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Sample records for stroke program early

  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. ASPECTS (Alberta Stroke Program Early CT Score) Assessment of the Perfusion-Diffusion Mismatch.

    Science.gov (United States)

    Lassalle, Louis; Turc, Guillaume; Tisserand, Marie; Charron, Sylvain; Roca, Pauline; Lion, Stephanie; Legrand, Laurence; Edjlali, Myriam; Naggara, Olivier; Meder, Jean-François; Mas, Jean-Louis; Baron, Jean-Claude; Oppenheim, Catherine

    2016-10-01

    Rapid and reliable assessment of the perfusion-weighted imaging (PWI)/diffusion-weighted imaging (DWI) mismatch is required to promote its wider application in both acute stroke clinical routine and trials. We tested whether an evaluation based on the Alberta Stroke Program Early CT Score (ASPECTS) reliably identifies the PWI/DWI mismatch. A total of 232 consecutive patients with acute middle cerebral artery stroke who underwent pretreatment magnetic resonance imaging (PWI and DWI) were retrospectively evaluated. PWI-ASPECTS and DWI-ASPECTS were determined blind from manually segmented PWI and DWI volumes. Mismatch-ASPECTS was defined as the difference between PWI-ASPECTS and DWI-ASPECTS (a high score indicates a large mismatch). We determined the mismatch-ASPECTS cutoff that best identified the volumetric mismatch, defined as VolumeTmax>6s/VolumeDWI≥1.8, a volume difference≥15 mL, and a VolumeDWImismatch-ASPECTS ≥2 best identified a volumetric mismatch, with a sensitivity of 0.93 (95% confidence interval, 0.89-0.98) and a specificity of 0.82 (95% confidence interval, 0.74-0.89). The mismatch-ASPECTS method can detect a true mismatch in patients with acute middle cerebral artery stroke. It could be used for rapid screening of patients with eligible mismatch, in centers not equipped with ultrafast postprocessing software. © 2016 American Heart Association, Inc.

  3. Validation of Serial Alberta Stroke Program Early CT Score as an Outcome Predictor in Thrombolyzed Stroke Patients.

    Science.gov (United States)

    Kong, Wan-Yee; Tan, Benjamin Y Q; Ngiam, Nicholas J H; Tan, Deborah Y C; Yuan, Christine H; Holmin, Staffan; Andersson, Tommy; Lundström, Erik; Teoh, Hock Luen; Chan, Bernard P L; Rathakrishnan, Rahul; Ting, Eric Y S; Sharma, Vijay K; Yeo, Leonard L L

    2017-10-01

    The Alberta Stroke Program Early CT Score (ASPECTS) on baseline imaging is an established predictor of functional outcome in anterior circulation acute ischemic stroke (AIS). We studied ASPECTS before intravenous thrombolysis (IVT) and at 24 hours to assess its prognostic value. Data for consecutive anterior circulation AIS patients treated with IVT from 2006 to 2013 were extracted from a prospectively managed registry at our tertiary center. Pre-thrombolysis and 24-hour ASPECTS were evaluated by 2 independent neuroradiologists. Outcome measures included symptomatic intracranial hemorrhage (SICH), modified Rankin Scale (mRS) at 90 days, and mortality. Unfavorable functional outcome was defined by mRS >1. Dramatic ASPECTS progression (DAP) was defined as deterioration in ASPECTS by 6 points or more. Of 554 AIS patients thrombolyzed during the study period, 400 suffered from anterior circulation infarction. The median age was 65 years (interquartile range (IQR): 59-70) and the median National Institutes of Health Stroke Scale score was 18 points (IQR: 12-22). Compared with the pre-IVT ASPECTS (area under the curve [AUC] = .64, 95% confidence interval [CI]: .54-.65, P = .001), ASPECTS on the 24-hour CT scan (AUC = .78, 95% CI: .73-.82, P < .001), and change in ASPECTS (AUC = .69, 95% CI: .64-.74, P < .001) were better predictors of unfavorable functional outcome at 3 months. DAP, noted in 34 (14.4%) patients with good baseline ASPECTS (8-10 points), was significantly associated with unfavorable functional outcome (odds ratio [OR]: 9.91, 95% CI: 3.37-29.19, P ≤ .001), mortality (OR: 21.99, 95% CI: 7.98-60.58, P < .001), and SICH (OR: 8.57, 95% CI: 2.87-25.59, P < .001). Compared with the pre-thrombolysis score, ASPECTS measured at 24 hours as well as serial change in ASPECTS is a better predictor of 3-month functional outcome. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. Early rehabilitation after stroke.

    Science.gov (United States)

    Bernhardt, Julie; Godecke, Erin; Johnson, Liam; Langhorne, Peter

    2017-02-01

    Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions. Trials in this early time window are few. Although the seminal AVERT trial suggests that a cautious approach is necessary immediately (stroke, early mobility training and mobilization appear well tolerated, with few reasons to delay initiating some rehabilitation within the first week. The results of large clinical trials of early aphasia therapy are on the horizon, and examples of targeted upper limb treatments with better patient selection are emerging. Early rehabilitation trials are complex, particularly those that intervene across acute and rehabilitation care settings, but these trials are important if we are to optimize recovery potential in the critical window for repair. Concerted efforts to standardize 'early' recruitment, appropriately stratify participants and implement longer term follow-up is needed. Trial standards are improving. New recommendations from a recent Stroke Recovery and Rehabilitation Roundtable will help drive new research.

  5. Impact of pretreatment noncontrast CT Alberta Stroke Program Early CT Score on clinical outcome after intra-arterial stroke therapy.

    Science.gov (United States)

    Yoo, Albert J; Zaidat, Osama O; Chaudhry, Zeshan A; Berkhemer, Olvert A; González, R Gilberto; Goyal, Mayank; Demchuk, Andrew M; Menon, Bijoy K; Mualem, Elan; Ueda, Dawn; Buell, Hope; Sit, Siu Po; Bose, Arani

    2014-03-01

    The efficacy of intra-arterial treatment remains uncertain. Because most centers performing IAT use noncontrast CT (NCCT) imaging, it is critical to understand the impact of NCCT findings on treatment outcomes. This study aimed to compare functional independence and safety among patients undergoing intra-arterial treatment stratified by the extent of ischemic change on pretreatment NCCT. The study cohort was derived from multicenter trials of the Penumbra System. Inclusion criteria were anterior circulation proximal occlusion, evaluable pretreatment NCCT, and known time to reperfusion. Ischemic change was quantified using the Alberta Stroke Program Early CT Score (ASPECTS) and stratified into 3 prespecified groups for comparison: 0 to 4 (most ischemic change) versus 5 to 7 versus 8 to 10 (least ischemic change). A total of 249 patients were analyzed: 40 with ASPECTS 0 to 4, 83 with ASPECTS 5 to 7, and 126 with ASPECTS 8 to 10. For ASPECTS 0 to 4, 5 to 7, and 8 to 10, respectively, good outcome (modified Rankin Scale score, 0-2) rates were 5%, 38.6%, and 46% (P<0.0001), and mortality rates were 55%, 28.9%, and 19% (P=0.0001). The only significant pairwise differences were between ASPECTS 0 to 4 and other groups. Symptomatic hemorrhage was more common with lower ASPECTS (P=0.02). Shorter time to reperfusion was significantly associated with better outcomes among patients with ASPECTS 8 to 10 (P=0.01). A similar relationship was seen for ASPECTS 5 to 7 but was not statistically significant. No such relationship was seen for ASPECTS 0 to 4. NCCT seems useful for excluding patients with the greatest burden of ischemic damage from futile intra-arterial treatment, which is unlikely to result in patient functional independence and increases the risk of hemorrhage.

  6. Alberta Stroke Program Early CT Score-Time Score Predicts Outcome after Endovascular Therapy in Patients with Acute Ischemic Stroke: A Retrospective Single-Center Study.

    Science.gov (United States)

    Todo, Kenichi; Sakai, Nobuyuki; Kono, Tomoyuki; Hoshi, Taku; Imamura, Hirotoshi; Adachi, Hidemitsu; Yamagami, Hiroshi; Kohara, Nobuo

    2018-04-01

    Clinical outcomes after successful endovascular therapy in patients with acute ischemic stroke are associated with several factors including onset-to-reperfusion time (ORT), the National Institute of Health Stroke Scale (NIHSS) score, and the Alberta Stroke Program Early CT Score (ASPECTS). The NIHSS-time score, calculated as follows: [NIHSS score] × [onset-to-treatment time (h)] or [NIHSS score] × [ORT (h)], has been reported to predict clinical outcomes after intravenous recombinant tissue plasminogen activator therapy and endovascular therapy for acute stroke. The objective of the current study was to assess whether the combination of the ASPECTS and the ORT can predict the outcomes after endovascular therapy. The charts of 117 consecutive ischemic stroke patients with successful reperfusion after endovascular therapy were retrospectively reviewed. We analyzed the association of ORT, ASPECTS, and ASPECTS-time score with clinical outcome. ASPECTS-time score was calculated as follows: [11 - ASPECTS] × [ORT (h)]. Rates of good outcome for patients with ASPECTS-time scores of tertile values, scores 5.67 or less, scores greater than 5.67 to 10.40 or less, and scores greater than 10.40, were 66.7%, 56.4%, and 33.3%, respectively (P < .05). Ordinal logistic regression analysis showed that the ASPECTS-time score (per category increase) was an independent predictor for better outcome (common odds ratio: .374; 95% confidence interval: .150-0.930; P < .05). A lower ASPECTS-time score may predict better clinical outcomes after endovascular treatment. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Alberta Stroke Program Early CT Scale evaluation of multimodal computed tomography in predicting clinical outcomes of stroke patients treated with aspiration thrombectomy.

    Science.gov (United States)

    Psychogios, Marios-Nikos; Schramm, Peter; Frölich, Andreas Maximilian; Kallenberg, Kai; Wasser, Katrin; Reinhardt, Lars; Kreusch, Andreas S; Jung, Klaus; Knauth, Michael

    2013-08-01

    Patient selection is crucial in the endovascular treatment of acute ischemic stroke patients. Baseline computed tomographic (CT) images, evaluated with the Alberta Stroke Program Early CT Scale (ASPECTS), are considered significant predictors of outcome. In this study, we evaluated CT images and perfusion parameters, analyzed with ASPECTS, as final outcome predictors after endovascular stroke treatment. We analyzed a cohort of patients with acute ischemic stroke and endovascular treatment. Patients with an occlusion of the M1 segment and multimodal CT imaging were included. CT perfusion data were reconstructed using commercial software. Two experienced neuroradiologists separately reviewed and scored CT and CT perfusion images with the ASPECTS score. Parameters were compared between patients with poor and with favorable follow-up outcome. Significantly different variables were further analyzed by forward stepwise logistic regression. Fifty-one patients were included in our study. Baseline characteristics did not differ between patients with favorable and poor outcomes. No significant difference in recanalization status, the various times, or CT ASPECTS was demonstrated between these 2 groups. Significant differences were demonstrated for age (P=0.0049), cerebral blood volume ASPECTS (P=0.0007), and between cerebral blood volume and cerebral blood flow ASPECTS (P=0.0045). Cerebral blood volume ASPECTS>7 demonstrated the highest sensitivity and specificity for favorable outcome with 84% and 79%, respectively. CT perfusion parameters, evaluated with ASPECTS, are optimal predictors of outcome and are more sensitive and specific than CT ASPECTS in the prediction of favorable outcome. Use of these parameters in treatment decisions could reduce futile recanalizations.

  8. Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

    International Nuclear Information System (INIS)

    Kawiorski, Michal M.; Alonso de Lecinana, Maria; Martinez-Sanchez, Patricia; Fuentes, Blanca; Sanz-Cuesta, Borja E.; Marin, Begona; Ruiz-Ares, Gerardo; Diez-Tejedor, Exuperio; Garcia-Pastor, Andres; Diaz-Otero, Fernando; Calleja, Patricia; Lourido, Daniel; Vicente, Agustina; Fandino, Eduardo; Sierra-Hidalgo, Fernando

    2016-01-01

    Reliable predictors of poor clinical outcome despite successful revascularization might help select patients with acute ischemic stroke for thrombectomy. We sought to determine whether baseline Alberta Stroke Program Early CT Score (ASPECTS) applied to CT angiography source images (CTA-SI) is useful in predicting futile recanalization. Data are from the FUN-TPA study registry (ClinicalTrials.gov; NCT02164357) including patients with acute ischemic stroke due to proximal arterial occlusion in anterior circulation, undergoing reperfusion therapies. Baseline non-contrast CT and CTA-SI-ASPECTS, time-lapse to image acquisition, occurrence, and timing of recanalization were recorded. Outcome measures were NIHSS at 24 h, symptomatic intracranial hemorrhage, modified Rankin scale score, and mortality at 90 days. Futile recanalization was defined when successful recanalization was associated with poor functional outcome (death or disability). Included were 110 patients, baseline NIHSS 17 (IQR 12; 20), treated with intravenous thrombolysis (IVT; 45 %), primary mechanical thrombectomy (MT; 16 %), or combined IVT + MT (39 %). Recanalization rate was 71 %, median delay of 287 min (225; 357). Recanalization was futile in 28 % of cases. In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3-0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5-1.2). A score ≤5 in CTA-SI-ASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %). CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies. (orig.)

  9. Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Kawiorski, Michal M.; Alonso de Lecinana, Maria [Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid (Spain); Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala de Henares, Madrid (Spain); Martinez-Sanchez, Patricia; Fuentes, Blanca; Sanz-Cuesta, Borja E.; Marin, Begona; Ruiz-Ares, Gerardo; Diez-Tejedor, Exuperio [Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid (Spain); Garcia-Pastor, Andres; Diaz-Otero, Fernando [Hospital Universitario Gregorio Maranon, IiSGM, Universidad Complutense de Madrid, Madrid (Spain); Calleja, Patricia [Hospital Universitario 12 de Octubre, Universidad Autonoma de Madrid, Madrid (Spain); Lourido, Daniel; Vicente, Agustina; Fandino, Eduardo [Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala de Henares, Madrid (Spain); Sierra-Hidalgo, Fernando [Hospital Universitario 12 de Octubre, Universidad Autonoma de Madrid, Madrid (Spain); Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid (Spain)

    2016-05-15

    Reliable predictors of poor clinical outcome despite successful revascularization might help select patients with acute ischemic stroke for thrombectomy. We sought to determine whether baseline Alberta Stroke Program Early CT Score (ASPECTS) applied to CT angiography source images (CTA-SI) is useful in predicting futile recanalization. Data are from the FUN-TPA study registry (ClinicalTrials.gov; NCT02164357) including patients with acute ischemic stroke due to proximal arterial occlusion in anterior circulation, undergoing reperfusion therapies. Baseline non-contrast CT and CTA-SI-ASPECTS, time-lapse to image acquisition, occurrence, and timing of recanalization were recorded. Outcome measures were NIHSS at 24 h, symptomatic intracranial hemorrhage, modified Rankin scale score, and mortality at 90 days. Futile recanalization was defined when successful recanalization was associated with poor functional outcome (death or disability). Included were 110 patients, baseline NIHSS 17 (IQR 12; 20), treated with intravenous thrombolysis (IVT; 45 %), primary mechanical thrombectomy (MT; 16 %), or combined IVT + MT (39 %). Recanalization rate was 71 %, median delay of 287 min (225; 357). Recanalization was futile in 28 % of cases. In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3-0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5-1.2). A score ≤5 in CTA-SI-ASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %). CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies. (orig.)

  10. Early infection and prognosis after acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Reith, J

    2001-01-01

    Infection is a frequent complication in the early course of acute stroke and may adversely affect stroke outcome. In the present study, we investigate early infection developing in patients within 3 days of admission to the hospital and its independent relation to recovery and stroke outcome....... In addition, we identify predictors for early infections, infection subtypes, and their relation to initial stroke severity....

  11. Extent of early ischemic changes on computed tomography (CT) before thrombolysis: prognostic value of the Alberta Stroke Program Early CT Score in ECASS II.

    Science.gov (United States)

    Dzialowski, Imanuel; Hill, Michael D; Coutts, Shelagh B; Demchuk, Andrew M; Kent, David M; Wunderlich, Olaf; von Kummer, Rüdiger

    2006-04-01

    The significance of early ischemic changes (EICs) on computed tomography (CT) to triage patients for thrombolysis has been controversial. The Alberta Stroke Program Early CT Score (ASPECTS) semiquantitatively assesses EICs within the middle cerebral artery territory using a10-point grading system. We hypothesized that dichotomized ASPECTS predicts response to intravenous thrombolysis and incidence of secondary hemorrhage within 6 hours of stroke onset. Data from the European-Australian Acute Stroke Study (ECASS) II study were used in which 800 patients were randomized to recombinant tissue plasminogen activator (rt-PA) or placebo within 6 hours of symptom onset. We retrospectively assessed all baseline CT scans, dichotomized ASPECTS at 7, defined favorable outcome as modified Rankin Scale score 0 to 2 after 90 days, and secondary hemorrhage as parenchymal hematoma 1 (PH1) or PH2. We performed a multivariable logistic regression analysis and assessed for an interaction between rt-PA treatment and baseline ASPECTS score. We scored ASPECTS >7 in 557 and < or =7 in 231 patients. There was no treatment-by-ASPECTS interaction with dichotomized ASPECTS (P=0.3). This also applied for the 0- to 3-hour and 3- to 6-hour cohorts. However, a treatment-by-ASPECTS effect modification was seen in predicting PH (0.043 for the interaction term), indicating a much higher likelihood of thrombolytic-related parenchymal hemorrhage in those with ASPECTS < or =7. In ECASS II, the effect of rt-PA on functional outcome is not influenced by baseline ASPECTS. Patients with low ASPECTS have a substantially increased risk of thrombolytic-related PH.

  12. Serial Alberta Stroke Program early CT score from baseline to 24 hours in Solitaire Flow Restoration with the Intention for Thrombectomy study: a novel surrogate end point for revascularization in acute stroke.

    Science.gov (United States)

    Liebeskind, David S; Jahan, Reza; Nogueira, Raul G; Jovin, Tudor G; Lutsep, Helmi L; Saver, Jeffrey L

    2014-03-01

    The Alberta Stroke Program Early CT Score (ASPECTS) on baseline imaging is an established predictor of acute ischemic stroke outcomes. We analyzed change on serial ASPECTS at baseline and 24-hour imaging in the Solitaire Flow Restoration with the Intention for Thrombectomy (SWIFT) study to determine prognostic value and to identify subgroups with extensive injury after intervention. ASPECTS at baseline and 24 hours was independently scored in all anterior circulation SWIFT cases, blinded to all other trial data. ASPECTS at baseline, at 24 hours, and serial changes were analyzed with univariate and multivariate approaches. One hundred thirty-nine patients (mean age, 67 [SD, 12] years; 52% women; median National Institutes of Health Stroke Scale, 18 [interquartile range, 8-28]) with complete data at both time points were studied. Multivariate analyses showed that higher 24-hour ASPECTS predicted good clinical outcome (day 90 modified Rankin Scale, 0-2; odds ratio, 1.67; PScale outcomes (mean modified Rankin Scale, 4.4 versus 2.7; P<0.001). Twenty-four-hour ASPECTS provides better prognostic information compared with baseline ASPECTS. Predictors of dramatic infarct progression on ASPECTS are hyperglycemia, hypertension, and nonreperfusion. Serial ASPECTS change from baseline to 24 hours predicts clinical outcome, providing an early surrogate end point for thrombectomy trials. http://www.clinicaltrials.gov. Unique identifier: NCT01054560.

  13. Stroke scale score and early prediction of outcome after stroke

    International Nuclear Information System (INIS)

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

    2004-01-01

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

  14. Impact of window setting optimization on accuracy of computed tomography and computed tomography angiography source image-based Alberta Stroke Program Early Computed Tomography Score.

    Science.gov (United States)

    Arsava, Ethem Murat; Saarinen, Jukka T; Unal, Ali; Akpinar, Erhan; Oguz, Kader K; Topcuoglu, Mehmet Akif

    2014-01-01

    The use of narrower window width settings on computed tomography (CT) improves sensitivity for detection of early ischemic changes in acute ischemic stroke. This study analyzed the effect of optimization of window settings on the accuracy of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) performed on noncontrast CT (NCCT) and CT angiography source images (CTA-SI). ASPECTS was calculated on NCCT and CTA-SI with standard and optimized window width/center settings in a consecutive series of patients with acute ishcemic stroke. The difference between CT-based ASPECTS and ASPECTS performed on follow-up magnetic resonance imaging (MRI) were calculated to determine the disparity between initial estimates of the extent of ischemia on CT and follow-up lesion imaging by MRI. Forty-four patients were included into the study. The mean difference with respect to follow-up MRI-ASPECTS was 4.1 ± 2.2 for standard NCCT-ASPECTS, 3.7 ± 2.3 for optimized NCCT-ASPECTS, 3.0 ± 2.2 for standard CTA-SI-ASPECTS, and 2.7 ± 2.1 for optimized CTA-SI-ASPECTS. The improvement introduced by the optimization of window settings and use of CTA-SI was statistically significant (P window display settings. This improvement is irrespective of experience or specialty of the rater performing the assessment. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Cortical swallowing processing in early subacute stroke

    Directory of Open Access Journals (Sweden)

    Fischer Maren

    2011-03-01

    Full Text Available Abstract Background Dysphagia is a major complication in hemispheric as well as brainstem stroke patients causing aspiration pneumonia and increased mortality. Little is known about the recovery from dysphagia after stroke. The aim of the present study was to determine the different patterns of cortical swallowing processing in patients with hemispheric and brainstem stroke with and without dysphagia in the early subacute phase. Methods We measured brain activity by mean of whole-head MEG in 37 patients with different stroke localisation 8.2 +/- 4.8 days after stroke to study changes in cortical activation during self-paced swallowing. An age matched group of healthy subjects served as controls. Data were analyzed by means of synthetic aperture magnetometry and group analyses were performed using a permutation test. Results Our results demonstrate strong bilateral reduction of cortical swallowing activation in dysphagic patients with hemispheric stroke. In hemispheric stroke without dysphagia, bilateral activation was found. In the small group of patients with brainstem stroke we observed a reduction of cortical activation and a right hemispheric lateralization. Conclusion Bulbar central pattern generators coordinate the pharyngeal swallowing phase. The observed right hemispheric lateralization in brainstem stroke can therefore be interpreted as acute cortical compensation of subcortically caused dysphagia. The reduction of activation in brainstem stroke patients and dysphagic patients with cortical stroke could be explained in terms of diaschisis.

  16. Interobserver agreement between senior radiology resident, neuroradiology fellow, and experienced neuroradiologist in the rating of Alberta Stroke Program Early Computed Tomography Score (ASPECTS).

    Science.gov (United States)

    Kobkitsuksakul, Chai; Tritanon, Oranan; Suraratdecha, Vichan

    2018-02-21

    The distribution of ischemic changes caused by infarction of the middle cerebral artery (MCA) territories is usually measured using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). The first interpreter of the brain computed tomography (CT) in the emergency department is the on-call radiology resident. The primary objective of this study was to describe the agreement of the ASPECTS performed retrospectively by the resident compared with expert raters. The second objective was to ascertain the appropriate window setting for early detection of acute ischemic stroke and good interobserver agreement between the interpreters. We identified consecutive patients presenting with hemiparesis or aphasia at the emergency department who underwent brain CT and CT angiography. Each scan was rated using ASPECTS by senior radiology resident, neuroradiology fellow, and later by consensus between two expert raters. Statistical analysis included determination of Cohen's kappa (κ) coefficient and intraclass correlation coefficient (ICC). A total of 43 patients met our study criteria. Interobserver agreements for ASPECTS varied from 0.486 to 0.678 in Cohen's κ coefficient between consensus of two neuroradiologists and a neuroradiology fellow, and from 0.198 to 0.491 for consensus between two neuroradiologists and a senior radiology resident. ICC among three raters (expert consensus, neuroradiology fellow, and senior radiology resident), was very good when 8 HU window width and 32 HU center level setting was used. ASPECTS varied among raters. However, when using a narrowed window setting for interpretation, interobserver agreement improved.

  17. Fabry disease and early stroke

    DEFF Research Database (Denmark)

    Feldt-Rasmussen, U

    2011-01-01

    Fabry disease, an X-linked lysosomal storage disorder, results from deficient activity of the enzyme a-galactosidase A. Affected males with the classic phoenotype have acroparaesthesias, hypohidrosis, and corneal opacities in childhood and develop renal failure, cardiac hypertrophy or strokes...... in the third to fifth decade of life. Some female heterozygotes are asymptomatic, some as severely affected as males. The natural history of Fabry patients includes transitory cerebral ischaemia and strokes, even in very young persons of both genders. The mechanism is partly due to vascular endothelial...... accumulation of GL-3. White matter lesions on MRI occur. Both males and females can be safely treated with enzyme replacement; and thus screening for Fabry disease of young stroke populations should be considered. There are, however, no hard data of treatment effect on mortality and morbidity. The analyses...

  18. Fabry disease and early stroke

    DEFF Research Database (Denmark)

    Feldt-Rasmussen, U

    2011-01-01

    Fabry disease, an X-linked lysosomal storage disorder, results from deficient activity of the enzyme α-galactosidase A. Affected males with the classic phoenotype have acroparaesthesias, hypohidrosis, and corneal opacities in childhood and develop renal failure, cardiac hypertrophy or strokes...... in the third to fifth decade of life. Some female heterozygotes are asymptomatic, some as severely affected as males. The natural history of Fabry patients includes transitory cerebral ischaemia and strokes, even in very young persons of both genders. The mechanism is partly due to vascular endothelial...... accumulation of GL-3. White matter lesions on MRI occur. Both males and females can be safely treated with enzyme replacement; and thus screening for Fabry disease of young stroke populations should be considered. There are, however, no hard data of treatment effect on mortality and morbidity. The analyses...

  19. Early home-supported discharge after stroke

    DEFF Research Database (Denmark)

    Langhorne, P.; Jepsen, Birgitte G.; Larsen, Torben

    2014-01-01

    This report is a brief practical problem-based guide to support clinical management in the implementation of early home-supported discharge as an integrated part of stroke care. However, it is clear that skilled members of a multidisciplinary team are needed and they need to work in a coordinated...... benefit most are likely to have moderate stroke severity and may be able to cooperate with rehabilitation in the home setting. Staffing requirements will vary according to several factors. These will include (a) the severity and complexity of stroke impairments, (b) the current level of community support...

  20. Effect of baseline Alberta Stroke Program Early CT Score on safety and efficacy of intra-arterial treatment: a subgroup analysis of a randomised phase 3 trial (MR CLEAN)

    NARCIS (Netherlands)

    Yoo, Albert J.; Berkhemer, Olvert A.; Fransen, Puck S. S.; van den Berg, Lucie A.; Beumer, Debbie; Lingsma, Hester F.; Schonewille, Wouter J.; Sprengers, Marieke E. S.; van den Berg, René; van Walderveen, Marianne A. A.; Beenen, Ludo F. M.; Wermer, Marieke J. H.; Nijeholt, Geert J. Lycklama À; Boiten, Jelis; Jenniskens, Sjoerd F. M.; Bot, Joseph C. J.; Boers, Anna M. M.; Marquering, Henk A.; Roos, Yvo B. W. E. M.; van Oostenbrugge, Robert J.; Dippel, Diederik W. J.; van der Lugt, Aad; van Zwam, Wim H.; Majoie, Charles B. L. M.

    2016-01-01

    Whether infarct size modifies intra-arterial treatment effect is not certain, particularly in patients with large infarcts. We examined the effect of the baseline Alberta Stroke Program Early CT Score (ASPECTS) on the safety and efficacy of intra-arterial treatment in a subgroup analysis of the

  1. Effect of baseline Alberta Stroke Program Early CT Score on safety and efficacy of intra-arterial treatment: a subgroup analysis of a randomised phase 3 trial (MR CLEAN)

    NARCIS (Netherlands)

    Yoo, A.J.; Berkhemer, O.A.; Fransen, P.S.; Berg, L.A. van den; Beumer, D.; Lingsma, H.F.; Schonewille, W.J.; Sprengers, M.E.; Berg, R. van den; Walderveen, M.A. van; Beenen, L.F.; Wermer, M.J.; Nijeholt, G.J.; Boiten, J.; Jenniskens, S.F.M.; Bot, J.C.; Boers, A.M.; Marquering, H.A.; Roos, Y.B.; Oostenbrugge, R.J. van; Dippel, D.W.; Lugt, A. van der; Zwam, W.H. van; Majoie, C.B.; et al.,

    2016-01-01

    BACKGROUND: Whether infarct size modifies intra-arterial treatment effect is not certain, particularly in patients with large infarcts. We examined the effect of the baseline Alberta Stroke Program Early CT Score (ASPECTS) on the safety and efficacy of intra-arterial treatment in a subgroup analysis

  2. Exclusion of Isolated Cortical Swelling Can Increase Efficacy of Baseline Alberta Stroke Program Early CT Score in the Prediction of Prognosis in Acute Ischemic Stroke Patients Treated with Thrombolysis.

    Science.gov (United States)

    Naito, Tatsuhiko; Takeuchi, Sousuke; Arai, Noritoshi

    2015-12-01

    The accuracy of the Alberta Stroke Program Early CT Score (ASPECTS) as a prognostic indicator in the treatment of cerebral infarction with thrombolysis remains controversial. We hypothesized that ASPECTS can more accurately predict treatment outcomes by excluding isolated cortical swelling (ICS) from ASPECTS and retrospectively tested patients treated with thrombolysis. This retrospective cohort study included 106 patients treated with intravenous thrombolysis for cerebral infarction in our hospital. We included only patients with middle cerebral artery infarction. For the modification of ASPECTS, we removed each ICS from the ASPECTS system. We compared the correlation coefficients between the ASPECTS and modified ASPECTS with regard to treatment outcome, and performed a multivariate logistic regression analysis to evaluate the association between modified ASPECTS and outcomes. The primary outcome was a modified Rankin Scale score equal to or less than 2 on discharge and the secondary outcomes included an improvement of National Institutes of Health Stroke Scale (NIHSS) score of 4 or greater within 24 hours. Seventy-two patients were included in this study. The correlation coefficient of modified ASPECTS was significantly higher than that of ASPECTS in the primary outcome (r = .249 versus r = .363, P < .001) and in the improvement of NIHSS score (r = .303 versus r = .443, P < .001). Multivariate analysis revealed that a modified ASPECTS greater than 7 was significantly associated with the primary outcome (odds ratio [OR] = 1.334, 95% confidence interval [CI] = 1.071-1.661, P = .012) and the improvement of the NIHSS score (OR = 1.555, 95% CI = 1.208-2.003, P = .001). The present study reveals that ASPECTS may be more strongly associated with outcome by excluding ICS. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Automated brain computed tomographic densitometry of early ischemic changes in acute stroke

    NARCIS (Netherlands)

    Stoel, Berend C.; Marquering, Henk A.; Staring, Marius; Beenen, Ludo F.; Slump, Cornelis H.; Roos, Yvo B.; Majoie, Charles B.

