with atrial fibrillation was detected.Conclusion. Insufficient assignment of drugs with a proven effect on the prognosis in patients with risk factors prior to the development of the reference stroke draws attention. High incidence of recurrent strokes indicates an underactive secondary prevention.

  1. 24-Hour Alberta Stroke Program Early CT Score Assessment in Post-Stroke Spasticity Development in Patients with a First Documented Anterior Circulation Ischemic Stroke.

    Science.gov (United States)

    Volny, Ondrej; Justanova, Maria; Cimflova, Petra; Kasickova, Linda; Svobodova, Ivana; Muzik, Jan; Bares, Martin

    2018-01-01

    Neuroanatomic substrates responsible for development of post-stroke spasticity are still poorly understood. The study is focused on identification of brain regions within the territory of the middle cerebral artery associated with spasticity development. This is a single-center prospective cohort study of first documented anterior circulation ischemic strokes with a neurologic deficit lasting >7 days (from March 2014 to September 2016, all patients are involved in a registry). Ischemic cerebral lesions within the territory of middle cerebral artery were evaluated using the Alberta Stroke Program Early CT Score (ASPECTS) on control 24-hour computed tomography or magnetic resonance imaging. Spasticity was assessed with modified Ashworth scale. Seventy-six patients (mean age 72 years, 45% females; 30% treated with IV tissue plasminogen activator, 6.5% mechanical thrombectomy) fulfilled the study inclusion criteria. Forty-nine (64%) developed early elbow or wrist flexor spasticity defined as modified Ashworth scale >1 (at day 7-10), in 44 (58%) the spasticity remained present at 6 months. There were no differences between the patients who developed spasticity and those who did not when comparing admission stroke severity (National Institutes of Health Stroke Scale 5 [interquartile range {IQR} 4-8] versus 6 [IQR 4-10]) and vascular risk factors (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, coronary artery disease). Nor was there a difference in 24-hour ASPECTS score (9 [IQR 8-10] versus 9 [IQR 7-10]). No differences were found between the groups with and without the early upper limb flexor spasticity of particular regions (M1, M2, M3, M4, M5, M6, lentiform, insula, caudate, internal capsule) and precentral-postcentral gyrus, premotor cortex, supplementary motor area, posterior limb of internal capsule, and thalamus were compared. We did not find any middle cerebral artery territory associated with post-stroke spasticity development by detailed

  2. Unrealistic pessimism about risk of coronary heart disease and stroke in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Asimakopoulou, Koula G.; Skinner, T. Chas; Spimpolo, Jennifer

    2008-01-01

    Objective: We examined the accuracy of type 2 diabetes (T2D) patients' risk estimates of developing coronary heart disease (CHD)/having a stroke as a consequence of diabetes and their mood about these risks. Methods: Patients reported their perceived risks of developing CHD/having a stroke...... disease risk and mood was also seen where higher risk of actual and perceived CHD/stroke was related to worse mood. A positive relationship between mood and extent of perceptual error was further observed; the more inaccurate patients' perceptions of CHD/stroke risk were, the better their mood. Mood...... and rated their mood about these risks using a self-report measure. Using an objective risk calculator, they were then told their actual risk of CHD and stroke and their mood was re-assessed. Results: Patients' estimates of their risk of CHD/stroke were grossly inflated. A negative relationship between...

  3. Acoustic Analysis and Speech Intelligibility in Patients Wearing Conventional Dentures and Rugae Incorporated Dentures

    OpenAIRE

    Adaki, Raghavendra; Meshram, Suresh; Adaki, Shridevi

    2013-01-01

    Phonetics is an important function of oral cavity. It has been overlooked quite frequently while fabricating the complete dentures. In this study modification of anterior palatal surface of denture is done and assessed for its impact on phonetics. Purpose is to assess acoustic and speech intelligibility analysis in edentulous patients and also to evaluate the influence of conventional dentures, arbitrary rugae and customized rugae dentures on speech in complete denture wearers. Ten healthy ed...

  4. Association of Osteopontin, Neopterin, and Myeloperoxidase With Stroke Risk in Patients With Prior Stroke or Transient Ischemic Attacks: Results of an Analysis of 13 Biomarkers From the Stroke Prevention by Aggressive Reduction in Cholesterol Levels Trial.

    Science.gov (United States)

    Ganz, Peter; Amarenco, Pierre; Goldstein, Larry B; Sillesen, Henrik; Bao, Weihang; Preston, Gregory M; Welch, K Michael A

    2017-12-01

    Established risk factors do not fully identify patients at risk for recurrent stroke. The SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) evaluated the effect of atorvastatin on stroke risk in patients with a recent stroke or transient ischemic attack and no known coronary heart disease. This analysis explored the relationships between 13 plasma biomarkers assessed at trial enrollment and the occurrence of outcome strokes. We conducted a case-cohort study of 2176 participants; 562 had outcome strokes and 1614 were selected randomly from those without outcome strokes. Time to stroke was evaluated by Cox proportional hazards models. There was no association between time to stroke and lipoprotein-associated phospholipase A 2 , monocyte chemoattractant protein-1, resistin, matrix metalloproteinase-9, N-terminal fragment of pro-B-type natriuretic peptide, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, or soluble CD40 ligand. In adjusted analyses, osteopontin (hazard ratio per SD change, 1.362; P strokes. After adjustment for the Stroke Prognostic Instrument-II and treatment, osteopontin, neopterin, and myeloperoxidase remained independently associated with outcome strokes. The addition of these 3 biomarkers to Stroke Prognostic Instrument-II increased the area under the receiver operating characteristic curve by 0.023 ( P =0.015) and yielded a continuous net reclassification improvement (29.1%; P stroke and improved risk classification when added to a clinical risk algorithm. URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00147602. © 2017 American Heart Association, Inc.

  5. Incidence of DWI-positive stroke in patients with vertigo of unclear etiology, preliminary results.

    Science.gov (United States)

    Leker, Ronen R; Hur, Tamir Ben; Gomori, John M; Paniri, R; Eichel, Roni; Cohen, Jose E

    2013-03-01

    Acute vertigo may be secondary to stroke or to non-ischemic causes. Accurate identification of vertigo secondary to ischemia may lead to appropriate timely intervention that can minimize stroke-related damage and can help in tailoring the most appropriate individual therapy for affected patients. Diffusion weighted MRI (DWI) is very accurate for diagnosing stroke and we therefore aimed to test whether it can aid in making a correct diagnosis of vertigo secondary to stroke. All patients presenting with vertigo in which the diagnosis of stroke was considered underwent DWI only MRI. Data regarding the symptoms and neurological deficits, vascular risk factors, imaging findings, and outcomes was accrued. Patients with stroke on DWI were compared with those without ischemia. Between June 2010 and August 2011, 28 patients fulfilling the entry criteria were identified with a mean age of 62·2±12·8 (60% male). The final diagnosis was stroke in 11 patients (39%). Patients with stroke did not differ from those without stroke in their risk factor profile. However, patients with stroke more often tended to present with vertigo accompanied by other neurological symptoms (73% versus 12% respectively, P = 0·001). After adjusting for age and the presence of diabetes, the presence of multiple symptoms remained the only variable that was associated with a positive DWI scan (odds ratio: 30: 95% confidence interval: 2·6-349). Most patients with stroke had very mild strokes with a median admission NIHSS score of 3 and DWI lesion volumes >2 cm were found in only three patients. Most stroke patients made a good recovery (modified Rankin score ≤2 in seven of nine patients with 90 day data). The most common diagnosis in patients without stroke was of vertigo of peripheral origin (14/17). DWI only MRI can be used to rapidly screen patients presenting with vertigo and suspected vertebrobasilar stroke. The occurrence of vertigo in combination with other focal neurological symptoms may

  6. Apathy among institutionalized stroke patients: prevalence and clinical correlates.

    Science.gov (United States)

    van Almenkerk, Suzanne; Smalbrugge, Martin; Depla, Marja F I A; Eefsting, Jan A; Hertogh, Cees M P M

    2015-02-01

    Apathy is a frequent neuropsychiatric consequence of stroke. In the under-researched population of institutionalized stroke patients, we aimed to explore the prevalence of apathy, its clinical correlates, and the relation to the amount of stimulating activities in the nursing home (NH). A cross-sectional, observational study. Dutch NHs. 274 chronic stroke patients. Data were collected through observation lists that were filled out in structured interviews with qualified nurse assistants who knew the residents well. The lists comprised the NH-version of the Apathy Evaluation Scale (AES10), the Barthel Index, the Neuropsychiatric Inventory Questionnaire, and sections of the Resident Assessment Instrument for Long-Term Care Facilities. Attending physicians and therapists provided additional information. Apathy (AES10 score ≥30) was present in 28% of residents. Multilevel regression analyses revealed that this apathy was independently related to (moderate, severe) cognitive impairment (odds ratio [OR] 11.30 [95% confidence interval (CI): 4.96-25.74], OR 5.54 [95% CI: 2.48-12.40]), very severe ADL-dependency (OR 12.10 [95% CI: 1.35-108.66]), and being >12 hours per day in bed (OR 2.10 [95% CI: 1.07-4.13]). It was not related to depressive mood symptoms (OR 1.75 [95% CI: 0.91-3.37]). Only in residents aged less than 80 years were a higher amount of activities independently related to a lower AES10 score (-0.70 [95% CI: -1.18 to -0.20] points per four extra activities in a 4-week period). Apathy is prevalent in largely one-quarter of institutionalized stroke patients, and that is most strongly related to cognitive impairment in this explorative study. We discuss the need for research on the relation with distinct dimensions of depression and fatigue as partly overlapping constructs, and on (individualized) stimulating activities as a possible intervention method. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights

  7. Correlative study between neuron-specific enolase and blood sugar level in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Aparna Pandey

    2011-01-01

    Full Text Available Background: A study to investigate the level of the neurobiochemical marker, Neuron-Specific Enolase (NSE, at the time of admission and its correlation with the blood sugar level in ischemic stroke patients. Patients and Methods: We investigated 90 patients with complete stroke who were admitted to the Stroke Unit of the Department of Neurology at Sri Aurobindo Institute of Medical Sciences. NSE was measured with commercially available quantitative ′sandwich′ enzyme-linked immunosorbent assay kits obtained from R and D Systems. Hyperglycemia was defined as blood glucose concentration ≥ 7 mmol / L, and measured using the glucose oxidase method immediately. Results: Significantly increased NSE and lipid profile levels were found in ischemic stroke patients as compared to the control. Hyperglycemic ischemic stroke patients had increased levels of NSE, lipid profile, and National Institute of Health stroke scale scores (NIHSS score compared to normoglycemic ischemic stroke patients. In addition the serum NSE level of hyperglycemic stroke patients was also positively correlated with the blood sugar level (r = 0.734 P < 0.001. Conclusions: Hyperglycemia predicts an increased risk of poor outcome after ischemic stroke and it is reflected by a significantly increased level of Neuron-Specific Enolase.

  8. Pacemaker Placement in Patients with Stroke-Mediated Autonomic Dysregulation

    Directory of Open Access Journals (Sweden)

    Ali A. Alsaad

    2017-01-01

    Full Text Available Lateral medullary syndrome (LMS is an ischemic disease of the medulla oblongata, which involves the territory of the posterior inferior cerebellar artery. Lateral medullary syndrome is often missed as the cause of autonomic dysregulation in patients with recent brain stem stroke. Due to the location of the baroreceptor regulatory center in the lateral medulla oblongata, patients with LMS occasionally have autonomic dysregulation-associated clinical manifestations. We report a case of LMS-associated autonomic dysregulation. The case presented as sinus arrest and syncope, requiring permanent pacemaker placement. A dual-chamber pacemaker was placed, after failure of conservative measures to alleviate the patient’s symptoms. Our case shows the importance of recognizing LMS as a potential cause for life-threatening arrhythmias, heart block, and symptomatic bradycardia. Placement of permanent pacemaker may be necessary in some patients with LMS presenting with syncope, secondary to sinus arrest.

  9. Risk factors of outcomes in elderly patients with acute ischemic stroke in China.

    Science.gov (United States)

    Wu, Qi; Zou, Chunying; Wu, Chengji; Zhang, Shuping; Huang, Zuoyi

    2016-08-01

    Stroke results in poor outcomes among elderly patients. However, the factors associated with outcome over different follow-up periods in this population are unknown. To evaluate the outcomes and risk factors of outcomes in elderly patients after stroke. Outcomes, including mortality, dependency (defined as a mRS >2), and recurrence rates, and associated risk factors were assessed at 3 and 12 months after stroke in patients aged ≥80 years. There were 419 acute ischemic stroke patients aged ≥80 years at 3 months, and 309 patients at 12 months; outcomes and relevant risk factors were assessed in these patients. Hypertension was more prevalent in women than in men. At 3 months, the mortality, dependency, and recurrence rates were 13.8, 54.2, and 18.1 %, respectively; the corresponding rates at 12 months were 26.9, 58.0, and 32.6 %, respectively. In the multivariate analysis, after adjusting by confounding factors, TOAST classification and stroke severity were associated with mortality and recurrence, while stroke severity was associated with dependency at 3 months. The mortality and dependency rates at 12 months were significantly associated with moderate and severe stroke, but severe stroke was an independent factor associated with recurrence. Stroke subtype and severity were associated with stroke outcomes among elderly patients in northern China. These findings suggest that it is crucial to highlight the affected factors of stroke outcome among elderly patients for reduce the burden of stroke in China.