    2015-01-01

    The Alberta Stroke Program Early CT score (ASPECTS) scoring method is frequently used for quantifying early ischemic changes (EICs) in patients with acute ischemic stroke in clinical studies. Varying interobserver agreement has been reported, however, with limited agreement. Therefore, our goal was

  4. Alberta stroke program early computed tomographic scoring performance in a series of patients undergoing computed tomography and MRI: reader agreement, modality agreement, and outcome prediction.

    Science.gov (United States)

    McTaggart, Ryan A; Jovin, Tudor G; Lansberg, Maarten G; Mlynash, Michael; Jayaraman, Mahesh V; Choudhri, Omar A; Inoue, Manabu; Marks, Michael P; Albers, Gregory W

    2015-02-01

    In this study, we compare the performance of pretreatment Alberta Stroke Program Early Computed Tomographic scoring (ASPECTS) using noncontrast CT (NCCT) and MRI in a large endovascular therapy cohort. Prospectively enrolled patients underwent baseline NCCT and MRI and started endovascular therapy within 12 hours of stroke onset. Inclusion criteria for this analysis were evaluable pretreatment NCCT, diffusion-weighted MRI (DWI), and 90-day modified Rankin Scale scores. Two expert readers graded ischemic change on NCCT and DWI using the ASPECTS. ASPECTS scores were analyzed with the full scale or were trichotomized (0-4 versus 5-7 versus 8-10) or dichotomized (0-7 versus 8-10). Good functional outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. Seventy-four patients fulfilled our study criteria. The full-scale inter-rater agreement for CT-ASPECTS and DWI-ASPECTS was 0.579 and 0.867, respectively. DWI-ASPECTS correlated with functional outcome (P=0.004), whereas CT-ASPECTS did not (P=0.534). Both DWI-ASPECTS and CT-ASPECTS correlated with DWI volume. The receiver operating characteristic analysis revealed that DWI-ASPECTS outperformed both CT-ASPECTS and the time interval between symptom onset and start of the procedure for predicting good functional outcome (modified Rankin Scale score, ≤2) and DWI volume ≥70 mL. Inter-rater agreement for DWI-ASPECTS was superior to that for CT-ASPECTS. DWI-ASPECTS outperformed NCCT ASPECTS for predicting functional outcome at 90 days. © 2014 American Heart Association, Inc.

  5. Early stroke discharge team: A participatory evaluation

    OpenAIRE

    Moule, P.; Young, P.; Margaret Glogowska; Jayne Weare

    2011-01-01

    Aims: International evaluation of Early Stroke Discharge (ESD) has concentrated on measuring the impact of service provision. This research aimed to address the question, ‘How did the ESD team members and external stakeholders experience the service implementation process?’ \\ud Methodology: Between October 2009 and February 2010, six team members and four external stakeholders were interviewed as part of a participatory evaluation. Interviews were used to explore the experiences of the proces...

  6. Effects of early motivational interviewing on post-stroke depressive symptoms: A pilot randomized study of the Good Mood Intervention program.

    Science.gov (United States)

    Kerr, Debra; McCann, Terence; Mackey, Elizabeth; Wijeratne, Tissa

    2018-03-26

    The aim of this pilot randomized study was to investigate the feasibility of early motivational interviewing, for reducing mood after acute stroke. Depression is a frequent consequence of stroke that can adversely affect recovery. DESIGN: Pilot randomized study. Intervention group patients received 3, individual motivational interviewing sessions by nurses or social workers prior to hospital discharge. Adult patients with acute stroke during 2013 to 2014. Research assistant who collected data was blind to group assignment. Data were collected at 3 time points: baseline, 1-month, and 3-month follow-up. Outcome measures (anxiety, depression, quality of life) were analysed by descriptive statistics. Forty-eight patients were enrolled, and 79% retention was achieved at 3 months. Eight participants withdrew (16.7%), and 2 were unable to participate (death: 2.1% and new onset aphasia: 2.1%), leaving 38 participants in the final cohort (Intervention: N = 18, Control: N = 20). Anxiety, depression, and quality of life measures did not alter significantly in the study period. Carefully designed studies are required to investigate the effectiveness of early motivational interviewing for improving mood after stroke. The therapy can be administered by nurses, but significant resources are required in terms of training and fidelity. © 2018 John Wiley & Sons Australia, Ltd.

  7. 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

  8. Early continuous video electroencephalography in neonatal stroke.

    LENUS (Irish Health Repository)

    Walsh, Brian H

    2011-01-01

    Perinatal stroke is the second most common cause of neonatal seizures, and can result in long-term neurological impairment. Diagnosis is often delayed until after seizure onset, owing to the subtle nature of associated signs. We report the early electroencephalographic (EEG) findings in a female infant with a perinatal infarction, born at 41 weeks 2 days and weighing 3.42 kg. Before the onset of seizures, the EEG from 3 hours after delivery demonstrated occasional focal sharp waves over the affected region. After electroclinical seizures, focal sharp waves became more frequent, complex, and of higher amplitude, particularly in \\'quiet sleep\\'. In \\'active sleep\\

  9. Early continuous video electroencephalography in neonatal stroke.

    LENUS (Irish Health Repository)

    Walsh, Brian H

    2012-01-31

    Perinatal stroke is the second most common cause of neonatal seizures, and can result in long-term neurological impairment. Diagnosis is often delayed until after seizure onset, owing to the subtle nature of associated signs. We report the early electroencephalographic (EEG) findings in a female infant with a perinatal infarction, born at 41 weeks 2 days and weighing 3.42 kg. Before the onset of seizures, the EEG from 3 hours after delivery demonstrated occasional focal sharp waves over the affected region. After electroclinical seizures, focal sharp waves became more frequent, complex, and of higher amplitude, particularly in \\'quiet sleep\\'. In \\'active sleep\\

  10. Facilities of Early Rehabilitation post Stroke in Poland 2010

    DEFF Research Database (Denmark)

    Opara, Jozef; Langhorne, Peter; Larsen, Torben

    2012-01-01

    ? Aims - Growing costs of health care are encouraging healthcare planners to look for new organizational solutions of services which could enable rehabilitation as early as possible after disease onset. Early post-stroke rehabilitation consists of many elements that provide for early onset rehabilitation...... admission from neurological wards to rehabilitation departments, about the number of sessions per day, the time duration of one session, the number of sessions per week, the average length of stay in department, the methods of outcome measurement etc. Analysis - We sent out 375 questionnaire and received......-stroke, i.e. within 3 months of stroke. Comment - Taking into account that about half of stroke survivors will need rehabilitation (30 days after stroke onset), the current facilities of early post-stroke rehabilitation in Poland cannot meet this need. We should do our best to introduce rehabilitation...

  11. Factor V leiden and ischemic stroke risk: the Genetics of Early Onset Stroke (GEOS) study.

    Science.gov (United States)

    Hamedani, Ali G; Cole, John W; Cheng, Yuching; Sparks, Mary J; O'Connell, Jeffrey R; Stine, Oscar C; Wozniak, Marcella A; Stern, Barney J; Mitchell, Braxton D; Kittner, Steven J

    2013-05-01

    Factor V Leiden (FVL) has been associated with ischemic stroke in children but not in adults. Although the FVL mutation is associated with increased risk for venous thrombosis, its association with ischemic stroke in young adults remains uncertain. Therefore, we examined the association between FVL and ischemic stroke in participants of the Genetics of Early Onset Stroke (GEOS) study. A population-based case control study identified 354 women and 476 men 15 to 49 years of age with first-ever ischemic stroke and 907 controls. Participant-specific data included vascular risk factors, FVL genotype and, for cases, the ischemic stroke subtype by modified Trial of ORG 10172 in Acute Stroke criteria. Logistic regression was used to calculate odds ratios for the entire population and for subgroups stratified by risk factors and ischemic stroke subtype. The frequency of the FVL mutation was similar between ischemic stroke patients (3.6%; 95% confidence interval [CI] 2.5%-5.1%) and nonstroke controls (3.8%; 95% CI 2.7%-5.2%). This frequency did not change significantly when cases were restricted to patients with stroke of undetermined etiology (4.1%; 95% CI 2.6%-6.4%). Among young adults, we found no evidence for an association between FVL and either all ischemic stroke or the subgroup with stroke of undetermined etiology. Published by Elsevier Inc.

  12. Processes of early stroke care and hospital costs

    DEFF Research Database (Denmark)

    Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H

    2014-01-01

    Background: The relationship between processes of early stroke care and hospital costs remains unclear. Aims: We therefore examined the association in a population-based cohort study. Methods: We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005...... of hospitalization were $23352 (standard deviation 27827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose-response relationship. The adjusted costs were $24566 (95% confidence interval 19364-29769) lower for patients who received 75......-100% of the relevant processes of care compared with patients receiving 0-24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Conclusions: Early care in agreement with key guidelines recommendations for the management...

  13. Facilities of Early Rehabilitation after Stroke in Poland 2010

    Science.gov (United States)

    Opara, Jozef A.; Langhorne, Peter; Larsen, Torben; Mehlich, Krzysztof; Szczygiel, Jaroslaw

    2012-01-01

    The aim of this work was to survey the contemporary facilities for early post-stroke rehabilitation in Poland. The main research questions were as follows: what is the availability of inpatient rehabilitation for post-stroke patients in neurological departments and in rehabilitation departments? The growing costs of healthcare are encouraging…

  14. Early Detection of Post-Stroke Depression

    NARCIS (Netherlands)

    de Man - van Ginkel, J.M.

    2012-01-01

    In the first two years after stroke approximately one-third of the patients suffer from depression, also referred to as post-stroke depression (PSD). Patients with PSD suffer from symptoms, such as a diminished interest or pleasure (anhedonia), depressed mood, sleep disturbances, loss of energy,

  15. Early depressed mood after stroke predicts long-term disability: the Northern Manhattan Stroke Study (NOMASS).

    Science.gov (United States)

    Willey, Joshua Z; Disla, Norbelina; Moon, Yeseon Park; Paik, Myunghee C; Sacco, Ralph L; Boden-Albala, Bernadette; Elkind, Mitchell S V; Wright, Clinton B

    2010-09-01

    Depression is highly prevalent after stroke and may influence recovery. We aimed to determine whether depressed mood acutely after stroke predicts subsequent disability and mortality. As part of the Northern Manhattan Stroke Study, a population-based incident stroke case follow-up study performed in a multiethnic urban population, participants were asked about depressed mood within 7 to 10 days after stroke. Participants were followed every 6 months the first 2 years and yearly thereafter for 5 years for death and disability measured by the Barthel Index. We fitted polytomous logistic regression models using a canonical link to examine the association between depressed mood after stroke and disability comparing moderate (Barthel Index 60 to 95) and severe (Barthel Index or=95). Cox proportional hazards models were created to examine the association between depressed mood and mortality. A question about depressed mood within 7 to 10 days after stroke was asked in 340 of 655 patients with ischemic stroke enrolled, and 139 reported that they felt depressed. In multivariate analyses controlling for sociodemographic factors, stroke severity, and medical conditions, depressed mood was associated with a greater odds of severe disability compared with no disability at 1 (OR 2.91, 95% CI 1.07 to 7.91) and 2 years (OR 3.72, 95% CI 1.29 to 10.71) after stroke. Depressed mood was not associated with all-cause mortality or vascular death. Depressed mood after stroke is associated with disability but not mortality after stroke. Early screening and intervention for mood disorders after stroke may improve outcomes and requires further research.

  16. Bilateral Medial Medullary Stroke: A Challenge in Early Diagnosis

    Directory of Open Access Journals (Sweden)

    Amir M. Torabi

    2013-01-01

    Full Text Available Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences. Early diagnosis is crucial. Here, I present a young patient with acute vertigo, progressive generalized weakness, dysarthria, and respiratory failure, who initially was misdiagnosed with acute vestibular syndrome. Initial brain magnetic resonance imaging (MRI that was done in the acute phase was read as normal. Other possibilities were excluded by lumbar puncture and MRI of cervical spine. MR of C-spine showed lesion at medial medulla; therefore a second MRI of brain was requested, showed characteristic “heart appearance” shape at diffusion weighted (DWI, and confirmed bilateral medial medullary stroke. Retrospectively, a vague-defined hyperintense linear DWI signal at midline was noted in the first brain MRI. Because of the symmetric and midline pattern of this abnormal signal and similarity to an artifact, some radiologists or neurologists may miss this type of stroke. Radiologists and neurologists must recognize clinical and MRI findings of this rare type of stroke, which early treatment could make a difference in patient outcome. The abnormal DWI signal in early stages of this type of stroke may not be a typical “heart appearance” shape, and other variants such as small dot or linear DWI signal at midline must be recognized as early signs of stroke. Also, MRI of cervical spine may be helpful if there is attention to brainstem as well.

  17. Aspects correlates with Scandinavian Stroke Scale for predicting early neurological impairment.

    Science.gov (United States)

    Luvizutto, Gustavo José; Gabriel, Maicon Gonçalves; Braga, Gabriel Pereira; Fernandes, Thiago Dias; Resende, Luiz Antônio de Lima; Pontes Neto, Octávio Marques; Bazan, Rodrigo

    2015-05-01

    To investigate the correlation between the Alberta Program Early CT Score (ASPECTS) and the Scandinavian Stroke Scale (SSS) for the evaluation of neurological impairment in patients with acute stroke. 59 patients with a first acute ischemic stroke were evaluated. The ASPECTS were evaluated by 2 neurologists at admission and by another neurologist after 48 hours. The NIHSS and SSS was applied to determinate stroke severity. Correlations and agreements were analysed statistically by Spearman and Kappa tests. ASPECTS was correlated with National Institute of Health Stroke Scale (NIHSS) at admission (r = -0.52; p motor power, and speech (r = 0.51; p < 0.001). The SSS of 25.5 shows sensitivity (68%) and specificity (72%) when associated with ASPECTS ≤ 7. The SSS can predict worst neurological impairment when associated with lower values of ASPECTS.

  18. Copeptin: Limited Usefulness in Early Stroke Differentiation?

    Directory of Open Access Journals (Sweden)

    Johannes von Recum

    2015-01-01

    Full Text Available Background. Stroke can be a challenging diagnosis in an emergency-setting. We sought to determine whether copeptin may be a useful biomarker to differentiate between ischemic stroke (IS, transient ischemic attack (TIA, and stroke-mimics. Methods. In patients with suspected stroke arriving within 4.5 hours of symptom-onset, copeptin-levels were measured in initial blood-samples. The final diagnosis was adjudicated by vascular neurologists blinded to copeptin-values. Results. Of all 36 patients with available copeptin-values (median age 71 years, IQR: 54–76; 44% female, 20 patients (56% were diagnosed with IS, no patient was diagnosed with hemorrhagic stroke, nine patients (25% were diagnosed with TIA, and seven patients (19% were stroke-mimics. Copeptin-levels (in pmol/L tended to be higher in patients with IS [19.1 (11.2–48.5] compared to TIA [9.4 (5.4–13.8]. In stroke-mimics the range of values was extremely broad [33.3 (7.57–255.7]. The diagnostic accuracy of copeptin for IS was 63% with a sensitivity of 80% and a positive predictive value of 64%. Conclusion. In this cohort of patients copeptin-levels within 4.5 hours of symptom onset were higher in patients with IS compared to TIA but the broad range of values in stroke-mimics limits diagnostic accuracy. This trial is registered with UTN: U1111-1119-7602.

  19. Stroke care in Galicia: telemedicine in the early, multidisciplinary treatment of all acute stroke cases.

    Science.gov (United States)

    Rodríguez-Castro, Emilio; Vázquez-Lima, Manuel José; Rodríguez-Yáñez, Manuel; Verde, Luis; Castillo, José

    2018-02-01

    Stroke is the main cause of morbidity and mortality in Spain and in Galicia in particular. Tissue viability after stroke depends on the time taken to restore circulation. The widely dispersed and aging population of this region challenges efforts to provide equal care for patients with time-sensitive emergencies such as stroke. Two regional hospitals (Hospital do Salnés and Hospital do Barbanza) and the reference Hospital Clínico de Santiago launched a telestroke pilot program in 2011 in which patients whose treatment was guided at a distance were discharged with lower levels of stroke severity and mortality. That outcome was probably attributable to more rapid diagnosis. Given those preliminary results and the characteristics of the population, the centrally coordinated Galician Stroke Care Plan was launched in 2016 to provide a telemedicine service that connects all hospitals in the health system of Galicia. This paper summarizes the experience of developing and implementing the program.

  20. Early home-supported discharge of stroke patients

    DEFF Research Database (Denmark)

    Larsen, T.; Olsen, Tom Skyhøj; Sørensen, J.

    2006-01-01

    OBJECTIVES: A comprehensive and systematic assessment (HTA) of early home-supported discharge by a multidisciplinary team that plans, coordinates, and delivers care at home (EHSD) was undertaken and the results were compared with that of conventional rehabilitation at stroke units. METHODS...... are discussed. CONCLUSIONS: EHSD is evidenced as a dominant health intervention. However, financial barriers between municipalities and health authorities have to be overcome. For qualitative reasons, a learning path of implementation is recommended where one stroke unit in a region initiates EHSD...... for dissemination of new experience to the other stroke units....

  1. Successful Reperfusion With Mechanical Thrombectomy Is Associated With Reduced Disability and Mortality in Patients With Pretreatment Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score ≤6.

    Science.gov (United States)

    Desilles, Jean-Philippe; Consoli, Arthuro; Redjem, Hocine; Coskun, Oguzhan; Ciccio, Gabriele; Smajda, Stanislas; Labreuche, Julien; Preda, Cristian; Ruiz Guerrero, Clara; Decroix, Jean-Pierre; Rodesch, Georges; Mazighi, Mikael; Blanc, Raphaël; Piotin, Michel; Lapergue, Bertrand

    2017-04-01

    In acute ischemic stroke patients, diffusion-weighted imaging (DWI)-Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is correlated with infarct volume and is an independent factor of functional outcome. Patients with pretreatment DWI-ASPECTS ≤6 were excluded or under-represented in the recent randomized mechanical thrombectomy trials. Our aim was to assess the impact of reperfusion in pretreatment DWI-ASPECTS ≤6 patients treated with mechanical thrombectomy. We analyzed data collected between January 2012 and August 2015 in a bicentric prospective clinical registry of consecutive acute ischemic stroke patients treated with mechanical thrombectomy. Every patient with a documented internal carotid artery or middle cerebral artery occlusion with pretreatment DWI-ASPECTS ≤6 was eligible for this study. The primary end point was a favorable outcome defined by a modified Rankin Scale score ≤2 at 90 days. Two hundred and eighteen patients with a DWI-ASPECTS ≤6 were included. Among them, 145 (66%) patients had successful reperfusion at the end of mechanical thrombectomy. Reperfused patients had an increased rate of favorable outcome (38.7% versus 17.4%; P =0.002) and a decreased rate of mortality at 3 months (22.5% versus 39.1%; P =0.013) compared with nonreperfused patients. The symptomatic intracranial hemorrhage rate was not different between the 2 groups (13.0% versus 14.1%; P =0.83). However, in patients with DWI-ASPECTS <5, favorable outcome was low (13.0% versus 9.5%; P =0.68) with a high mortality rate (45.7% versus 57.1%; P =0.38) with or without successful reperfusion. Successful reperfusion is associated with reduced mortality and disability in patients with a pretreatment DWI-ASPECTS ≤6. Further data from randomized studies are needed, particularly in patients with DWI-ASPECTS <5. © 2017 American Heart Association, Inc.

  2. Stroke unit care, inpatient rehabilitation and early supported discharge.

    Science.gov (United States)

    Rodgers, Helen; Price, Chris

    2017-04-01

    Stroke units reduce death and disability through the provision of specialist multidisciplinary care for diagnosis, emergency treatments, normalisation of homeostasis, prevention of complications, rehabilitation and secondary prevention. All stroke patients can benefit from provision of high-quality basic medical care and some need high impact specific treatments, such as thrombolysis, that are often time dependent. A standard patient pathway should include assessment of neurological impairment, vascular risk factors, swallowing, fluid balance and nutrition, cognitive function, communication, mood disorders, continence, activities of daily living and rehabilitation goals. Good communication and shared decision making with patients and their families are key to high-quality stroke care. Patients with mild or moderate disability, who are medically stable, can continue rehabilitation at home with early supported discharge teams rather than needing a prolonged stay in hospital. National clinical guidelines and prospective audits are integral to monitoring and developing stroke services in the UK. © Royal College of Physicians 2017. All rights reserved.

  3. Premature menopause or early menopause and risk of ischemic stroke

    Science.gov (United States)

    Rocca, Walter A.; Grossardt, Brandon R.; Miller, Virginia M.; Shuster, Lynne T.; Brown, Robert D.

    2011-01-01

    Objective The general consensus has been that estrogen is invariably a risk factor for ischemic stroke (IS). We reviewed new observational studies that challenge this simple conclusion. Methods This was a review of observational studies of the association of premature or early menopause with stroke or IS published in English from 2006 through 2010. Results Three cohort studies showed an increased risk of all stroke in women who underwent bilateral oophorectomy compared with women who conserved their ovaries before age 50 years. The increased risk of stroke was reduced by hormonal therapy (HT) in one of the studies, suggesting that estrogen deprivation is involved in the association. Four additional observational studies showed an association of all stroke or IS with the early onset of menopause or with a shorter lifespan of ovarian activity. In three of the seven studies, the association was restricted to IS. Age at menopause was more important than type of menopause (natural vs induced). Conclusions The findings from seven recent observational studies challenge the consensus that estrogen is invariably a risk factor for IS and can be reconciled by a unifying timing hypothesis. We hypothesize that estrogen is protective for IS before age 50 years and may become a risk factor for IS after age 50 years or, possibly, after age 60 years. These findings are relevant to women who experienced premature or early menopause, or to women considering prophylactic bilateral oophorectomy before the onset of natural menopause. PMID:21993082

  4. Early Seizures After Stroke: Neurology Intensive Care Unit Experience

    OpenAIRE

    Şadiye Gümüşyayla; Gönül Vural

    2018-01-01

    Objective: The aim of this study was to investigate the frequency of early seizures, the affecting factors, and the prognostic effect of seizures in patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and sinus venous thrombosis (SVT) examined in the intensive care unit (ICU). Materials and Methods: In the neurology ICU, the records of patients followed up with AIS, ICH, and SVT within a defined time period were retrospectively examined. Results: Early seizures ...

  5. DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) Mismatch in Thrombectomy Candidates: An Intrarater and Interrater Agreement Study.

    Science.gov (United States)

    Fahed, Robert; Lecler, Augustin; Sabben, Candice; Khoury, Naim; Ducroux, Célina; Chalumeau, Vanessa; Botta, Daniele; Kalsoum, Erwah; Boisseau, William; Duron, Loïc; Cabral, Dominique; Koskas, Patricia; Benaïssa, Azzedine; Koulakian, Hasmik; Obadia, Michael; Maïer, Benjamin; Weisenburger-Lile, David; Lapergue, Bertrand; Wang, Adrien; Redjem, Hocine; Ciccio, Gabriele; Smajda, Stanislas; Desilles, Jean-Philippe; Mazighi, Mikaël; Ben Maacha, Malek; Akkari, Inès; Zuber, Kevin; Blanc, Raphaël; Raymond, Jean; Piotin, Michel

    2018-01-01

    We aimed to study the intrarater and interrater agreement of clinicians attributing DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) mismatch in patients with acute ischemic stroke referred for mechanical thrombectomy. Eighteen raters independently scored anonymized magnetic resonance imaging scans of 30 participants from a multicentre thrombectomy trial, in 2 different reading sessions. Agreement was measured using Fleiss κ and Cohen κ statistics. Interrater agreement for DWI-ASPECTS was slight (κ=0.17 [0.14-0.21]). Four raters (22.2%) had a substantial (or higher) intrarater agreement. Dichotomization of the DWI-ASPECTS (0-5 versus 6-10 or 0-6 versus 7-10) increased the interrater agreement to a substantial level (κ=0.62 [0.48-0.75] and 0.68 [0.55-0.79], respectively) and more raters reached a substantial (or higher) intrarater agreement (17/18 raters [94.4%]). Interrater agreement for DWI-FLAIR mismatch was moderate (κ=0.43 [0.33-0.57]); 11 raters (61.1%) reached a substantial (or higher) intrarater agreement. Agreement between clinicians assessing DWI-ASPECTS and DWI-FLAIR mismatch may not be sufficient to make repeatable clinical decisions in mechanical thrombectomy. The dichotomization of the DWI-ASPECTS (0-5 versus 0-6 or 0-6 versus 7-10) improved interrater and intrarater agreement, however, its relevance for patients selection for mechanical thrombectomy needs to be validated in a randomized trial. © 2017 American Heart Association, Inc.

  6. Plaque inflammation and unstable morphology are associated with early stroke recurrence in symptomatic carotid stenosis.

    LENUS (Irish Health Repository)

    Marnane, Michael

    2014-03-01

    Although symptomatic carotid stenosis is associated with 3-fold increased risk of early stroke recurrence, the pathophysiologic mechanisms of high early stroke risk have not been established. We aimed to investigate the relationship between early stroke recurrence after initial symptoms and histological features of plaque inflammation and instability in resected carotid plaque.

  7. Improving Outcomes Achieved by a New Stroke Program in Hungary

    Directory of Open Access Journals (Sweden)

    Csilla Égi

    2015-10-01

    Full Text Available Background: Stroke is a devastating disease with increasing incidence and prevalence due to population aging. Even with the best care, a proportion of patients dies or is left with significant neurological and cognitive disability. Organization of stroke centers markedly improved outcomes worldwide. We initiated a ‘lysis alarm' program in September 2013 at our medical center. Methods: This is a retrospective review of electronic data from patients with acute ischemic stroke before (October 2012-June 2013 and after (October 2013-June 2014 the ‘lysis alarm' program was introduced at our medical center. Results: Prior to the introduction of the stroke program, there were only 19 thrombolysis procedures in 777 acute stroke patients in 9 months, while this figure rose to 32 thrombolysis procedures in 737 acute stroke patients after the initiation of the program. The ‘door-to-needle' time decreased from 88 to 71 min when the two study periods were compared. These changes were associated with decreased stroke mortality in patients receiving thrombolytic treatment (16% prior to the program and 9% during the program. In 2013, there were 1,439 thrombolysis procedures, representing 3.2% of all stroke cases throughout Hungary. After the introduction of the ‘lysis alarm' program, we have reached a 4% thrombolysis rate at our medical center. Conclusions: Our thrombolysis rate is higher than the national average, but still low compared to the rates of Western European countries. We are continuously working to enhance our stroke program. Here, we discuss those components that need to be further refined in order to improve stroke intervention and outcome.

  8. Non-invasive brain stimulation in early rehabilitation after stroke.

    Science.gov (United States)

    Blesneag, A V; Popa, L; Stan, A D

    2015-01-01

    The new tendency in rehabilitation involves non-invasive tools that, if applied early after stroke, promote neurorecovery. Repetitive transcranial magnetic stimulation and transcranial direct current stimulation may correct the disruption of cortical excitability and effectively contribute to the restoration of movement and speech. The present paper analyses the results of non-invasive brain stimulation (NIBS) trials, highlighting different aspects related to the repetitive transcranial magnetic stimulation frequency, transcranial direct current stimulation polarity, the period and stimulation places in acute and subacute ischemic strokes. The risk of adverse events, the association with motor or language recovery specific training, and the cumulative positive effect evaluation are also discussed.

  9. Mechanisms of early and delayed stroke after systematic off-pump coronary artery bypass.

    Science.gov (United States)

    Chen, Jeng-Wei; Lin, Cheng-Hsin; Hsu, Ron-Bin

    2015-10-01

    Stroke is one of the most devastating complications after cardiac surgery. Off-pump coronary artery bypass (OPCAB) has been reported to offer a lower risk of stroke. However, limited information was available on timing and mechanisms of stroke after OPCAB. We sought to assess the incidence, timing, and mechanisms of stroke after OPCAB. A retrospective review of 1010 patients undergoing systematic OPCAB between 2001 and 2012. Stroke was defined as any focal or global neurologic deficits lasting for more than 24 hours. Stroke was classified as early stroke when it occurred less than 24 hours postoperatively, and delayed stroke when it occurred more than 24 hours postoperatively. Stroke mechanisms were classified as embolic or hypoperfusion. In a total of 10 patients (1.0%) 11 episodes of stroke developed after OPCAB. Early stroke occurred in five (0.5%) patients and delayed stroke occurred in six (0.6%) patients. Of five early strokes, the mechanisms were embolic in two (40%) and hypoperfusion in three (60%). Of six delayed strokes, the mechanisms were embolic in five (83%) and unknown in one. Of six delayed strokes, all the patients had diabetes mellitus and acute cardiac events prior to surgery, and five patients had postoperative atrial fibrillation. The incidence of stroke after systematic OPCAB was low. Early and delayed strokes were equally distributed. Stroke mechanisms were predominantly embolic. Early and delayed stroke differed in their mechanisms. Early and delayed stroke should be considered as two separate entities and different preventive strategies should be applied in future intervention. Copyright © 2014. Published by Elsevier B.V.