  10. Early Prediction and Outcome of Septic Encephalopathy in Acute Stroke Patients With Nosocomial Coma

    OpenAIRE

    Tong, Dao-Ming; Zhou, Ye-Ting; Wang, Guang-Sheng; Chen, Xiao-Dong; Yang, Tong-Hui

    2015-01-01

    Background Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). Methods A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with...

  11. Registry of patients with stroke stated in a public hospital of Peru, 2000-2009

    OpenAIRE

    Castañeda-Guarderas, Ana; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. Médico Cirujano.; Beltrán-Ale, Guillermo; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. Médico Cirujano.; Casma-Bustamante, Renzo; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. Médico Cirujano.; Ruíz-Grosso, Paulo; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. Grupo de Trabajo en Salud Mental, Universidad Peruana Cayetano Heredia. Lima, Perú. Médico Cirujano.; Málaga, Germán; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. Centro de Excelencia en Enfermedades Crónicas (CRONICAS), Universidad Peruana Cayetano Heredia. Lima, Perú. Departamento de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú. Médico Internista, Magíster en Medicina.

    2014-01-01

    We performed a descriptive study taking on account the characteristics of the registries of the patients hospitalized at the Hospital Nacional Cayetano Heredia between the years 2000 and 2009 with stroke as hospitalization diagnosis. 2225 records were obtained from patients older than 18, with stroke. According to ICD-10, 1071 had diagnosis of ischemic stroke, 554 were hemorrhagic, 183 were subarachnoid hemorrhage, 49 were ischemic plus hemorrhagic, 10 were transient ischemic attack (TIA)...

  12. Increased Zinc Serum Level: New Clues in Babol Stroke Patients, Northern Iran

    OpenAIRE

    Alijan Ahmadi Ahangar; Payam Saadat; Sona Niroomand; Shayan Alijanpour; Reza Sohrabnezhad; Alireza Firozejahi; Mohamad Ali Biani; Fatemeh Arab; Hamed Hosseinzadeh; Sekine Faraji; Jalal Niroomand

    2018-01-01

    Background. Stroke is the second leading cause of death worldwide. The role of zinc as a new predictor of stroke was considered. Methods. This prospective study was conducted in Ayatollah Rouhani Hospital within a year on 100 stroke and 100 control patients. Findings. The difference in zinc serum level in two groups was significant (deficiency: 3 (3%) in patients versus 20 (20%) in control group, normal: 25 (25%) versus 54 (54%), and increased level: 72 (72%) versus 26 (26%); p

  13. Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit : a randomized pilot study

    NARCIS (Netherlands)

    Sulter, Geert; Elting, Jan Willem; Langedijk, Marc; Maurits, Natasha M; De Keyser, Jacques

    2003-01-01

    BACKGROUND AND PURPOSE: Pathophysiological considerations and observational studies indicate that elevated body temperature, hypoxia, hypotension, and cardiac arrhythmias in the acute phase of ischemic stroke may aggravate brain damage and worsen outcome. METHODS: Both units were organized with the

  14. A Survey of Speech-Language Therapy Provision for People with Post-Stroke Dysarthria in the UK

    Science.gov (United States)

    Miller, Nick; Bloch, Steven

    2017-01-01

    Background: A large number of people who experience a stroke are affected by dysarthria. This may be in isolation or in association with aphasia and/or dysphagia. Despite evidence highlighting the psychological and social impact of having post-stroke dysarthria and a number of clinical guidelines that make recommendations for appropriate…

  15. Periodontal disease and oral hygiene practices in patients with ischemic stroke

    Directory of Open Access Journals (Sweden)

    Ritu Jain

    2015-01-01

    Full Text Available Aims: A case-control study was conducted to examine the prevalence of periodontal disease and oral hygiene practices in ischemic stroke patients. Settings and Design: Case-control study. Materials and Methods: This study was conducted from March 2010 to March 2011. Control subjects were either the relatives of stroke patients or selected randomly from the patients reporting to the hospital for treatment. The detailed case history and stroke characteristics were collected. Oral examination was done using the WHO Oral health assessment questionnaire and oral hygiene practices were obtained from the patients. Stroke outcome was assessed using modified Rankin scale (mRS (good [mRS ≤ 2]; poor [mRS > 2]. Results: One hundred and eight first-ever ischemic stroke patients and 108 age- and gender-matched healthy controls were included. Thirty-six (33.3% patients showed periodontal damage, only 15 (13.9% of controls had periodontal involvement (P = 0.001. Periodontal disease was commonly seen in stroke patients than the control subjects (odds ratio 3 [95% confidence interval: 1.6-6.1]; P = 0.0007. Stroke patients (17.4% were more likely to use a finger or twig to clean their teeth than controls (1.9% (P < 0.0001. Stroke patients had more number of missing teeth (4.02 ± 5.85 as compared to controls (1.81 ± 3.89 (P = 0.002. Conclusions: Periodontal disease was common in stroke patients as compared to controls. Oral hygiene-related behavior of stroke patients may have a role to play in the complex interplay of factors linking periodontal disease and edentulism to stroke.

  16. The Association of Lesion Location and Sleep Related Breathing Disorder in Patients with Acute Ischemic Stroke.

    Science.gov (United States)

    Fisse, Anna Lena; Kemmling, André; Teuber, Anja; Wersching, Heike; Young, Peter; Dittrich, Ralf; Ritter, Martin; Dziewas, Rainer; Minnerup, Jens

    2017-01-01

    Sleep related breathing disorders (SRBD) are common in patients with ischemic stroke and are associated with poor outcome. SRBD after stroke were assumed to be a direct consequence of injury of specific central nervous system structures. However, whether specific locations of ischemic infarcts cause SRBD is yet unknown. We therefore investigated the association of ischemic lesion location with SRBD. Patients with acute ischemic stroke treated on our stroke unit were included in a prospective observational study. All patients underwent magnetic resonance imaging (MRI) and polygraphy in the acute phase after stroke. SRBD was defined by an apnea-hypopnea index (AHI) ≥10. MRI were evaluated using standardized maps to depict voxel-wise probability distribution of infarction for patients with and without SRBD. Groups were compared using logistic regression analysis. Of 142 patients included, 86 (59%) had a SRBD. Age, body mass index and prevalence of arterial hypertension were significantly higher in patients with SRBD. There was no statistically significant association between any lesion location and SRBD. We found no association of lesion location and SRBD in stroke patients, whereas established risk factors for SRBD, known from general population, were significantly associated with SRBD. Given the high prevalence of SRBD in stroke patients, these findings suggest that cerebral ischemia facilitates the occurrence of SRBD in patients with pre-existing risk factors rather than causing it by damaging specific central nervous system structures. Our findings can be used to identify stroke patients who might benefit from polygraphy screening.

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

    Science.gov (United States)

    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.

  18. Acoustic characteristics of ataxic speech in Japanese patients with spinocerebellar degeneration (SCD).

    Science.gov (United States)

    Ikui, Yukiko; Tsukuda, Mamoru; Kuroiwa, Yoshiyuki; Koyano, Shigeru; Hirose, Hajime; Taguchi, Takahide

    2012-01-01

    In English- and German-speaking countries, ataxic speech is often described as showing scanning based on acoustic impressions. Although the term 'scanning' is generally considered to represent abnormal speech features including prosodic excess or insufficiency, any precise acoustic analysis of ataxic speech has not been performed in Japanese-speaking patients. This raises the question of what is the most dominant acoustic characteristic of ataxic speech in Japanese subjects, particularly related to the perceptual impression of 'scanning'. The study was designed to investigate the nature of speech characteristics of Japanese ataxic subjects, particularly 'scanning', by means of acoustic analysis. The study comprised 20 Japanese cases with spinocerebellar degeneration diagnosed to have a perceptual impression of scanning by neurologists (ataxic group) and 20 age-matched normal healthy subjects (control group). Recordings of speech samples of Japanese test sentences were obtained from each subject. The recorded and digitized acoustic samples were analysed using 'Acoustic Core-8' (Arcadia Inc.). Sentence duration was significantly longer in the ataxic group as compared with the control group, indicating that the speaking rate was slower in the ataxic subjects. Segment duration remained consistent in both vowels and consonants in the control group as compared with the ataxic group. In particular, the duration of vowel segments, i.e. the nucleus of Japanese mora, was significantly invariable in the control group regardless of differences between subjects as well as in segments compared with the ataxic group. In addition, the duration of phonemically long Japanese vowels was significantly shorter in the ataxic group. The results indicate that the perceptual impression of 'scanning' in Japanese ataxic cases derives mainly from the breakdown of isochrony in terms of difficulty in keeping the length of vowel segments of Japanese invariable during speech production. In

  19. Mirror Box Training in Hemiplegic Stroke Patients Affects Body Representation

    Science.gov (United States)

    Tosi, Giorgia; Romano, Daniele; Maravita, Angelo

    2018-01-01

    The brain integrates multisensory inputs coming from the body (i.e., proprioception, tactile sensations) and the world that surrounds it (e.g., visual information). In this way, it is possible to build supra-modal and coherent mental representations of our own body, in order to process sensory events and to plan movements and actions in space. Post-stroke acquired motor deficits affect the ability to move body parts and to interact with objects. This may, in turn, impair the brain representation of the affected body part, resulting in a further increase of disability and motor impairment. To the aim of improving any putative derangements of body representation induced by the motor deficit, here we used the Mirror Box (MB). MB is a rehabilitative tool aimed at restoring several pathological conditions where body representation is affected, including post-stroke motor impairments. In this setting, observing the reflection of the intact limb in the mirror, while the affected one is hidden behind the mirror, can exert a positive influence upon different clinical conditions from chronic pain to motor deficits. Such results are thought to be mediated by a process of embodiment of the mirror reflection, which would be integrated into the representation of the affected limb. A group of 45 post-stroke patients was tested before and after performing a MB motor training in two conditions, one with the mirror between the hands and one without it, so that patients could see their impaired limb directly. A forearm bisection task, specifically designed to measure the metric representation of the body (i.e., size), was used as dependent variable. Results showed that, at baseline, the forearm bisection is shifted proximally, compatibly with a shrink of the metric representation of the affected arm towards the shoulder. However, following the MB session bisection scores shifted distally, compatibly with a partial correction of the metric representation of that arm. The effects

  20. Mirror Box Training in Hemiplegic Stroke Patients Affects Body Representation

    Directory of Open Access Journals (Sweden)

    Giorgia Tosi

    2018-01-01

    Full Text Available The brain integrates multisensory inputs coming from the body (i.e., proprioception, tactile sensations and the world that surrounds it (e.g., visual information. In this way, it is possible to build supra-modal and coherent mental representations of our own body, in order to process sensory events and to plan movements and actions in space. Post-stroke acquired motor deficits affect the ability to move body parts and to interact with objects. This may, in turn, impair the brain representation of the affected body part, resulting in a further increase of disability and motor impairment. To the aim of improving any putative derangements of body representation induced by the motor deficit, here we used the Mirror Box (MB. MB is a rehabilitative tool aimed at restoring several pathological conditions where body representation is affected, including post-stroke motor impairments. In this setting, observing the reflection of the intact limb in the mirror, while the affected one is hidden behind the mirror, can exert a positive influence upon different clinical conditions from chronic pain to motor deficits. Such results are thought to be mediated by a process of embodiment of the mirror reflection, which would be integrated into the representation of the affected limb. A group of 45 post-stroke patients was tested before and after performing a MB motor training in two conditions, one with the mirror between the hands and one without it, so that patients could see their impaired limb directly. A forearm bisection task, specifically designed to measure the metric representation of the body (i.e., size, was used as dependent variable. Results showed that, at baseline, the forearm bisection is shifted proximally, compatibly with a shrink of the metric representation of the affected arm towards the shoulder. However, following the MB session bisection scores shifted distally, compatibly with a partial correction of the metric representation of that arm

  1. Mirror Box Training in Hemiplegic Stroke Patients Affects Body Representation.

    Science.gov (United States)

    Tosi, Giorgia; Romano, Daniele; Maravita, Angelo

    2017-01-01

    The brain integrates multisensory inputs coming from the body (i.e., proprioception, tactile sensations) and the world that surrounds it (e.g., visual information). In this way, it is possible to build supra-modal and coherent mental representations of our own body, in order to process sensory events and to plan movements and actions in space. Post-stroke acquired motor deficits affect the ability to move body parts and to interact with objects. This may, in turn, impair the brain representation of the affected body part, resulting in a further increase of disability and motor impairment. To the aim of improving any putative derangements of body representation induced by the motor deficit, here we used the Mirror Box (MB). MB is a rehabilitative tool aimed at restoring several pathological conditions where body representation is affected, including post-stroke motor impairments. In this setting, observing the reflection of the intact limb in the mirror, while the affected one is hidden behind the mirror, can exert a positive influence upon different clinical conditions from chronic pain to motor deficits. Such results are thought to be mediated by a process of embodiment of the mirror reflection, which would be integrated into the representation of the affected limb. A group of 45 post-stroke patients was tested before and after performing a MB motor training in two conditions, one with the mirror between the hands and one without it, so that patients could see their impaired limb directly. A forearm bisection task, specifically designed to measure the metric representation of the body (i.e., size), was used as dependent variable. Results showed that, at baseline, the forearm bisection is shifted proximally, compatibly with a shrink of the metric representation of the affected arm towards the shoulder. However, following the MB session bisection scores shifted distally, compatibly with a partial correction of the metric representation of that arm. The effects

  2. Platelets Proteomic Profiles of Acute Ischemic Stroke Patients.

    Directory of Open Access Journals (Sweden)