  10. Early Seizures After Stroke: Neurology Intensive Care Unit Experience

    Directory of Open Access Journals (Sweden)

    Şadiye Gümüşyayla

    2018-03-01

    Full Text Available Objective: The aim of this study was to investigate the frequency of early seizures, the affecting factors, and the prognostic effect of seizures in patients with acute ischemic stroke (AIS, intracerebral hemorrhage (ICH, and sinus venous thrombosis (SVT examined in the intensive care unit (ICU. Materials and Methods: In the neurology ICU, the records of patients followed up with AIS, ICH, and SVT within a defined time period were retrospectively examined. Results: Early seizures occurred in 48 out of 199 patients who were followed up with AIS, ICH, and SVT in the neurology ICU within the specified time period. The frequency of having early seizures was found to be higher in patients with left hemisphere lesions, cortical lesions, and those with AIS with hemorrhagic transformation. Lesion volume was found to be higher in patients with AIS who had early seizures compared with those who had AIS without seizures. Early seizures were observed in all patients with SVT who were followed up in the ICU. Conclusion: Early seizures are a common complication in patients with stroke followed up in neurology ICUs. Determination of effective factors in early seizures is important for its early diagnosis and treatment

  11. Early versus delayed rehabilitation treatment in hemiplegic patients with ischemic stroke: proprioceptive or cognitive approach?

    Science.gov (United States)

    Morreale, Manuela; Marchione, Pasquale; Pili, Antonio; Lauta, Antonella; Castiglia, Stefano F; Spallone, Aldo; Pierelli, Francesco; Giacomini, Patrizia

    2016-02-01

    Early/intensive mobilization may improve functional recovery after stroke but it is not clear which kind of "mobilization" is more effective. Proprioceptive neuromuscular facilitation (PNF) and cognitive therapeutic exercise (CTE) are widespread applied in post-stroke rehabilitation but their efficacy and safety have not been systematically investigated. To compare PNF and CTE methods in a two different time setting (early versus standard approach) in order to evaluate different role of time and techniques in functional recovery after acute ischemic stroke. We designed a prospectical multicenter blinded interventional study of early versus standard approach with two different methods by means of both PNF and CTE. A discrete stroke-dedicated area for out-of-thrombolysis patients, connected with two different comprehensive stroke centres in two different catchment areas. Three hundred and forty consecutive stroke patient with first ever sub-cortical ischemic stroke in the mean cerebral artery (MCA) territory and contralateral hemiplegia admitted within 6 and 24 hours from symptoms onset. All patients were randomly assigned by means of a computer generated randomization sequence in blocks of 4 to one to the 4 interventional groups: early versus delayed rehabilitation programs with Kabat's schemes or Perfetti's technique. Patients in both delayed group underwent to a standard protocol in the acute phase. disability at 3-12 months. Disability measures: modified Rankin Score and Barthel Index. Safety outcome: immobility-related adverse events. Six-Minute Walking Test, Motricity Index, Mini-Mental State Examination, Beck Depression Inventory. Disability was not different between groups at 3 months but Barthel Index significantly changed between early versus delayed groups at 12 months (P=0.01). Six-Minute Walking Test (P=0.01) and Motricity Index in both upper (P=0.01) and lower limbs (P=0.001) increased in early versus delayed groups regardless rehabilitation schedule. A

  12. MRI in predication of early hemorrhagic transformation after acute stroke

    International Nuclear Information System (INIS)

    Guo Gang; Wu Renhua; Mikulis, D.J.

    2007-01-01

    Objective: To investigate the relationship among early parenchymal enhancement, post- gadolinium (Gd) hyperintense middle cerebral artery (HMCA), and subsequent hemorrhagic transformation (HT) in patients with hyperacute ischemic stroke. Methods: Twenty-four consecutive patients with ischemic stroke who underwent MRI within 6 h [(4.3±1.4) h] of symptom onset were retrospectively reviewed. All of these patients underwent at least one follow-up MRI or non-enhanced CT study at 2 to 7 days. Post-Gd T 1 WI were analyzed for parenchymal enhancement and hyperintense MCA. Gradient echo MRI and CT were used for assessment of HT. Results: Ten patients developed HT on follow-up imaging (hemorrhagic group). Early parenchymal enhancement was found in 6 patients with HT (P 1 WI after Gd-DTPA administration are independent predictors of subsequent HT. (authors)

  13. 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.

  14. Long-Term Effect of Participation in an Early Exercise and Education Program on Clinical Outcomes and Cost Implications, in Patients with TIA and Minor, Non-Disabling Stroke.

    Science.gov (United States)

    Faulkner, James; Stoner, Lee; Lanford, Jeremy; Jolliffe, Evan; Mitchelmore, Andrew; Lambrick, Danielle

    2017-06-01

    Participation in exercise and education programs following transient ischemic attack (TIA) or minor stroke may decrease cardiovascular disease risk. The purpose of this study was to assess the long-term effect (3.5 years) of an exercise and education program administered soon after TIA or minor stroke diagnosis on clinical outcome measures (stroke classification and number, patient deaths, hospital/emergency department admission) and cost implications obtained from standard hospital records. Hospital records were screened for 60 adults (male, n = 31; 71 ± 10 years), diagnosed with TIA or non-disabling stroke, who had previously been randomised and completed either an 8-week exercise and education program, or usual care control. Follow-up clinical outcomes and cost implications were obtained 3.5 ± 0.3 years post-exercise. Participants randomised to the exercise and education program had significantly fewer recurrent stroke/TIAs (n = 3 vs. n = 13, Cohen's d = 0.79) than the control group (P ≤ 0.003). Similar finding were reported for patient deaths (n = 0 vs. n = 4, d = 0.53), and hospital admissions (n = 48 vs. n = 102, d = 0.54), although these findings were only approaching statistical significance. The relative risk (mean; 95%CI) of death, stroke/TIAs and hospital admissions were 0.11 (0.01 to 1.98), 0.23 (0.07 to 0.72) and 0.79 (0.57 to 1.09), respectively. Hospital admission costs were significantly lower for the exercise group ($9041 ± 15,080 NZD [~$6000 ± 10,000 USD]) than the control group ($21,750 ± 22,973 NZD [~$14,000 ± 15,000 USD]) during the follow-up period (P exercise and education programs for patients with TIA and minor stroke. URL: http://www.anzctr.org.au/ ; Trial Registration Number: ACTRN12611000630910.

  15. 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...

  16. 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.

  17. 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

  18. Development of a Chronic Disease Management Program for Stroke Survivors Using Intervention Mapping: The Stroke Coach.

    Science.gov (United States)

    Sakakibara, Brodie M; Lear, Scott A; Barr, Susan I; Benavente, Oscar; Goldsmith, Charlie H; Silverberg, Noah D; Yao, Jennifer; Eng, Janice J

    2017-06-01

    To describe the systematic development of the Stroke Coach, a theory- and evidence-based intervention to improve control of lifestyle behavior risk factors in patients with stroke. Intervention development. Community. Individuals who have had a stroke. We used intervention mapping to guide the development of the Stroke Coach. Intervention mapping is a systematic process used for intervention development and composed of steps that progress from the integration of theory and evidence to the organization of realistic strategies to facilitate the development of a practical intervention supported by empirical evidence. Social cognitive theory was the underlying premise for behavior change, whereas control theory methods were directed toward sustaining the changes to ensure long-term health benefits. Practical evidence-based strategies were linked to behavioral determinants to improve stroke risk factor control. Not applicable. The Stroke Coach is a patient-centered, community-based, telehealth intervention to promote healthy lifestyles after stroke. Over 6 months, participants receive seven 30- to 60-minute telephone sessions with a lifestyle coach who provides education, facilitates motivation for lifestyle modification, and empowers participants to self-management their stroke risk factors. Participants also receive a self-management manual and a self-monitoring kit. Through the use of intervention mapping, we developed a theoretically sound and evidence-grounded intervention to improve risk factor control in patients with stroke. If empirical evaluation of the Stroke Coach produces positive results, the next step will be to develop an implementation intervention to ensure successful uptake and delivery of the program in community and outpatient settings. Copyright © 2017 American Congress of Rehabilitation Medicine. All rights reserved.

  19. Aspects correlates with Scandinavian Stroke Scale for predicting early neurological impairment

    Directory of Open Access Journals (Sweden)

    Gustavo José Luvizutto

    2015-05-01

    Full Text Available Objective To investigate the correlation between the Alberta Program Early CT Score (ASPECTS and the Scandinavian Stroke Scale (SSS for the evaluation of neurological impairment in patients with acute stroke. Method 59 patients with a first acute ischemic stroke were evaluated. The ASPECTS were evaluated by 2 neurologists at admission and by another neurologist after 48 hours. The NIHSS and SSS was applied to determinate stroke severity. Correlations and agreements were analysed statistically by Spearman and Kappa tests. Results ASPECTS was correlated with National Institute of Health Stroke Scale (NIHSS at admission (r = -0.52; p < 0.001 and SSS (r = 0.50; p < 0.001. The ASPECTS and SSS items were most correlated with arm (r = 0.52; p < 0.001 and hand (r = 0.49; p < 0.001 motor power, and speech (r = 0.51; p < 0.001. The SSS of 25.5 shows sensitivity (68% and specificity (72% when associated with ASPECTS ≤ 7. Conclusion The SSS can predict worst neurological impairment when associated with lower values of ASPECTS.

  20. Implementation of a Stroke Competency Program to Improve Nurses' Knowledge of and Adherence to Stroke Guidelines.

    Science.gov (United States)

    Reynolds, Staci Sue; Murray, Laura L; McLennon, Susan M; Bakas, Tamilyn

    2016-12-01

    Nurses play an integral part in providing evidence-based care to patients with stroke, yet some patients receive unnecessary or even harmful care. The literature supports the use of multifaceted strategies to promote implementation of evidence-based practice; however, there is a gap in knowing which combinations of strategies are most successful. The purpose of this study was to determine if a tailored, multifaceted Stroke Competency Program would improve nurses' knowledge of and adherence to evidence-based practices in the care of patients with stroke. This program bundled implementation strategies of local opinion leaders, printed educational materials, and educational outreach. This study used a pretest/posttest program design. Nursing adherence was measured via documentation audits with knowledge measured by an author-developed assessment. Most participating nurses had approximately 10 years of nursing experience and were baccalaureate prepared; participation ranged from 32% to 58% (n = 88). Overall, an improvement in nursing adherence was noted after the program as well as significant improvements in nursing knowledge. Although the Stroke Competency Program improved nursing knowledge of and adherence to stroke guidelines, future research should seek to extend these findings to identify which bundle of strategies are most effective for implementing evidence into nursing practice using psychometrically sound outcome measures.

  1. 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....

  2. Participatory design in the development of an early therapy intervention for perinatal stroke.

    Science.gov (United States)

    Basu, Anna Purna; Pearse, Janice Elizabeth; Baggaley, Jessica; Watson, Rose Mary; Rapley, Tim

    2017-01-23

    Perinatal stroke is the leading cause of unilateral (hemiparetic) cerebral palsy, with life-long personal, social and financial consequences. Translational research findings indicate that early therapy intervention has the potential for significant improvements in long-term outcome in terms of motor function. By involving families and health professionals in the development and design stage, we aimed to produce a therapy intervention which they would engage with. Nine parents of children with hemiparesis and fourteen health professionals involved in the care of infants with perinatal stroke took part in peer review and focus groups to discuss evolving therapy materials, with revisions made iteratively. The materials and approach were also discussed at a meeting of the London Child Stroke Research Reference Group. Focus group data were coded using Normalisation Process Theory constructs to explore potential barriers and facilitators to routine uptake of the intervention. We developed the Early Therapy in Perinatal Stroke (eTIPS) program - a parent-delivered, home-based complex intervention addressing a current gap in practice for infants in the first 6 months of life after unilateral perinatal stroke and with the aim of improving motor outcome. Parents and health professionals saw the intervention as different from usual practice, and valuable (high coherence). They were keen to engage (high cognitive participation). They considered the tasks for parents to be achievable (high collective action). They demonstrated trust in the approach and felt that parents would undertake the recommended activities (high collective action). They saw the approach as flexible and adaptable (high reflexive monitoring). Following suggestions made, we added a section on involving the extended family, and obtained funding for a website and videos to supplement written materials. Focus groups with parents and health professionals provided meaningful feedback to iteratively improve the

  3. NASA Early Career Fellowship Program

    Science.gov (United States)

    Smith, H. D.

    2012-12-01

    The Early Career Fellowship program was established in 2005 to facilitate the integration of outstanding early career planetary science researchers into established research funding programs by providing tools and experience useful to maintain a successful research program. Executing a successful research program requires a few key elements such as: successful proposal writing; adequate (paid) research time; management of a laboratory; collaboration and networking; frequent and high-quality publications; and adequate start-up equipment funds. These elements may be particularly critical for early career researchers searching for a tenure- track or equivalent position. The Early Career Fellowship program recognizes the importance of these skills and provides extra funding and resources to begin a successful research program. For consideration into The Early Career Fellowship program, the candidate needs to be the P. I. or Science P.I. of a funded research proposal from one of the participating R&A program areas, be within 7 years of earning a PhD, hold a non-tenure track position, and indicate the early career candidacy when submitting the research proposal. If the research proposal is funded and the discipline scientist nominates the candidate as an early career fellow, the candidate is then considered a Fellow and eligible to propose for Step 2. Upon obtaining a tenure-track equivalent position the Fellow submits a Step 2 proposal for up to one hundred thousand dollars in start-up funds. Start-up funds may be used for salary; undergraduate and/or graduate research assistants; supplies and instrument upgrades; travel to conferences, meetings, and advisory groups; time and travel for learning new skills; publication page charges; books and journal subscriptions; computer time and/or specialized software; and other justified research-specific needs. The early career fellowship program provides resources that a more established scientist would have acquired allowing

  4. Early Retiree Reinsurance Program Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Early Retiree Reinsurance Program (ERRP) was established by section 1102 of the Patient Protection and Affordable Care Act (the Affordable Care Act) enacted on...

  5. Effects of a Stroke Primary Prevention Program on Risk Factors for At-Home Elderly

    OpenAIRE

    Jeon, Mi Yang; Jeong, HyeonCheol

    2015-01-01

    Background To prevent stroke from occurring, stroke risk factors in at-risk subjects should be controlled and the diseases causing stroke should be managed. This study evaluated a nursing intervention to prevent stroke in at-risk elderly living at home. The program consisted of stroke and nutrition education as well as exercise guidance. Material/Methods This study targeted 93 elderly people living at home residing in E province with 1 or more stroke risk factors, including high blood pressur...

  6. Remote post-conditioning reduces hypoxic damage early after experimental stroke

    DEFF Research Database (Denmark)

    Hasseldam, Henrik; Hansen-Schwartz, Jacob; Munkholm, Nina

    2013-01-01

    Given that reliable markers for early ischemic brain damage are lacking, we set out to test whether pimonidazole can be used as a reliable tool in the quantification of hypoxic insults, at early time points following experimental stroke.......Given that reliable markers for early ischemic brain damage are lacking, we set out to test whether pimonidazole can be used as a reliable tool in the quantification of hypoxic insults, at early time points following experimental stroke....

  7. Blood Biomarkers for the Early Diagnosis of Stroke: The Stroke-Chip Study.

    Science.gov (United States)

    Bustamante, Alejandro; López-Cancio, Elena; Pich, Sara; Penalba, Anna; Giralt, Dolors; García-Berrocoso, Teresa; Ferrer-Costa, Carles; Gasull, Teresa; Hernández-Pérez, María; Millan, Mónica; Rubiera, Marta; Cardona, Pedro; Cano, Luis; Quesada, Helena; Terceño, Mikel; Silva, Yolanda; Castellanos, Mar; Garces, Moisés; Reverté, Silvia; Ustrell, Xavier; Marés, Rafael; Baiges, Joan Josep; Serena, Joaquín; Rubio, Francisco; Salas, Eduardo; Dávalos, Antoni; Montaner, Joan

    2017-09-01

    Stroke diagnosis could be challenging in the acute phase. We aimed to develop a blood-based diagnostic tool to differentiate between real strokes and stroke mimics and between ischemic and hemorrhagic strokes in the hyperacute phase. The Stroke-Chip was a prospective, observational, multicenter study, conducted at 6 Stroke Centers in Catalonia. Consecutive patients with suspected stroke were enrolled within the first 6 hours after symptom onset, and blood samples were drawn immediately after admission. A 21-biomarker panel selected among previous results and from the literature was measured by immunoassays. Outcomes were differentiation between real strokes and stroke mimics and between ischemic and hemorrhagic strokes. Predictive models were developed by combining biomarkers and clinical variables in logistic regression models. Accuracy was evaluated with receiver operating characteristic curves. From August 2012 to December 2013, 1308 patients were included (71.9% ischemic, 14.8% stroke mimics, and 13.3% hemorrhagic). For stroke versus stroke mimics comparison, no biomarker resulted included in the logistic regression model, but it was only integrated by clinical variables, with a predictive accuracy of 80.8%. For ischemic versus hemorrhagic strokes comparison, NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) >4.9 (odds ratio, 2.40; 95% confidence interval, 1.55-3.71; P 4.7 (odds ratio, 2.02; 95% confidence interval, 1.19-3.45; P =0.010), together with age, sex, blood pressure, stroke severity, atrial fibrillation, and hypertension, were included in the model. Predictive accuracy was 80.6%. The studied biomarkers were not sufficient for an accurate differential diagnosis of stroke in the hyperacute setting. Additional discovery of new biomarkers and improvement on laboratory techniques seem necessary for achieving a molecular diagnosis of stroke. © 2017 American Heart Association, Inc.

  8. 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.

  9. The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients.

    Science.gov (United States)

    Yeldan, Ipek; Huseyınsınoglu, Burcu Ersoz; Akıncı, Buket; Tarakcı, Ela; Baybas, Sevim; Ozdıncler, Arzu Razak

    2015-11-01

    [Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measures were the upper extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres Southern California Sensory Integration Test, and the Barthel Index were used as secondary outcome measures. [Results] No statistically significant improvements were found for any measures in either group after the treatment. In terms of minimally clinically important differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this pilot study revealed that very early mirror therapy has no additional effect on functional improvement of upper extremity function in acute stroke patients. Multicenter trials are needed to determine the results of early application of mirror therapy in stroke rehabilitation.

  10. 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.

  11. 'Hip-hop' stroke: a stroke educational program for elementary school children living in a high-risk community.

    Science.gov (United States)

    Williams, Olajide; Noble, James M

    2008-10-01

    Public stroke recognition is poor and poses a barrier to acute stroke treatment. We describe a stroke literacy program that teaches elementary school children in high-risk communities to recognize stroke and form an urgent action plan; we then present results of an intervention study using the program. "Hip-Hop" Stroke uses culturally and age-appropriate music and dance to enhance an interactive didactic curriculum including the FAST mnemonic (Facial droop, Arm weakness, Speech disturbance, Time to call 911). The program occurred in central Harlem, New York City, a community with high stroke risk. During the 2006 to 2007 school year, 582 fourth, fifth, and sixth graders (9 to 11 years of age) participated in 1-hour sessions over 3 consecutive days. Stroke knowledge was tested before and after the program with a 94% group participant retention. Students learned and retained knowledge well for stroke localization (20% correct before intervention, 93% correct immediately afterward, and 86% correct after 3-month delay; Phip-hop music may improve retention of stroke knowledge among the youth.

  12. Very early mobilization following acute stroke: Controversies, the unknowns, and a way forward

    Directory of Open Access Journals (Sweden)

    Bernhardt Julie

    2008-01-01

    Full Text Available Evidence that organized stroke-unit care results in better outcome has led to positive changes in stroke service delivery around the world. It is well accepted that stroke rehabilitation should commence as early as possible for optimal recovery to be achieved. Exactly how early rehabilitation should start is controversial. Early mobilization (getting up out of bed within 24 h of stroke onset is a well-established feature of acute stroke care in many Scandinavian hospitals. Elsewhere in the world, stroke protocols enforce bed rest for the first few days or foster long periods of bed rest after stroke. This paper aims to provide an overview of the topic of very early mobilization (VEM. It is divided into three sections: section 1 reviews the effects of bed rest and outlines arguments both for and against enforced bed rest after stroke; in section 2, VEM as a treatment for stroke and the limitations of existing literature in the field are described; and section 3 outlines the systematic approach that has been taken by our team of clinical researchers to the study the effect of VEM after stroke. Conclusion: VEM represents a simple, easy-to-deliver intervention, requiring little or no equipment. It is potentially deliverable to 85% of the acute stroke population and, if proven to be effective, may help reduce the significant personal and community burden of stroke. As current opinion about when mobilization should begin is divided, one way to move forward is through the conduct of a large high-quality clinical trial (such as A Very Early Rehabilitation Trial (AVERT. Although some inroads have been made, further research in this field is clearly warranted

  13. 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.

  14. 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...

  15. Early management and outcome of acute stroke in Auckland

    International Nuclear Information System (INIS)

    Anderson, N.E.; Bonita, R.; Broad, J.B.

    1997-01-01

    Studies of acute stroke management in stroke units and tertiary referral hospitals may not accurately reflect practice within the population. Reliable information on the management of stroke within a population is sparse. The aims of this study was to compare clinical practice in acute stroke management in Auckland with guidelines for the management and treatment of stroke in other countries; to provide a baseline measure against which future changes in management can be evaluated. All new stroke events in Auckland residents in 12 months were traced through multiple case finding sources. For each patient, a record of investigations and treatment during the first week of hospital admission was kept. One thousand eight hundred and three stroke events (including subarachnoid haemorrhages) occurred in 1761 patients in one year. Twenty-seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of the 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed tomography (CT). Of 376 validated ischaemic strokes, 44% were treated with aspirin and 12% with intravenous heparin. Of the 690 unspecified strokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 28 day in-hospital case fatality for all stroke events admitted to an acute hospital during the first week was 25%. It was concluded that in Auckland, management of acute stroke differed from clinical guidelines in the high proportion of patients managed in the community, the low rate of neurological consultation, and the low frequency of CT scanning. Despite these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high proportion of cases evaluated by a neurologist and CT. (authors)

  16. Early post-acute stroke seizures: Clinical profile and outcome in a ...

    African Journals Online (AJOL)

    Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology 2003;60:400-4. 10. Bladin CF, Alexandrov AV, Bellavance A, Bornstein N,. Chambers B, Coté R, et al. Seizures after stroke: A prospective multicenter study. Arch Neurol 2000;57: 1617-22. 11. De Reuck J, De Groote L, Van Maele G. Single ...

  17. Early Elevated Troponin Levels After Ischemic Stroke Suggests a Cardioembolic Source.

    Science.gov (United States)

    Yaghi, Shadi; Chang, Andrew D; Ricci, Brittany A; Jayaraman, Mahesh V; McTaggart, Ryan A; Hemendinger, Morgan; Narwal, Priya; Dakay, Katarina; Mac Grory, Brian; Cutting, Shawna M; Burton, Tina M; Song, Christopher; Mehanna, Emile; Siket, Matthew; Madsen, Tracy E; Reznik, Michael; Merkler, Alexander E; Lerario, Michael P; Kamel, Hooman; Elkind, Mitchell S V; Furie, Karen L

    2018-01-01

    Elevated cardiac troponin is a marker of cardiac disease and has been recently shown to be associated with embolic stroke risk. We hypothesize that early elevated troponin levels in the acute stroke setting are more prevalent in patients with embolic stroke subtypes (cardioembolic and embolic stroke of unknown source) as opposed to noncardioembolic subtypes (large-vessel disease, small-vessel disease, and other). We abstracted data from our prospective ischemic stroke database and included all patients with ischemic stroke during an 18-month period. Per our laboratory, we defined positive troponin as ≥0.1 ng/mL and intermediate as ≥0.06 ng/mL and stroke subtype (embolic stroke of unknown source and cardioembolic subtypes) and positive and intermediate troponin levels, adjusting for key confounders, including demographics (age and sex), clinical characteristics (hypertension, hyperlipidemia, diabetes mellitus, renal function, coronary heart disease, congestive heart failure, current smoking, and National Institutes of Health Stroke Scale score), cardiac variables (left atrial diameter, wall-motion abnormalities, ejection fraction, and PR interval on ECG), and insular involvement of infarct. We identified 1234 patients, of whom 1129 had admission troponin levels available; 10.0% (113/1129) of these had a positive troponin. In fully adjusted models, there was an association between troponin positivity and embolic stroke of unknown source subtype (adjusted odds ratio, 4.46; 95% confidence interval, 1.03-7.97; P =0.003) and cardioembolic stroke subtype (odds ratio, 5.00; 95% confidence interval, 1.83-13.63; P =0.002). We found that early positive troponin after ischemic stroke may be independently associated with a cardiac embolic source. Future studies are needed to confirm our findings using high-sensitivity troponin assays and to test optimal secondary prevention strategies in patients with embolic stroke of unknown source and positive troponin. © 2017 American

  18. The effect of a locally adapted, secondary stroke risk factor self-management program on medication adherence among veterans with stroke/TIA

    OpenAIRE

    Damush, Teresa M.; Myers, Laura; Anderson, Jane A.; Yu, Zhangsheng; Ofner, Susan; Nicholas, Gloria; Kimmel, Barbara; Schmid, Arlene A.; Kent, Thomas; Williams, Linda S.

    2015-01-01

    We targeted stroke/transient ischemic attack (TIA) survivors to engage in self-management practices to manage secondary stroke risk factors. We conducted a randomized, regional pilot trial of a locally adapted, secondary stroke prevention program. We implemented the program at two Veterans Administration Medical Centers. Program sessions targeted stroke risk factor self-management. Specifically, we evaluated the effect of the program on the reach, implementation, and effectiveness on patient ...

  19. A systematic review of the effectiveness of stroke self-management programs for improving function and participation outcomes: self-management programs for stroke survivors

    NARCIS (Netherlands)

    Warner, G.; Packer, T.L.; Villeneuve, M.; Audulv, A.; Versnel, J.

    2015-01-01

    PURPOSE: A systematic review of stroke self-management programs was conducted to: (i) identify how many and what self-management support strategies were included in stroke self-management interventions and (ii) describe whether self-management programs effectively improved outcomes, focusing

  20. 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.

  1. Early home-supported discharge for patients with stroke in Portugal

    DEFF Research Database (Denmark)

    Santana, Silvina; Rente, José; Neves, Conceição

    2017-01-01

    Objective: To evaluate an early home-supported discharge service for stroke patients. Design: We carried out a prospective, randomised, open-label, blinded-endpoint trial (allocation ratio of 1:1) with patients assigned to either an early home-supported discharge service or usual care. Setting......: The study was undertaken in Aveiro, Portugal, between April 2009 and April 2013. Subjects: We included stroke patients aged 25-85 years admitted to the stroke unit with an initial Functional Independence Measure of up to 100, who gave informed consent. Interventions: Patients in the early home......-supported discharge group began their rehabilitation intervention in the stroke unit and the early home-supported discharge team worked with them at home for a maximum of one month. Patients in the control group received usual services. Main measures: The primary outcome measure was the Functional Independence...

  2. Structural MRI markers of brain aging early after ischemic stroke.

    Science.gov (United States)

    Werden, Emilio; Cumming, Toby; Li, Qi; Bird, Laura; Veldsman, Michele; Pardoe, Heath R; Jackson, Graeme; Donnan, Geoffrey A; Brodtmann, Amy

    2017-07-11

    To examine associations between ischemic stroke, vascular risk factors, and MRI markers of brain aging. Eighty-one patients (mean age 67.5 ± 13.1 years, 31 left-sided, 61 men) with confirmed first-ever (n = 66) or recurrent (n = 15) ischemic stroke underwent 3T MRI scanning within 6 weeks of symptom onset (mean 26 ± 9 days). Age-matched controls (n = 40) completed identical testing. Multivariate regression analyses examined associations between group membership and MRI markers of brain aging (cortical thickness, total brain volume, white matter hyperintensity [WMH] volume, hippocampal volume), normalized against intracranial volume, and the effects of vascular risk factors on these relationships. First-ever stroke was associated with smaller hippocampal volume ( p = 0.025) and greater WMH volume ( p = 0.004) relative to controls. Recurrent stroke was in turn associated with smaller hippocampal volume relative to both first-ever stroke ( p = 0.017) and controls ( p = 0.001). These associations remained significant after adjustment for age, sex, education, and, in stroke patients, infarct volume. Total brain volume was not significantly smaller in first-ever stroke patients than in controls ( p = 0.056), but the association became significant after further adjustment for atrial fibrillation ( p = 0.036). Cortical thickness and brain volumes did not differ as a function of stroke type, infarct volume, or etiology. Brain structure is likely to be compromised before ischemic stroke by vascular risk factors. Smaller hippocampal and total brain volumes and increased WMH load represent proxies for underlying vascular brain injury. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

  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. Feasibility of Early Functional Rehabilitation in Acute Stroke Survivors using the Balance-Bed – A Technology that Emulates Microgravity

    Directory of Open Access Journals (Sweden)

    Lars I.E. Oddsson

    2015-05-01

    Full Text Available Evidence-based guidelines recommend early functional rehabilitation of stroke patients when risk of patient harm can be managed. Current tools do not allow balance training under load conditions sufficiently low for acute stroke patients. This single-arm pilot study tested feasibility and safety for acute stroke survivors to use Balance-Bed, a technology for balance exercises in supine initially developed to emulate microgravity effects on balance. Nine acute stroke patients (50-79 yrs. participated in 3-10 sessions over 16-46 days as part of their rehabilitation in a hospital inpatient setting. Standard inpatient measures of outcome were monitored where lack of progress from admission to discharge might indicate possible harm. Total FIM scores at admission (median 40, range 22-53 changed to (74, 50-96, Motor FIM scores from (23, 13-32 to (50, 32-68 and Berg Balance scores from (3, 0-6 to (19, 7-43 at discharge. Changes reached Minimal Clinical Important Difference for a sufficient proportion (>0.6 of the patients to indicate no harm to the patients. In addition, therapists reported the technology was safe, provided a positive experience for the patient and fit within the rehabilitation program. They reported the device should be easier to set up and exit. We conclude acute stroke patients tolerated Balance-Bed exercises such as standing on one or two legs, squats, stepping in place as well as balance perturbations provided by the therapist. We believe this is the first time it has been demonstrated that acute stroke patients can safely perform whole body balance training including balance perturbations as part of their rehabilitation program. Future studies should include a control group and compare outcomes from best practices to interventions using the Balance-Bed. In addition, the technology is relevant for countermeasure development for spaceflight and as a test-bed of balance function under microgravity-like conditions.

  5. Detection of Early Ischemic Changes in Noncontrast CT Head Improved with "Stroke Windows".

    Science.gov (United States)

    Mainali, Shraddha; Wahba, Mervat; Elijovich, Lucas

    2014-01-01

    Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar artery sign; sulcal effacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fifty patients (42% females, 58% males) with a mean NIHSS of 13.4 were identified. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%; P Windows (14% and 36%; P Windows (6% and 46%; P Windows significantly improved detection of EIC.

  6. Validity of Multisensor Array for Measuring Energy Expenditure of an Activity Bout in Early Stroke Survivors

    Directory of Open Access Journals (Sweden)

    Sharon Flora Kramer

    2018-01-01

    Full Text Available Introduction. Stroke survivors use more energy than healthy people during activities such as walking, which has consequences for the way exercise is prescribed for stroke survivors. There is a need for wearable device that can validly measure energy expenditure (EE of activity to inform exercise prescription early after stroke. We aimed to determine the validity and reliability of the SenseWear-Armband (SWA to measure EE and step-counts during activity 0.75 for walking and sit-to-stand, respectively. However, agreement levels changed with increasing EE levels (i.e., proportional bias. The SWA did not accurately measure step-counts. Conclusion. The SWA should be used with caution to measure EE of activity of mild to moderate stroke survivors <1 month after stroke.

  7. Physical Therapists' Guideline Adherence on Early Mobilization and Intensity of Practice at Dutch Acute Stroke Units A Country-Wide Survey

    NARCIS (Netherlands)

    Otterman, Nicoline M.; van der Wees, Philip J.; Bernhardt, Julie; Kwakkel, Gert

    2012-01-01

    Background and Purpose-Clinical practice guidelines for patients with stroke recommend early stroke rehabilitation at acute hospital stroke units. The present study aimed to (1) explore the organization of early stroke rehabilitation; (2) investigate current practice with respect to early

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Analysis of the morbidity and associated factors of early onset post-stroke depression

    Directory of Open Access Journals (Sweden)

    Yu ZHANG

    2015-03-01

    Full Text Available Objective To investigate the morbidity and associated factors of early onset depression after acute ischemic stroke, in order to improve its diagnostic rate and cure rate.  Methods The depression symptoms of 150 patients with acute ischemic stroke were evaluated by using Hamilton Depression Rating Scale-17 (HAMD-17 2 weeks after onset. According to Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-Ⅳ criteria, patients with HAMD-17 score ≥ 7 were diagnosed as post-stroke depression (PSD. Clinical data of those patients, including gender, age, education, laboratory indexes, predisposing factors, National Institute of Health Stroke Scale (NIHSS score, Trial of Org10172 in Acute Stroke Treatment (TOAST type, Oxfordshire Community Stroke Project (OCSP classification, and concurrent carotid artery stenosis were recorded. Univariate and multivariate Logistic regression analysis was used to investigate the related factors of PSD.  Results The morbidity of PSD in patients 2 weeks after stroke onset was 18% (27/150. Univariate and multivariate Logistic regression analysis showed triglyceride level (P = 0.042, neural function deficiency (P = 0.001 and concurrent carotid artery stenosis (P = 0.003 were independent risk factors for early onset PSD. Further subgroup analysis indicated concurrent carotid artery stenosis was the independent risk factor for PSD in non-minor stroke patients (P = 0.014. Conclusions Stroke patients with severe neurological deficits and carotid artery stenosis are susceptible to early onset PSD. DOI: 10.3969/j.issn.1672-6731.2015.03.007

  10. Early versus late rehabilitation for stroke survivors: A prospective study

    Directory of Open Access Journals (Sweden)

    Moshiur Rahman Khasru

    2017-11-01

    Full Text Available The aim of this study was to examine the optimum time of rehabilitation initiation after stroke in terms of disabilities, mobility and fall risk assessment. Data were collected prospectively at seven tertiary level health care centers in Bangladesh during the 36 months period from 2013 to 2016. All respondents were divided into four groups based on the initiation of rehabilitation as: a 0-24 hours, b 25-72 hours, c 4-7 days and d 8-60 days. Results show that significant improvement on stroke recovery, disabilities reduction, improvement in mobility restriction and reduction of fall risks in all the four groups but more improvement was observed in 0-24 hour’s group during follow-up after 3 and 12 weeks. On multinomial logistic regression analysis, the independent factors shows the mobility restriction and fall risk were more in the younger patients, male gender, married, hemorrhagic lesion and bilateral stroke.

  11. Early ficolin-1 is a sensitive prognostic marker for functional outcome in ischemic stroke

    DEFF Research Database (Denmark)

    Zangari, Rosalia; Zanier, Elisa R; Torgano, G

    2016-01-01

    : Plasma levels of the LP initiators ficolin-1, -2, and -3 and mannose-binding lectin (MBL) were measured in 80 stroke patients at 6 h only and in 85 patients at 48 h and later. Sixty-one age- and sex-matched healthy individuals served as controls. Stroke severity was measured on admission using...... the discriminating ability of an outcome model including NIHSS and age (area under the curve (AUC) 0.95, CI 95 % 0.90-0.99, p = 0.0001). CONCLUSIONS: The ficolins are consumed within 6 h after stroke implicating activation of the LP. Early ficolin-1 is selectively related to 3-month unfavorable outcome....

  12. Accuracy of Physical Therapists' Early Predictions of Upper-Limb Function in Hospital Stroke Units: The EPOS Study

    NARCIS (Netherlands)

    Nijland, R.H.M.; van Wegen, E.E.H.; Harmeling-van Wel, B.; Kwakkel, G.

    2013-01-01

    Background. Early prediction of outcome after stroke is becoming increasingly important, as most patients are discharged from hospital stroke units within several days after stroke. Objectives. The primary purposes of this study were: (1) to determine the accuracy of physical therapists' predictions

  13. Relation between change in blood pressure in acute stroke and risk of early adverse events and poor outcome

    DEFF Research Database (Denmark)

    Sandset, Else C; Murray, Gordon D; Bath, Philip M W

    2012-01-01

    The Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of candesartan in acute stroke. In the present analysis we aim to investigate the effect of change in blood pressure during the first 2 days of stroke on the risk of early adverse events and poor outcome....

  14. A Comparison of Aphasia Therapy Outcomes before and after a Very Early Rehabilitation Programme Following Stroke

    Science.gov (United States)

    Godecke, Erin; Ciccone, Natalie A.; Granger, Andrew S.; Rai, Tapan; West, Deborah; Cream, Angela; Cartwright, Jade; Hankey, Graeme J.

    2014-01-01

    Background: Very early aphasia rehabilitation studies have shown mixed results. Differences in therapy intensity and therapy type contribute significantly to the equivocal results. Aims: To compare a standardized, prescribed very early aphasia therapy regimen with a historical usual care control group at therapy completion (4-5 weeks post-stroke)…

  15. Critical potential of early cardiac surgery for infective endocarditis with cardio-embolic strokes.

    Science.gov (United States)

    Suzuki, Makoto; Takanashi, Shuichiro; Ohshima, Yutaro; Nagatomo, Yuji; Seki, Atsushi; Takamisawa, Itaru; Tobaru, Tetsuya; Naito, Kazuhiro; Kin, Hajime; Umemura, Jun; Takayama, Morimasa; Sumiyoshi, Tetsuya; Tomoike, Hitonobu

    2017-01-15

    Early cardiac surgery may have a trade-off between stabilized hemodynamics with controlled infection and a risk of peri-operative death in patients with infective endocarditis (IE) complicated with cardio-embolic strokes. We retrospectively studied clinical characteristics and outcomes in 68 consecutive patients with IE (mean age, 58±3years, 62% male) who admitted in our institute during June 2013 and August 2015. Cardio-embolic strokes were noted in 37% of patients (n=25) with IE and overall in-hospital mortality was 4 times higher in IE with cardio-embolic strokes than IE with an absence of strokes (n=43) (20% vs. 4.7%, p=0.045). Bacteremia of Staphylococcus aureus (p=0.021) and a complication of cardio-embolic strokes (p=0.031) were independently associated with in-hospital death in those with IE. However, in-hospital mortality was quite low in 19 with early cardiac surgery compared with 6 with conventional treatment in those with cardio-embolic strokes (11% vs. 50%, p=0.035). Multivariate logistic analysis demonstrated that lack of early cardiac surgery (p=0.014), a complication of cerebral hemorrhage (p=0.002), and a presence of refractory heart failure (p=0.047) were independently associated with in-hospital death in those with IE complicated with cardio-embolic strokes. Early cardiac surgery may provide clinical advantages overcoming peri-operative risks in those with IE complicated with cardio-embolic strokes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Randomized controlled trial of early rehabilitation after intracerebral hemorrhage stroke: difference in outcomes within 6 months of stroke.

    Science.gov (United States)

    Liu, Ning; Cadilhac, Dominique A; Andrew, Nadine E; Zeng, Lingxia; Li, Zongfang; Li, Jin; Li, Yan; Yu, Xuewen; Mi, Baibing; Li, Zhe; Xu, Honghai; Chen, Yangjing; Wang, Juan; Yao, Wanxia; Li, Kuo; Yan, Feng; Wang, Jue

    2014-12-01

    Mechanisms, acute management, and outcomes for patients who experience intracerebral hemorrhage may differ from patients with ischemic stroke. Studies of very early rehabilitation have been mainly undertaken in patients with ischemic stroke, and it is unknown if benefits apply to those with intracerebral hemorrhage. We hypothesized that early rehabilitation, within 48 hours of stroke, would improve survival and functional outcomes in patients with intracerebral hemorrhage. This was a multicenter, randomized controlled study, with blinded assessment of outcome at 3 and 6 months. Eligible patients were randomized to receive standard care or standard care plus early rehabilitation. Primary outcome includes survival. Secondary outcomes includes health-related quality of life using the 36-item Short Form Questionnaire, function measured with the modified Barthel Index, and anxiety measured with the Zung Self-Rated Anxiety Scale. Two hundred forty-three of 326 patients were randomized (mean age, 59 years; 56% men). At 6 months, patients receiving standard care were more likely to have died (adjusted hazard ratio, 4.44; 95% confidence interval [CI], 1.24-15.87); for morbidity outcomes, a 6-point difference in the Physical Component Summary score of the 36-item Short Form Questionnaire (95% CI, 4.2-8.7), a 7-point difference for the Mental Component Summary score (95% CI, 4.5-9.5), a 13-point difference in Modified Barthel Index scores (95% CI, 6.8-18.3), and a 6-point difference in Self-Rating Anxiety Scale scores (95% CI, 4.4-8.3) was reported in favor of the intervention groups. For the first time, we have shown that commencing rehabilitation within 48 hours of intracerebral hemorrhage improves survival and functional outcomes at 6 months after stroke in hospitalized patients in China. http://www.chictr.org/en. Unique identifier: ChiCTR-TRC-13004039. © 2014 American Heart Association, Inc.

  17. Predictors of early arrival at the emergency department in acute ischaemic stroke.

    LENUS (Irish Health Repository)

    Curran, C

    2012-01-31

    BACKGROUND: A requirement of an effective acute stroke service is the early arrival of patients to the hospital emergency department (ED). This will allow the possible use of thrombolytic therapy or other acute interventions within a limited time window. AIMS: We investigated the predictors of early arrival in a single hospital serving a mixed urban and rural catchment area. METHODS: A retrospective review of all case notes for 1 year was performed. RESULTS: Of 105 acute strokes, 91 were cerebral infarcts and a total of 71 cases presenting initially to the ED had timing available for analysis. 39.4% presented within 3 h, and 12.7% were potentially suitable for thrombolysis. Those living closer to the hospital were not more likely to arrive within 3 h (Z = -0.411, p = 0.68). Presenting directly to the hospital by emergency services (or private transport) was significantly associated with early arrival in a univariate comparison (p < 0.001), and in a multivariate model. CONCLUSION: The only independent predictor of early arrival to the ED is direct presentation. Improved public education of the importance of recognition of stroke symptoms and rapid contact with the emergency services will improve the early attendance following acute stroke, allowing increased use of acute stroke treatments.

  18. Vulnerability to stroke: implications of perinatal programming of the hypothalamic-pituitary-adrenal axis

    Directory of Open Access Journals (Sweden)

    Tara K S Craft

    2009-12-01

    Full Text Available Chronic stress is capable of exacerbating each major, modifiable, endogenous risk factor for cerebrovascular and cardiovascular disease. Indeed, exposure to stress can increase both the incidence and severity of stroke, presumably through activation of the hypothalamic-pituitary-adrenal (HPA axis. Now that characterization of the mechanisms underlying epigenetic programming of the HPA axis is well underway, there has been renewed interest in examining the role of early environment on the evolution of health conditions across the entire lifespan. Indeed, neonatal manipulations in rodents that reduce stress-responsivity, and subsequent life-time exposure to glucocorticoids, are associated with a reduction in the development of neuroendocrine, neuroanatomical, and cognitive dysfunctions that typically progress with age. Although improved day to day regulation of the HPA axis also may be accompanied by a decrease in stroke risk, evidence from rodent studies suggest that an associated cost could be increased susceptibility to inflammation and neuronal death in the event that a stroke does occur and the individual is exposed to persistently elevated corticosteroids. Given its importance in regulation of health and disease states, any long-term modulation of the HPA axis is likely to be associated with both benefits and potential risks. The goals of this review article are to examine 1 the clinical and experimental data suggesting that neonatal experiences can shape HPA axis regulation, 2 the influence of stress and the HPA axis on stroke incidence and severity, and 3 the potential for neonatal programming of the HPA axis to impact adult cerebrovascular health.

  19. 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 ...

  20. Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

    Directory of Open Access Journals (Sweden)

    Herlitz Johan

    2010-09-01

    Full Text Available Abstract Background The two major complications of atherosclerosis are acute myocardial infarction (AMI and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably. In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count. This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase. Method A literature search was performed on the PubMed, Embase (Ovid SP and Cochrane Library databases. Results In both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women. With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably. In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke. Conclusion Both in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between

  1. Early childhood programs and the education system.

    Science.gov (United States)

    Beach, Jane; Bertrand, Jane

    2009-12-01

    Policy makers, advocates and experts agree that the current delivery of early childhood development programs is fragmented. Many point to the education system as a better alternative for a more coherent approach that has the necessary infrastructure in place in communities, and is well placed to meet the needs of all young children and their families. In other jurisdictions, early childhood development programs have moved into education. In Canada, provincial and local school authorities are taking on more early childhood programs.

  2. Early consciousness disorder in acute ischemic stroke: incidence, risk factors and outcome.

    Science.gov (United States)

    Li, Jie; Wang, Deren; Tao, Wendan; Dong, Wei; Zhang, Jing; Yang, Jie; Liu, Ming

    2016-08-17

    Little is known about the incidence and risk factors of early consciousness disorder (ECD) in patients with acute ischemic stroke, or about how ECD may affect complications and outcomes. Patients admitted to our hospital within 24 h of onset of acute ischemic stroke were consecutively enrolled. ECD was evaluated clinically and using the Glasgow coma scale. Multivariate analysis was used to identify risk factors of ECD, as well as associations between ECD and clinical outcomes. Of the 569 patients enrolled, 199 (35 %) had ECD. Independent risk factors of ECD were advanced age (OR 1.027, 95 % CI 1.007 to 1.048), National Institutes of Health Stroke Score on admission (OR 1.331, 95 % CI 1.257 to 1.410), and massive cerebral infarct (OR 3.211, 95 % CI 1.642 to 6.279). ECD was associated with higher frequency of stroke-related complications (83.4 % vs. 31.1 %, P stroke. Risk factors include advanced age, stroke severity, and massive cerebral infarct. ECD is associated with higher frequency of stroke-related complications and 3-month death/disability.

  3. Depression is an independent determinant of life satisfaction early after stroke.

    Science.gov (United States)

    Oosterveer, Daniëlla M; Mishre, Radha Rambaran; van Oort, Andrea; Bodde, Karin; Aerden, Leo A M

    2017-03-06

    Life satisfaction is reduced in stroke patients. However, as a rule, rehabilitation goals are not aimed at life satisfaction, but at activities and participation. In order to optimize life satisfaction in stroke patients, rehabilitation should take into account the determinants of life satisfaction. The aim of this study was therefore to determine what factors are independent determinants of life satisfaction in a large group of patients early after stroke. Stroke-surviving patients were examined by a specialized nurse 6 weeks after discharge from hospital or rehabilitation setting. A standardized history and several screening lists, including the Lisat-9, were completed. Step-wise regression was used to identify independent determinants of life satisfaction. A total of 284 stroke-surviving patients were included in the study. Of these, 117 answered all of the Lisat-9 questions. Most patients (66.5%) rated their life as a whole as "satisfying" or "very satisfying". More depressive symptoms were independently associated with lower life satisfaction (p life early after a stroke. The score on the Hospital Anxiety and Depression Scale depression items is independently associated with life satisfaction. Physicians should therefore pay close attention to the mood of these patients.

  4. Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke.

    Science.gov (United States)

    Yu, Sungwook; Arima, Hisatomi; Bertmar, Carin; Clarke, Stephen; Herkes, Geoffrey; Krause, Martin

    2018-04-15

    The neutrophil to lymphocyte ratio (NLR) is closely linked to mortality in patients with cardiovascular disease. We investigated whether NLR is associated with early clinical outcomes in patients with acute ischemic stroke. We collated data from a tertiary hospital's stroke registry including admitted patients with a first-ever acute ischemic stroke within 72 h of onset. White blood cell counts and peripheral differential counts were measured on admission. Early clinical outcomes were in-hospital mortality and disability at discharge assessed by the modified Rankin scale (mRS). Among 1131 stroke patients, 454 patients were included and classified into tertile groups based on NLR on admission. Patients in higher tertiles of NLR were likely to have severe neurologic deficit at discharge. Higher NLR tertiles were associated with an unfavourable shift of mRS score (p < .0001). This association remained significant after adjustment for clinical and laboratory variables including age, sex, hypertension, hypercholesterolemia, atrial fibrillation, stroke severity, and glucose level (p = .032 for trend). However, risk of death or major disability (score of 3-6 on mRS) and in-hospital mortality were not significantly different across NLR tertile groups. In patients with acute ischemic stroke, NLR was predictive of short-term functional outcome. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

  5. Cervical artery dissection: early recognition and stroke prevention [digest].

    Science.gov (United States)

    Cadena, Rhonda; Kim, Jeremy

    2016-07-22

    Cervical artery dissections involve the carotid or vertebral arteries. Although the overall incidence is low, they remain a common cause of stroke in children, young adults, and trauma patients. Symptoms such as headache, neck pain, and dizziness are commonly seen in the emergency department, but may not be apparent in the obtunded trauma patient. A missed diagnosis of cervical artery dissection can result in devastating neurological sequelae, so emergency clinicians must act quickly to recognize this event and begin treatment as soon as possible while neurological consultation is obtained. This issue reviews the evidence in applying advanced screening criteria and choosing imaging and antithrombotic treatment strategies for patients with cervical artery dissections to reduce the occurrence of ischemic stroke. [Points & Pearls is a digest of Emergency Medicine Practice].

  6. Impact of early applied upper limb stimulation: The EXPLICIT-stroke programme design

    Directory of Open Access Journals (Sweden)

    Lindeman Eline

    2008-12-01

    Full Text Available Abstract Background Main claims of the literature are that functional recovery of the paretic upper limb is mainly defined within the first month post stroke and that rehabilitation services should preferably be applied intensively and in a task-oriented way within this particular time window. EXplaining PLastICITy after stroke (acronym EXPLICIT-stroke aims to explore the underlying mechanisms of post stroke upper limb recovery. Two randomized single blinded trials form the core of the programme, investigating the effects of early modified Constraint-Induced Movement Therapy (modified CIMT and EMG-triggered Neuro-Muscular Stimulation (EMG-NMS in patients with respectively a favourable or poor probability for recovery of dexterity. Methods/design 180 participants suffering from an acute, first-ever ischemic stroke will be recruited. Functional prognosis at the end of the first week post stroke is used to stratify patient into a poor prognosis group for upper limb recovery (N = 120, A2 project and a group with a favourable prognosis (N = 60, A1 project. Both groups will be randomized to an experimental arm receiving respectively modified CIMT (favourable prognosis or EMG-NMS (poor prognosis for 3 weeks or to a control arm receiving usual care. Primary outcome variable will be the Action Research Arm Test (ARAT, assessed at 1,2,3,4,5, 8, 12 and 26 weeks post stroke. To study the impact of modified CIMT or EMG-NMS on stroke recovery mechanisms i.e. neuroplasticity, compensatory movements and upper limb neuromechanics, 60 patients randomly selected from projects A1 and A2 will undergo TMS, kinematical and haptic robotic measurements within a repeated measurement design. Additionally, 30 patients from the A1 project will undergo fMRI at baseline, 5 and 26 weeks post stroke. Conclusion EXPLICIT stroke is a 5 year translational research programme which main aim is to investigate the effects of early applied intensive intervention for regaining dexterity

  7. [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.

  8. Morphological classification of mobile plaques and their association with early recurrence of stroke.

    Science.gov (United States)

    Ogata, Toshiyasu; Yasaka, Masahiro; Wakugawa, Yoshiyuki; Kitazono, Takanari; Okada, Yasushi

    2010-01-01

    The present study investigated the frequency and morphological characteristics of carotid mobile plaques and examined the relationship between carotid mobile plaques and recurrent strokes. The study included 94 consecutive acute stroke patients with large-artery atherosclerosis associated with extracranial carotid stenosis. We investigated the presence of mobile plaques by carotid ultrasonography and classified patients into two groups (mobile group and non-mobile group). We compared backgrounds, MRI and ultrasonographic findings, neurological severity on admission and at discharge, and the rate of early recurrent stroke between both groups. Mobile plaques were detected in 12 patients (12.8%). There were four types of mobile plaques: (1) the jellyfish-type plaque, in which the fibrous cap fluctuated like a jellyfish; (2) the streaming-band-type plaque, in which the string attached to the plaque was swaying; (3) the mobile-thrombus-type plaque, in which a mobile mass was attached to the plaque surface, and (4) the fluctuating-ulcer-type plaque, which contained a mobile substance in the plaque ulcer. Although National Institutes of Health Stroke Scale (NIHSS) scores on admission were less severe in the mobile group than in the non-mobile group (median 1 vs. 4, respectively; p = 0.004), the rate of early recurrent stroke was significantly higher in the mobile group than in the non-mobile group (33.3 vs. 7.3%, respectively; p = 0.022). There were no significant differences in NIHSS scores at discharge between groups. Morphologically, several types of mobile plaques were detected in consecutive patients with acute stroke associated with carotid stenosis. Mobile plaques are strongly associated with an early recurrence of stroke. Copyright © 2010 S. Karger AG, Basel.

  9. The predictive value of CT signs in the early and subacute stages of ischaemic stroke

    International Nuclear Information System (INIS)

    Podkowa, J.; Kowalewski, K.; Filarski, J.; Sasiadek, M.; Sokolowska, D.; Podemski, R.; Guranski, K.

    2003-01-01

    Computed tomography (CT), despite the development of new imaging methods like diffusion-weighted MR and perfusion MR, is usually the initial examination procedure in stroke patients. However, the predictive value of early CT signs in ischaemic stroke has not been established yet. Therefore, the purpose of this study was to assess the clinical significance of CT findings in the early and subacute stages of the ischaemic stroke. Thirty-five patients with ischaemic stroke of middle cerebral artery territory had CT studies performed within 18 hours after ictus and on the 5th day. Following CT signs were analyzed: the extent of hypodensity and mass effect (both calculated using our own method), obscuring of the lentiform and caudate nuclei, as well as the insular ribbon, Sylvian fissure and lateral ventricle compression, ventricular displacement, and hyperdense middle cerebral artery sign (HMCAS). The results were compared statistically with clinical scorings at admission and on day 30. Among the early CT signs only lentiform nucleus obscuring was correlated with both early and the late clinical scales. Caudate nucleus obscuring, Sylvian fissure compression and mass effect extent were correlated with early clinical scoring only, while lateral ventricle compression with the late clinical scale. Other findings affected neither early nor late clinical scorings. Most of the follow-up CT symptoms showed a strong correlation with the late clinical scoring, with an exception of Sylvian fissure compression and HMCAS. Early CT has limited predictive value in assessing stroke patients. The only statistically significant signs are lentiform nucleus obscuring and ventricular compression. However, most subacute CT findings have high predictive value. (author)

  10. Early Prediction of Outcome of Activities of Daily Living After Stroke A Systematic Review

    NARCIS (Netherlands)

    Veerbeek, Janne M.; Kwakkel, Gert; van Wegen, Erwin E. H.; Ket, Johannes C. F.; Heymans, Martijn W.

    Background and Purpose-Knowledge about robust and unbiased factors that predict outcome of activities of daily living (ADL) is paramount in stroke management. This review investigates the methodological quality of prognostic studies in the early poststroke phase for final ADL to identify variables

  11. Early prediction of outcome of activities of daily living after stroke: a systematic review

    NARCIS (Netherlands)

    Veerbeek, J.M.; Kwakkel, G.; van Wegen, E.E.H.; Ket, J.C.F.; Heijmans, M.W.

    2011-01-01

    BACKGROUND AND PURPOSE-Knowledge about robust and unbiased factors that predict outcome of activities of daily living (ADL) is paramount in stroke management. This review investigates the methodological quality of prognostic studies in the early poststroke phase for final ADL to identify variables

  12. An Annotated Bibliography of Current Literature Dealing with Stroke Education Programs in a Physical Rehabilitation Setting.

    Science.gov (United States)

    Donohue, Ann Teresa

    This study makes available to nurses and other rehabilitation team members pertinent information to meet stroke patients' educational needs. The study was conducted to support the theory that those patients and families who actively participate in a stroke education program will more positively cope with the losses resulting from the disability…

  13. Responsiveness of the Berg Balance Scale in patients early after stroke.

    Science.gov (United States)

    Saso, Adam; Moe-Nilssen, Rolf; Gunnes, Mari; Askim, Torunn

    2016-05-01

    The Berg Balance Scale (BBS) has previously shown good measurement properties. However, its ability to detect important change in patients early after stroke is still unknown. The purpose of the present study was to determine the minimal important change (MIC) and its relation to the minimal detectable change (MDC) for BBS in patients early after stroke. This prospective follow-up study included patients within the first 2 weeks after onset of stroke. The BBS, Barthel Index, and Scandinavian Stroke Scale were obtained at inclusion and 1 month later. At the follow-up assessment, the Patient Global Impression of Change was obtained. A receiver operating characteristic (ROC) curve was used to calculate the cut-off value for the MIC. Fifty-two patients (mean age of 78.7, SD 8.5 years) were included. All measures showed a significant improvement from baseline to follow-up. The ROC analysis identified a MIC of ≥6 BBS points, while the MDC was 5.97 BBS points at the 80% confidence level. This study shows that a change of 6 BBS point or more can be considered an important change for patients in the sub-acute phase after stroke, which also represents an 80% probability of exceeding the measurement error. A total of 80% of unchanged patients would display random fluctuations within the bounds of MDC80, while 20% of unchanged patients would exceed MDC80.

  14. HELP: Healthy Early Literacy Program

    Science.gov (United States)

    Rader, Laura A.

    2008-01-01

    A daily intensive supplemental reading and writing program was developed to assist students who were: 1. identified with a language disability and 2. identified as at-risk for reading failure in an urban elementary school. The purpose of the program was to help these students understand and develop the connection between oral and written language…

  15. Building a Knowledge to Action Program in Stroke Rehabilitation.

    Science.gov (United States)

    Janzen, Shannon; McIntyre, Amanda; Richardson, Marina; Britt, Eileen; Teasell, Robert

    2016-09-01

    The knowledge to action (KTA) process proposed by Graham et al (2006) is a framework to facilitate the development and application of research evidence into clinical practice. The KTA process consists of the knowledge creation cycle and the action cycle. The Evidence Based Review of Stroke Rehabilitation is a foundational part of the knowledge creation cycle and has helped guide the development of best practice recommendations in stroke. The Rehabilitation Knowledge to Action Project is an audit-feedback process for the clinical implementation of best practice guidelines, which follows the action cycle. The objective of this review was to: (1) contextualize the Evidence Based Review of Stroke Rehabilitation and Rehabilitation Knowledge to Action Project within the KTA model and (2) show how this process led to improved evidence-based practice in stroke rehabilitation. Through this process, a single centre was able to change clinical practice and promote a culture that supports the use of evidence-based practices in stroke rehabilitation.

  16. Effects of early age at natural menopause on coronary heart disease and stroke in Chinese women.

    Science.gov (United States)

    Shen, Lijun; Song, Lulu; Liu, Bingqing; Li, Hui; Zheng, Xiaoxuan; Zhang, Lina; Yuan, Jing; Liang, Yuan; Wang, Youjie

    2017-08-15

    Menopause is identified as a risk factor for cardiovascular disease because of the change of estrogen. The objective of the study was to explore the associations between early age at natural menopause (menopause at an age≤45years) and the presence of CHD and stroke. The study subjects were from the first follow-up survey of the Dongfeng-Tongji cohort study. A total of 16,515 postmenopausal women were included for the analysis. Logistic regression models were used to examine the associations between age at natural menopause (≤45, 45-52, >52years) and the presence of CHD and stroke adjusted for sociodemographic characteristics, lifestyle, reproductive history and metabolic factors. In the fully adjusted model, for each 1-year delay in menopausal age, the prevalence of CHD and stroke was reduced by 3% (OR, 0.97; 95% CI, 0.95-0.98) and 5% (OR, 0.95; 95% CI, 0.92-0.98), respectively. Women with early menopause (≤45years) had a higher prevalence of CHD (OR, 1.33; 95% CI, 1.13-1.57) compared with those with menopause at ages 45-52years. Similarly, women with early menopause (≤45years) was associated with higher prevalence of stroke (OR, 1.69; 95% CI, 1.25-2.30) compared with those with menopause at ages 45-52years. Early age at natural menopause is significantly associated with the presence of CHD and stroke among Chinese women. Copyright © 2017. Published by Elsevier B.V.