    Ozge Cevik

    Full Text Available Platelets play a crucial role in the pathogenesis of stroke and antiplatelet agents exist for its treatment and prevention. Through the use of LC-MS based protein expression profiling, platelets from stroke patients were analyzed and then correlated with the proteomic analyses results in the context of this disease. This study was based on patients who post ischemic stroke were admitted to hospital and had venous blood drawn within 24 hrs of the incidence. Label-free protein expression analyses of the platelets' tryptic digest was performed in triplicate on a UPLC-ESI-qTOF-MS/MS system and ProteinLynx Global Server (v2.5, Waters was used for tandem mass data extraction. The peptide sequences were searched against the reviewed homo sapiens database (www.uniprot.org and the quantitation of protein variation was achieved through Progenesis LC-MS software (V4.0, Nonlinear Dynamics. These Label-free differential proteomics analysis of platelets ensured that 500 proteins were identified and 83 of these proteins were found to be statistically significant. The differentially expressed proteins are involved in various processes such as inflammatory response, cellular movement, immune cell trafficking, cell-to-cell signaling and interaction, hematological system development and function and nucleic acid metabolism. The expressions of myeloperoxidase, arachidonate 12-Lipoxygenase and histidine-rich glycoprotein are involved in cellular metabolic processes, crk-like protein and ras homolog gene family member A involved in cell signaling with vitronectin, thrombospondin 1, Integrin alpha 2b, and integrin beta 3 involved in cell adhesion. Apolipoprotein H, immunoglobulin heavy constant gamma 1 and immunoglobulin heavy constant gamma 3 are involved in structural, apolipoprotein A-I, and alpha-1-microglobulin/bikunin precursor is involved in transport, complement component 3 and clusterin is involved in immunity proteins as has been discussed. Our data provides

  3. Perceptual Speech Assessment after Maxillary Advancement Osteotomy in Patients with a Repaired Cleft Lip and Palate

    Directory of Open Access Journals (Sweden)

    Seok-Kwun Kim

    2012-05-01

    Full Text Available BackgroundMaxillary hypoplasia refers to a deficiency in the growth of the maxilla commonly seen in patients with a repaired cleft palate. Those who develop maxillary hypoplasia can be offered a repositioning of the maxilla to a functional and esthetic position. Velopharyngeal dysfunction is one of the important problems affecting speech after maxillary advancement surgery. The aim of this study was to investigate the impact of maxillary advancement on repaired cleft palate patients without preoperative deterioration in speech compared with non-cleft palate patients.MethodsEighteen patients underwent Le Fort I osteotomy between 2005 and 2011. One patient was excluded due to preoperative deterioration in speech. Eight repaired cleft palate patients belonged to group A, and 9 non-cleft palate patients belonged to group B. Speech assessments were performed preoperatively and postoperatively by using a speech screening protocol that consisted of a list of single words designed by Ok-Ran Jung. Wilcoxon signed rank test was used to determine if there were significant differences between the preoperative and postoperative outcomes in each group A and B. And Mann-Whitney U test was used to determine if there were significant differences in the change of score between groups A and B.ResultsNo patients had any noticeable change in speech production on perceptual assessment after maxillary advancement in our study. Furthermore, there were no significant differences between groups A and B.ConclusionsRepaired cleft palate patients without preoperative velopharyngeal dysfunction would not have greater risk of deterioration of velopharyngeal function after maxillary advancement compared to non-cleft palate patients.

  4. Perceptual speech assessment after maxillary advancement osteotomy in patients with a repaired cleft lip and palate.

    Science.gov (United States)

    Kim, Seok-Kwun; Kim, Ju-Chan; Moon, Ju-Bong; Lee, Keun-Cheol

    2012-05-01

    Maxillary hypoplasia refers to a deficiency in the growth of the maxilla commonly seen in patients with a repaired cleft palate. Those who develop maxillary hypoplasia can be offered a repositioning of the maxilla to a functional and esthetic position. Velopharyngeal dysfunction is one of the important problems affecting speech after maxillary advancement surgery. The aim of this study was to investigate the impact of maxillary advancement on repaired cleft palate patients without preoperative deterioration in speech compared with non-cleft palate patients. Eighteen patients underwent Le Fort I osteotomy between 2005 and 2011. One patient was excluded due to preoperative deterioration in speech. Eight repaired cleft palate patients belonged to group A, and 9 non-cleft palate patients belonged to group B. Speech assessments were performed preoperatively and postoperatively by using a speech screening protocol that consisted of a list of single words designed by Ok-Ran Jung. Wilcoxon signed rank test was used to determine if there were significant differences between the preoperative and postoperative outcomes in each group A and B. And Mann-Whitney U test was used to determine if there were significant differences in the change of score between groups A and B. No patients had any noticeable change in speech production on perceptual assessment after maxillary advancement in our study. Furthermore, there were no significant differences between groups A and B. Repaired cleft palate patients without preoperative velopharyngeal dysfunction would not have greater risk of deterioration of velopharyngeal function after maxillary advancement compared to non-cleft palate patients.

  5. Acute cerebrovascular disease in the young: the Stroke in Young Fabry Patients study.

    Science.gov (United States)

    Rolfs, Arndt; Fazekas, Franz; Grittner, Ulrike; Dichgans, Martin; Martus, Peter; Holzhausen, Martin; Böttcher, Tobias; Heuschmann, Peter U; Tatlisumak, Turgut; Tanislav, Christian; Jungehulsing, Gerhard J; Giese, Anne-Katrin; Putaala, Jukaa; Huber, Roman; Bodechtel, Ulf; Lichy, Christoph; Enzinger, Christian; Schmidt, Reinhold; Hennerici, Michael G; Kaps, Manfred; Kessler, Christof; Lackner, Karl; Paschke, Eduard; Meyer, Wolfgang; Mascher, Hermann; Riess, Olaf; Kolodny, Edwin; Norrving, Bo

    2013-02-01

    Strokes have especially devastating implications if they occur early in life; however, only limited information exists on the characteristics of acute cerebrovascular disease in young adults. Although risk factors and manifestation of atherosclerosis are commonly associated with stroke in the elderly, recent data suggests different causes for stroke in the young. We initiated the prospective, multinational European study Stroke in Young Fabry Patients (sifap) to characterize a cohort of young stroke patients. Overall, 5023 patients aged 18 to 55 years with the diagnosis of ischemic stroke (3396), hemorrhagic stroke (271), transient ischemic attack (1071) were enrolled in 15 European countries and 47 centers between April 2007 and January 2010 undergoing a detailed, standardized, clinical, laboratory, and radiological protocol. Median age in the overall cohort was 46 years. Definite Fabry disease was diagnosed in 0.5% (95% confidence interval, 0.4%-0.8%; n=27) of all patients; and probable Fabry disease in additional 18 patients. Males dominated the study population (2962/59%) whereas females outnumbered men (65.3%) among the youngest patients (18-24 years). About 80.5% of the patients had a first stroke. Silent infarcts on magnetic resonance imaging were seen in 20% of patients with a first-ever stroke, and in 11.4% of patients with transient ischemic attack and no history of a previous cerebrovascular event. The most common causes of ischemic stroke were large artery atherosclerosis (18.6%) and dissection (9.9%). Definite Fabry disease occurs in 0.5% and probable Fabry disease in further 0.4% of young stroke patients. Silent infarcts, white matter intensities, and classical risk factors were highly prevalent, emphasizing the need for new early preventive strategies. Clinical Trial Registration Information- URL: http://www.clinicaltrials.gov.Unique identifier: NCT00414583.

  6. PO-06 - Cancer and the risk of venous thromboembolism in stroke patients

    DEFF Research Database (Denmark)

    Corraini, P; Ording, A G; Henderson, V W

    2016-01-01

    was matched to the stroke patients by date of diagnosis, year of birth, sex, and specific comorbidities using the Charlson Comorbidity Index and other VTE risk factors. We computed VTE cumulative risks, rates and rate ratios, as well as the interaction with comorbidity (as the excess VTE rates not explained......INTRODUCTION: The impact of comorbidity and in particular cancer on the risk of venous thromboembolism (VTE) after stroke is poorly understood. AIM: We aimed to determine the impact of comorbidity, in particular cancer, on the risk of venous thromboembolism in stroke patients as the excess VTE...... by stroke and comorbidity alone) during five years of follow-up. RESULTS: Five-year VTE risks were 2.16% and 1.85% in the stroke and general population comparison cohorts, respectively. Three-month VTE rate ratios peaked at a 6-fold increase (95% confidence interval: 4.9;6.2) in stroke patients and remained...

  7. Long-Term Survival of Young Stroke Patients: A Population-Based Study of Two Stroke Registries from Tartu, Estonia

    Directory of Open Access Journals (Sweden)

    R. Vibo

    2012-01-01

    We have used 2 population-based first-ever stroke registry data (1991–1993 and 2001–2003 to analyse the 1-, 5-, and 7-year outcome of young stroke patients by the Kaplan-Meier method of analysis. From the group of 1206 patients, 129 (11% were aged under 55 years. The overall survival rate at 1, 5, and 7 years was 0.70 (95% CI 0.62–0.78, 0.63 (95% CI 0.55–0.72, and 0.61 (95% CI 0.53–0.70, respectively. The survival was significantly worse for patients with intracerebral haemorrhage (P<0.01 and for those aged from 45 to 54 years compared to the younger age group from 0 to 44 years (P=0.03. For patients with ischemic stroke, aged from 15 to 44 years, the 1-, 5-, and 7-year survival rate was 0.89 (95% CI 0.79–1.00, 0.75 (95% CI 0.61–0.93, and 0.75 (0.61–0.93, respectively. There was no difference in overall survival between the two studied periods. We report a low long-term survival rate among young stroke patients in Estonia. Increasing age and hemorrhagic stroke subtype were associated with lower survival. We have previously shown a worse outcome for 1-year survival compared to other studies and currently this trend continues for 5- and 7-year survival rates. In fact, these are the lowest survival rates for the combined and separate stroke subtypes reported so far.

  8. Patients With Undetermined Stroke Have Increased Atrial Fibrosis: A Cardiac Magnetic Resonance Imaging Study.

    Science.gov (United States)

    Fonseca, Ana Catarina; Alves, Pedro; Inácio, Nuno; Marto, João Pedro; Viana-Baptista, Miguel; Pinho-E-Melo, Teresa; Ferro, José M; Almeida, Ana G

    2018-03-01

    Some patients with ischemic strokes that are currently classified as having an undetermined cause may have structural or functional changes of the left atrium (LA) and left atrial appendage, which increase their risk of thromboembolism. We compared the LA and left atrial appendage of patients with different ischemic stroke causes using cardiac magnetic resonance imaging. We prospectively included a consecutive sample of ischemic stroke patients. Patients with structural changes on echocardiography currently considered as causal for stroke in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification were excluded. A 3-T cardiac magnetic resonance imaging was performed. One hundred and eleven patients were evaluated. Patients with an undetermined cause had a higher percentage of LA fibrosis ( P =0.03) than patients with other stroke causes and lower, although not statistically significant, values of LA ejection fraction. Patients with atrial fibrillation and undetermined stroke cause showed a similar value of atrial fibrosis. The LA phenotype that was found in patients with undetermined cause supports the hypothesis that an atrial disease may be associated with stroke. © 2018 American Heart Association, Inc.

  9. Reduction in spasticity in stroke patient with paraffin therapy.

    Science.gov (United States)

    Wang, Jing; Yu, Peng; Zeng, Ming; Gu, Xudong; Liu, Yan; Xiao, Mingyue

    2017-01-01

    The aim of the study was to confirm whether paraffin therapy offer clinical value in the treatment of spasticity due to stroke. Fifty-two patients with spasticity in the upper limb were included. The patients were randomized into the experimental group with paraffin therapy (n = 27) and the control group with placebo therapy (n = 25). The outcome measures besides temperature examination were undertaken at time points of 0 (T0), 2 (T1) and 4 weeks (T2) following therapy treatment. The extent of spasticity was measured using Modified Ashworth Score (MAS) during passive movement at the shoulder, elbow, wrist and finger joints. Visual analogue scale (VAS) was used to evaluate the hemiplegic upper limb pain and functional activity of the upper limb motor function was evaluated by Brunnstrom recovery stage. All adverse events were recorded. MAS decreased significantly in Exp group compared with Con group, at the time points of T1 and T2, both before and immediately after paraffin therapy. Paraffin treatment failed to show remarkable improvement in pain compared with placebo-treated patient at movement at any time point. But VAS in Exp exhibited a tendency to decrease over time in shoulder, elbow, wrist and hand. With regard to the Brunnstrom score, patients in Exp showed significant improvement at the end of trial compared to the beginning. The values of temperature showed significant increment immediately after paraffin therapy at each time point in Exp group. Paraffin therapy may be a kind of noninvasive, promising method to reduce spasticity of stroke patients.

  10. Phonological analysis of substitution errors of patients with apraxia of speech

    Directory of Open Access Journals (Sweden)

    Maysa Luchesi Cera

    Full Text Available Abstract The literature on apraxia of speech describes the types and characteristics of phonological errors in this disorder. In general, phonemes affected by errors are described, but the distinctive features involved have not yet been investigated. Objective: To analyze the features involved in substitution errors produced by Brazilian-Portuguese speakers with apraxia of speech. Methods: 20 adults with apraxia of speech were assessed. Phonological analysis of the distinctive features involved in substitution type errors was carried out using the protocol for the evaluation of verbal and non-verbal apraxia. Results: The most affected features were: voiced, continuant, high, anterior, coronal, posterior. Moreover, the mean of the substitutions of marked to markedness features was statistically greater than the markedness to marked features. Conclusions: This study contributes toward a better characterization of the phonological errors found in apraxia of speech, thereby helping to diagnose communication disorders and the selection criteria of phonemes for rehabilitation in these patients.