  17. The impact of early stroke on identity: A discourse analytic study.

    Science.gov (United States)

    Guise, Jennifer; McKinlay, Andy; Widdicombe, Sue

    2010-01-01

    This article examines the ways in which sufferers talk about early stroke and the effects this chronic condition has on identity. Traditional research into chronic illness has largely used medical, psychiatric or cognitive models. We adopt a social constructionist perspective and use a discourse analytic methodology to study data collected via focus group interaction. Analysis of the data collected shows that participants displayed sensitivity about having acquired a potentially 'damaged' sense of self by mitigating negative features of their experiences. Participants also attended to the issue of whether their accounts were persuasive or believable. Some carers were present in these discussions. As a consequence, participants who had suffered a stroke displayed sensitivity to the way that carers might respond to mitigation of the negative aspects of stroke.

  18. Albuminuria predicts early neurological deterioration in patients with acute ischemic stroke.

    Science.gov (United States)

    Kanamaru, Takuya; Suda, Satoshi; Muraga, Kanako; Okubo, Seiji; Watanabe, Yoko; Tsuruoka, Syuichi; Kimura, Kazumi

    2017-01-15

    Reduced glomerular filtration rate (GFR) and albuminuria have been independently associated with an increased risk of stroke and unfavorable long-term outcomes. However, the association between GFR, albuminuria, and early neurological deterioration (END) in patients with ischemic stroke has not been well studied to date. We therefore investigated the ability of estimated GFR (eGFR) and albuminuria to predict END in patients with acute ischemic stroke. We retrospectively enrolled 294 patients that were admitted to our stroke center with acute ischemic stroke between January 2011 and September 2012. General blood and urine examinations, including eGFR and urinary albumin/creatinine ratio (UACR) measurements, were performed on admission. Kidney dysfunction was defined by a low eGFR value (albuminuria (≥30mg/g creatinine). END was defined as a ≥2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score within 7days after admission. Kidney dysfunction was diagnosed in 200 of the 294 patients (68.0%). END was observed in 60 patients (20.4%). Age, blood glucose level on admission, UACR on admission, and NIHSS score on admission were significantly associated with END, while no relationship between eGFR on admission and END was identified. A multivariable logistic regression analysis showed that END was positively associated with high UACR (≥39.6mg/g creatinine) and a high NIHSS score (≥6 points). Our data suggest that high UACR on admission may predict END in patients with acute ischemic stroke. Larger prospective studies are required to validate the correlation between albuminuria and END. Copyright © 2016 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2015-06-17

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

  20. 75 FR 24450 - Early Retiree Reinsurance Program

    Science.gov (United States)

    2010-05-05

    ... comments in the CMS drop slots located in the main lobby of the building. A stamp- in clock is available... regulatory terminology and concepts should be the same or similar between the RDS Program and the Early...

  1. Early vascular aging in young and middle-aged ischemic stroke patients: the Norwegian Stroke in the Young Study.

    Directory of Open Access Journals (Sweden)

    Sahrai Saeed

    Full Text Available Ischemic stroke survivors have high risk of cardiovascular morbidity and mortality even at young age, suggesting that early arterial aging is common among such patients.We measured aortic stiffness by carotid-femoral pulse wave velocity (PWV in 205 patients (69% men aged 15-60 years with acute ischemic stroke in the prospective Norwegian Stroke in the Young Study. High for age carotid-femoral PWV was identified in the reference normogram.Patients were on average 49 ± 10 years old, 34% had a history of hypertension and 37% had metabolic syndrome (MetS. In the total study population, higher PWV was associated with history of hypertension (β = 0.18, higher age (β = 0.34, systolic blood pressure (BP (β = 0.28 and serum creatinine (β = 0.18 and lower high-density lipoprotein (HDL cholesterol (β = -0.10, all p < 0.01 in multivariate linear regression analysis (multiple R2 = 0.42, p < 0.001. High for age PWV was found in 18% of patients. In univariate analyses, known hypertension was associated with a 6-fold, MetS with a 4-fold and presence of carotid plaque with a 3.7-fold higher risk for high for age PWV (all p < 0.01. In multiple logistic regression analysis higher systolic BP (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.02-1.06; p < 0.01, history of hypertension (OR 3.59; 95% CI 1.52-8.51; p < 0.01, low HDL cholesterol (OR 3.03; 95% CI 1.00-9.09; p = 0.05 and higher serum creatinine (OR 1.04; 95% CI 1.01-1.06; p < 0.01 were associated with high for age PWV.Higher PWV is common in younger and middle-aged ischemic stroke patients and associated with a clustering of classical cardiovascular risk factors. ClinicalTrials.gov NCT01597453.

  2. Early menopause predicts future coronary heart disease and stroke: the Multi-Ethnic Study of Atherosclerosis.

    Science.gov (United States)

    Wellons, Melissa; Ouyang, Pamela; Schreiner, Pamela J; Herrington, David M; Vaidya, Dhananjay

    2012-10-01

    Cardiovascular disease is the number one killer of women. Identifying women at risk of cardiovascular disease has tremendous public health importance. Early menopause is associated with increased cardiovascular disease events in some predominantly white populations, but not consistently. Our objective was to determine if self-reported early menopause (menopause at an age menopause (either natural menopause or surgical removal of ovaries at an age menopause. In survival curves, women with early menopause had worse coronary heart disease and stroke-free survival (log rank P = 0.008 and P = 0.0158). In models adjusted for age, race/ethnicity, Multi-ethnic Study Atherosclerosis site, and traditional cardiovascular disease risk factors, this risk for coronary heart disease and stroke remained (hazard ratio, 2.08; 95% CI, 1.17-3.70; and hazard ratio, 2.19; 95% CI, 1.11-4.32, respectively). Early menopause is positively associated with coronary heart disease and stroke in a multiethnic cohort, independent of traditional cardiovascular disease risk factors.

  3. Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India

    Directory of Open Access Journals (Sweden)

    Lalitha Pidaparthi

    2016-01-01

    Full Text Available Background: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. Objective: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. Materials and Methods: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed. Results: Out of 2,593 stroke patients, only 145 (5.6% patients presented within 6 h of stroke onset and among them 118 (81.4% patients had ischemic stroke and 27 (18.6% patients had hemorrhagic stroke. A total of 89/118 (75.4% patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4, hemorrhagic infarct (N = 1, gastrointestinal bleed (N = 1, oral anticoagulant usage with prolonged international normalized ratio (INR (N = 1, and recent cataract surgery (N = 1]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7, fear of bleed (N = 4, rapidly improving symptoms (N = 4, mild stroke (N = 2, delayed neurologist referral within the hospital (N = 2, and logistic difficulty in organizing endovascular treatment (N = 2. Conclusion: One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions.

  4. The validity and reliability of signs of early infarction on CT in acute ischaemic stroke

    International Nuclear Information System (INIS)

    Dippel, D.W.J.; Du Ry van Beest Holle, M.; Kooten, F. van; Koudstaal, P.J.

    2000-01-01

    It has been suggested that subtle signs of early cerebral infarction on CT are important indicators of outcome and of the effect of thrombolytic treatment in acute ischaemic stroke. We studied these signs prospectively, in 260 patients with an anterior circulation stroke from a European-Australian randomised trial of lubeluzole in acute ischaemic stroke. Interobserver reliability was assessed by means of the χ statistic. The validity of the early signs was assessed by comparing the assessments of the first CT with another CT at 1 week after the onset of stroke, and with stroke outcome at 12 weeks. Each initial CT study was assessed by two of a group of five reviewers, who were blinded to each other's assessments and to the findings on the follow-up CT. The images were assessed twice, once without clinical information and again after disclosure of the side (left or right hemisphere) of the lesion. All reviewers were experienced clinicians with a special interest and training in vascular neurology and CT. The median time between stroke onset and the first CT was 3.2 h; 59 % of the patients were imaged within 3 h and 77 % within 6 h. More than half of the patients (52 %) had a large middle cerebral artery territory (MCA) infarct on follow-up CT. Chance-adjusted interobserver agreement (χ) for any early infarct was 0.27 (95 % confidence interval (CI): 0.15 to 0.39). Agreement (χ) on the extent of a middle cerebral artery (MCA) infarct and on the indication for treatment with recombinant tissue plasminogen activator (rt-PA) was fair: 0.37 and 0.35, respectively. Patients with early signs of an infarct of more than 1/3 of the MCA territory were more likely to have a large MCA infarct on follow-up CT (odds ratio 5.7, 95 % confidence interval 2.8-11.5); the positive and negative predictive value of these signs was 81 % and 57 %, respectively. Chance-adjusted interobserver agreement on early, subtle signs of a large MCA territory infarct on CT by neurologists was thus no

  5. Effects of Twice-Weekly Intense Aerobic Exercise in Early Subacute Stroke: A Randomized Controlled Trial.

    Science.gov (United States)

    Sandberg, Klas; Kleist, Marie; Falk, Lars; Enthoven, Paul

    2016-08-01

    To examine the effects of 12 weeks of twice-weekly intensive aerobic exercise on physical function and quality of life after subacute stroke. Randomized controlled trial. Ambulatory care. Patients (N=56; 28 women) aged ≥50 years who had a mild stroke (98% ischemic) and were discharged to independent living and enrolled 20 days (median) after stroke onset. Sixty minutes of group aerobic exercise, including 2 sets of 8 minutes of exercise with intensity up to exertion level 14 or 15 of 20 on the Borg rating of perceived exertion scale, twice weekly for 12 weeks (n=29). The nonintervention group (n=27) received no organized rehabilitation or scheduled physical exercise. Primary outcome measures included aerobic capacity on the standard ergometer exercise stress test (peak work rate) and walking distance on the 6-minute walk test (6MWT). Secondary outcome measures included maximum walking speed for 10m, balance on the timed Up and Go (TUG) test and single leg stance (SLS), health-related quality of life on the European Quality of Life Scale (EQ-5D), and participation and recovery after stroke on the Stroke Impact Scale (SIS) version 2.0 domains 8 and 9. Participants were evaluated pre- and postintervention. Patient-reported measures were also evaluated at 6-month follow-up. The following improved significantly more in the intervention group (pre- to postintervention): peak work rate (group × time interaction, P=.006), 6MWT (P=.011), maximum walking speed for 10m (PAerobic exercise was associated with improved EQ-5D scores (visual analog scale, P=.008) and perceived recovery (SIS domain 9, P=.002). These patient-reported improvements persisted at 6-month follow-up. Intensive aerobic exercise twice weekly early in subacute mild stroke improved aerobic capacity, walking, balance, health-related quality of life, and patient-reported recovery. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. Early Blood-Brain Barrier Disruption after Mechanical Thrombectomy in Acute Ischemic Stroke.

    Science.gov (United States)

    Shi, Zhong-Song; Duckwiler, Gary R; Jahan, Reza; Tateshima, Satoshi; Szeder, Viktor; Saver, Jeffrey L; Kim, Doojin; Sharma, Latisha K; Vespa, Paul M; Salamon, Noriko; Villablanca, J Pablo; Viñuela, Fernando; Feng, Lei; Loh, Yince; Liebeskind, David S

    2018-02-27

    The impact of blood-brain barrier (BBB) disruption can be detected by intraparenchymal hyperdense lesion on the computed tomography (CT) scan after endovascular stroke therapy. The purpose of this study was to determine whether early BBB disruption predicts intracranial hemorrhage and poor outcome in patients with acute ischemic stroke treated with mechanical thrombectomy. We analyzed patients with anterior circulation stroke treated with mechanical thrombectomy and identified BBB disruption on the noncontrast CT images immediately after endovascular treatment. Follow-up CT or magnetic resonance imaging scan was performed at 24 hours to assess intracranial hemorrhage. We dichotomized patients into those with moderate BBB disruption versus those with minor BBB disruption and no BBB disruption. We evaluated the association of moderate BBB disruption after mechanical thrombectomy with intracranial hemorrhage and clinical outcomes. Moderate BBB disruption after mechanical thrombectomy was found in 56 of 210 patients (26.7%). Moderate BBB disruption was independently associated with higher rates of hemorrhagic transformation (OR 25.33; 95% CI 9.93-64.65; P disruption with intracranial hemorrhage remained in patients with successful reperfusion after mechanical thrombectomy. The location of BBB disruption was not associated with intracranial hemorrhage and poor outcome. Moderate BBB disruption is common after mechanical thrombectomy in a quarter of patients with acute ischemic stroke and increases the risk of intracranial hemorrhage and poor outcome. Copyright © 2018 by the American Society of Neuroimaging.

  7. A promising method of enhancement for early detection of ischemic stroke

    Science.gov (United States)

    Sajjadi, Mehdi; Karami, Mehdi; Amirfattahi, Rassoul; Bateni, Vahid; Ahamadzadeh, Mohammad R.; Ebrahimi, Bahareh

    2012-01-01

    Background: Computed Tomography (CT) scan without contrast is the modality of choice for diagnosis of stroke. However, routine brain CT scan, with linear processing has some limitations in early diagnosis of ischemic stroke. The aim of this study was to evaluate and compare the sensitivity and specificity of processed CT images with conventional ones in early diagnosis of cerebrovascular attack (CVA). Patients and Methods: This was a self-controlled study conducted in a university referal hospital from 2010 to 2011. Seventy CT scans underwent a process using Laplacian Pyramid transform. Thirty five of participants were diagnosed with CVA while others had only headache and no ischemic stroke diagnosis based on the first and follow-up CT scans. A neuroradiologist made diagnosis with and without the help of processed CT scans. The McNemar and Wilcoxon analysis were used to compare the sensitivity, specificity, positive and negative predictive values of two methods. Results: The sensitivity (% 65.7 vs. %31.4, P value = 0.001), positive predictive value (% 85.2 vs. % 61, P value = 0.03) and negative predictive value (% 73.9% vs. %49, P value = 0.01) of the processed method were significantly higher than the routine one, while no difference was seen in specificity (% 88.6 vs. %77.1, P value = 0.15). Moreover, the accuracy of the processed method was significantly better than the linear one (P value Pyramid method can composed CT scans which can be more helpful in early detection of ischemic stroke. PMID:23826011

  8. Comparing unilateral and bilateral upper limb training: The ULTRA-stroke program design

    Directory of Open Access Journals (Sweden)

    Koppe Peter

    2009-11-01

    Full Text Available Abstract Background About 80% of all stroke survivors have an upper limb paresis immediately after stroke, only about a third of whom (30 to 40% regain some dexterity within six months following conventional treatment programs. Of late, however, two recently developed interventions - constraint-induced movement therapy (CIMT and bilateral arm training with rhythmic auditory cueing (BATRAC - have shown promising results in the treatment of upper limb paresis in chronic stroke patients. The ULTRA-stroke (acronym for Upper Limb TRaining After stroke program was conceived to assess the effectiveness of these interventions in subacute stroke patients and to examine how the observed changes in sensori-motor functioning relate to changes in stroke recovery mechanisms associated with peripheral stiffness, interlimb interactions, and cortical inter- and intrahemispheric networks. The present paper describes the design of this single-blinded randomized clinical trial (RCT, which has recently started and will take several years to complete. Methods/Design Sixty patients with a first ever stroke will be recruited. Patients will be stratified in terms of their remaining motor ability at the distal part of the arm (i.e., wrist and finger movements and randomized over three intervention groups receiving modified CIMT, modified BATRAC, or an equally intensive (i.e., dose-matched conventional treatment program for 6 weeks. Primary outcome variable is the score on the Action Research Arm test (ARAT, which will be assessed before, directly after, and 6 weeks after the intervention. During those test sessions all patients will also undergo measurements aimed at investigating the associated recovery mechanisms using haptic robots and magneto-encephalography (MEG. Discussion ULTRA-stroke is a 3-year translational research program which aims (1 to assess the relative effectiveness of the three interventions, on a group level but also as a function of patient

  9. Randomized Controlled Trial of Early Versus Delayed Statin Therapy in Patients With Acute Ischemic Stroke: ASSORT Trial (Administration of Statin on Acute Ischemic Stroke Patient).

    Science.gov (United States)

    Yoshimura, Shinichi; Uchida, Kazutaka; Daimon, Takashi; Takashima, Ryuzo; Kimura, Kazuhiro; Morimoto, Takeshi

    2017-11-01

    Several studies suggested that statins during hospitalization were associated with better disability outcomes in patients with acute ischemic stroke, but only 1 small randomized trial is available. We conducted a multicenter, open-label, randomized controlled trial in patients with acute ischemic strokes in 11 hospitals in Japan. Patients with acute ischemic stroke and dyslipidemia randomly received statins within 24 hours after admission in the early group or on the seventh day in the delayed group, in a 1:1 ratio. Statins were administered for 12 weeks. The primary outcome was patient disability assessed by modified Rankin Scale at 90 days. A total of 257 patients were randomized and analyzed (early 131, delayed 126). At 90 days, modified Rankin Scale score distribution did not differ between groups ( P =0.68), and the adjusted common odds ratio of the early statin group was 0.84 (95% confidence interval, 0.53-1.3; P =0.46) compared with the delayed statin group. There were 3 deaths at 90 days (2 in the early group, 1 in the delayed group) because of malignancy. Ischemic stroke recurred in 9 patients (6.9%) in the early group and 5 patients (4.0%) in the delayed group. The safety profile was similar between groups. Our randomized trial involving patients with acute ischemic stroke and dyslipidemia did not show any superiority of early statin therapy within 24 hours of admission compared with delayed statin therapy 7 days after admission to alleviate the degree of disability at 90 days after onset. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02549846. © 2017 American Heart Association, Inc.

  10. 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.

  11. F-18 fluoromisonidazole PET predicts early lesion progression in acute ischemic stroke patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, G. H.; Kim, J. S.; Oh, S. J.; Cho, A. H.; Cho, K. H.; Kang, D. H.; Kim, J. S.; Kwon, S. E. [Asan Medical Center, Seoul (Korea, Republic of)

    2007-07-01

    F-18 fluoromisonidazole (FMISO) PET has been known to image viable hypoxic area. We performed this study to define whether FMISO PET can reveal ischemic penumbra of acute ischemic stroke. We prospectively selected acute ischemic stroke patients with large diffusion-perfusion mismatch due to occlusion of MCA or ICA on MRI among patients who visited emergency room within 24 hours after stroke onset. FMISO PET and diffusion weighted MR image (DWI) performed within 48 hours after initial MRI. We excluded the patients who performed any reperfusion procedure. To define the final infarcted area, DWI was performed again 2 days after PET scan. Brain FMISO PET was performed 3 hour after the injection of FMISO (370 MBq). FMISO PET was assessed by visual and quantitative analysis. The extent of abnormally increased FMISO uptake was automatically calculated by the number and size of voxels having higher count than upper 3SD of the mean count of contralateral normal hemisphere. We compared the extent of abnormal FMISO uptake area with the change of the extent of ischemic lesions on DWI. Fifteen patients were enrolled in this study. Ten of these patients showed abnormally increased FMISO uptake in peri-infarct area. Ischemic lesion size on follow-up DWI significantly increased in all patients with abnormally increased FMISO uptake except one patient of whom the MCA spontaneously recanalized on follow up angiogram. Ischemic lesions on DWI increased in only one of five patients without abnormally increased FMISO uptake. The extent of abnormally increased FMISO uptake area was positively correlated with infarct size progression on DWI (Spearman correlation coefficient = 0.757, p<0.01). FMISO uptake specifically and sensitively predicted early lesion progression in acute ischemic stroke patients with large diffusion-perfusion mismatch. Therefore, FMISO PET will be a good indicator of the revascularization or reperfusion procedure for acute ischemic stroke by defining ischemic

  12. Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke: The EXPLICIT-Stroke Randomized Clinical Trial

    NARCIS (Netherlands)

    Kwakkel, G.; Winters, C.; Wegen, E.E.H. van; Nijland, R.H.; Kuijk, A.A. van; Visser-Meily, A.; Groot, J. de; Vlugt, E. de; Arendzen, J.H.; Geurts, A.C.H.; Meskers, C.G.

    2016-01-01

    Background and Objective Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered

  13. Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early after Stroke : The EXPLICIT-Stroke Randomized Clinical Trial

    NARCIS (Netherlands)

    Kwakkel, Gert; Winters, Caroline; Van Wegen, Erwin E.H.; Nijland, Rinske H.M.; Van Kuijk, Annette A.A.; Visser-Meily, Anne; De Groot, Jurriaan; De Vlugt, Erwin; Arendzen, J. Hans; Geurts, Alexander C.H.; Meskers, Carel G.M.

    2016-01-01

    Background and Objective. Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered

  14. The Prothrombin G20210A Mutation is Associated with Young-Onset Stroke: The Genetics of Early Onset Stroke Study and Meta-Analysis

    Science.gov (United States)

    Jiang, Baijia; Ryan, Kathleen A.; Hamedani, Ali; Cheng, Yuching; Sparks, Mary J.; Koontz, Deborah; Bean, Christopher J.; Gallagher, Margaret; Hooper, W. Craig; McArdle, Patrick F.; O'Connell, Jeffrey R.; Stine, O. Colin; Wozniak, Marcella A.; Stern, Barney J.; Mitchell, Braxton D.; Kittner, Steven J.; Cole, John W.

    2014-01-01

    Background and Purpose Although the prothrombin G20210A mutation has been implicated as a risk factor for venous thrombosis, its role in arterial ischemic stroke is unclear, particularly among young-adults. To address this issue, we examined the association between prothrombin G20210A and ischemic stroke in a Caucasian case-control population and additionally performed a meta-analysis Methods From the population-based Genetics of Early Onset Stroke (GEOS) study we identified 397 individuals of European ancestry aged 15-49 years with first-ever ischemic stroke and 426 matched-controls. Logistic regression was used to calculate odds ratios in the entire population and for subgroups stratified by gender, age, oral contraceptive use, migraine and smoking status. A meta-analysis of 17 case-control studies (n=2305 cases ischemic stroke did not achieve statistical significance (OR=2.5,95%CI=0.9-6.5,p=0.07). However, among adults aged 15-42 (younger than median age), cases were significantly more likely than controls to have the mutation (OR=5.9,95%CI=1.2-28.1,p=0.03), whereas adults ages 42-49 were not (OR=1.4,95%CI=0.4-5.1,p=0.94). In our meta-analysis, the mutation was associated with significantly increased stroke risk in adults ischemic stroke in young-adults and may have an even stronger association among those with earlier onset strokes. Our finding of a stronger association in the younger-young adult population requires replication. PMID:24619398

  15. Prothrombin G20210A mutation is associated with young-onset stroke: the genetics of early-onset stroke study and meta-analysis.

    Science.gov (United States)

    Jiang, Baijia; Ryan, Kathleen A; Hamedani, Ali; Cheng, Yuching; Sparks, Mary J; Koontz, Deborah; Bean, Christopher J; Gallagher, Margaret; Hooper, W Craig; McArdle, Patrick F; O'Connell, Jeffrey R; Stine, O Colin; Wozniak, Marcella A; Stern, Barney J; Mitchell, Braxton D; Kittner, Steven J; Cole, John W

    2014-04-01

    Although the prothrombin G20210A mutation has been implicated as a risk factor for venous thrombosis, its role in arterial ischemic stroke is unclear, particularly among young adults. To address this issue, we examined the association between prothrombin G20210A and ischemic stroke in a white case-control population and additionally performed a meta-analysis. From the population-based Genetics of Early Onset Stroke (GEOS) study, we identified 397 individuals of European ancestry aged 15 to 49 years with first-ever ischemic stroke and 426 matched controls. Logistic regression was used to calculate odds ratios (ORs) in the entire population and for subgroups stratified by sex, age, oral contraceptive use, migraine, and smoking status. A meta-analysis of 17 case-control studies (n=2305 cases ischemic stroke did not achieve statistical significance (OR=2.5; 95% confidence interval [CI]=0.9-6.5; P=0.07). However, among adults aged 15 to 42 years (younger than median age), cases were significantly more likely than controls to have the mutation (OR=5.9; 95% CI=1.2-28.1; P=0.03), whereas adults aged 42 to 49 years were not (OR=1.4; 95% CI=0.4-5.1; P=0.94). In our meta-analysis, the mutation was associated with significantly increased stroke risk in adults ≤55 years (OR=1.4; 95% CI=1.1-1.9; P=0.02), with significance increasing with addition of the GEOS results (OR=1.5; 95% CI=1.1-2.0; P=0.005). The prothrombin G20210A mutation is associated with ischemic stroke in young adults and may have an even stronger association among those with earlier onset strokes. Our finding of a stronger association in the younger young adult population requires replication.

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

    Science.gov (United States)

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

    2014-01-01

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

  17. The bicalutamide Early Prostate Cancer Program. Demography

    DEFF Research Database (Denmark)

    See, W A.; McLeod, D; Iversen, P

    2001-01-01

    BACKGROUND: The optimal treatment for early prostate cancer has yet to be established. A well-tolerated hormonal therapy such as bicalutamide could be a useful treatment option in this setting, either as adjuvant or immediate therapy. A major collaborative clinical trials program was set up...... to investigate bicalutamide as a treatment option for local prostate cancer (localized or locally advanced disease). METHODS: The bicalutamide Early Prostate Cancer program comprises three randomized, double-blind, placebo-controlled trials of similar design that are being conducted in distinct geographical...... areas (North America; Australia, Europe, Israel, South Africa and Mexico; and Scandinavia). Men with T1b-4N0-1M0 (TNM 1997) prostate cancer have been randomized on a 1:1 basis to receive bicalutamide 150 mg daily or placebo. Recruitment to the program closed in July 1998, and follow-up is ongoing. Study...

  18. Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives.

    Science.gov (United States)

    Xu, Tianma; O'Loughlin, Kate; Clemson, Lindy; Lannin, Natasha A; Dean, Catherine; Koh, Gerald

    2017-12-25

    Drawing on the perspectives of stroke survivors, family members and domestic helpers, this study explores participants' experiences of self-perceived fall risk factors after stroke, common fall prevention strategies used, and challenges to community participation after a fall. Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n = 9), family caregivers (n = 4), and domestic helpers (n = 4) who have cared for a stroke survivor with a previous fall. Purposive sampling was used for recruitment; all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software. All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor's safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process. Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore. Implications for rehabilitation Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities. Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors. Fall prevention programs for community-dwelling stroke survivors should target both stroke

  19. Assessing Costs and Benefits of Early Childhood Intervention Programs. Overview and Applicaton to the Starting Early Starting Smart Program

    National Research Council Canada - National Science Library

    Karoly, Lynn

    2001-01-01

    Agency and program administrators and decisionmakers responsible for implementing early childhood intervention programs are becoming more interested in quantifying the costs and benefits of such programs...

  20. Feasibility of a Nurse-Led Weekend Group Exercise Program for People after Stroke

    Directory of Open Access Journals (Sweden)

    Katharine Scrivener

    2017-01-01

    Full Text Available Background. Additional physical activity including repetitive task practice can improve outcomes after stroke. The additional practice can be facilitated by therapists and family members or could also be delivered by nursing staff. Objective. To investigate the feasibility of a nurse-led weekend exercise program after stroke. Participants. Individuals after stroke, who participated in a weekend exercise program during their hospital admission. Methods. A retrospective audit of the number of referrals to and amount of exercise repetitions achieved in a nurse-led weekend exercise program was undertaken. The weekend exercise program occurs on each Saturday and Sunday for one hour. The repetitions of exercise completed during each class were documented by staff. An audit was conducted to ascertain the amount and type of exercise completed within the class. Results. During the study period 284 people were referred to the exercise program. The mean number of exercise repetitions completed per participant in each class was 180.7 (SD 205.4. The number of exercise repetitions completed by participants was highly variable ranging from 0 to 1190 per class. Conclusion. The amount of average exercise repetitions completed in the Weekend Warrior program was large but with significant variability. A nurse-led exercise class is a feasible method of delivering exercise opportunities to individuals in hospital after stroke.

  1. Early Menopause Predicts Future Coronary Heart Disease and Stroke: The Multi-Ethnic Study of Atherosclerosis (MESA)

    Science.gov (United States)

    Wellons, Melissa; Ouyang, Pamela; Schreiner, Pamela J; Herrington, David M; Vaidya, Dhananjay

    2012-01-01

    Objective Cardiovascular disease is the number one killer of women. Identifying women at risk of cardiovascular disease has tremendous public health importance. Early menopause is associated with increased cardiovascular disease events in some predominantly white populations, but not consistently. Our objective was to determine if a self-reported early menopause (menopause at an age menopause (either natural menopause or surgical removal of ovaries at an age menopause. In survival curves, women with early menopause had worse coronary heart disease and stroke-free survival (log rank p=menopause is positively associated with coronary heart disease and stroke in a multiethnic cohort, independent of traditional cardiovascular disease risk factors. PMID:22692332

  2. Treatment of stroke with early imaging and revascularization: when to be aggressive?

    Science.gov (United States)

    Toni, Danilo; Pieroni, Alessio

    2017-01-01

    Neuroimaging has a key role in the assessment and treatment of acute stroke. Cerebral computer tomography is the first step to differentiate hemorragic from ischemic stroke and to detect, in the latter, early signs representative of the lesion severity and predicting a possible hemorrhagic infarction after thrombolytic treatment.Advanced neuroimaging techniques are relevant in the assessment of the ischemic and/or hypo-perfused area, being an essential tool in uncertain situations or when the time of symptoms onset is unavailable, increasing the efficacy and safety of endovenous thrombolysis by enlarging its therapeutic window and leading to more accurate selection of patients to be treated.Moreover, advanced neuroimaging may be of help in choosing the patients to be submitted to endovascular treatment when occlusion of an intracranial artery is documented, either after intravenous thrombolysis or as a primary approach.Here we describe the impact of neuroimaging in the decisional process in acute ischemic stroke, presenting the literature evidence on the topic, especially regarding the recent trials on endovascular treatment.

  3. 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.

  4. Early detection and efficient therapy of cardiac angiosarcoma due to routine transesophageal echocardiography after cerebrovascular stroke

    Directory of Open Access Journals (Sweden)

    Dirk Vogelgesang

    2008-08-01

    Full Text Available Dirk Vogelgesang1, Johannes B Dahm2, Holm Großmann3, Andre Hippe4, Astrid Hummel5, Christian Lotze6, Silke Vogelgesang71Practice of Cardiology, Greifswald, 2Practice of Cardiology, Goettingen, 3Department of Cardiovascular Surgery, Herzzentrum Karlsburg, 4Department of Neurology, 5Department of Cardiology, 6Department of Haematology and Oncology, 7Department of Pathology, University of Greifswald, Greifswald, GermanyAbstract: Primary malignant cardiac tumors (cardiac angiosarcomas are exceedingly rare. Since there are initially nonspecific or missing symptoms, these tumors are usually diagnosed only in an advanced, often incurable stage, after the large tumor mass elicits hemodynamic obstructive symptoms. A 59-year-old female presented with symptoms of cerebral ischemia. A computed tomography (CT scan showed changes suggestive of stroke. Transesophageal echocardiography revealed an inhomogeneous, medium-echogenic, floating mass at the roof of the left atrium near the mouth of the right upper pulmonary vein, indicative of a thrombus. At surgery, a solitary tumor was completely enucleated. Histologically, cardiac angiosarcoma was diagnosed. The patient received adjuvant chemotherapy and was free of symptoms and recurrence of disease at 14 months follow-up. Due to the fortuitous appearance of clinical signs indicative of stroke, cardiac angiosarcoma was diagnosed and effectively treated at an early, nonmetastatic, and therefore potentially curable stage. Although cardiac angiosarcoma is a rare disease, it should be taken into consideration as a potential cause of cerebral embolic disease.Keywords: cardiac angiosarcoma, stroke, embolism

  5. Elevated Plasma Homocysteine Level Increased the Risk of Early Renal Impairment in Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Chen, Jingjuan; Li, Guode; Xu, Zuohang; Zhang, Chengguo; Wang, Yukai; Xie, Haiqun; Shao, Yan; Peng, Lingmei; Lu, Jiancong; Yuan, Dahua

    2017-11-01

    Renal insufficiency is associated with the prognosis of acute ischemic stroke (AIS) and homocysteine (Hcy) levels. This study investigated the association between plasma Hcy levels and renal insufficiency in patients with AIS. A total of 987 patients with AIS who had been treated at the First People's Hospital of Foshan between 2011 and 2014 were retrospectively studied. Based on their cystatin C (Cys C) levels, the patients were divided into the normal renal function group (Cys C ≤ 1.25 mg/L) or the renal impairment group (Cys C > 1.25 mg/L). Multivariate regression analysis was applied to reveal the association between hyperhomocysteinemia (HHcy) and renal impairment. The renal impairment group showed more advanced age of onset, higher percentage of prior stroke and hypertension, higher baseline National Institute of Health Stroke Scale score, lower high-density lipoprotein cholesterol levels, and higher Hcy levels compared with the normal renal function group. A multivariate analysis revealed a relationship between early renal impairment and Hcy levels: an increase of Hcy by 1 μmol/L was associated with an increase of 12-18% of the risk of renal impairment among patients with AIS and HHcy. Patients with AIS and HHcy had a 2.42-3.51 fold increase of the risk of renal impairment compared with patients with normal Hcy level (P renal impairment.

  6. 34 CFR 303.11 - Early intervention program.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Early intervention program. 303.11 Section 303.11... AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND... intervention program. As used in this part, early intervention program means the total effort in a State that...

  7. From Early Intervention to Early Childhood Programs: Timeline for Early Successful Transitions (TEST)

    Science.gov (United States)

    Brandes, Joyce A.; Ormsbee, Christine K.; Haring, Kathryn A.

    2007-01-01

    More than one million transitions between early intervention services and early childhood programs are facilitated annually for youngsters with special needs. To be successful, these transitions require planning and ongoing communication between all parties. This article substantiates the need for a timeline/checklist and provides a model of…

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

    Science.gov (United States)

    Donoso Brown, Elena V; Fichter, Renae

    2017-12-01

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

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

    Science.gov (United States)

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

    2014-09-01

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

  10. The efficacy of mirror therapy combined with conventional stroke rehabilitation program on motor and functional recovery

    Directory of Open Access Journals (Sweden)

    Selen Kuzgun

    2012-12-01

    Full Text Available OBJECTIVE: A variety of methods is used in the treatment of upper extremity functional impairment after stroke.In recent years, a new therapeutic approach in the treatment of stroke rehabilitation is the mirror therapy.The purpose of this study is to investigate the efficacy of mirror therapy,which is applied through motor imagination training, combined with conventional stroke rehabilitation program on upper extremity motor and functional recovery in patients with subacute stroke. MATERIAL and METHODS: This is a randomized,prospective,controlled single-blind trial.The study included 20 patients who were diagnosed with stroke.Patients were randomly divided into two groups:first group received conventional rehabilitation program and the second group received conventional rehabilitation program plus mirror therapy on nonparetic upper extremity consisting of wrist extension daily 4 times for 15minutes per session. Both groups received the conventional rehabilitation program for 4 weeks, 5 days a week and daily 1-2h. All patients were evaluated at baseline and at the end of the treatment(week 4.The evaluations were performed by using Brunnstrom Staging, Fugl Meyer Motor Function Scale(FM,Barthel Index(BI and goniometric measurement of wrist extension. RESULTS: The Brunnstrom stage(p<0.01, total score on FM and BI scores (p<0.01 were improved at week 4 compared to the baseline, whereas wrist subscore on FM and the goniometric measurements of the wrist and wrist extension were significantly improved only in group II.The two treatment groups were not statistically different in terms of posttreatment evaluation parameters. CONCLUSION: In our study,the mirror therapy combined with conventional rehabilitation program was not superior to conventional rehabilitation program alone in terms of upper extremity motor and functional recovery.

  11. Effects of exercise training programs on walking competency after stroke - A systematic review

    NARCIS (Netherlands)

    van de Port, Ingrid G. L.; Wood-Dauphinee, Sharon; Lindeman, Eline; Kwakkel, Gert

    2007-01-01

    To determine the effectiveness of training programs that focus on lower-limb strengthening, cardiorespiratory fitness, or gait-oriented tasks in improving gait, gait-related activities, and health-related quality of life after stroke. Randomized controlled trials (RCTs) were searched for in the

  12. Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation.

    Science.gov (United States)

    Choi, Yoon-Hee; Paik, Nam-Jong

    2018-03-08

    Stroke rehabilitation requires repetitive, intensive, goal-oriented therapy. Virtual reality (VR) has the potential to satisfy these requirements. Game-based therapy can promote patients' engagement in rehabilitation therapy as a more interesting and a motivating tool. Mobile devices such as smartphones and tablet PCs can provide personalized home-based therapy with interactive communication between patients and clinicians. In this study, a mobile VR upper extremity rehabilitation program using game applications was developed. The findings from the study show that the mobile game-based VR program effectively promotes upper extremity recovery in patients with stroke. In addition, patients completed two weeks of treatment using the program without adverse effects and were generally satisfied with the program. This mobile game-based VR upper extremity rehabilitation program can substitute for some parts of the conventional therapy that are delivered one-on-one by an occupational therapist. This time-efficient, easy to implement, and clinically effective program would be a good candidate tool for tele-rehabilitation for upper extremity recovery in patients with stroke. Patients and therapists can collaborate remotely through these e-health rehabilitation programs while reducing economic and social costs.

  13. Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation: A Prospective Magnetic Resonance Imaging Study.

    Science.gov (United States)

    Gioia, Laura C; Kate, Mahesh; Sivakumar, Leka; Hussain, Dulara; Kalashyan, Hayrapet; Buck, Brian; Bussiere, Miguel; Jeerakathil, Thomas; Shuaib, Ashfaq; Emery, Derek; Butcher, Ken

    2016-07-01

    Early anticoagulation after cardioembolic stroke remains controversial because of the potential for hemorrhagic transformation (HT). We tested the safety and feasibility of initiating rivaroxaban ≤14 days after cardioembolic stroke/transient ischemic attack. A prospective, open-label study of patients with atrial fibrillation treated with rivaroxaban ≤14 days of transient ischemic attack or ischemic stroke (National Institute of Health Stroke Scale stroke/18% transient ischemic attack) were enrolled. Median (interquartile range) time from onset to rivaroxaban was 3 (5) days. At treatment initiation, median National Institute of Health Stroke Scale was 2 (4), and median diffusion-weighted imaging volume was 7.9 (13.7) mL. At baseline, HT was present in 25 (42%) patients (hemorrhagic infarct [HI]1=19, HI2=6). On follow-up magnetic resonance imaging, no patients developed symptomatic HT. New asymptomatic HI1 developed in 3 patients, and asymptomatic progression from HI1 to HI2 occurred in 5 patients; otherwise, HT remained unchanged at day 7. These data support the safety of rivaroxaban initiation ≤14 days of mild-moderate cardioembolic stroke/transient ischemic attack. Magnetic resonance imaging evidence of petechial HT, which is common, does not appear to increase the risk of symptomatic HT. © 2016 American Heart Association, Inc.

  14. Effect of early trunk control training on balance function of patients with acute stroke

    Directory of Open Access Journals (Sweden)

    Bao-jin LI

    2017-07-01

    Full Text Available Background Trunk is the core part of human body, and plays an important role in maintaining the body balance. Studies show that trunk control training can improve the balance function and mobility ability, and promote motor function and activities of daily living (ADL of stroke patients. This study aims to investigate the effect of early trunk control training on the recovery of balance function of acute stroke patients.  Methods A total of 120 patients with acute ischemic stroke (duration ≤ 14 d were randomly divided into 2 groups: control group [N = 60, 39 males and 21 females; age 23-85 years, mean age (63.43 ± 13.61 years; duration 1-13 d, median duration 4.12 (2.30, 6.09 d] and observation group [N = 60, 40 males and 20 females; age 20-84 years, average age (62.55 ± 13.77 years; duration 1-12 d, median duration 4.19 (2.48, 6.30 d]. Control group was given routine drug treatment plus rehabilitation education and guidance, and observation group was given routine drug treatment, rehabilitation education and guidance plus trunk control training. Fugl-Meyer Assessment Scale-Balance (FMA-Balance and Modified Rivermead Mobility Index (MRMI were used to evaluate the balance function of patients in both groups before training and after 2-week training.  Results All patients finished the rehabilitation training programme without adverse reactions. Compared with before training, the scores of FMA-Balance (P =0.000 and MRMI (P = 0.000 were significantly increased after 2-week training in both groups. Compared to control group, the scores of FMA-Balance (P = 0.002 and MRMI (P = 0.002 were significantly increased after 2-week training in observation group.  Conclusions Early trunk control training can significantly improve the balance function and motor ability of patients with acute stroke. DOI: 10.3969/j.issn.1672-6731.2017.04.005

  15. Clinical and imaging features associated with an increased risk of early and late stroke in patients with symptomatic carotid disease

    DEFF Research Database (Denmark)

    Naylor, A R; Sillesen, H; Schroeder, T V

    2015-01-01

    intracranial disease; (v) a failure to recruit intracranial collaterals; (vi) low GSM; (vii) MR diagnosis of intra-plaque haemorrhage; (vii) spontaneous embolisation on TCD; and (viii) increased FDG uptake in the carotid plaque on PET. Clinical/imaging parameters associated with a lower risk of stroke include......OBJECTIVE: The aim of this review was to identify clinical and/or imaging parameters that are associated with an increased (decreased) risk of early/late stroke in patients with symptomatic carotid disease. IN THE FIRST 14 DAYS: Natural history studies suggest that 8-15% of patients with 50......-99% stenoses will suffer a stroke within 72 hours of their index symptom. Currently, there are insufficient validated data to identify highest-risk patients for emergency carotid endarterectomy (CEA), but an increased risk of stroke appears to be predicted by (i) an ABCD(2) score of 4-7; (ii) the presence...

  16. A piano training program to improve manual dexterity and upper extremity function in chronic stroke survivors

    Directory of Open Access Journals (Sweden)

    Myriam eVilleneuve

    2014-08-01

    Full Text Available Objective: Music-supported therapy was shown to induce improvements in motor skills in stroke survivors. Whether all stroke individuals respond similarly to the intervention and whether gains can be maintained over time remain unknown. We estimated the immediate and retention effects of a piano training program on upper extremity function in persons with chronic stroke. Methods: Thirteen stroke participants engaged in a 3-week piano training comprising of supervised sessions (9 x 60min and home practice. Fine and gross manual dexterity, movement coordination and functional use of the upper extremity were assessed at baseline, pre-intervention, post-intervention and at a 3-week follow-up. Results: Significant improvements were observed for all outcomes at post-intervention and follow-up, compared to pre-intervention scores. Larger magnitudes of change in manual dexterity and functional use of the upper extremity were associated with higher initial levels of motor recovery. Conclusions: Piano training can result in sustainable improvements in upper extremity function in chronic stroke survivors. Individuals with a higher initial level of motor recovery at baseline appear to benefit the most from this intervention.

  17. A piano training program to improve manual dexterity and upper extremity function in chronic stroke survivors.

    Science.gov (United States)

    Villeneuve, Myriam; Penhune, Virginia; Lamontagne, Anouk

    2014-01-01

    Music-supported therapy was shown to induce improvements in motor skills in stroke survivors. Whether all stroke individuals respond similarly to the intervention and whether gains can be maintained over time remain unknown. We estimated the immediate and retention effects of a piano training program on upper extremity function in persons with chronic stroke. Thirteen stroke participants engaged in a 3-week piano training comprising supervised sessions (9 × 60 min) and home practice. Fine and gross manual dexterity, movement coordination, and functional use of the upper extremity were assessed at baseline, pre-intervention, post-intervention, and at a 3-week follow-up. Significant improvements were observed for all outcomes at post-intervention and follow-up compared to pre-intervention scores. Larger magnitudes of change in manual dexterity and functional use of the upper extremity were associated with higher initial levels of motor recovery. Piano training can result in sustainable improvements in upper extremity function in chronic stroke survivors. Individuals with a higher initial level of motor recovery at baseline appear to benefit the most from this intervention.

  18. 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.

  19. A Meta-Analysis of Early Versus Delayed Surgery for Valvular Infective Endocarditis Complicated by Embolic Ischemic Stroke.

    Science.gov (United States)

    Mihos, Christos G; Pineda, Andres M; Santana, Orlando

    2016-01-01

    An embolic ischemic stroke occurs in 10% to 40% of patients with valvular infective endocarditis (IE) and confers significant morbidity. The optimal timing of valve surgery in this population is not well defined. With the use of PubMed, EMBASE, Ovid, and Cochrane databases, a systematic review identified 14 studies through October 2015 that compared early versus delayed surgery for valvular IE complicated by an ischemic stroke. Early surgery was defined as 3 days or less in one, 7 days or less in eight, and 14 days or less in five studies. Risk ratios (RRs) were calculated by the Mantel-Haenszel method under a fixed- or random-effects model, for the outcomes of perioperative stroke, operative mortality, and 1-year survival. A total of 833 patients (early surgery, 330; delayed surgery, 503) were included. The majority of operations were for aortic and/or mitral valve IE, with prosthetic valve IE present in 0% to 60%. Infection with Staphylococcus aureus ranged from 19% to 66%, and heart failure prevalence at the time of operation was 24% to 66%. Early surgery was associated with an increased risk of operative mortality (RR, 1.72; 95% confidence interval [CI], 1.27-2.34; P = 0.0005), which was significant regardless of surgery within the first 7 days (RR, 2.19; 95% CI, 1.45-3.31; P = 0.0002) or 14 days (RR, 1.72; 95% CI, 1.12-2.64; P = 0.01) after stroke. Surgical timing did not affect the risk of perioperative ischemic or hemorrhagic stroke or 1-year survival. In patients with valvular IE complicated by ischemic stroke, early surgery is associated with an increased risk of operative mortality, with no observed benefit in 1-year survival.

  20. Incorporating robotic-assisted telerehabilitation in a home program to improve arm function following stroke.

    Science.gov (United States)

    Linder, Susan M; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Rosenfeldt, Anson B; Clark, Cindy; Wolf, Steven L; Alberts, Jay L

    2013-09-01

    After stroke, many individuals lack resources to receive the intensive rehabilitation that is thought to improve upper extremity motor function. This case study describes the application of a telerehabilitation intervention using a portable robotic device combined with a home exercise program (HEP) designed to improve upper extremity function. The participant was a 54-year-old man, 22 weeks following right medullary pyramidal ischemic infarct. At baseline, he exhibited residual paresis of the left upper extremity, resulting in impaired motor control consistent with a flexion synergistic pattern, scoring 22 of 66 on the Fugl-Meyer Assessment. The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period. The participant demonstrated an improvement of 26 points on the Action Research Arm Test, 5 points on the Functional Ability Scale portion of the Wolf Motor Function Test, and 20 points on the Fugl-Meyer Assessment, all of which surpassed the minimal clinically important difference. Of the 17 tasks of the Wolf Motor Function Test, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his recovery from stroke on the Stroke Impact Scale quality-of-life questionnaire from 40 of 100 to 65 of 100. His score on the Center for Epidemiologic Studies Depression Scale improved by 19 points. This case demonstrates that robotic-assisted therapy paired with an HEP can be successfully delivered within a home environment to a person with stroke. Robotic-assisted therapy may be a feasible and efficacious adjunct to an HEP program to elicit substantial improvements in upper extremity motor function, especially in those persons with stroke who lack access to stroke rehabilitation centers.

  1. Improvement on detectability of early ischemic changes for acute stroke using nonenhanced computed tomography: Effect of matrix size

    Energy Technology Data Exchange (ETDEWEB)

    Ogura, Akio, E-mail: a-ogura@mbox.kyoto-inet.or.jp [Department of Radiology, Kyoto City Hospital (Japan); Graduate School of Medical Science, Kanazawa University (Japan); Hayakawa, Katsumi [Department of Radiology, Kyoto City Hospital (Japan); Miyati, Tosiaki [Graduate School of Medical Science, Kanazawa University (Japan); Maeda, Fumie [Department of Radiology, Kyoto City Hospital (Japan)

    2010-11-15

    Purpose: It has recently been reported that intravenous recombinant tissue plasminogen activator improves the clinical outcome after acute stroke. Computed tomography (CT) is the standard imaging method used to determine the indication for thrombolysis. However, detection of early ischemic change often results in an increase in local radiation exposure. Therefore, the effects of decreased matrix size and use of a noise reduction filter were evaluated. Materials and methods: The low contrast resolution was compared for different matrix sizes and imaging filters using a contrast-detail phantom. In addition, early ischemic change in clinical images with matrix sizes of 256 x 256 and 128 x 128 processed using three imaging filters (Gaussian, smoothing, and unsharp mask) from 11 patients within 3 h of stroke onset was evaluated by seven radiologists in a blind manner. Results: The use of images with a matrix size of 256 x 256 and processed with the Gaussian filter increased the detection of early signs of acute stroke. Conclusions: This study was performed to determine whether the converted matrix size and use of imaging filters could improve the detectability of early ischemic change on CT images in acute stroke. To reduce the dose of radiation exposure for patients, it was effective to use an optimal noise reduction filter and reasonable matrix size. In particular, changing the matrix size to 256 x 256 was the most effective for detection of early ischemic change in examinations using clinical images.

  2. Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: the North Dublin TIA study.

    LENUS (Irish Health Repository)

    Sheehan, Orla C

    2010-05-01

    Transient ischemic attack (TIA) etiologic data and the ABCD(2) score may improve early stroke risk prediction, but studies are required in population-based cohorts. We investigated the external validity of the ABCD(2) score, carotid stenosis, and atrial fibrillation for prediction of early recurrent stroke after TIA.

  3. Exercise in the Early Stage after Stroke Enhances Hippocampal Brain-Derived Neurotrophic Factor Expression and Memory Function Recovery.

    Science.gov (United States)

    Himi, Naoyuki; Takahashi, Hisashi; Okabe, Naohiko; Nakamura, Emi; Shiromoto, Takashi; Narita, Kazuhiko; Koga, Tomoshige; Miyamoto, Osamu

    2016-12-01

    Exercise in the early stage after stroke onset has been shown to facilitate the recovery from physical dysfunction. However, the mechanism of recovery has not been clarified. In this study, the effect of exercise on spatial memory function recovery in the early stage was shown, and the mechanism of recovery was discussed using a rat model of brain embolism. Intra-arterial microsphere (MS) injection induced small emboli in the rat brain. Treadmill exercise was started at 24 hours (early group) or 8 days (late group) after MS injection. The non-exercise (NE) and sham-operated groups were included as controls. Memory function was evaluated by the Morris water maze test, and hippocampal levels of brain-derived neurotrophic factor (BDNF) were measured by enzyme-linked immunosorbent assays. To further investigate the effect of BDNF on memory function, BDNF was continuously infused into the hippocampus via implantable osmotic pumps in the early or late stage after stroke. Memory function significantly improved only in the early group compared with the late and the NE groups, although hippocampal BDNF concentrations were temporarily elevated after exercise in both the early and the late groups. Rats infused with BDNF in the early stage exhibited significant memory function recovery; however, rats that received BDNF infusion in the late stage showed no improvement. Exercise elevates hippocampal BDNF levels in the early stage after cerebral embolism, and this event facilitates memory function recovery. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. Effects of propofol sedation during the early postoperative period in hemorrhagic stroke patients.

    Science.gov (United States)

    Hung, Yu-Chang; Lee, E-Jian; Chen, Hung-Yi; Ko, Shih-Wei; Shyr, Ming-Hwang; Chen, Tsung-Ying

    2009-09-01

    The early postoperative period is a critical time for patients after receiving a decompressive craniotomy. Prompt detection and early management of postoperative recurrent/residual hemorrhagic complications may dramatically improve clinical outcomes. The present cohort retrospective study involved 135 patients who received decompressive craniotomy and intensive care unit (ICU) supervision as life-saving measures. The purpose of the study was to evaluate the effects of propofol sedation on the clinical outcome during the ICU stay. The patients' demographic data, hemodynamic variables, the dose of propofol used during the first 48 hours after surgery, residual/recurrent blood clot volume after surgery, and neurologic and clinical outcomes were reviewed. The propofol dosages used for sedation were further divided into three categories: 3.33 mg/kg/hr, based on the doses infused during the first 12 hours after surgery. Our results indicated that the patients of the propofol-sedated group had a significantly smaller amount of residual/recurrent blood clot (p surgery achieved significantly improved clinical and neurologic outcomes than those who received either more than 3.33 mg/kg/hr or less than 0.66 mg/kg/hr of propofol. Our results support the use of propofol sedation during the early postoperative period after craniotomy in hemorrhagic stroke patients, because it improved both neurologic and clinical outcomes. However, early postoperative use of propofol sedation at larger dosages warrants special attention.

  5. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  6. Kick, Stroke and Swim: Complement Your Swimming Program by Engaging the Whole Body on Dry Land and in the Pool

    Science.gov (United States)

    Flynn, Susan; Duell, Kelly; Dehaven, Carole; Heidorn, Brent

    2017-01-01

    The Kick, Stroke and Swim (KSS) program can be used to engage students in swimming-skill acquisition and fitness training using a variety of modalities, strategies and techniques on dry land. Practicing swim strokes and techniques on land gives all levels of swimmers--from beginner to competitive--a kinesthetic awareness of the individual…

  7. EVALUATION OF EARLY ISCHEMIC CHANGES IN STROKE PATIENTS TREATED WITH THROMBOLYTIC THERAPY

    Directory of Open Access Journals (Sweden)

    Kolevski Goran

    2016-07-01

    Full Text Available Introduction:The aim of this study is to evaluate early brain ischemic changes on CT scan in stroke patients in correlation with the clinical outcome, as well as to evaluate if there is prognostic and predictive features that can be used. Patients and methods: We examined 20 patients with acute ischemic stroke, from which 12 were male and 8 were female, at the age from 47 to 76 years. Results: The hyperdense medial artery (HMA sign was present in 10 (50% patients. Concerning the ASPECTS score, 5 patients (25% had normal score of 10 points, while 7 patients (35% had score of 7 points. 12 patients (60% had unfavorable outcome, while 8 patients (40% had favorable outcome. Our statistical analysis shows that age of more than 65 years, presence of 2 or more risk-factors, ASPECTS score of 7 and presence of HMA sign were all statistically significant predictors of unfavorable outcome in examined patients (p<0.05 each. The presence of the hyperdense medial artery sign was the most significant single predictor for unfavorable clinical outcome (p=0.0042, p<0.05. Conclusion:The presence of HMA sign is the most significant single predictor for unfavorable clinical outcome.

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

    Science.gov (United States)

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

    2014-01-01

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

  9. A cost analysis of the first year after stroke - early triage and inpatient rehabilitation may reduce long term costs.

    Science.gov (United States)

    Mahler, M-P; Züger, K; Kaspar, K; Haefeli, A; Jenni, W; Leniger, T; Beer, J H

    2008-08-09

    To analyse the costs of stroke in the first year covered by insurance companies and to correlate them with the clinical outcome data. We contacted the insurance companies of 172 consecutive stroke patients of a single institution cohort for a detailed report of the stroke costs. A complete data set over one year was obtained from 131 patients (76%). Severity of stroke was significantly associated with increasing total costs (p = 0.0002). The rehabilitation clinic made up 37% of the total costs followed by nursing home with 21% and acute hospital with 21%. Mean cost of stroke per patient was 31,115 CHF in the first year. Costs per patient for inpatient rehabilitation were similar to those for the nursing home after one year; however, the Barthel-index of patients with inpatient rehabilitation increased by 42 +/- 29 points as compared to patients without inpatient rehabilitation by 23 +/- 26 points (p costs may be significantly reduced by an early and careful triage in the case management after stroke and a case-dependent investment in initial costly appearing inpatient rehabilitation.

  10. Mortality and institutionalization in early survivors of stroke: the effects of cognition, vascular mild cognitive impairment, and vascular dementia.

    Science.gov (United States)

    Brodaty, Henry; Altendorf, Annette; Withall, Adrienne; Sachdev, Perminder S

    2010-01-01

    We explored th effects of vascular mild cognitive impairment (VaMCI), vascular dementia (VaD), and other predictors on mortality and institutionalization in early survivors of ischemic stroke without previous dementia who had been admitted to a stroke unit. A total of 202 consecutive consenting eligible ischemic stroke survivors and a matched sample of 97 community controls were followed for up to 10 years. Data for 167 patients who underwent detailed assessment 3-6 months after stroke were analyzed to determine predictors of outcomes. Cumulative mortality rates for patients (and controls) were 27% (4%) for the first 5 years and rose to 83% (10%) by 10 years. Predictors of mortality were older age, any cognitive impairment, less independent function, and less education. Nursing home admission rates were 24% at 5 years and 32% at 10 years for patients and 0 for controls over 8.9 years. Predictors of institutionalization were less independent function and older age. Patients with ischemic stroke who survive the first week have moderate, lower-than-expected mortality rates in the first 5 years that increase thereafter. VaMCI, VaD, and functional decline are predictors of mortality, while functional decline and older age predict institutionalization. Copyright © 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Soleus stretch reflex inhibition in the early swing phase of gait using deep peroneal nerve stimulation in spastic stroke participants

    NARCIS (Netherlands)

    Voormolen, Marco M.; Ladouceur, Michel; Veltink, Petrus H.; Sinkjaer, Thomas

    2000-01-01

    Objectives: To investigate the feasibility of inhibiting the stretch reflex of the soleus muscle by a conditioning stimulus applied to the deep peroneal nerve in spastic stroke participants during the early swing phase of gait. - Materials and Methods: This study investigated the effect of an

  12. Prediction of early stroke risk in transient symptoms with infarction: relevance to the new tissue-based definition.

    Science.gov (United States)

    Arsava, E Murat; Furie, Karen L; Schwamm, Lee H; Sorensen, A Gregory; Ay, Hakan

    2011-08-01

    The risk of stroke shortly after transient ischemic attack with infarction on diffusion-weighted images, also known as transient symptoms with infarction (TSI), is substantially higher than is the risk after imaging-normal transient ischemic attack. We sought to assess the utility of a Web-based recurrence risk estimator (RRE; http://www.nmr.mgh.harvard.edu/RRE/) originally developed for use in patients with ischemic stroke for predicting 7-day risk of stroke in patients with TSI. We calculated RRE and ABCD² scores in a retrospective series of 257 consecutive patients with TSI diagnosed by diffusion-weighted images within 24 hours of symptom onset. We defined subsequent stroke as clinical deterioration associated with new infarction spatially distinct from the index lesion. We assessed the predictive performance of each model by computing the area under receiver-operating characteristics curve. Over 7-day follow-up, 16 patients developed a recurrent stroke (6.2%). The sensitivity and specificity of an RRE score of ≥ 2 for predicting 7-day stroke risk were 87% and 73%, respectively. The area under the receiver-operating characteristics curve was 0.85 (95% CI, 0.78-0.92) for RRE and 0.57 (95% CI, 0.45-0.69) for ABCD² score (z-test; Prisk of stroke after a TSI. If further validated in larger data sets, the RRE score could be useful in identifying high-risk patients with TSI who may benefit from early intervention with targeted stroke prevention strategies.

  13. Bridges self-management program for people with stroke in the community: A feasibility randomized controlled trial.

    Science.gov (United States)

    McKenna, Suzanne; Jones, Fiona; Glenfield, Pauline; Lennon, Sheila

    2015-07-01

    Enabling self-management behaviors is considered important in order to develop coping strategies and confidence for managing life with a long-term condition. However, there is limited research into stroke-specific self-management interventions. The aim of this randomized controlled trial was to evaluate the feasibility of delivering the Bridges stroke self-management program in addition to usual stroke rehabilitation compared with usual rehabilitation only. Participants recruited from the referrals to a community stroke team were randomly allocated to the Bridges stroke self-management program, receiving either one session of up to one-hour per week over a six-week period in addition to usual stroke rehabilitation, or usual rehabilitation only. Feasibility was measured using a range of methods to determine recruitment and retention; adherence to the program; suitability and variability of outcome measures used; application and fidelity of the program; and acceptability of the program to patients, carers and professionals. Twenty-five people were recruited to the study over a 13-month period. Eight out of the 12 participants in the Bridges stroke self-management program received all six sessions; there was one withdrawal from the study. There were changes in outcomes between the two groups. Participants who received the Bridges stroke self-management program appeared to have a greater change in self-efficacy, functional activity, social integration and quality of life over the six-week intervention period and showed less decline in mood and quality of life at the three-month follow-up. Professionals found the program acceptable to use in practice, and feedback from participants was broadly positive. The findings from this study appear promising, but questions remain regarding the feasibility of delivering the Bridges stroke self-management program in addition to usual rehabilitation. The dose response of receiving the program cannot be ruled out, and the next stage

  14. Gothenburg very early supported discharge study (GOTVED) NCT01622205: a block randomized trial with superiority design of very early supported discharge for patients with stroke.