  11. Trends in vascular risk factors, stroke performance measures, and outcomes in patients with first-ever ischemic stroke in Taiwan between 2000 and 2012.

    Science.gov (United States)

    Hsieh, Cheng-Yang; Wu, Darren Philbert; Sung, Sheng-Feng

    2017-07-15

    With the aging of the population in Taiwan, the financial burden of stroke on the healthcare system is expected to rise. We aimed to investigate the trends in vascular risk factors, adherence to stroke performance measures, and stroke outcomes based on a nationwide representative sample. Adult patients hospitalized for first-ever ischemic stroke between 2000 and 2012 were identified from a nationwide administrative database. The study period was divided into 1-year intervals. The Cuzick test and the Cochran-Armitage test were used to determine the significance of changes over time. Trends in stroke outcomes as a function of year were assessed using logistic regression, controlling for age, sex, comorbidity, and stroke severity. A total of 11,462 patients (mean age 67.3years, female 40.9%) were hospitalized. Between 2000 and 2012, the prevalence of hypertension, diabetes mellitus, hyperlipidemia, and atrial fibrillation increased while the prevalence of coronary artery disease decreased. The proportion of patients taking antihypertensive or antidiabetic medication prior to stroke decreased, whereas the proportion of patients taking lipid lowering medication increased. Adherence to the five selected performance measures significantly improved. A significant decreasing trend in the proportion of recurrent stroke or all-cause death within one year was observed regardless of whether adjustment for age, sex, comorbidity, and stroke severity was made. Despite the rising prevalence of vascular risk factors, improved adherence to stroke performance measures was accompanied by better stroke outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital

    OpenAIRE

    Luvizutto, Gustavo José; Gameiro, Mônica de Oliveira Orsi; Schelp, Arthur Oscar; Braga, Gabriel Pereira; Ribeiro, Priscila Watson; Bazan, Rodrigo

    2015-01-01

    [Purpose] The study aimed to characterize patients treated by rehabilitation section after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation records of individuals with ischemic stroke were studied retrospectively, excluding individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1, prior stroke, structural bone deformities, associated neurological disease, and prior cognitive deficit. The data evaluated were age, gender, etiology, ...

  13. The relationship between pneumonia and Glasgow coma scale assessment on acute stroke patients

    Science.gov (United States)

    Ritarwan, K.; Batubara, C. A.; Dhanu, R.

    2018-03-01

    Pneumonia is one of the most frequent medical complications of a stroke. Despite the well-documented association of a stroke associated infections with increased mortality and worse long-term outcome, on the other hand, the limited data available on independent predictors of pneumonia in acute stroke patients in an emergency unit. To determine the independentrelationship between pneumonia and Glasgow Coma Scale assessment on acute stroke patients. The cohort retrospective study observed 55 acute stroke patients who stayed in intensive care unit Adam Malik General Hospital from January until August 2017. Pneumonia was more frequent in patients with Ischemic stroke (OR 5.40; 95% CI: 1.28 – 6.40, p=0.003), higher National Institute of Health Stroke Scale (NIHSS) (p=0.014) and lower Glasgow Coma Scale (p=0.0001). Analysis multivariate logistic regression identified NIHSS as an independent of predictors of pneumonia (95% CI : 1.047 – 1.326, p=0.001). Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficits evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

  14. Improving communication in the primary care setting: perspectives of patients with speech disabilities.

    Science.gov (United States)

    Morris, Megan A; Yorkston, Kathryn; Clayman, Marla L

    2014-01-01

    Patients with speech disabilities can present with challenges when communicating during primary-care clinical encounters. Little is known about the healthcare communication experiences of patients with severe speech disabilities. Twelve participants took part in open-ended, in-person interviews. All participants had either acquired or developmental, severe speech disabilities but were not limited by cognitive and language disabilities. A multi-disciplinary team conducted a thematic analysis that included reading the transcripts and then developing and applying a list of codes through consensus. Participants discussed provider behaviors that affected communication during clinical encounters. They wanted providers to acknowledge their competence by speaking directly to them and using age-appropriate language. Additionally, participants appreciated when providers adapted to their communication style by maintaining eye contact, asking the patient how to best communicate with them, providing time for the patient to communicate, not interrupting the patient, and admitting when they do not understand the patient. Primary-care providers need to be cognizant of the communication needs of patients with communication disabilities. While the needs might be similar to other patient populations, patients with communication disabilities present with unique challenges. With accommodations, patients with speech disabilities can potentially be more engaged in their healthcare conversations.

  15. Magnitude of stroke and associated factors among patients who ...

    African Journals Online (AJOL)

    unhcc

    Thus, improving personal behaviour/ life style/ and early screening are important to prevent stroke in the study area. [Ethiop. J. Health Dev. 2016;30(3):129-134]. Key words: Stroke, factor, Felege Hiwot Hospital, Bahir Dar, Ethiopia. Background. Stroke or cerebrovascular accident is defined as the abrupt onset of neurologic ...

  16. Dysphagia in the patient after stroke: consequences and nurse intervention

    Directory of Open Access Journals (Sweden)

    Ana Frias

    2015-12-01

    Full Text Available Objectives: to check the consequences of poststroke dysphagia and to reflect on the nurse’s intervention in dysphagia rehabilitation. Methodology: it was performed a systematic literature review of the topic in question; research based on international databases EBSCOhost, LILACS, SciELO.We were able to identify some studies publications between 2006 and 2014. We intend to answer the guiding question: What are the consequences of dysphagia in the patient after stroke? » Results vs. Discussion: after a thorough analysis, we have selected 11 articles and found that the most frequent consequences of dysphagia are the pulmonary complications by saliva and/or food suction. The nurse specialist still has a barely visible role, but his/her interventions are critical in these patients rehabilitation. Conclusions: rehabilitation is essential to avoid the consequences of poststroke dysphagia. The rehabilitation process must go through a multidisciplinary team of which nurses are an integral and essential part.

  17. [Nursing interventions for stroke patients: an integrative literature review].

    Science.gov (United States)

    Cavalcante, Tahissa Frota; Moreira, Rafaella Pessoa; Guedes, Nirla Gomes; de Araujo, Thelma Leite; Lopes, Marcos Venícios de Oliveira; Damasceno, Marta Maria Coelho; Lima, Francisca Elisângela Teixeira

    2011-12-01

    The objective of this study was to analyze the knowledge on nursing interventions for hospitalized stroke patients. An integrative literature review was performed by accessing five online databases, in September 2009. The descriptors used in the search were nursing care and stoke, in Portuguese, English and Spanish. A total 223 articles were found, and 12 were selected. It was found in the articles that there was a greater number of clinical nursing interventions, followed by educational, managerial and research interventions. Clinical interventions are more related to the biological aspects of patients. As to the educational interventions, the articles point at the fundamental role of nurses, as well as that of relatives and caregivers. The main managerial intervention was the coordination of health care. As for research interventions, only one was identified and described as the development and improvement of health care practice through clinical evidence.

  18. The profile of risk factors and in-patient outcomes of stroke in ...

    African Journals Online (AJOL)

    85%, 73% and 58% of patients had systemic arterial hypertension, physical inactivity and obesity respectively as common risk factors. We identified that patients with stroke had a median of 3 traditional risk factors, were unaware of the presence of these risk factors or were poorly controlled if known. Stroke was associated ...

  19. Optimal Scoring Methods of Hand-Strength Tests in Patients with Stroke

    Science.gov (United States)

    Huang, Sheau-Ling; Hsieh, Ching-Lin; Lin, Jau-Hong; Chen, Hui-Mei

    2011-01-01

    The purpose of this study was to determine the optimal scoring methods for measuring strength of the more-affected hand in patients with stroke by examining the effect of reducing measurement errors. Three hand-strength tests of grip, palmar pinch, and lateral pinch were administered at two sessions in 56 patients with stroke. Five scoring methods…

  20. Risk factors for burn-out in caregivers of stroke patients, and possibilities for intervention

    NARCIS (Netherlands)

    van den Heuvel, ETP; de Witte, LP; Schure, LM; Sanderman, R; Meyboom-de Jong, B

    2001-01-01

    Objective: To identify which caregivers of stroke patients living at home experience the highest levels of strain and are at risk of burn-out, and to investigate how support for caregivers of stroke patients could best be organized, and when this support should be offered. Design and setting:

  1. Identification of risk factors related to perceived unmet demands in patients with chronic stroke

    NARCIS (Netherlands)

    van de Port, I. G. L.; van den Bos, G. A. M.; Voorendt, M.; Kwakkel, G.; Lindeman, E.

    2007-01-01

    PURPOSE: To investigate the prevalence of unmet demands concerning autonomy and participation and to identify risk factors related to these unmet demands in patients with chronic stroke. METHOD: A cross-sectional study of 147 patients three years after stroke. We assessed perceived unmet care

  2. Assessment of the Anterior Talofibular Ligament Thickness in Patients with Chronic Stroke: An Ultrasonographic Study

    Directory of Open Access Journals (Sweden)

    Mustafa Turgut Yildizgoren

    2017-09-01

    Conclusion: Chronic stroke patients have a thicker ATFL on both the affected and unaffected sides, compared with healthy individuals. This architectural feature of the ATFL may be a result of equinovarus deformity together with spastic muscles. For this reason, early treatment of deformed ligaments and spastic muscles is needed to prevent equinovarus deformity in patients with stroke.

  3. Early prediction and outcome of septic encephalopathy in acute stroke patients with nosocomial coma.

    Science.gov (United States)

    Tong, Dao-Ming; Zhou, Ye-Ting; Wang, Guang-Sheng; Chen, Xiao-Dong; Yang, Tong-Hui

    2015-07-01

    Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with or without SE. Risk factors for patients with SE were compared with those without SE by univariate and multivariate analysis. Of 94 stroke patients with NC, 46 (49%) had NC with SE and 48 (51%) had NC without SE. The onset-to-NC time was significant later in stroke patients with SE than those without SE (P stroke patients with SE was higher than those without SE (76.1% vs. 45.8%, P = 0.003). High fever and severe SIRS are two early predictors of stroke patients with SE, and survival rates were worse in stroke patients with SE than those without SE.

  4. The shuttle walk test: a new approach to functional walking capacity measurements for patients after stroke?

    NARCIS (Netherlands)

    Bloemendaal, M.; Kokkeler, A.M.; Port, I.G. van de

    2012-01-01

    OBJECTIVE: To determine the construct validity, test-retest reliability, and measurement error of the shuttle walk test (SWT) for patients after stroke. DESIGN: Clinimetric study. SETTING: Three rehabilitation centers in the Netherlands. PARTICIPANTS: A sample of patients after stroke (N=75; mean

  5. Variations of Blood Pressure in Stroke Unit Patients May Result from Alternating Body Positions

    NARCIS (Netherlands)

    Aries, M.J.H.; Elting, Jan Willem; Stewart, Roy E.; de Keyser, Jacques; Thien, Theo; Kremer, Berry P.; Vroomen, Patrick C. A. J.

    Background: Blood pressure (BP) is one of the major vital parameters monitored in the stroke unit. The accuracy of indirect BP measurement is strongly influenced by the position of both patient and arm during the measurement. Acute stroke patients are often nursed in lateral decubitus positions. The

  6. Efficacy of strategy training in left hemisphere stroke patients with apraxia : A randomised clinical trial

    NARCIS (Netherlands)

    Donkervoort, M; Dekker, J; Stehmann-Saris, FC; Deelman, B. G.

    2001-01-01

    The objective of the present study was to determine in a controlled study the efficacy of strategy training in left hemisphere stroke patients with apraxia. A total of 113 left hemisphere stroke patients with apraxia were randomly assigned to two treatment groups; (1) strategy training integrated

  7. Caregivers of Alzheimer's Disease and Stroke Patients: Immunological and Psychological Considerations.

    Science.gov (United States)

    Reese, Dawn R.; And Others

    1994-01-01

    Examined psychological and immunological changes among 25 caregivers of Alzheimer's disease (AD) patients, 25 caregivers of stroke patients, and 25 noncaregivers. Found that AD caregiving group was more psychologically distressed than stroke group, and both caregiving groups were more psychologically distressed than controls. Found no differences…

  8. An International Standard Set of Patient-Centered Outcome Measures After Stroke

    NARCIS (Netherlands)

    Salinas, J. (Joel); Sprinkhuizen, S.M. (Sara M.); Ackerson, T. (Teri); Bernhardt, J. (Julie); Davie, C. (Charlie); George, M.G. (Mary G.); Gething, S. (Stephanie); Kelly, A.G. (Adam G.); Lindsay, P. (Patrice); Liu, L. (Liping); Martins, S.C.O. (Sheila C.O.); Morgan, L. (Louise); B. Norrving (Bo); Ribbers, G.M. (Gerard M.); Silver, F.L. (Frank L.); Smith, E.E. (Eric E.); Williams, L.S. (Linda S.); Schwamm, L.H. (Lee H.)

    2015-01-01

    markdownabstract__BACKGROUND AND PURPOSE:__ Value-based health care aims to bring together patients and health systems to maximize the ratio of quality over cost. To enable assessment of healthcare value in stroke management, an international standard set of patient-centered stroke outcome measures

  9. What determines good recovery in patients with the most severe strokes?

    DEFF Research Database (Denmark)

    Jørgensen, H S; Reith, J; Nakayama, H

    1999-01-01

    Even patients with the most severe strokes sometimes experience a remarkably good recovery. We evaluated possible predictors of a good outcome to search for new therapeutic strategies.......Even patients with the most severe strokes sometimes experience a remarkably good recovery. We evaluated possible predictors of a good outcome to search for new therapeutic strategies....

  10. Time to rethink long-term rehabilitation management of stroke patients.

    Science.gov (United States)

    Teasell, Robert; Mehta, Swati; Pereira, Shelialah; McIntyre, Amanda; Janzen, Shannon; Allen, Laura; Lobo, Liane; Viana, Ricardo

    2012-01-01

    It has long been assumed that stroke patients plateau in their recovery within 3 to 6 months of their stroke, and evidence for rehabilitation during the chronic stage is limited. As a consequence, rehabilitation resources for the management of chronic stroke are minimal. The primary objective was to identify randomized controlled trials (RCTs) across the continuum of stroke rehabilitation for interventions initiated 6 months or more following the onset of stroke. The secondary objective was to determine whether treatments provided post 6 moths are effective in improving outcomes among stroke survivors. Multiple databases were used to identify all RCTs published from 1970 to June 2012 in English language where the stroke interventions were initiated more than 6 months after the onset of the stroke. Data abstraction was performed using standardized data abstraction form that included general citation information, study participant characteristics, methodology, outcomes accessed, and overall findings. The results of our analysis revealed 339 RCTs. The mean number of subjects per study was 73. Two hundred fifty-six RCTs were related to motor recovery, 39 to cognitive function, and only 19 to psychosocial issues and community reintegration. The majority of the RCT s demonstrated a significant positive benefit. There is a robust evidence-base for stroke rehabilitation interventions in chronic stroke. This research synthesis reveals a paradox, whereby an impressive evidence-base contrasts with the limited optimism and resources available for rehabilitation in chronic stroke.

  11. Patterns of poststroke brain damage that predict speech production errors in apraxia of speech and aphasia dissociate.

    Science.gov (United States)

    Basilakos, Alexandra; Rorden, Chris; Bonilha, Leonardo; Moser, Dana; Fridriksson, Julius

    2015-06-01

    Acquired apraxia of speech (AOS) is a motor speech disorder caused by brain damage. AOS often co-occurs with aphasia, a language disorder in which patients may also demonstrate speech production errors. The overlap of speech production deficits in both disorders has raised questions on whether AOS emerges from a unique pattern of brain damage or as a subelement of the aphasic syndrome. The purpose of this study was to determine whether speech production errors in AOS and aphasia are associated with distinctive patterns of brain injury. Forty-three patients with history of a single left-hemisphere stroke underwent comprehensive speech and language testing. The AOS Rating Scale was used to rate speech errors specific to AOS versus speech errors that can also be associated with both AOS and aphasia. Localized brain damage was identified using structural magnetic resonance imaging, and voxel-based lesion-impairment mapping was used to evaluate the relationship between speech errors specific to AOS, those that can occur in AOS or aphasia, and brain damage. The pattern of brain damage associated with AOS was most strongly associated with damage to cortical motor regions, with additional involvement of somatosensory areas. Speech production deficits that could be attributed to AOS or aphasia were associated with damage to the temporal lobe and the inferior precentral frontal regions. AOS likely occurs in conjunction with aphasia because of the proximity of the brain areas supporting speech and language, but the neurobiological substrate for each disorder differs. © 2015 American Heart Association, Inc.

  12. Impact of stroke unit in a public hospital on length of hospitalization and rate of early mortality of ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Maria Sheila G. Rocha

    2013-10-01

    Full Text Available We ascertained whether a public health stroke unit reduces the length of hospitalization, the rate of inpatient fatality, and the mortality rate 30 days after the stroke. Methods We compared a cohort of stroke patients managed on a general neurology/medical ward with a similar cohort of stroke patients managed in a str oke unit. The in-patient fatality rates and 30-day mortality rates were analyzed. Results 729 patients were managed in the general ward and 344 were treated at a comprehensive stroke unit. The in-patient fatality rates were 14.7% for the general ward group and 6.9% for the stroke unit group (p<0.001. The overall mortality rate 30 days after stroke was 20.9% for general ward patients and 14.2% for stroke unit patients (p=0.005. Conclusions We observed reduced in-patient fatalities and 30-day mortality rates in patients managed in the stroke unit. There was no impact on the length of hospitalization.

  13. Impact of sensory integration training on balance among stroke patients: sensory integration training on balance among stroke patients.

    Science.gov (United States)

    Jang, Sang Hun; Lee, Jung-Ho

    2016-01-01

    This study attempts to investigate the impact that the sensory integration training has on the recovery of balance among patients with stroke by examining the muscle activity and limit of stability (LOS). A total of 28 subjects participated. The subjects were randomly allocated by the computer program to one of two groups: control (CON) group (n=15), sensory integration training (SIT) group (n=13). The research subjects received intervention five days a week for a total of four weeks. The CON group additionally received 30-minute general balance training, while the SIT group additionally received 30-minute sensory integration training. In the muscle activity, the improvement of Erector spinae (ES) and Gluteus medius (GM) was more significant in the SIT group than in the CON group. In the LOS, the improvement of affected side and forward side was significantly higher in the SIT group compared to the CON group. Sensory integration training can improve balance ability of patients with stroke by increasing muscle activity of stance limb muscles such as GM and trunk extensor such as ES along with enhancement of the limit of stability.

  14. Impact of sensory integration training on balance among stroke patients: sensory integration training on balance among stroke patients

    Directory of Open Access Journals (Sweden)

    Jang Sang Hun

    2016-01-01

    Full Text Available This study attempts to investigate the impact that the sensory integration training has on the recovery of balance among patients with stroke by examining the muscle activity and limit of stability (LOS. A total of 28 subjects participated. The subjects were randomly allocated by the computer program to one of two groups: control (CON group (n=15, sensory integration training (SIT group (n=13. The research subjects received intervention five days a week for a total of four weeks. The CON group additionally received 30-minute general balance training, while the SIT group additionally received 30-minute sensory integration training. In the muscle activity, the improvement of Erector spinae (ES and Gluteus medius (GM was more significant in the SIT group than in the CON group. In the LOS, the improvement of affected side and forward side was significantly higher in the SIT group compared to the CON group. Sensory integration training can improve balance ability of patients with stroke by increasing muscle activity of stance limb muscles such as GM and trunk extensor such as ES along with enhancement of the limit of stability.

  15. CHARACTERISTICS AND OUTCOME OF STROKE PATIENTS WITH CEREBROVASCULAR ACCIDENT AT THE INTENSIVE CARE UNIT OF A TERTIARY HOSPITAL IN NIGERIA

    OpenAIRE

    Tobi, KU; Okojie, NQ

    2013-01-01

    Background: Patients with severe stroke defined as NIHSS score >17 constituting about 15-20% of cerebrovascular accident require admission into the Intensive Care Unit (ICU). However the benefit of ICU admission for stroke patients remains controversial.

  16. Clustered stroke patients on a general medical unit: what nursing skills and knowledge contribute to optimal patient outcomes?

    Science.gov (United States)

    Clayton, Brenda

    2014-01-01

    The purpose of this paper is to explore the nurse's role in caring for adult stroke patients, both ischemic and hemorrhagic, who are clustered on general medical units. There is evidence in the literature that having patients cared for in a dedicated stroke unit improves patient outcomes by decreasing disability and mortality rates for stroke survivors. However having a dedicated stroke unit may not be practical or feasible because of the population distribution, particularly for smaller urban and rural communities. Therefore, training nurses on the general medical units to provide care to clustered stroke patients requires specific skill training. This will decrease hospital stays and improve patient outcomes, as a result of specialized trained health care workers. A review of the literature indicates that there are specific skills and knowledge the nurse requires to perform evidence-based best practice therapy and have optimal patient outcomes when caringfor patients on general medical units.

  17. Incidence of constipation in stroke patients: A systematic review and meta-analysis.

    Science.gov (United States)

    Li, Jianxiang; Yuan, Mengguo; Liu, Yunfang; Zhao, Yang; Wang, Jingqing; Guo, Weifeng

    2017-06-01

    There is growing awareness of a link between the gut and cardiovascular disease. Constipation is common among individuals who have had a stroke, and it negatively affects social functioning and quality of life. However, no systematic study on the incidence of constipation in stroke patients has been reported.We selected studies included in Medline, Embase, Cochrane database, and Web of Science. Studies were included if they reported the incidence in stroke patients. Two authors selected the studies, extracted the data independently, and assessed these. Subgroup analyses were conducted according to the stroke subtype and stage of stroke.After detailed evaluations, 8 studies (n  =  1385 participants) were found that contained data that were suitable for meta-analytic synthesis. A forest plot showed that the incidence of constipation was 48% (95% confidence interval [CI]  =  33%-63%). In the analysis of the type of stroke subgroup, the incidence of constipation in patients who had had a hemorrhagic stroke (66% [95% CI  =  40-91%]) was higher than that in patients who had experienced an ischemic stroke (51% [95% CI  =  27%-75%]). The incidence in the acute stage (45% [95% CI  =  36%-54%]) was lower than that in the rehabilitation stage (48% [95% CI  =  23%-73%]).Constipation after a stroke event occurs frequently. This finding may raise awareness about bowel complications to allow correct evaluation and proper management.

  18. High incidence of respiratory infections in 'nil by mouth' tube-fed acute ischemic stroke patients.

    Science.gov (United States)

    Langdon, P C; Lee, A H; Binns, C W

    2009-01-01

    Respiratory infections are common in acute stroke. Previous studies have found dysphagia is associated with respiratory infections. Of interest is whether patients who are 'Nil by Mouth' (NBM) and tube fed have higher risk of developing infections due to aspiration of bacteria-laden saliva or refluxed material than stroke patients who are fed orally. Prospective cohort of 330 ischemic stroke survivors were followed for 30 days and infections recorded. 115 infections were treated with antibiotics; these included 51 respiratory infections. Incidence of infection in NBM tube-fed stroke patients (n = 74) was 69%, with 30 respiratory infections occurring in 74 patients who received enteral feeding after stroke. Logistic regression analysis showed tube feeding during admission was a significant risk for respiratory infection. We also saw a significant time-to-event effect with 73% (22/30) respiratory infections in tube-fed survivors diagnosed on days 2-4 after stroke, and 76% (39/51) of infections in all tube-fed survivors occurring by day 7 after stroke. Relevance to a theory of critical period of susceptibility to infection in acute stroke is discussed. NBM tube-fed survivors were unlikely to have aspirated anything other than saliva/secretions or reflux, yet experienced significantly higher rates of respiratory infections than survivors fed orally. Stringent oral care and measures to prevent reflux are potentially modifiable aspects of stroke management. 2008 S. Karger AG, Basel.

  19. Assessment of utility of Siriraj Stroke Score (SSS in stroke patients of Pt. BD Sharma PGIMS hospital, Rohtak, India

    Directory of Open Access Journals (Sweden)

    H. Singh

    2001-09-01

    Full Text Available India has predominantly poor rural population where brain CT scan, most often advised investigation in patients of stroke, may not always be available, hence Indian physician in such setting base his diagnosis on bed side sign evaluation for which Siriraj Stroke Score (SSS could be helpful. Objective of study: to assess the utility of SSS in patients of stroke. Methodology: sixty subjects of stroke were evaluated on SSS and 'probable' diagnosis so made was compared with CT scan's (brain 'certain' diagnosis. Main findings: by using SSS, the probable bedside diagnosis was cerebral infarct (score < -1 in 32 subjects and cerebral haemorrhage (score > +1 in 24 subjects while 4 subjects had indeterminant score (-1 to +1. Fifty subjects had their probable diagnosis matched with brain CT scan certain diagnosis. The above findings showed that SSS had 93.7% sensitivity, 76.6% specificity, 81.2% positive predictive value, 92% negative predictive value with an overall accuracy as 93.7% for diagnosis of cerebral infarction. For patients of cerebral haemorrhage the sensitivity was 83.3%, specificity was 92.5%, positive predictive value was 86.9%, negative predictive values was 92.5% with overall accuracy as 83.3%. Principal conclusion: physicians in the rural settings may find SSS to be quite useful in the management of stroke especially where more sophisticated radiological investigations may not be available for confirmation of diagnosis due to high cost or attended due to transportation risk. (Med J Indones 2007; 10: 164-8Keywords: stroke, cerebrovascular accident, infarction, haemorrhage

  20. Anosognosia in patients with acute hemispheric ischemic stroke

    Directory of Open Access Journals (Sweden)

    V. N. Grigoryeva

    2016-01-01

    Full Text Available Objective: to investigate the frequency of anosognosia (a deficit of self-awareness, its anatomic correlates associated with other neuropsychological and neurological disorders in acute hemispheric ischemic stroke (IS.Patients and methods 150 patients (83 men and 67 women; mean age, 63.0±9.3 years with acute hemispheric IS were examined. All the patients underwent neurological, neuroimaging, and neuropsychological (by the procedure described by A.R. Luria examinations. neuropsychological investigations. Anosognosia was diagnosed using the Dysexecutive Questionnaire (DEX and the authors' procedure involving a scale to measure impaired self-rating of motor abilities and a scale to measure impaired self-rating of cognitive abilities in everyday life.Results and discussion. In the acute period of hemispheric IS, reduced self-awareness of motor and cognitive abilities was noted in 14% of the patients and unawareness of only cognitive abilities was recorded in 15%. Patients with anosognosia and cognitive dysfunction (ACD and those with anosognosia and motor dysfunction (AMD had right-sided hemispheric IS more frequently (76% while this was not found in patients with isolated ACD. The development of anosognosia for paralysis and paresis was favored by the large sizes of an ischemic focus that involved a few lobes in the posterior regions of the brain although no lesions were found in the anosognosia-specific anatomical regions. ACD and AMD proved to be associated with unilateral spatial and tactile neglect and obvious regulatory dysfunction. 