    Science.gov (United States)

    Sunnerhagen, Katharina S; Danielsson, Anna; Rafsten, Lena; Björkdahl, Ann; Axelsson, Åsa B; Nordin, Åsa; Petersson, Cathrine A; Lundgren-Nilsson, Åsa; Fröjd, Karin

    2013-06-24

    Stroke is the disease with the highest costs for hospital care and also after discharge. Early supported discharge (ESD) has shown to be efficient and safe and the best results with well-organised discharge teams and patients with less severe strokes. The aim is to investigate if very early supported discharge (VESD) for stroke patients in need for on-going individualised rehabilitation at home is useful for the patient and cost effective. A randomized controlled trial comparing VESD with ordinary discharge. confirmed stroke, >18 years of age, living within 30 min from the stroke unit, on day 2 0-16 points on the National institute of health stroke scale (NIHSS) and 50-100 points on the Barthel Index (BI), with BI 100 then the patient can be included if the Montreal Cognitive Assessment is 16, BI block randomization of 20 and with blinded assessor. levels of anxiety and depression. independence, security, level of function, quality of health, needs of support in activities of daily living and caregiver burden. Power calculation is based on the level of anxiety and with a power of 80%, p-value 0.05 (2 sided test) 44 persons per group are needed. Data is gathered on co-morbidity, re-entry to hospital, mortality and a health economic analysis. Interviews will be accomplished with a strategic sample of 15 patients in the intervention group before discharge, within two weeks after homecoming and 3 months later. Interviews are also planned with 15 relatives in the intervention group 3 months after discharge. The ESD studies in the Cochrane review present hospital stays of a length that no longer exist in Sweden. There is not yet, to our knowledge, any study of early supported discharge with present length of hospital stay. Thus it is not clear if home rehabilitation nowadays without risks, is cost effective, or with the same patient usefulness as earlier studies. ClinicalTrials.gov NCT01622205.

  15. Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale.

    Science.gov (United States)

    Malouin, F; Pichard, L; Bonneau, C; Durand, A; Corriveau, D

    1994-11-01

    This study compared the measurements of the Motor Assessment Scale (MAS) to that of the Fugl-Meyer Assessment (FMA), a reliable and valid test for motor function in stroke patients. Thirty-two patients (20 men, 12 women) with a mean age of 60 years, and a mean time since stroke of 64.5 days, were tested with the FMA and MAS on two consecutive days. The Spearman correlation coefficient for total FMA and total MAS scores was 0.96. For selected items, significant (p scale can better discriminate the level of motor recovery than the MAS in the early stage of recovery or in the more disabled subjects.

  16. Prevalence, Incidence, Prognosis, Early Stroke Risk, and Stroke-Related Prognostic Factors of Definite or Probable Transient Ischemic Attacks in China, 2013

    Directory of Open Access Journals (Sweden)

    Bin Jiang

    2017-06-01

    Full Text Available The epidemiological characteristics of transient ischemic attacks (TIAs in China are unclear. In 2013, we conducted a nationally representative, door-to-door epidemiological survey on TIA in China using a complex, multistage, probability sampling design. Results showed that the weighted prevalence of TIA in China was 103.3 [95% confidence interval (CI: 83.9–127.2] per 100,000 in the population, 92.4 (75.0–113.8 per 100,000 among men, and 114.7 (87.2–151.0 per 100,000 among women. The weighted incidence of TIA was 23.9 (17.8–32.0 per 100,000 in the population, 21.3 (14.3–31.5 per 100,000 among men, and 26.6 (17.0–41.7 per 100,000 among women. No difference in average prognosis was found between TIA and stroke in the population. Weighted risk of stroke among TIA patients was 9.7% (6.5–14.3%, 11.1% (7.5–16.1%, and 12.3% (8.4–17.7% at 2, 30, and 90 days, respectively. The risk of stroke was higher among male patients with a history of TIA than among female patients with a history of TIA (OR: 2.469; 95% CI: 1.172–5.201; P = 0.018, and higher among TIA patients with hypertension than among TIA patients without hypertension (OR: 2.671; 1.547–4.613; P < 0.001. It can be concluded that there are an estimated 1.35 million TIA patients nationwide, with 0.31 million new cases of TIA annually in China. TIA patients were not better managed prior to a stroke event. Early risk of stroke among TIA patients is high. Sex and hypertension may be stroke-associated prognostic factors among TIA patients. TIA clinics and surveillance should be integrated into the national health-care system.

  17. Early tracheostomy in ventilated stroke patients: Study protocol of the international multicentre randomized trial SETPOINT2 (Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2).

    Science.gov (United States)

    Schönenberger, Silvia; Niesen, Wolf-Dirk; Fuhrer, Hannah; Bauza, Colleen; Klose, Christina; Kieser, Meinhard; Suarez, José I; Seder, David B; Bösel, Julian

    2016-04-01

    Tracheostomy is a common procedure in long-term ventilated critical care patients and frequently necessary in those with severe stroke. The optimal timing for tracheostomy is still unknown, and it is controversial whether early tracheostomy impacts upon functional outcome. The Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2 (SETPOINT2) is a multicentre, prospective, randomized, open-blinded endpoint (PROBE-design) trial. Patients with acute ischemic stroke, intracerebral hemorrhage or subarachnoid hemorrhage who are so severely affected that two weeks of ventilation are presumed necessary based on a prediction score are eligible. It is intended to enroll 190 patients per group (n = 380). Patients are randomized to either percutaneous tracheostomy within the first five days after intubation or to ongoing orotracheal intubation with consecutive weaning and extubation and, if the latter failed, to percutaneous tracheostomy from day 10 after intubation. The primary endpoint is functional outcome defined by the modified Rankin Scale (mRS, 0-4 (favorable) vs. 5 + 6 (unfavorable)) after six months; secondary endpoints are mortality and cause of mortality during intensive care unit-stay and within six months from admission, intensive care unit-length of stay, duration of sedation, duration of ventilation and weaning, timing and reasons for withdrawal of life support measures, relevant intracranial pressure rises before and after tracheostomy. The necessity and optimal timing of tracheostomy in ventilated stroke patients need to be identified. SETPOINT2 should clarify whether benefits in functional outcome can be achieved by early tracheostomy in these patients. © 2016 World Stroke Organization.

  18. The cost effectiveness of an early transition from hospital to nursing home for stroke patients: design of a comparative study.

    Science.gov (United States)

    Heijnen, Ron W H; Evers, Silvia M A A; van der Weijden, Trudy D E M; Limburg, Martien; Schols, Jos M G A

    2010-05-26

    As the incidence of stroke has increased, its impact on society has increased accordingly, while it continues to have a major impact on the individual. New strategies to further improve the quality, efficiency and logistics of stroke services are necessary. Early discharge from hospital to a nursing home with an adequate rehabilitation programme could help to optimise integrated care for stroke patients.The objective is to describe the design of a non-randomised comparative study evaluating early admission to a nursing home, with multidisciplinary assessment, for stroke patients. The study is comprised of an effect evaluation, an economic evaluation and a process evaluation. The design involves a non-randomised comparative trial for two groups. Participants are followed for 6 months from the time of stroke. The intervention consists of a redesigned care pathway for stroke patients. In this care pathway, patients are discharged from hospital to a nursing home within 5 days, in comparison with 12 days in the usual situation. In the nursing home a structured assessment takes place, aimed at planning adequate rehabilitation. People in the control group receive the usual care. The main outcome measures of the effect evaluation are quality of life and daily functioning. In addition, an economic evaluation will be performed from a societal perspective. A process evaluation will be carried out to evaluate the feasibility of the intervention as well as the experiences and opinions of patients and professionals. The results of this study will provide information about the cost effectiveness of the intervention and its effects on clinical outcomes and quality of life. Relevant strengths and weaknesses of the study are addressed in this article. Current Controlled Trails ISRCTN58135104.

  19. Thrombolytic utilization for ischemic stroke in US hospitals with neurology residency program.

    Science.gov (United States)

    Moradiya, Yogesh; Crystal, Howard; Valsamis, Helen; Levine, Steven R

    2013-12-03

    We aimed to compare the rates of thrombolysis utilization for acute ischemic stroke in hospitals with neurology residency (NR) to those of other teaching (OT) and nonteaching (NT) hospitals. A retrospective serial cross-sectional cohort study of a nationally representative sample of stroke patients was conducted. Accreditation Council for Graduate Medical Education-accredited NR program-affiliated hospitals in the United States were cross-matched to the hospitals in the Nationwide Inpatient Sample from 2000 to 2010. ICD-9-CM codes were used for case ascertainment. A total of 712,433 adult ischemic stroke patients from 6,839 hospital samples were included, of whom 10.1%, 29.1%, and 60.8% were treated in NR, OT, and NT hospitals, respectively. Stroke patients in NR received thrombolysis more frequently (3.74% ± 0.24% [standard error]) than in OT (2.28% ± 0.11%, p < 0.001) and NT hospitals (1.44% ± 0.06%, p < 0.001). The adjusted odds ratios (ORs) of thrombolysis rates in NR vs OT and NR vs NT increased with each decade increment in age. In multivariate analysis, NR was independently predictive of higher thrombolysis rate (adjusted OR 1.51; 95% confidence interval [CI] 1.44-1.59 [NR vs OT], and adjusted OR 1.82; 95% CI 1.73-1.91 [NR vs NT]). Acute stroke care in NR hospitals is associated with an increased thrombolytic utilization. The disparities between the thrombolysis rate in NR and that in OT and NT hospitals are greater among elderly patients.

  20. A family involvement and patient-tailored health management program in elderly Korean stroke patients' day care centers.

    Science.gov (United States)

    Chang, Ae Kyung; Park, Yeon-Hwan; Fritschi, Cynthia; Kim, Mi Ja

    2015-01-01

    This study aimed to examine the effects of a family involvement and functional rehabilitation program in an adult day care center on elderly Korean stroke patients' perceived health, activities of daily living, instrumental activities of daily living, and cost of health services, and on family caregivers' satisfaction. Using one-group pre- and posttest design, dyads consisting of 19 elderly stroke patients and family caregivers participated in 12-week intervention, including involvement of family caregivers in day care services and patient-tailored health management. Outcomes of patients and caregivers were significantly improved (all p health services did not decrease significantly. This program improved functional levels and health perception of elderly stroke patients and caregivers' satisfaction. However, results must be interpreted with caution, because this was only a small, single-group pilot study. This program may be effective for elderly stroke patients and their caregivers. © 2013 Association of Rehabilitation Nurses.

  1. Gait training assisted by multi-channel functional electrical stimulation early after stroke: study protocol for a randomized controlled trial.

    Science.gov (United States)

    van Bloemendaal, Maijke; Bus, Sicco A; de Boer, Charlotte E; Nollet, Frans; Geurts, Alexander C H; Beelen, Anita

    2016-10-01

    Many stroke survivors suffer from paresis of lower limb muscles, resulting in compensatory gait patterns characterised by asymmetries in spatial and temporal parameters and reduced walking capacity. Functional electrical stimulation has been used to improve walking capacity, but evidence is mostly limited to the orthotic effects of peroneal functional electrical stimulation in the chronic phase after stroke. The aim of this study is to investigate the therapeutic effects of up to 10 weeks of multi-channel functional electrical stimulation (MFES)-assisted gait training on the restoration of spatiotemporal gait symmetry and walking capacity in subacute stroke patients. In a proof-of-principle study with a randomised controlled design, 40 adult patients with walking deficits who are admitted for inpatient rehabilitation within 31 days since the onset of stroke are randomised to either MFES-assisted gait training or conventional gait training. Gait training is delivered in 30-minute sessions each workday for up to 10 weeks. The step length symmetry ratio is the primary outcome. Blinded assessors conduct outcome assessments at baseline, every 2 weeks during the intervention period, immediately post intervention and at 3-month follow-up. This study aims to provide preliminary evidence for the feasibility and effectiveness of MFES-assisted gait rehabilitation early after stroke. Results will inform the design of a larger multi-centre trial. This trial is registered at the Netherlands Trial Register (number NTR4762 , registered 28 August 2014).

  2. Exploring health care providers' perceptions of the needs of stroke carers: informing development of an optimal health program.

    Science.gov (United States)

    O'Brien, Casey L; Moore, Gaye; Rolley, John X; Ski, Chantal F; Thompson, David R; Lautenschlager, Nicola T; Gonzales, Graeme; Hsueh, Ya-Seng Arthur; Castle, David

    2014-01-01

    Health care provider experiences of the carer have been researched, but little is written about how these can inform development of support programs. This study aimed to (1) explore health care provider perceptions of stroke carer roles and support needs and (2) examine carer needs across the stroke care trajectory to assist with development of an Optimal Health Program (OHP) to support carers. This study is part of a staged program of research that will evaluate and refine the OHP. Four dual-moderated semi-structured focus groups of stroke health care providers across acute, subacute, and community rehabilitation services were conducted. Facilitators used a semi-structured focus group schedule to guide discussion. Sessions were recorded, transcribed, and analyzed using thematic and content analysis. Three key themes emerged: transition, information, and impact of stroke. A number of subthemes highlighted the distinct roles of health care providers and carers. Specific elements of the OHP were identified as having the potential to advance support for carers across the stroke care trajectory. Findings support the integration of an OHP for carers within existing stroke care services in Australian public hospital and community settings. This study suggests how health care provider experiences could inform a self-management OHP to assist carers in navigating stroke services and to address their health-related concerns.

  3. Evaluation of a Home-Based Physical Therapy Program in Ischemic Stroke Patients

    Directory of Open Access Journals (Sweden)

    Elena Sîrbu

    2012-12-01

    Full Text Available The rehabilitation therapy should begin in the acute-care hospital as soon as possible after the stroke and continued after discharging patients from the hospital to their home environment. The purpose of this study was to evaluate the efficiency of a home-based physical therapy program in the improvement of motor function, balance and activities of daily living. Material and methods. Fourteen ischemic first stroke patients (8 women and 6 men, aged from 49 to 84 (mean 69 were recruited from the Neurology Department of the Emergency County Hospital Timişoara. After hospital discharge, they were assigned to a 12-week home physical therapy program in order to improve motor function, balance and activities of daily living (ADL. All patients were assessed before and after the training program with the following tests: (1 Barthel index; (2 Berg Balance Scale; (3 Motricity index; (4 Functional Independence Measure. Results. After 12 weeks of physical therapy, the motricity index showed a significant improvement in the study group which means a better motor outcome (p= 0,08. The mean score of the Barthel index was significantly increased (p=0.02, showing improvement in ADL ability. There was a benefit in reducing disability suggesting a better functional capacity and a higher level of independence (p= 0.03. Finally, our results showed that hemiplegic patients presented a better balance function after completing the rehabilitation program (p= 0,05.Conclusions.The intervention of a 12-week home physical therapy program in stroke survivors provided significantly better outcomes in motor function, balance function and activities of daily living.

  4. The Stroke and Carer Optimal Health Program (SCOHP) to enhance psychosocial health: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Brasier, Catherine; Ski, Chantal F; Thompson, David R; Cameron, Jan; O'Brien, Casey L; Lautenschlager, Nicola T; Gonzales, Graeme; Hsueh, Ya-Seng Arthur; Moore, Gaye; Knowles, Simon R; Rossell, Susan L; Haselden, Rachel; Castle, David J

    2016-09-09

    Stroke is a leading cause of disability and distress, and often profoundly affects the quality of life of stroke survivors and their carers. With the support of carers, many stroke survivors are returning to live in the community despite the presence of disability and ongoing challenges. The sudden and catastrophic changes caused by stroke affects the mental, emotional and social health of both stroke survivors and carers. The aim of this study is to evaluate a Stroke and Carer Optimal Health Program (SCOHP) that adopts a person-centred approach and engages collaborative therapy to educate, support and improve the psychosocial health of stroke survivors and their carers. This study is a prospective randomised controlled trial. It will include a total of 168 stroke survivors and carers randomly allocated into an intervention group (SCOHP) or a control group (usual care). Participants randomised to the intervention group will receive nine (8 + 1 booster) sessions guided by a structured workbook. The primary outcome measures for stroke survivors and carers will be health-related quality of life (AQoL-6D and EQ-5D) and self-efficacy (GSE). Secondary outcome measures will include: anxiety and depression (HADS); coping (Brief COPE); work and social adjustment (WSAS); carer strain (MCSI); carer satisfaction (CASI); and treatment evaluation (TEI-SF and CEQ). Process evaluation and a health economic cost analysis will also be conducted. We believe that this is an innovative intervention that engages the stroke survivor and carer and will be significant in improving the psychosocial health, increasing independence and reducing treatment-related costs in this vulnerable patient-carer dyad. In addition, we expect that the intervention will assist carers and stroke survivors to negotiate the complexity of health services across the trajectory of care and provide practical skills to improve self-management. ACTRN12615001046594 . Registered on 7 October 2015.

  5. Early-onset stroke with moyamoya-like syndrome and extraneurological signs: a first reported paediatric series

    International Nuclear Information System (INIS)

    Law-ye, Bruno; Saliou, Guillaume; Toulgoat, Frederique; Tardieu, Marc; Deiva, Kumaran; Adamsbaum, Catherine; Husson, Beatrice

    2016-01-01

    Moyamoya syndrome is characterised by an occlusion of the carotid terminations with the development of collateral vessels. Our objective is to describe a series of infants presenting early-onset moyamoya-like syndrome, which may constitute a distinct entity. From a cohort of children with rare cerebral vascular pathologies, we studied eight infants (28 days-1 year) with early-onset moyamoya-like syndrome demonstrated by angiography. We retrospectively analysed the patterns on MRI and MRA, as well as all other available data. Median age at diagnosis was 7 months (IQR: 6-8) with arterial ischaemic stroke in the middle cerebral artery territory. All of the children experienced severe stroke recurrence within a median time of 11 months (IQR: 10-12), and all showed extraneurological symptoms. The anterior cerebral circulation was involved in all cases and the posterior circulation was involved in six. Two children died and all of the other children suffered permanent neurological deficits. The presence of extraneurological signs in cases of early-onset moyamoya syndrome is suggestive of a newly described systemic vasculopathy with predominantly cerebrovascular expression. Given its rapid progression marked by severe recurrent strokes and poor clinical outcome, early diagnosis could help in the decision to institute aggressive therapy. (orig.)

  6. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

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

    2011-01-01

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

  7. Mobile game-based virtual reality rehabilitation program for upper limb dysfunction after ischemic stroke.

    Science.gov (United States)

    Choi, Yoon-Hee; Ku, Jeonghun; Lim, Hyunmi; Kim, Yeo Hyung; Paik, Nam-Jong

    2016-05-02

    Virtual reality (VR) has the potential to provide intensive, repetitive, and task-oriented training, and game-based therapy can enhance patients' motivation and enjoyment. The objective of the present study was to develop a mobile game-based upper extremity VR program for patients who have experienced stroke, and to evaluate the feasibility and effectiveness of the program. This randomized, double-blind, controlled trial included 24 patients with ischemic stroke. The intervention group (n = 12) received 30 min of conventional occupational therapy (OT) and 30 min of the mobile upper extremity rehabilitation program using a smartphone and a tablet PC (MoU-Rehab). The controls (n = 12) received conventional OT alone for 1 h per day. Rehabilitation consisted of 10 sessions of therapy, 5 days per week, for 2 weeks. The outcome measures (Fugl-Meyer Assessment of the upper extremity [FMA-UE], Brunnström stage [B-stage] for the arm and the hand, manual muscle testing [MMT], modified Barthel index [MBI], EuroQol-5 Dimension [EQ-5D], and Beck Depression Inventory [BDI]) were assessed at the beginning and end of treatment, and at 1 month. User satisfaction was evaluated by a questionnaire. A greater improvement in the FMA-UE, B-stage, and MMT was found after treatment with the MoU-Rehab than with conventional therapy. The extent of improvements in the MBI, EQ-5D, and BDI was not significantly different between the two groups. Patients in the experimental group completed the 2-weeks treatment without adverse effects, and they were generally satisfied with MoU-Rehab. This mobile game-based VR rehabilitation program appears to be feasible and effective for promoting upper limb recovery after ischemic stroke.

  8. Stroke is not a treatment dilemma for early valve surgery in active infective endocarditis.

    Science.gov (United States)

    Wan, Su; Sung, Kiick; Park, Pyo Won; Kim, Wook Sung; Lee, Young Tak; Jun, Tae-Gook; Yang, Ji-Hyuk; Jeong, Dong Seop; Cho, Yang Hyun

    2014-09-01

    While early valve surgery for active infective endocarditis (AIE) is recommended, surgeons have hesitated to operate on patients complicated by cerebral septic embolism resulting in cerebral bleeding when cardiopulmonary bypass is required intraoperatively. The study aim was to review the outcomes of operations for AIE, and to determine the risks of neurologic complications resulting from cerebral septic embolism. Between 1994 and June 2011, among 278 patients who underwent heart valve surgery for AIE at the authors' institution, 39 (14%) had cerebral septic embolisms. Cerebral lesions were verified by imaging, and were predominantly multiple embolic infarctions (34 patients; 87.2%). Five patients had brain abscess, and 10 had hemorrhage with or without infarction. The mean interval between the recent onset of a stroke and surgery was 10.1 ± 10.1 days (range: 0-43 days). One patient died postoperatively of septic shock. New neurologic complications occurred in five patients, including secondary hemorrhagic transformation in the previous lesions (n = 2), newly developed subdural and subarachnoid hemorrhage (n = 2), and an increased degree of subarachnoid hemorrhage (n = 1). One patient needed a craniotomy, and the others were treated medically. There were five late deaths, including one cardiac death, and one redo valve surgery due to repaired valve failure during the follow up period of 46.3 ± 40.4 months (range: 1.9-127.4 months). The overall and event-free survival rates at five and 10 years were 84.3 ± 6.5% and 75.9 ± 9.9%, and 81.7 ± 6.8% and 73.6 ± 9.9%, respectively. Surgery for AIE with cerebral septic embolisms can be performed safely, with good early and mid-term follow-up results. When urgent or emergent surgery for AIE is needed, neurologic complications should not be a reason for delay.

  9. Association of early National Institutes of Health Stroke Scale improvement with vessel recanalization and functional outcome after intravenous thrombolysis in ischemic stroke.

    Science.gov (United States)

    Kharitonova, Tatiana; Mikulik, Robert; Roine, Risto O; Soinne, Lauri; Ahmed, Niaz; Wahlgren, Nils

    2011-06-01

    Early neurological improvement (ENI) after thrombolytic therapy of acute stroke has been linked with recanalization and favorable outcome, although its definition shows considerable variation. We tested the ability of ENI, as defined in previous publications, to predict vessel recanalization and 3-month functional outcome after intravenous thrombolysis recorded in an extensive patient cohort in the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). Of 21,534 patients registered between December 2002 and December 2008, 798 patients (3.7%) had CT- or MR angiography-documented baseline vessel occlusion and also angiography data at 22 to 36 hours post-treatment. ENI definitions assessed at 2 hours and 24 hours post-treatment were (1) National Institutes of Health Stroke Scale (NIHSS) score improvement ≥4 points from baseline; (2) NIHSS 0, 1, or improvement ≥8; (3) NIHSS ≤3 or improvement ≥10; (4) improvement by 20%; (5) 40% from baseline; or (6) NIHSS score 0 to 1. Receiver operating curve analysis and multiple logistic regression were performed to evaluate the association of ENI with vessel recanalization and favorable functional outcome (modified Rankin Scale score 0 to 2 at 3 months). ENI at 2 hours had fair accuracy to diagnose recanalization as derived from receiver operating curve analysis. Definitions of improvement based on percent of NIHSS score change from baseline demonstrate better accuracy to diagnose recanalization at 2 hours and 24 hours than the definitions based on NIHSS cutoffs (the best performance at 2 hours was area under the curve 0.633, sensitivity 58%, specificity 69%, positive predictive value 68%, and negative predictive value 59% for 20% improvement; and area under the curve 0.692, sensitivity 69%, specificity 70%, positive predictive value 70%, and negative predictive value 62% for 40% improvement at 24 hours). ENI-predicted functional outcome with OR 2.8 to 6.0 independently from

  10. Design considerations for a theory-driven exergame-based rehabilitation program to improve walking of persons with stroke.

    Science.gov (United States)

    Wüest, Seline; van de Langenberg, Rolf; de Bruin, Eling D

    2014-01-01

    Virtual rehabilitation approaches for promoting motor recovery has attracted considerable attention in recent years. It appears to be a useful tool to provide beneficial and motivational rehabilitation conditions. Following a stroke, hemiparesis is one of the most disabling impairments and, therefore, many affected people often show substantial deficits in walking abilities. Hence, one of the major goals of stroke rehabilitation is to improve patients' gait characteristics and hence to regain their highest possible level of walking ability. Because previous studies indicate a relationship between walking and balance ability, this article proposes a stroke rehabilitation program that targets balance impairments to improve walking in stroke survivors. Most currently, available stroke rehabilitation programs lack a theory-driven, feasible template consistent with widely accepted motor learning principles and theories in rehabilitation. To address this hiatus, we explore the potential of a set of virtual reality games specifically developed for stroke rehabilitation and ordered according to an established two-dimensional motor skill classification taxonomy. We argue that the ensuing "exergame"-based rehabilitation program warrants individually tailored balance progression in a learning environment that allows variable practice and hence optimizes the recovery of walking ability.

  11. Demonstration and Research Center for Early Education (DARCEE). Program Report.

    Science.gov (United States)

    Far West Lab. for Educational Research and Development, Berkeley, CA.

    This document is the first in a series of 12 early childhood program descriptions compiled by the Far West Laboratory for Educational Research and Development. The program described here is the Demonstration and Research Center for Early Education (DARCEE) which was established at the George Peabody College for Teachers in Nashville, Tennessee, in…

  12. Usability of Videogame-Based Dexterity Training in the Early Rehabilitation Phase of Stroke Patients: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Tim Vanbellingen

    2017-12-01

    Full Text Available BackgroundApproximately 70–80% of stroke survivors have limited activities of daily living, mainly due to dexterous problems. Videogame-based training (VBT along with virtual reality seems to be beneficial to train upper limb function.ObjectiveTo evaluate the usability of VBT using the Leap Motion Controller (LMC to train fine manual dexterity in the early rehabilitation phase of stroke patients as an add-on to conventional therapy. Additionally, this study aimed to estimate the feasibility and potential efficacy of the VBT.MethodsDuring 3 months, 64 stroke patients were screened for eligibility, 13 stroke patients were included (4 women and 9 men; age range: 24–91 years; mean time post stroke: 28.2 days.InterventionNine sessions of 30 min VBT, three times per week as an add-on to conventional therapy with stroke inpatients.Outcome measuresPrimary outcome was the usability of the system measured with the System Usability Scale. Secondary outcomes concerning feasibility were the compliance rate calculated from the total time spent on the intervention (TT compared to planned time, the opinion of participants via open-end questions, and the level of active participation measured with the Pittsburgh Rehabilitation Participation Scale. Regarding the potential efficacy secondary outcomes were: functional dexterity measured with the Nine Hole Peg Test (NHPT, subjective dexterity measured with the Dexterity Questionnaire 24, grip strength measured with the Jamar dynamometer, and motor impairment of the upper limb measured with the Fugl-Meyer Upper Extremity (FM-UE scale.ResultsPrimarily, the usability of the system was good to excellent. The patient’s perception of usability remained stable over a mean period of 3 weeks of VBT. Secondly, the compliance rate was good, and the level of active participation varied between good and very good. The opinion of the participants revealed that despite individual differences, the overall impression

  13. Secondary prevention after minor stroke and TIA - usual care and development of a support program.

    Directory of Open Access Journals (Sweden)

    Stefanie Leistner

    Full Text Available Effective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program.Two consecutive cohorts of patients with acute minor stroke or TIA undergoing usual outpatient care versus a secondary prevention program were compared. Risk factor control and medication adherence were assessed in 6-month follow-ups (6M-FU. Usual care consisted of detailed information concerning vascular risk factor targets given at discharge and regular outpatient care by primary care physicians. The stepwise modeled support program additionally employed up to four outpatient appointments. A combination of educational and behavioral strategies was employed.168 patients in the observational cohort who stated their openness to participate in a prevention program (mean age 64.7 y, admission blood pressure (BP: 155/84 mmHg and 173 patients participating in the support program (mean age 67.6 y, BP: 161/84 mmHg were assessed at 6 months. Proportions of patients with BP according to guidelines were 50% in usual-care and 77% in the support program (p<0.01. LDL<100 mg/dl was measured in 62 versus 71% (p = 0.12. Proportions of patients who stopped smoking were 50 versus 79% (p<0.01. 72 versus 89% of patients with atrial fibrillation were on oral anticoagulation (p = 0.09.Risk factor control remains unsatisfactory in usual care. Targets of secondary prevention were met more often within the supported cohort. Effects on (cerebro-vascular recurrence rates are going to be assessed in a multicenter randomized trial.

  14. Growth hormone treatment for childhood short stature and risk of stroke in early adulthood.

    Science.gov (United States)

    Poidvin, Amélie; Touzé, Emmanuel; Ecosse, Emmanuel; Landier, Fabienne; Béjot, Yannick; Giroud, Maurice; Rothwell, Peter M; Carel, Jean-Claude; Coste, Joël

    2014-08-26

    We investigated the incidence of stroke and stroke subtypes in a population-based cohort of patients in France treated with growth hormone (GH) for short stature in childhood. Adult morbidity data were obtained in 2008-2010 for 6,874 children with idiopathic isolated GH deficiency or short stature who started GH treatment between 1985 and 1996. Cerebrovascular events were validated using medical reports and imaging data and classified according to standard definitions of subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic stroke. Case ascertainment completeness was estimated with capture-recapture methods. The incidence of stroke and of stroke subtypes was calculated and compared with population values extracted from registries in Dijon and Oxford, between 2000 and 2012. Using both Dijon and Oxford population-based registries as references, there was a significantly higher risk of stroke among patients treated with GH in childhood. The excess risk of stroke was mainly attributable to a very substantially and significantly higher risk of hemorrhagic stroke (standardized incidence ratio from 3.5 to 7.0 according to the registry rates considered, and accounting or not accounting for missed cases), and particularly subarachnoid hemorrhage (standardized incidence ratio from 5.7 to 9.3). We report a strong relationship between hemorrhagic stroke and GH treatment in childhood for isolated growth hormone deficiency or childhood short stature. Patients treated with GH worldwide should be advised about this association and further studies should evaluate the potentially causal role of GH treatment in these findings. © 2014 American Academy of Neurology.