  1. 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 ...

  2. Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II.

    Science.gov (United States)

    Bettger, Janet Prvu; Li, Zixiao; Xian, Ying; Liu, Liping; Zhao, Xingquan; Li, Hao; Wang, Chunxue; Wang, Chunjuan; Meng, Xia; Wang, Anxin; Pan, Yuesong; Peterson, Eric D; Wang, Yilong; Wang, Yongjun

    2017-04-01

    Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

  3. Preadmission oral anticoagulant treatment and clinical outcome among patients hospitalized with acute stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Svendsen, Marie Louise; Hansen, Morten Lock

    2014-01-01

    Preadmission oral anticoagulant treatment (OAT) has been linked with less severe stroke and a better outcome in patients with atrial fibrillation. However, the existing studies have methodological limitations and have, with one exception, not included hemorrhagic strokes. We performed a nationwide...... historic follow-up study using data from population-based healthcare registries to assess the effect of preadmission OAT on stroke outcomes further....

  4. No association between exacerbation frequency and stroke in patients with COPD

    Directory of Open Access Journals (Sweden)

    Windsor C

    2016-02-01

    Full Text Available Claire Windsor,1 Emily Herrett,1 Liam Smeeth,1 Jennifer Kathleen Quint1,2 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; 2Department of Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK Background: Patients with chronic obstructive pulmonary disease (COPD have a higher risk of stroke than the general population. Chronic inflammation associated with COPD is thought to contribute to this risk. Exacerbations of COPD are associated with a rise in inflammation, suggesting that there may be an association between exacerbation frequency and the risk of stroke. This study examined that association.Methods: Using the UK Clinical Practice Research Datalink, COPD patients with a first stroke between January 2004 and December 2013 were identified as cases and matched on age, sex, and general practice to controls with COPD but without a stroke (6,441 cases and 19,323 controls. Frequent exacerbators (FEs were defined as COPD patients with ≥2 exacerbations, and infrequent exacerbators (IEs have ≤1 exacerbation in the year prior to their stroke. Conditional logistic regression was used to estimate the association between exacerbation frequency and stroke overall, and by stroke subtype (hemorrhagic, ischemic, or transient ischemic attack. Exacerbations were also categorized into 0, 1, 2, or ≥3 exacerbations in the year prior to stroke.Results: There was no evidence that FE had an increased odds of stroke compared to IE (OR [odds ratio] =0.95, 95% CI [confidence interval] =0.89–1.01. There was strong evidence that the risk of stroke decreased with each exacerbation of COPD experienced per year (Ptrend =0.003. In the subgroup analysis investigating stroke subtype, FE had 33% lower odds of hemorrhagic stroke than IE (OR =0.67, 95% CI =0.51–0.88, P=0.003. No association was found within other stroke types

  5. Association of plasma homocysteine and white matter hypodensities in a sample of stroke patients

    International Nuclear Information System (INIS)

    Naveed, G.

    2015-01-01

    Studies of homocysteine in vascular disorders have yielded conflicting data. There are also differences based on various ethnicities and cultures. In this study, we have examined the homocysteine patterns in local stroke patients, so as to ascertain the homocysteine status in a sample of local population. Homocysteine-white matter hypodensities relationship in stroke is emerging, as an important aspect in stroke pathophysiology and is thought to have prognostic and therapeutic values. Methods: We included 150 stroke patients who were diagnosed as having clinical stroke on the basis of history; physical examination and CT (Computerized Tomography) scan of brain. These patients were recruited from neurology and emergency wards of two public sector hospitals of Lahore. The presence or absence of white matter hypodensities were diagnosed after consultation with a radiologist. Blood samples were collected from the same stroke patients. Results: We found a strong association between white matter hypodensities and total homocysteine in plasma of stroke patients p<0.001. Conclusion: Homocysteine is a risk factor for white matter hypodensities in stroke patients in our study. (author)

  6. [The Determinants of Dysphagia in Patients With Stroke During Hospitalized Rehabilitation].

    Science.gov (United States)

    Szu, Li-Yun; Hsieh, Suh-Ing; Tseng, Su-Mei; Huang, Tzu-Hsin

    2017-06-01

    Stroke was the third leading cause of death in Taiwan in 2014. A study found that 53.61% of stroke patients suffered from dysphagia disorder during the rehabilitation phase, which may result in lung aspiration and death. The determinants of dysphagia among nationally hospitalized-rehabilitation stroke patients have not been explored comprehensively. To explore the incidence of dysphagia among hospitalized-rehabilitation stroke patients and the related determinants of dysphagia. This descriptive and correlational research design employed a convenience sample of 130 hospitalized stroke patients from rehabilitation wards at a northern regional hospital in Taiwan. A questionnaire and functional assessment were used to collect data. Instruments used included personal and clinical characteristics data questionnaire, the National Institute of Health Stroke Scale (NIHSS), Barthel Index, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Standardization Swallowing Assessment (SSA), and Acute Stroke Dysphagia Screening (ASDS). Data analyses contained descriptive statistics and logistic regression. The incidence of stroke dysphagia was 63.8% (SSA) and 64.6% (ASDS), respectively. Age, marital status, stroke site, stroke severity (NIHSS), and cognitive status (MMSE) were identified as significant determinants of dysphagia in bivariate logistic regression, whereas stroke severity and cognitive status were identified as significant independent determinants of dysphagia in multivariate logistic regression. Two-thirds of the participant sample were affected by dysphagia, for which NIHSS and cognitive status were identified as significant determinants. Thus, nurses may conduct early screening for high risk populations based on patients' clinical characteristics in order to reduce aspiration pneumonia problems and to improve the quality of clinical care for dysphagia patients.

  7. Comparing withdrawal and not withdrawal of life-sustaining treatment among patients who died from stroke

    Directory of Open Access Journals (Sweden)

    Helvig E

    2015-09-01

    Full Text Available Eirik Helvig,1 Lars Thomassen,2 Ulrike Waje-Andreassen,2 Halvor Naess3 1Department of Neurology, Haukeland University Hospital, Jonas Liesgt, Bergen, 2Institute of Clinical Medicine, University of Bergen, Bergen, 3Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, NorwayBackground: In severe stroke, a decision to withdraw life-sustaining treatment is sometimes made in cooperation with the family. The aim of this study was to study the time from withdrawing life-sustaining treatment to death in patients with severe ischemic or hemorrhagic stroke.Methods: In total, 2,506 patients with stroke admitted to Haukeland University Hospital between 2006 and 2011 were prospectively registered in the Bergen NORSTROKE database. Risk factors, stroke severity, etiology, and blood analyses were registered. Retrospectively, the patients' records were examined to determine the number of days from withdrawing all life-sustaining treatment to death in patients who died from severe stroke during the hospital stay.Results: Life-sustaining treatment was withheld in 50 patients with severe stroke. Median time to death after withdrawing life-sustaining treatment was 4 days, and a quarter lived at least 1 week (range =1–11 days. Cox regression analyses showed that short time from withdrawing life-sustaining treatment to death was associated with high age (Hazard ratio [HR] =1.05, P=0.07, male sex (HR =2.9, P=0.01, high C-reactive protein on admission (HR =1.01, P=0.001, and hemorrhagic stroke (versus ischemic stroke, HR =1.5, P=0.03.Conclusion: One week after withdrawing life-sustaining treatment, a quarter of our patients with severe stroke remained alive. Short time to death was associated with high age, male sex, hemorrhagic stroke, and high C-reactive protein on admittance. Keywords: stroke, withdrawal of life-sustaining treatment, prognosis

  8. Stroke Risk among Patients with Type 2 Diabetes Mellitus in Zhejiang: A Population-Based Prospective Study in China

    Directory of Open Access Journals (Sweden)

    Lihua Guo

    2016-01-01

    Full Text Available Objective. This study aimed to explore the incidence of stroke and stroke subtypes among patients with type 2 diabetes mellitus (T2DM based on the long-term surveillance data in Zhejiang, China, during 2007 to 2013. Materials and Methods. During January 1, 2007, and December 31, 2013, a total of 327,268 T2DM and 307,984 stroke patients were registered on Diabetes and Stroke Surveillance System, respectively. Stroke subtypes were classified according to standard definitions of subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic stroke. The incidence of stroke and stroke subtypes was calculated by standardized incidence ratio (SIRs with 95% confidence intervals (CIs compared with general population. Results. The incidence of stroke and stroke subtypes among patients with T2DM was significantly higher than in general population. Stroke risk was found significantly increased with an SIR of 3.87 (95% CI 3.76–3.99 and 3.38 (95% CI 3.27–3.48 in females and males, respectively. The excess risk of stroke was mainly attributable to the significantly higher risk of cerebral infarctions with the risk for T2DM being four times that for general population. Conclusions. The relationship between stroke and T2DM was strong, especially in female. The incidence of stroke and stroke subtypes among patients with T2DM was up to 3-fold higher than in general population in Zhejiang province, especially the subtype of cerebral infarctions.

  9. Aphasia As a Predictor of Stroke Outcome.

    Science.gov (United States)

    Lazar, Ronald M; Boehme, Amelia K

    2017-09-19

    Aphasia is a common feature of stroke, affecting 21-38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes. During the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Independence Measures (FIM) scores, longer stays in rehabilitation settings, poorer function in activities of daily living, and mortality. Factors that complicate the analysis of aphasia on post-stroke outcomes, however, include widely different systems of care across international settings that result in varying admission patterns to acute stroke units, allowable length of stays based on reimbursement, and criteria for rehabilitation placement. Aphasia arising from stroke is associated with worse outcomes both in the acute and chronic periods. Future research will have to incorporate disparate patterns in analytic models, and to take into account specific aphasia profiles and evolving methods of post-stroke speech-language therapy.

  10. Evaluation of clopidogrel resistance in ischemic stroke patients.

    Science.gov (United States)

    Fukuoka, Takuya; Furuya, Daisuke; Takeda, Hidetaka; Dembo, Tomohisa; Nagoya, Harumitu; Kato, Yuji; Deguchi, Ichiro; Maruyama, Hajime; Horiuchi, Yohsuke; Tanahashi, Norio

    2011-01-01

    Clopidogrel has potent antiplatelet effects, but recent interest has focused on clopidogrel resistance, in which platelet function is not inhibited despite taking the drug. This study evaluated clopidogrel resistance in ischemic stroke patients. After taking oral clopidogrel 75 mg/day for ≥1 week, platelet aggregometry was performed by turbidimetry in all patients, and by a screen filtration pressure method using whole blood in 37 patients. Using turbidimetry, resistance was defined as platelet maximum aggregation rate ≥34% with aggregation-inducing agent ADP 1 µmol/L, or ≥66% with ADP 4 µmol/L. Using the screen filtration pressure method, resistance was defined as a minimum concentration of ≤3 µmol/L ADP to induce secondary aggregation of platelets. This study was conducted in 72 patients (52 men, 20 women; mean age, 69 ± 8 years; range, 50-84 years) with non-cardiogenic ischemic cerebrovascular disease. Based on turbidimetry, the rate of clopidogrel resistance was 8.3% with ADP 1 µmol/L and 18.1% with 4 µmol/L. Based on the screen filtration pressure, the rate of clopidogrel resistance was 8.1%. The differences between turbidimetry and screen filtration pressure methods, regarding the measurement of the presence of resistance in the same patient, were observed. Clopidogrel resistance varies greatly depending on the method of measuring platelet aggregation and the definition of resistance. Rates of 8-18% were obtained using our methods and criteria.

  11. Quality of care and mortality among patients with stroke - A nationwide follow-up study

    DEFF Research Database (Denmark)

    Ingeman, A.; Pedersen, Lars; Hundborg, Heidi Holmager

    2008-01-01

    Background: The relationship between process and outcome measures among patients with stroke is unclear. Objectives: To examine the association between quality of care and mortality among patients with stroke in a nationwide population-based follow-up study. Methods: Using data from The Danish...... National Indicator Project, a quality improvement initiative with participation of all Danish hospital departments caring for patients with stroke, we identified 29,573 patients hospitalized with stroke between January 13, 2003 and October 31, 2005. Quality of care was measured in terms of 7 specific...... criteria: early admission to a stroke unit, early initiation of antiplatelet or oral anticoagulant therapy, early examination with computed tomography/magnetic resonance imaging scan, and early assessment by a physiotherapist, an occupational therapist, and of nutritional risk. Data on 30- and 90-day...

  12. Analysis of clinical and imaging characters and prognosis in patients with epilepsy after stroke

    International Nuclear Information System (INIS)

    Huang Yongguang; Zeng Huiliang

    2003-01-01

    Objective: To evaluate the relationship between clinical, imaging characters and prognosis in patients with epilepsy after stroke. Methods: In total 78 cases of post-stroke epilepsy were studied retrospectively out of 840 cases. Results: The incidence of post-stroke epilepsy was 9.29%. The early-stage epilepsy (less than 2 weeks) accounted for 61.54%. The major type of seizure were partial seizure and general tonic-clonic seizure. The incidence was higher in patients with cerebral hemorrhage or with lesions involving the cortex. Symptomatolytic medication was effective. Compared with non-epilepsy group, the mortality of epilepsy was higher. Conclusion: Post-stroke epilepsy is usually accompanied with cortical focus, which is more often seen in patients with cerebral hemorrhage than in patients with cerebral infarction. Post-stroke epilepsy responses well to the medication but indicates a poor prognosis

  13. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators

    DEFF Research Database (Denmark)

    van Walraven, Carl; Hart, Robert G; Connolly, Stuart

    2009-01-01

    . Outcomes included ischemic stroke, serious bleeding (intracranial hemorrhage or systemic bleeding requiring hospitalization, transfusion, or surgery), and cardiovascular events (ischemic stroke, myocardial infarction, systemic embolism, or vascular death). RESULTS: The analysis included 8932 patients......BACKGROUND AND PURPOSE: Stroke risk increases with age in patients who have nonvalvular atrial fibrillation. It is uncertain whether the efficacy of stroke prevention therapies in atrial fibrillation changes as patients age. The objective of this study was to determine the effect of age...... on the relative efficacy of oral anticoagulants (OAC) and antiplatelet (AP) therapy (including acetylsalicylic acid and triflusal) on ischemic stroke, serious bleeding, and vascular events in patients with atrial fibrillation. METHODS: This is an analysis of the Atrial Fibrillation Investigators database, which...

  14. Is Barthel index a relevant measure for measuring prevalence of urinary incontinence in stroke patients?

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Dehlendorff, Christian

    2012-01-01

    distinguished between types of UI (38% urge UI, 28% stress UI, and 14% other UI). There were significantly fewer stroke patients who reported UI by the Barthel Index compared to the DAN‐PSS questionnaire in term of urge UI (P stress UI (P PSS......To compare the prevalence of urinary incontinence (UI) measured by Barthel Index and the Danish Prostate Symptom Score (DAN‐PSS‐1) questionnaire in stroke patients. A cross‐sectional, hospital based survey was initiated whereby 407 stroke patients, average age 67 (SD 12) years with a mean interval...... of 101 days since onset of last stroke at inclusion. The stroke patients self‐reported the prevalence of UI by Barthel Index and the DAN‐PSS‐1 questionnaire. The prevalence of UI was 10.5% measured by the Barthel Index and 49% by the DAN‐PSS‐1 questionnaire. Furthermore, the DAN‐PSS‐1 questionnaire...

  15. Association of Nonsteroidal Anti-inflammatory Drug Use With Stroke Among Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Chih-Cheng Hsu

    2017-05-01

    Discussion: In summary, the results show supportive evidence that NSAID use increased the risk of stroke in dialysis patients, which suggests the importance of closely monitoring the transient effects of initial NSAID treatment to patients on dialysis.

  16. Ethnic Comparison of Clinical Characteristics and Ischemic Stroke Subtypes Among Young Adult Patients With Stroke in Hawaii.

    Science.gov (United States)

    Nakagawa, Kazuma; Ito, Cherisse S; King, Sage L

    2017-01-01

    Native Hawaiians and other Pacific Islanders (NHOPI) with ischemic stroke have younger age of stroke onset compared with whites. However, ethnic differences in stroke subtypes in this population have been inadequately studied. Consecutive young adult patients (aged ≤55 years) who were hospitalized for ischemic stroke between 2006 and 2012 at a tertiary center in Honolulu were studied. Clinical characteristics and stroke subtypes based on pathophysiological TOAST classification (Trial of Org 10172) of NHOPI and Asians were compared with whites. A total of 427 consecutive young adult (mean age, 46.7±7.8 years) patients (NHOPI 45%, Asians 38%, and whites 17%) were studied. NHOPI had a higher prevalence of hypertension, diabetes mellitus, prosthetic valve, higher body mass index, hemoglobin A1c, and lower high-density lipoprotein than whites (all PStroke subtype distribution was not different between the ethnic groups. Specifically, the prevalence of small-vessel disease was similar between NHOPI (26.6%), whites (28.4%), and Asians (24.8%). In the univariate analyses, the use of intravenous tissue-type plasminogen activator was lower among NHOPI (4.7%; P=0.01) and Asians (3.1%; P=0.002) than among whites (12.5%). In the multivariable model, NHOPI (odds ratio, 0.35; 95% confidence interval, 0.12-0.98) and Asians (odds ratio, 0.23; 95% confidence interval, 0.07-0.74) were less likely to be treated with intravenous tissue-type plasminogen activator than whites. NHOPI have greater cardiovascular risk factors than whites, but there were no differences in stroke subtypes between the ethnic groups. Furthermore, NHOPI and Asians may be less likely to be treated with intravenous tissue-type plasminogen activator than whites. © 2016 American Heart Association, Inc.

  17. Protocol and methodology of the Stroke in Young Fabry Patients (sifap1) study: a prospective multicenter European study of 5,024 young stroke patients aged 18-55 years.

    LENUS (Irish Health Repository)

    Rolfs, Arndt

    2011-01-01

    Stroke in the young has not been thoroughly investigated with most previous studies based on a small number of patients from single centers. Furthermore, recent reports indicate that Fabry disease may be a significant cause for young stroke. The primary aim of our study was to determine the prevalence of Fabry disease in young stroke patients, while the secondary aim was to describe patterns of stroke in young patients.

  18. Missed strokes using computed tomography imaging in patients with vertigo: population-based cohort study.

    Science.gov (United States)

    Grewal, Keerat; Austin, Peter C; Kapral, Moira K; Lu, Hong; Atzema, Clare L

    2015-01-01

    The purpose of this study was to determine the proportion of emergency department (ED) patients with a diagnosis of peripheral vertigo who received computed tomography (CT) head imaging in the ED and to examine whether strokes were missed using CT imaging. This population-based retrospective cohort study assessed patients who were discharged from an ED in Ontario, Canada, with a diagnosis of peripheral vertigo, April 2006 to March 2011. Patients who received CT imaging (exposed) were matched by propensity score methods to patients who did not (unexposed). If performed, CT imaging was presumed to be negative for stroke because brain stem/cerebellar stroke would result in hospitalization. We compared the incidence of stroke within 30, 90, and 365 days subsequent to ED discharge between groups, to determine whether the exposed group had a higher frequency of early strokes than the matched unexposed group. Among 41 794 qualifying patients, 8596 (20.6%) received ED head CT imaging, and 99.8% of these patients were able to be matched to a control. Among exposed patients, 25 (0.29%) were hospitalized for stroke within 30 days when compared with 11 (0.13%) among matched nonexposed patients. The relative risk of a 30- and 90-day stroke among exposed versus unexposed patients was 2.27 (95% confidence interval, 1.12-4.62) and 1.94 (95% confidence interval, 1.10-3.43), respectively. There was no difference between groups at 1 year. Strokes occurred at a median of 32.0 days (interquartile range, 4.0-33.0 days) in exposed patients, compared with 105 days (interquartile range, 11.5-204.5) in unexposed patients. One fifth of patients diagnosed with peripheral vertigo in Ontario received imaging that is not recommended in guidelines, and that imaging was associated with missed strokes. © 2014 American Heart Association, Inc.

  19. Characteristics of Inpatient Care and Rehabilitation for Acute First-Ever Stroke Patients

    Science.gov (United States)

    Chang, Won Hyuk; Shin, Yong-Il; Lee, Sam-Gyu; Oh, Gyung-Jae; Lim, Young Shil

    2015-01-01

    Purpose The purpose of this study was to analyze the status of inpatient care for acute first-ever stroke at three general hospitals in Korea to provide basic data and useful information on the development of comprehensive and systematic rehabilitation care for stroke patients. Materials and Methods This study conducted a retrospective complete enumeration survey of all acute first-ever stroke patients admitted to three distinct general hospitals for 2 years by reviewing medical records. Both ischemic and hemorrhagic strokes were included. Survey items included demographic data, risk factors, stroke type, state of rehabilitation treatment, discharge destination, and functional status at discharge. Results A total of 2159 patients were reviewed. The mean age was 61.5±14.4 years and the ratio of males to females was 1.23:1. Proportion of ischemic stroke comprised 54.9% and hemorrhagic stroke 45.1%. Early hospital mortality rate was 8.1%. Among these patients, 27.9% received rehabilitation consultation and 22.9% underwent inpatient rehabilitation treatment. The mean period from admission to rehabilitation consultation was 14.5 days. Only 12.9% of patients were transferred to a rehabilitation department and the mean period from onset to transfer was 23.4 days. Improvements in functional status were observed in the patients who had received inpatient rehabilitation treatment after acute stroke management. Conclusion Our analysis revealed that a relatively small portion of patients who suffered from an acute first-ever stroke received rehabilitation consultation and inpatient rehabilitation treatment. Thus, applying standardized clinical practice guidelines for post-acute rehabilitation care is needed to provide more effective and efficient rehabilitation services to patients with stroke. PMID:25510773

  20. Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia.

    Science.gov (United States)

    Yamada, Shinya; Lin, Chin-Yu; Chang, Shih-Lin; Chao, Tze-Fan; Lin, Yenn-Jiang; Lo, Li-Wei; Chung, Fa-Po; Hu, Yu-Feng; Tuan, Ta-Chuan; Liao, Jo-Nan; Te, Abigail Louise D; Chang, Yao-Ting; Chang, Ting-Yung; Wu, Cheng-I; Higa, Satoshi; Chen, Shih-Ann

    2017-12-01

    The risk of stroke in patients with short-run atrial tachyarrhythmia (AT) remains unclear. This study aimed to investigate the relationship between short-run AT and the stroke and the use of the CHA 2 DS 2 -VASc score for the risk stratification. From the registry of 24-hour Holter monitoring, 5342 subjects without known atrial fibrillation or stroke were enrolled. Short-run AT was defined as episodes of supraventricular ectopic beats stroke. Patients with short-run AT had significantly higher stroke rates compared with patients without short-run AT (11.4% versus 8.3%; P strokes per 100 person-years for patients with CHA 2 DS 2 -VASc score of 0 and 1 were 0.23 and 0.67, respectively. However, the number of them for patients with CHA 2 DS 2 -VASc score of 2, 3, 4, and ≥5 were 1.62, 1.89, 1.30, and 2.91, respectively. In patients with CHA 2 DS 2 -VASc score of 0 or 1, age (>61 years old) and burden of premature atrial contractions (>25 beats/d) independently predicted the risk of stroke. In subgroup analyses, short-run AT patients were divided into 3 groups based on their CHA 2 DS 2 -VASc scores: low score (score of 0 [men] or 1 [women]; n=324), intermediate score (score of 1 [men] or 2 [women]; n=275), and high score (score of ≥2 [men] or ≥3 [women]; n=996). When compared with low score, intermediate and high scores were independent predictors for stroke (hazard ratio, 6.165; P stroke. Therefore, the CHA 2 DS 2 -VASc score could be used for the risk stratification. Age and burden of premature atrial contractions were independent predictors for stroke in patients with CHA 2 DS 2 -VASc score of 0 or 1. © 2017 American Heart Association, Inc.

  1. Genome-wide meta-analysis of cerebral white matter hyperintensities in patients with stroke.

    Science.gov (United States)

    Traylor, Matthew; Zhang, Cathy R; Adib-Samii, Poneh; Devan, William J; Parsons, Owen E; Lanfranconi, Silvia; Gregory, Sarah; Cloonan, Lisa; Falcone, Guido J; Radmanesh, Farid; Fitzpatrick, Kaitlin; Kanakis, Allison; Barrick, Thomas R; Moynihan, Barry; Lewis, Cathryn M; Boncoraglio, Giorgio B; Lemmens, Robin; Thijs, Vincent; Sudlow, Cathie; Wardlaw, Joanna; Rothwell, Peter M; Meschia, James F; Worrall, Bradford B; Levi, Christopher; Bevan, Steve; Furie, Karen L; Dichgans, Martin; Rosand, Jonathan; Markus, Hugh S; Rost, Natalia

    2016-01-12

    For 3,670 stroke patients from the United Kingdom, United States, Australia, Belgium, and Italy, we performed a genome-wide meta-analysis of white matter hyperintensity volumes (WMHV) on data imputed to the 1000 Genomes reference dataset to provide insights into disease mechanisms. We first sought to identify genetic associations with white matter hyperintensities in a stroke population, and then examined whether genetic loci previously linked to WMHV in community populations are also associated in stroke patients. Having established that genetic associations are shared between the 2 populations, we performed a meta-analysis testing which associations with WMHV in stroke-free populations are associated overall when combined with stroke populations. There were no associations at genome-wide significance with WMHV in stroke patients. All previously reported genome-wide significant associations with WMHV in community populations shared direction of effect in stroke patients. In a meta-analysis of the genome-wide significant and suggestive loci (p EVL], p = 4.0 × 10(-8); rs962888 [C1QL1], p = 1.1 × 10(-8); rs9515201 [COL4A2], p = 6.9 × 10(-9)). Genetic associations with WMHV are shared in otherwise healthy individuals and patients with stroke, indicating common genetic susceptibility in cerebral small vessel disease. © 2015 American Academy of Neurology.

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

    Science.gov (United States)

    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.

  3. A comparison of outcome for stroke patients in Barbados and South London.

    Science.gov (United States)

    Smeeton, Nigel C; Corbin, David O C; Hennis, Anselm J M; Hambleton, Ian R; Rose, Angela M C; Fraser, Henry S; Heuschmann, Peter U; Wolfe, Charles D A

    2011-04-01

    Little is known about the poststroke outcome in Caribbean populations. We investigated differences in the activities of daily living, level of social activities, living circumstances and survival for stroke patients in Barbados and London. Data were collected from the South London Stroke Register and the Barbados Register of Strokes for patients with a first-ever stroke registered between January 2001 and December 2004. The ability to perform activities of daily living was measured by the Barthel Index and level of social activities by the Frenchay Activities Index. Living circumstances were categorised into private household vs. institutional care. Death and dependency, activities of daily living and social activities were assessed at three-months, one- and two-years using logistic regression, adjusted for differences in demographic, socioeconomic and stroke severity characteristics. At three-months, a high level of social activities was more likely for the Barbados Register of Strokes (odds ratio 1.84; 95% confidence interval 1.03-3.29); there were no differences in activities of daily living; and Barbados Register of Strokes patients were less likely to be in institutional care (relative risk ratio 0.38; 95% confidence interval 0.18-0.79). Following adjustment, Barbados Register of Strokes patients had a higher risk of mortality at three-months (relative risk ratio 1.85; 95% confidence interval 1.03-3.30), one-year (relative risk ratio 1.83; 95% confidence interval 1.08-3.09) and two-years (relative risk ratio 1.82; 95% confidence interval 1.08-3.07). This difference was due to early poststroke deaths; for patients alive at four-weeks poststroke, survival thereafter was similar in both settings. In Barbados, there was evidence for a healthy survivor effect, and short-term social activity was greater than that in the South London Stroke Register. © 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization.

  4. Reduced poststroke mortality in patients with stroke and atrial fibrillation treated with anticoagulants: results from a Danish quality-control registry of 22,179 patients with ischemic stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2007-01-01

    severity (according to the Scandinavian Stroke Scale), computed tomography scan, and an evaluation for cardiovascular risk factors. Follow-up duration was 4 years (mean, 1.2 years). RESULTS: Of all patients, 22 179 (89.4%) experienced an ischemic stroke. In total, 3670 (16.5%) had AF, and 1909 had....... METHODS: A nationwide registry that was started in 2001 with the aim of registering all hospitalized stroke patients in Denmark now includes 24 791 patients. We studied the survival of patients with ischemic stroke and AF with respect to anticoagulation treatment. All underwent an evaluation for stroke......BACKGROUND AND PURPOSE: The preventive effect of anticoagulation in patients with stroke and atrial fibrillation (AF) is documented only in trials of minor stroke. Although anticoagulation reduced stroke recurrence, those trials did not demonstrate an influence of anticoagulation on survival...

  5. Impact of state Medicaid coverage on utilization of inpatient rehabilitation facilities among patients with stroke.

    Science.gov (United States)

    Skolarus, Lesli E; Burke, James F; Morgenstern, Lewis B; Meurer, William J; Adelman, Eric E; Kerber, Kevin A; Callaghan, Brian C; Lisabeth, Lynda D

    2014-08-01

    Poststroke rehabilitation is associated with improved outcomes. Medicaid coverage of inpatient rehabilitation facility (IRF) admissions varies by state. We explored the role of state Medicaid IRF coverage on IRF utilization among patients with stroke. Working age ischemic stroke patients with Medicaid were identified from the 2010 Nationwide Inpatient Sample. Medicaid coverage of IRFs (yes versus no) was ascertained. Primary outcome was discharge to IRF (versus other discharge destinations). We fit a logistic regression model that included patient demographics, Medicaid coverage, comorbidities, length of stay, tissue-type plasminogen activator use, state Medicaid IRF coverage, and the interaction between patient Medicaid status and state Medicaid IRF coverage while accounting for hospital clustering. Medicaid did not cover IRFs in 4 (TN, TX, SC, WV) of 42 states. The impact of State Medicaid IRF coverage was limited to Medicaid stroke patients (P for interaction stroke patients in states with Medicaid IRF coverage, Medicaid stroke patients hospitalized in states without Medicaid IRF coverage were less likely to be discharged to an IRF of 11.6% (95% confidence interval, 8.5%-14.7%) versus 19.5% (95% confidence interval, 18.3%-20.8%), Pstroke patients with Medicaid. Given the increasing stroke incidence among the working age and Medicaid expansion under the Affordable Care Act, careful attention to state Medicaid policy for poststroke rehabilitation and analysis of its effects on stroke outcome disparities are warranted. © 2014 American Heart Association, Inc.

  6. Pragmatic elements of the speech of Broca's aphasic patients: clinical preliminar study

    Directory of Open Access Journals (Sweden)

    Juliano Luis Fontanari

    1987-03-01

    Full Text Available The author studies three patients with Broca aphasia characterized by the Boston Diagnostic Aphasia Examination, and following A.R. Luria's criterion on the use and comprehension of pragmatic elements of speech - deixis of time, person, place, discourse and social, implicatures of Grice, conventional, generalized and particularized and presupposition. For this, the author works on the development of three hours speech resulted from interviews and also uses specific tests. One of the patients lost the propositional content of speech and internal language, typical of severe dinamic aphasia. The other two showed instability in comprehension and use of time and place deixis only during the tests, not revealing this anomaly at non-artificial conditions. These findings suggest that metalanguage is upset with its specific temporo-spatial elements affected, and it is possible that there is a graduation in the loss of discourse linkage with verbal and nonverbal context in which mediation is made by pragmatic relation in frontal lesions.

  7. [Pragmatic elements of the speech of patients with Broca's aphasia: preliminary clinical study].

    Science.gov (United States)

    Fontanari, J L

    1987-03-01

    The author studies three patients with Broca aphasia characterized by the Boston Diagnostic Aphasia Examination, and following A.R. Luria's criterion on the use and comprehension of pragmatic elements of speech--deixis of time, person, place, discourse and social, implicatures of Grice, conventional, generalized and particularized and presupposition. For this, the author works on the development of three hours speech resulted from interviews and also uses specific tests. One of the patients lost the propositional content of speech and internal language, typical of severe dynamic aphasia. The other two showed instability in comprehension and use of time and place deixis only during the tests, not revealing this anomaly at non-artificial conditions. These findings suggest that metalanguage is upset with its specific temporo-spatial elements affected, and it is possible that there is a graduation in the loss of discourse linkage with verbal and nonverbal context in which mediation is made by pragmatic relation in frontal lesions.

  8. Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics.

    Science.gov (United States)

    Rostanski, Sara K; Williams, Olajide; Stillman, Joshua I; Marshall, Randolph S; Willey, Joshua Z

    2016-10-01

    Acute stroke is a time-sensitive condition in which rapid diagnosis must be made in order for thrombolytic treatment to be administered. A certain proportion of patients who receive thrombolysis will be found on further evaluation to have a diagnosis other than stroke, so-called "stroke mimics." Little is known about the role of language discordance in the emergency department diagnosis of acute ischemic stroke. This is a retrospective analysis of all acute ischemic stroke patients who received IV tissue plasminogen activator (tPA) in our emergency department between July 2011 and December 2015. Baseline characteristics, patient language, and final diagnosis were compared between encounters in which the treating neurologist and patient spoke the same language (concordant cases) and encounters in which they did not (discordant cases). A total of 350 patients received IV tPA during the study period. English was the primary language for 52.6%, Spanish for 44.9%, and other languages for 2.6%; 60.3% of cases were classified as language concordant and 39.7% as discordant. We found no significant difference in the proportion of stroke mimics in the language concordant compared to discordant groups (16.6% vs 9.4%, p = 0.06). Similarly, the proportion of stroke mimics did not differ between English- and Spanish-speaking patients (15.8% vs 11.5%, p = 0.27). Language discordance was not associated with acute stroke misdiagnosis among patients treated with IV tPA. Prospective evaluation of communication during acute stroke encounters is needed to gain clarity on the role of language discordance in acute stroke misdiagnosis.

  9. Temporal acuity and speech recognition score in noise in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Mehri Maleki

    2014-04-01

    Full Text Available Background and Aim: Multiple sclerosis (MS is one of the central nervous system diseases can be associated with a variety of symptoms such as hearing disorders. The main consequence of hearing loss is poor speech perception, and temporal acuity has important role in speech perception. We evaluated the speech perception in silent and in the presence of noise and temporal acuity in patients with multiple sclerosis.Methods: Eighteen adults with multiple sclerosis with the mean age of 37.28 years and 18 age- and sex- matched controls with the mean age of 38.00 years participated in this study. Temporal acuity and speech perception were evaluated by random gap detection test (GDT and word recognition score (WRS in three different signal to noise ratios.Results: Statistical analysis of test results revealed significant differences between the two groups (p<0.05. Analysis of gap detection test (in 4 sensation levels and word recognition score in both groups showed significant differences (p<0.001.Conclusion: According to this survey, the ability of patients with multiple sclerosis to process temporal features of stimulus was impaired. It seems that, this impairment is important factor to decrease word recognition score and speech perception.

  10. The relation between serum Vitamin D levels and body antioxidant status in ischemic stroke patients: A case?control study

    OpenAIRE

    Afshari, Laleh; Amani, Reza; Soltani, Farhad; Haghighizadeh, Mohammad Hossein; Afsharmanesh, Mohammad Reza

    2015-01-01

    Background: Stroke is the second cause of death among elderly people. Oxidative stress plays an important role in brain damage after stroke. Currently, Vitamin D has been shown as an antioxidant. The aim of this study was to evaluate the status of Vitamin D, antioxidant enzymes, and the relation between them in ischemic stroke patients. Materials and Methods: This case?control study was carried out on 36 patients with ischemic stroke patients and 36 matched subjects as controls. Intake of fru...

  11. Manual Aspiration Thrombectomy in Patients with Acute Stroke-Related Calcified Cerebral Emboli.

    Science.gov (United States)

    Koh, Esther; Kwak, Hyo Sung; Chung, Gyung-Ho

    2017-10-01

    The aim of this study was to evaluate the effectiveness of mechanical aspiration thrombectomy (MAT) in patients with acute ischemic stroke from calcified cerebral emboli. Procedural results were reviewed for acute stroke patients with clinically neurological deficits who underwent recanalization from October 2012 through September 2015. Initial imaging studies and cerebral angiography were analyzed. Of the total number of patients with acute stroke, 5 patients were confirmed to have acute ischemic stroke by calcified cerebral emboli. On initial brain computed tomographic imaging, all patients showed small, dense single calcifications in the middle cerebral artery with no definitive ischemic low-density lesions (M1: 3, M2: 2, mean size: 4.8 mm). All patients had angiographic findings of filling defects from calcified emboli. Four patients had good collateral flow and two had continuous distal flow. All patients underwent MAT using a Penumbra catheter (Penumbra Inc., Alameda, CA). MAT did not remove calcified emboli in all patients. Two patients with good collateral flow had favorable functional outcomes (modified Rankin Scale score ≤2). Four patients had diffuse calcification in the aortic arch, carotid artery, and aortic valve. Cerebral angiography supports a diagnosis of stroke when calcified cerebral emboli have contrast-filling defects and a degree of vascular occlusion. However, in this study, MAT was not an effective treatment for patients with calcified cerebral emboli because of hardness of the calcified plaque and packing into the arterial lumen. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone

    Energy Technology Data Exchange (ETDEWEB)

    Sattler, Margriet G.A., E-mail: g.a.sattler@umcg.nl [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Vroomen, Patrick C. [Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Sluiter, Wim J. [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Schers, Henk J. [Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (Netherlands); Berg, Gerrit van den [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Langendijk, Johannes A. [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Wolffenbuttel, Bruce H.R. [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Bergh, Alphons C.M. van den [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Beek, André P. van [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)

    2013-09-01

    Purpose: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. Methods and Materials: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical Center Groningen in The Netherlands was studied. Radiation therapy was administered in 236 patients. The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) and the Oxfordshire Community Stroke Project classification methods were used to determine causative mechanism and anatomic localization of stroke. Stroke incidences in patients treated with RT were compared with that observed after surgery alone. Risk factors for stroke incidence were studied by log–rank test, without and with stratification for other significant risk factors. In addition, the stroke incidence was compared with the incidence rate in the general Dutch population. Results: Thirteen RT patients were diagnosed with stroke, compared with 12 surgery-alone patients. The relative risk (RR) for stroke in patients treated with postoperative RT was not significantly different compared with surgery-alone patients (univariate RR 0.62, 95% confidence interval [CI] 0.28-1.35, P=.23). Stroke risk factors were coronary or peripheral artery disease (univariate and multivariate RR 10.4, 95% CI 4.7-22.8, P<.001) and hypertension (univariate RR 3.9, 95% CI 1.6-9.8, P=.002). There was no difference in TOAST and Oxfordshire classification of stroke. In this pituitary adenoma cohort 25 strokes were observed, compared with 16.91 expected (standard incidence ratio 1.48, 95% CI 1.00-1.96, P=.049). Conclusions: In pituitary adenoma patients, an increased incidence of stroke was observed compared with the general population. However, postoperative RT was not associated with an increased incidence of stroke or differences in causative mechanism or anatomic localization of stroke compared with surgery alone. The primary stroke risk

  13. Eficácia da fonoterapia em um caso de afasia expressiva decorrente de acidente vascular encefálico Speech therapy effectiveness in a case of expressive aphasia resulting from stroke

    Directory of Open Access Journals (Sweden)

    Letícia Regina Kunst

    2012-01-01

    a male patient, aged 68, treated in the clinic since May 2009. His therapeutic process was analyzed up to December 2010. The client suffered an ischemic stroke in the left cerebral hemisphere, on January 2009, when suddenly presented mutism. After the evaluations, the therapist concluded that the client presented "aphasia, compromising the oral and the writing expression, caused by ischemic stroke". So, the treatment plan was created. Since the start of therapy, significant linguistic changes could be observed in the client. A primary factor for the satisfactory recover was the quick search for the speech treatment (15 days after the stroke, because there is a degree of spontaneous recovery in aphasic clients. But, the good results are minimal without the adequate therapy. Only one month after the beginning of the therapy, the client improved substantially his vocabulary. Despite the injury area is extensive and fundamental to the language, it was observed very positive results with the therapy. So, we believe that the early speech therapy contributed a lot to the linguistic recover, since the client communicate satisfactorily, if we consider the great extension of his injury.

  14. Religious faith and psychosocial adaptation among stroke patients in Kuwa