  15. Logical Analysis of Data (LAD model for the early diagnosis of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Hoehn Gerard

    2008-07-01

    Full Text Available Abstract Background Strokes are a leading cause of morbidity and the first cause of adult disability in the United States. Currently, no biomarkers are being used clinically to diagnose acute ischemic stroke. A diagnostic test using a blood sample from a patient would potentially be beneficial in treating the disease. Results A classification approach is described for differentiating between proteomic samples of stroke patients and controls, and a second novel predictive model is developed for predicting the severity of stroke as measured by the National Institutes of Health Stroke Scale (NIHSS. The models were constructed by applying the Logical Analysis of Data (LAD methodology to the mass peak profiles of 48 stroke patients and 32 controls. The classification model was shown to have an accuracy of 75% when tested on an independent validation set of 35 stroke patients and 25 controls, while the predictive model exhibited superior performance when compared to alternative algorithms. In spite of their high accuracy, both models are extremely simple and were developed using a common set consisting of only 3 peaks. Conclusion We have successfully identified 3 biomarkers that can detect ischemic stroke with an accuracy of 75%. The performance of the classification model on the validation set and on cross-validation does not deteriorate significantly when compared to that on the training set, indicating the robustness of the model. As in the case of the LAD classification model, the results of the predictive model validate the function constructed on our support-set for approximating the severity scores of stroke patients. The correlation and root mean absolute error of the LAD predictive model are consistently superior to those of the other algorithms used (Support vector machines, C4.5 decision trees, Logistic regression and Multilayer perceptron.

  16. Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke

    Science.gov (United States)

    Winstein, Carolee J.; Wolf, Steven L.; Dromerick, Alexander W.; Lane, Christianne J.; Nelsen, Monica A.; Lewthwaite, Rebecca; Cen, Steven Yong; Azen, Stanley P.

    2016-01-01

    IMPORTANCE Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. OBJECTIVE To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. DESIGN, SETTING, AND PARTICIPANTS Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. INTERVENTIONS Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program[ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. MAIN OUTCOMES AND MEASURES The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). RESULTS Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African American; mean time since stroke onset, 46 days), 304 (84%) completed the 12-month primary outcome assessment; in intention-to-treat analysis, mean group change scores (log WMFT, baseline to 12 months) were, for the ASAP group, 2.2 to 1.4 (difference, 0.82); DEUCC group, 2.0 to 1.2 (difference, 0.84); and UCC group, 2.1 to 1.4 (difference, 0.75), with no significant between-group differences (ASAP vs DEUCC:0.14; 95% CI, −0.05 to 0.33; P = .16; ASAP vs UCC: −0.01; 95% CI, −0.22 to 0.21; P = .94; and

  17. Starting early: integration of self-management support into an acute stroke service.

    Science.gov (United States)

    Mäkelä, Petra; Gawned, Sara; Jones, Fiona

    2014-01-01

    Self-management support following stroke is rare, despite emerging evidence for impact on patient outcomes. The promotion of a common approach to self-management support across a stroke pathway requires collaboration between professionals. To date, the feasibility of self-management support in acute stroke settings has not been evaluated. The Bridges stroke self-management package (SMP) is based on self-efficacy principles. It is delivered by professionals and supported by a patient-held workbook. The aim of this project was to introduce the Bridges stroke SMP to the multidisciplinary staff of a London hyperacute and acute stroke unit. The 'Plan Do Study Act' (PDSA) cycle guided iterative stages of project development, with normalisation process theory helping to embed the intervention into existing ways of working. Questionnaires explored attitudes, beliefs and experiences of the staff who were integrating self-management support into ways of working in the acute stroke setting. Self-management support training was delivered to a total of 46 multidisciplinary stroke staff. Of the staff who attended the follow-up training, 66% had implemented Bridges self-management support with patients since initial training, and 100% felt their practice had changed. Questionnaire findings demonstrated that staff attitudes and beliefs had changed following training, particularly regarding ownership and type of rehabilitation goals set, and prioritisation of self-management support within acute stroke care. Staff initiated an audit of washing and dressing practices pre- and post-training. This was designed to evaluate the number of occasions when techniques were used by staff to facilitate patients' independence and self-management. They found that the number of occasions featuring optimum practice went from 54% at baseline to 63% at three months post-training. This project demonstrated the feasibility of integrating self-management support into an acute stroke setting. Further

  18. Predictors of early post ischemic stroke apathy and depression: a cross-sectional study

    Science.gov (United States)

    2013-01-01

    Background Apathy and depression are important neuropsychiatric disorders that can occur after a stroke but the etiology and risk factors are not well understood. The purpose of this study was to identify risk factors for apathy and depression following a stroke. Methods Patients with an acute stroke who met the inclusion criteria were recruited from our hospital, and general information was recorded from patient charts. The Apathy Evaluation Scale, Clinician Version (AES-C) was used to evaluate these patients within 2 weeks after the stroke. The Montreal Cognitive Assessment (MoCA), mini-mental state examination (MMSE), Hamilton Depression Scale (HAMD), Mattis Dementia Rating Scale Initiation/Perseveration subset (MDRS I/P), Frontal Assessment Battery (FAB) and Stroop Color-Word Association Test were employed to evaluate emotion, cognitive function and executive function. The patients were divided into two groups: the apathy group and the non-apathy group. We also divided the patients into two groups based on whether or not they had post-stroke depression. The clinical characteristics and scores on the MoCA, MMSE, HAMD and MDRS I/P were compared between the apathy and non-apathy groups as well as between patients with and without depression. Logistic regression analysis was performed to identify risk factors for apathy and depression following a stroke. Results A total of 75 patients with acute stroke were recruited. Of these, 25 (33.3%) developed apathy and 12 (16%) developed depression. Multivariate logistic regression analysis indicated that a history of cerebrovascular disease (OR: 6.45, 95% CI: 1.48-28.05, P = 0.013), low HbA1c (OR: 0.31, 95% CI: 0.12-0.81, P = 0.017) and a low MDRS I/P score (OR: 0.84, 95% CI: 0.74, 0.96, P = 0.010) were risk factors for post-stroke apathy. Additionally, multivariate logistic regression indicated that a low MDRS I/P (OR: 0.85, 95% CI: 0.75, 0.97, P = 0.015) was associated with post-stroke depression

  19. [The effectiveness of physical therapy methods (Bobath and motor relearning program) in rehabilitation of stroke patients].

    Science.gov (United States)

    Krutulyte, Grazina; Kimtys, Algimantas; Krisciūnas, Aleksandras

    2003-01-01

    The purpose of this study was to examine whether two different physiotherapy regimes caused any differences in outcome in the rehabilitation after stroke. We examined 240 patients with stroke. Examination was carried out at the Rehabilitation Center of Kaunas Second Clinical Hospital. Patients were divided into 2 groups: Bobath method was applied to the first (I) group (n=147), motor relearning program (MRP) method was applied to the second (II) group (n=93). In every group of patients we established samples according to sex, age, hospitalization to rehab unit as occurrence of CVA degree of disorder (hemiplegia, hemiparesis). The mobility of patients was evaluated according to European Federation for Research in Rehabilitation (EFRR) scale. Activities of daily living were evaluated by Barthel index. Analyzed groups were evaluated before physical therapy. When preliminary analysis was carried out it proved no statically reliable differences between analyzed groups (reliability 95%). The same statistical analysis was carried out after physical therapy. The results of differences between patient groups were compared using chi(2) method. Bobath method was applied working with the first group of patients. The aim of the method is to improve quality of the affected body side's movements in order to keep both sides working as harmoniously as possible. While applying this method at work, physical therapist guides patient's body on key-points, stimulating normal postural reactions, and training normal movement pattern. MRP method was used while working with the second group patients. This method is based on movement science, biomechanics and training of functional movement. Program is based on idea that movement pattern shouldn't be trained; it must be relearned. CONCLUSION. This study indicates that physiotherapy with task-oriented strategies represented by MRP, is preferable to physiotherapy with facilitation/inhibition strategies, such the Bobath programme, in the

  20. The association between high on-treatment platelet reactivity and early recurrence of ischemic events after minor stroke or TIA.

    Science.gov (United States)

    Rao, Zilong; Zheng, Huaguang; Wang, Fei; Wang, Anxin; Liu, Liping; Dong, Kehui; Zhao, Xingquan; Wang, Yilong; Cao, Yibin

    2017-08-01

    To evaluate the role of HTPR in predicting early recurrence of ischemic events in patients with minor ischemic stroke or high-risk TIA. From January 2014 to September 2014, a single center continuously enrolled patients with minor ischemic stroke or high-risk TIA and gave them antiplatelet therapy consisting of aspirin with clopidogrel. HTPR was assessed by TEG after 7 days of antiplatelet therapy and detected CYP2C19 genotype. The incidence of recurrent ischemic events was assessed 3 months after onset. The incidence of recurrent ischemic events was compared between the HTPR and NTPR groups with the Kaplan-Meier method, and multivariate Cox proportional hazards models were used to determine the risk factors associated with recurrent ischemic events. We enrolled 278 eligible patients with minor ischemic stroke or high-risk TIA. Through TEG testing, patients with HTPR were 22.7%, and carriers were not associated with HTPR to ADP by TEG-ADP(%) (p = 0.193). A total of 265 patients completed 3 months of follow-up, and Kaplan-Meier analysis showed that patients with HTPR had a higher percentage of recurrent ischemic events compared with patients with NTPR (p = 0.002). In multivariate Cox proportional hazards models, history of ischemic stroke or TIA (HR 4.45, 95% CI 1.77-11.16, p = 0.001) and HTPR (HR 3.34, 95% CI 1.41-7.91, p = 0.006) was independently associated with recurrent ischemic events. In patients with minor stroke or TIA, the prevalence of HTPR was 22.7%, and HTPR was independently associated with recurrent ischemic events.

  1. Effect of a rehabilitation program using virtual reality for balance and functionality of chronic stroke patients

    Directory of Open Access Journals (Sweden)

    Wagner Henrique Souza Silva

    2015-09-01

    Full Text Available AbstractThis study aimed to investigate the effect of a rehabilitation program using virtual reality (VR in addition to conventional therapy for improvement of balance (BERG scale and functional independence (FIM scale in chronic stroke patients. Ten individuals, mean age of 51.4 (± 6.7 years, participated of eight 60-minute sessions comprising kinesiotherapy (15min, Nintendo Wii (30min and Learning transfer (15min exercises. After training, nonparametric statistical analysis showed significant improvement in total FIM (p= .01 and BERG scores (p= .00, and in some of their subitems: FIM - dressing lower body (p= .01, transfer to bathtub/shower (p= .02 and locomotion: stairs (p= .03; BERG - reaching forward with outstretched arm (p= .01, retrieving object from the floor (p= .04, turning 360º (p= .01, placing alternate foot on step (p≤ .01, standing with one foot in front (p= .01, and one leg stand (p= .03. These findings suggest a positive influence of virtual reality exercises adjunct to conventional therapy on rehabilitation of balance and functionality post stroke, and indicate the feasibility of the proposed VR-based rehabilitation program.

  2. A Cognitive Behavioral Depression Prevention Program for Early Adolescents

    Science.gov (United States)

    Miloseva, Lence

    2013-01-01

    The aim of this study was to present results of our one year experience with Cognitive Behavioral Psychology Program, in order to contribute to the building of whole school approach and positive psychology preventive mental health problems model. Based on Penn Resilience program (PRP), we modify and create program for early adolescents: how to…

  3. 101 Ways To Build Enrollment in Your Early Childhood Program.

    Science.gov (United States)

    Montanari, Ellen Orton

    Written for administrators of early childhood program centers, this book offers tips on how to increase enrollment. The book offers suggestions rather than a theoretical overview or a comprehensive marketing strategy. Suggestions offered include: (1) Offer a quality program; (2) be aware of your target market; (3) make your program unique; (4)…

  4. Financing Early Childhood Education Programs: State, Federal, and Local Issues

    Science.gov (United States)

    Hustedt, Jason T.; Barnett, W. Steven

    2011-01-01

    The landscape of financing early childhood education in the U.S. is complex. Programs run the gamut from tuition-supported private centers to public programs supported by federal, state, or local funds. Different funding streams are poorly coordinated. The federal government funds several major targeted programs that are available only to specific…

  5. Storymakers: Hopa Mountain's Early Literacy Program

    Science.gov (United States)

    Templin, Patricia A.

    2013-01-01

    Hopa Mountain's StoryMakers program is an innovative, research-based program for donating high quality young children's books to parents. Hopa Mountain is a nonprofit organization based in Bozeman, Montana. Hopa Mountain works with groups of rural and tribal citizen leaders who form StoryMakers Community Teams to talk one-on-one with local parents…

  6. Evaluation of a four month rehabilitation program for stroke patients with balance problems and binocular visual dysfunction

    DEFF Research Database (Denmark)

    Schow, Trine; Harris, Paul; Teasdale, Thomas William

    2016-01-01

    Trine Schow, Paul Harris, Thomas William Teasdale, Morten Arendt Rasmussen. Evaluation of a four month rehabilitation program for stroke patients with balance problems and binocular visual dysfunction. NeuroRehabilitation. 2016 Apr 6;38(4):331-41. doi: 10.3233/NRE-161324.......Trine Schow, Paul Harris, Thomas William Teasdale, Morten Arendt Rasmussen. Evaluation of a four month rehabilitation program for stroke patients with balance problems and binocular visual dysfunction. NeuroRehabilitation. 2016 Apr 6;38(4):331-41. doi: 10.3233/NRE-161324....

  7. INFLAMMATORY MARKERS IN ACUTE ISCHAEMIC STROKE IN RELATION TO CLINICAL SEVERITY AND EARLY OUTCOME

    Directory of Open Access Journals (Sweden)

    S. Gopi

    2018-01-01

    Full Text Available BACKGROUND Biochemical markers of inflammation could be useful to predict severity of stroke in acute phase. Stroke is the third cause of mortality and the first cause of disability. Recent literature have demonstrated that inflammation contributes to all phases of atherosclerosis. The results of researchers suggest that atherosclerosis is an inflammatory disease. The aim of the study is to assess the1. Level of peripheral inflammatory markers in acute ischaemic stroke and their relation to severity of acute stroke. 2. Value of inflammatory markers in predicting the short-term outcome and disability at the end of six months. MATERIALS AND METHODS This is a prospective case control study for 6 months done from September 2014 to August 2016 in 100 patients of acute ischaemic stroke within first 5 days of symptom onset in comparison >18 years of age with 50 age and sex matched controls. Blood samples for all cases and controls were sent for erythrocyte sedimentation rate, Neutrophil-to-Lymphocyte Ratio (NLR, hs-C-reactive protein, mean platelet volume, serum ferritin, serum albumin and S. gamma-glutamyl transferase at admission. RESULTS The mean values of ESR, NLR, hs-CRP in all the cases are higher when compared to the controls and are statistically significant, whereas the mean values of MPV, S. ferritin, S. albumin and GGT in cases are lower when compared to controls, but are within normal range and difference is statistically significant except ferritin. ESR, hs-CRP has significant correlation with severity of acute ischaemic stroke. The mean values of these markers increased with increase in severity. Serum albumin has significant correlation with severity of acute ischaemic stroke with mean values of these markers decreasing with increase in severity of stroke. There is no significant correlation of the inflammatory markers in present study with the short-term outcome. CONCLUSION Inflammation plays an important role in the pathogenesis of non

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

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    Sandesh Rayamajhi

    2014-06-01

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

  9. Safety and effectiveness of stem cell therapies in early-phase clinical trials in stroke: a systematic review and meta-analysis.

    Science.gov (United States)

    Nagpal, Anjali; Choy, Fong Chan; Howell, Stuart; Hillier, Susan; Chan, Fiona; Hamilton-Bruce, Monica A; Koblar, Simon A

    2017-08-30

    Stem cells have demonstrated encouraging potential as reparative therapy for patients suffering from post-stroke disability. Reperfusion interventions in the acute phase of stroke have shown significant benefit but are limited by a narrow window of opportunity in which they are beneficial. Thereafter, rehabilitation is the only intervention available. The current review summarises the current evidence for use of stem cell therapies in stroke from early-phase clinical trials. The safety and feasibility of administering different types of stem cell therapies in stroke seem to be reasonably proven. However, the effectiveness needs still to be established through bigger clinical trials with more pragmatic clinical trial designs that address the challenges raised by the heterogeneous nature of stroke per se, as well those due to unique characteristics of stem cells as therapeutic agents.

  10. BUS TRIPS—A Self-Management Program for People with Cognitive Impairments after Stroke

    Directory of Open Access Journals (Sweden)

    Emma Carlstedt

    2017-11-01

    Full Text Available Stroke is a major cause of disability worldwide and different types of impairments can affect the individual’s ability to manage everyday activities such as travel that is essential for participation in society. The purpose of this study was to investigate the feasibility of a new self-management intervention (BUS TRIPS focusing on travelling by bus, and potential contributions to an improved ability to travel by bus for people with cognitive impairments after stroke. This is a pilot study of five individuals, utilizing a multiple case study design with a mixed methods approach. Assessments (Stroke Impact Scale, General Self-Efficacy Scale and Life Satisfaction Scale-11, Item 1 were performed before, two weeks after, and three months after the program. The data collection also comprised reflection notes from the group leaders (an occupational therapist and a physiotherapist, a semi-structured group interview and an individual phone survey. The feasibility of the intervention was presented in four sub-categories: (1 appreciated group format despite too short sessions; (2 the importance of skilled leaders and motivated participants; (3 session material adequate but needs minor revision to fit the target group; and (4 homework is valuable but reflective group discussions must be supported. The narratives of each case showed that all participants made some progress related to travelling by bus, but the overall positive results could not be verified by all of the quantitative assessments. We conclude that the BUS TRIPS intervention is feasible and can potentially contribute to an improved ability to travel by bus for the target group. Future studies is called for, and should focus on recruitment challenges, to clarify assessments that would be suitable to use in larger scale clinical trials and during subsequent implementation in clinical practice.

  11. New Directions in Tribal Early Childhood Programs

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    Bohanon, Kelli

    2016-01-01

    This article explores the efforts of tribal communities building more coordinated and effective early childhood systems by taking advantage of federal funding opportunities and partnerships. Given a new level of understanding and response from federal agencies regarding the unique nature of tribal communities, efforts are being made to acknowledge…

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

    Science.gov (United States)

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

    2010-01-01

    Objective To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community. Methods Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain. Results After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P < .00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P < .003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P = .01). Conclusion APA-stroke appears to be safe, feasible, and efficacious in a community setting. PMID:19318465

  13. Assessing Costs and Benefits of Early Childhood Intervention Programs. Overview and Application to the Starting Early Starting Smart Program. Executive Summary

    National Research Council Canada - National Science Library

    Karoly, Lynn

    2001-01-01

    Agency and program administrators and decisionmakers responsible for implementing early childhood intervention programs are becoming more interested in quantifying the costs and benefits of such programs...

  14. Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke: A Population-Based Cohort Study of 45 000 Swedish Men.

    Science.gov (United States)

    Falkstedt, Daniel; Wolff, Valerie; Allebeck, Peter; Hemmingsson, Tomas; Danielsson, Anna-Karin

    2017-02-01

    Current knowledge on cannabis use in relation to stroke is based almost exclusively on clinical reports. By using a population-based cohort, we aimed to find out whether there was an association between cannabis use and early-onset stroke, when accounting for the use of tobacco and alcohol. The cohort comprises 49 321 Swedish men, born between 1949 and 1951, who were conscripted into compulsory military service between the ages of 18 and 20. All men answered 2 detailed questionnaires at conscription and were subject to examinations of physical aptitude, psychological functioning, and medical status. Information on stroke events up to ≈60 years of age was obtained from national databases; this includes strokes experienced before 45 years of age. No associations between cannabis use in young adulthood and strokes experienced ≤45 years of age or beyond were found in multivariable models: cannabis use >50 times, hazard ratios=0.93 (95% confidence interval [CI], 0.34-2.57) and 0.95 (95% CI, 0.59-1.53). Although an almost doubled risk of ischemic stroke was observed in those with cannabis use >50 times, this risk was attenuated when adjusted for tobacco usage: hazards ratio=1.47 (95% CI, 0.83-2.56). Smoking ≥20 cigarettes per day was clearly associated both with strokes before 45 years of age, hazards ratio=5.04 (95% CI, 2.80-9.06), and with strokes throughout the follow-up, hazards ratio=2.15 (95% CI, 1.61-2.88). We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age. Tobacco smoking, however, showed a clear, dose-response shaped association with stroke. © 2016 American Heart Association, Inc.

  15. Early Head Start Participants, Programs, Families, and Staff in 2014

    Science.gov (United States)

    Mohan, Anitha; Walker, Christina

    2016-01-01

    In 1994, the federal Early Head Start (EHS) program was created to address the comprehensive needs of low-income pregnant women and children under age 3. EHS was launched almost 30 years after Head Start was established in 1965 to serve low-income 3- and 4-year-old children and their families with comprehensive early education and support…

  16. Influencing factors for early acute cerebrovascular accidents in patients with stroke history following off-pump coronary artery bypass grafting.

    Science.gov (United States)

    Wang, Bin; Jia, Ming; Jia, Shijie; Wan, Jiuhe; Zhou, Xiao; Luo, Zhimin; Zhou, Ye; Zhang, Jianqun

    2014-06-01

    To analyse risk factors for early acute cerebrovascular accidents following off-pump coronary artery bypass grafting (OPCAB) in patients with stroke history, and to propose preventive measures to reduce the incidence of these events. A total of 468 patients with a history of stroke underwent OPCAB surgery in Beijing Anzhen Hospital of China from January 2010 to September 2012. They were retrospectively divided into two groups according to the occurrence of early acute cerebrovascular accidents within 48 hours following OPCAB. Multivariate logistic regression analysis was used to find risk or protective factors for early acute cerebrovascular accidents following the OPCAB. Fifty-two patients (11.1%) suffered from early acute cerebrovascular accidents in 468 patients, including 39 cases of cerebral infarction, two cases of cerebral haemorrhage, 11 cases of transient ischaemic attack (TIA). There were significant differences between the two groups in preoperative left ventricular ejection fraction ≤ 35%, severe bilateral carotid artery stenosis, poorly controlled hypertension, intraoperative application of Enclose® II proximal anastomotic device, postoperative acute myocardial infarction, atrial fibrillation, hypotension, ventilation time > 48h, ICU duration >48h and mortality. Multivariate logistic regression analysis showed that preoperative severe bilateral carotid stenosis (OR=6.378, 95%CI: 2.278-20.987) and preoperative left ventricular ejection fraction ≤ 35% (OR=2.737, 95%CI: 1.267-6.389), postoperative acute myocardial infarction (OR=3.644, 95%CI: 1.928-6.876), postoperative atrial fibrillation (OR=3.104, 95%CI:1.135∼8.016) and postoperative hypotension (OR=4.173, 95%CI: 1.836∼9.701) were independent risk factors for early acute cerebrovascular accidents in patients with a history of stroke following OPCAB procedures, while intraoperative application of Enclose® II proximal anastomotic device was protective factor (OR=0.556, 95%CI: 0.337-0.925). This

  17. Department of Energy - Office of Science Early Career Research Program

    Science.gov (United States)

    Horwitz, James

    The Department of Energy (DOE) Office of Science Early Career Program began in FY 2010. The program objectives are to support the development of individual research programs of outstanding scientists early in their careers and to stimulate research careers in the disciplines supported by the DOE Office of Science. Both university and DOE national laboratory early career scientists are eligible. Applicants must be within 10 years of receiving their PhD. For universities, the PI must be an untenured Assistant Professor or Associate Professor on the tenure track. DOE laboratory applicants must be full time, non-postdoctoral employee. University awards are at least 150,000 per year for 5 years for summer salary and expenses. DOE laboratory awards are at least 500,000 per year for 5 years for full annual salary and expenses. The Program is managed by the Office of the Deputy Director for Science Programs and supports research in the following Offices: Advanced Scientific and Computing Research, Biological and Environmental Research, Basic Energy Sciences, Fusion Energy Sciences, High Energy Physics, and Nuclear Physics. A new Funding Opportunity Announcement is issued each year with detailed description on the topical areas encouraged for early career proposals. Preproposals are required. This talk will introduce the DOE Office of Science Early Career Research program and describe opportunities for research relevant to the condensed matter physics community. http://science.energy.gov/early-career/

  18. The stroke oxygen pilot study: a randomized controlled trial of the effects of routine oxygen supplementation early after acute stroke--effect on key outcomes at six months.

    Directory of Open Access Journals (Sweden)

    Khalid Ali

    Full Text Available Post-stroke hypoxia is common, and may adversely affect outcome. We have recently shown that oxygen supplementation may improve early neurological recovery. Here, we report the six-month outcomes of this pilot study.Patients with a clinical diagnosis of acute stroke were randomized within 24 h of admission to oxygen supplementation at 2 or 3 L/min for 72 h or to control treatment (room air. Outcomes (see below were assessed by postal questionnaire at 6 months. Analysis was by intention-to-treat, and statistical significance was set at p ≤ 0.05.Out of 301 patients randomized two refused/withdrew consent and 289 (148 in the oxygen and 141 in the control group were included in the analysis: males 44%, 51%; mean (SD age 73 (12, 71 (12; median (IQR National Institutes of Health Stroke Scale score 6 (3, 10, 5 (3, 10 for the two groups respectively. At six months 22 (15% patients in the oxygen group and 20 (14% in the control group had died; mean survival in both groups was 162 days (p = 0.99. Median (IQR scores for the primary outcome, the modified Rankin Scale, were 3 (1, 5 and 3 (1, 4 for the oxygen and control groups respectively. The covariate-adjusted odds ratio was 1.04 (95% CI 0.67, 1.60, indicating that the odds of a lower (i.e. better score were non-significantly higher in the oxygen group (p = 0.86. The mean differences in the ability to perform basic (Barthel Index and extended activities of daily living (NEADL, and quality of life (EuroQol were also non-significant.None of the key outcomes differed at 6 months between the groups. Although not statistically significant and generally of small magnitude, the effects were predominantly in favour of the oxygen group; a larger trial, powered to show differences in longer-term functional outcomes, is now on-going.Controlled-Trials.com ISRCTN12362720; Eudract.ema.europa.eu 2004-001866-41.

  19. The bicalutamide Early Prostate Cancer Program. Demography

    DEFF Research Database (Denmark)

    See, W A.; McLeod, D; Iversen, P

    2001-01-01

    areas (North America; Australia, Europe, Israel, South Africa and Mexico; and Scandinavia). Men with T1b-4N0-1M0 (TNM 1997) prostate cancer have been randomized on a 1:1 basis to receive bicalutamide 150 mg daily or placebo. Recruitment to the program closed in July 1998, and follow-up is ongoing. Study...

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

    Science.gov (United States)

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

    2012-07-01

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

  1. The Early Prostate Cancer program: bicalutamide in nonmetastatic prostate cancer

    DEFF Research Database (Denmark)

    Iversen, Peter; Roder, Martin Andreas; Røder, Martin Andreas

    2008-01-01

    The Early Prostate Cancer program is investigating the addition of bicalutamide 150 mg to standard care for localized or locally advanced, nonmetastatic prostate cancer. The third program analysis, at 7.4 years' median follow-up, has shown that bicalutamide 150 mg does not benefit patients...

  2. Interkosmos the Eastern bloc's early space program

    CERN Document Server

    Burgess, Colin

    2016-01-01

    This book focuses on the Interkosmos program, which was formed in 1967, marking a fundamentally new era of cooperation by socialist countries, led by the Soviet Union, in the study and exploration of space. The chapters shed light on the space program that was at that time a prime outlet for the Soviet Union's aims at becoming a world power. Interkosmos was a highly publicized Russian space program that rapidly became a significant propaganda tool for the Soviet Union in the waning years of communism. Billed as an international “research-cosmonaut” imperative, it was also a high-profile means of displaying solidarity with the nine participating Eastern bloc countries. Those countries contributed pilots who were trained in Moscow for week-long “guest” missions on orbiting Salyut stations. They did a little subsidiary science and were permitted only the most basic mechanical maneuvers. In this enthralling new book, and following extensive international research, the authors fully explore ...

  3. [Early treatment and nursing role in the case of a haemorrhagic stroke].

    Science.gov (United States)

    Héraud-Carré, Séverine; Le Roy, Bruno; Prével, Gladys

    Paediatric stroke constitute a medical and/or surgical emergency. The speed and timeliness of the treatment have a significant impact on the prognosis. The nursing role, from carrying out continuous observation to specific procedures, is essential in the assessment, the care pathway and the short-, medium- and long-term outcome for the child. Copyright © 2017. Published by Elsevier Masson SAS.

  4. Time course of visuospatial neglect early after stroke : A longitudinal cohort study

    NARCIS (Netherlands)

    Nijboer, Tanja C. W.; Kollen, Boudewijn J.; Kwakkel, Gert

    The aim of the current study was to investigate recovery of visuospatial neglect during the first year after stroke. Visuospatial neglect was measured using two frequently and widely used tests: the letter cancellation test (LCT) and the line bisection test (LBT). This was a prospective cohort study

  5. Intravascular Cooling in the Treatment of Stroke (ICTuS): early clinical experience.

    Science.gov (United States)

    Lyden, Patrick D; Allgren, Robin L; Ng, Ken; Akins, Paul; Meyer, Brett; Al-Sanani, Fahmi; Lutsep, Helmi; Dobak, John; Matsubara, Bradley S; Zivin, Justin

    2005-01-01

    We sought to evaluate the safety and feasibility of mild therapeutic hypothermia using an endovascular temperature management system in awake acute ischemic stroke patients. The Intravascular Cooling in the Treatment of Stroke (ICTuS) study was an uncontrolled, multicenter development and feasibility study of conscious patients (n = 18) presenting within 12 hours of onset of an acute ischemic stroke at 5 clinical sites in the United States. Enrolled patients were to undergo core temperature management using an endovascular cooling system to induce and maintain mild, therapeutic hypothermia (target temperature of 33.0 degrees C) for a period of either 12 or 24 hours, followed by controlled rewarming to 36.5 degrees C over the subsequent 12-hour period. Nine patients underwent 12 hours of cooling followed by 12 hours of controlled rewarming, and 6 patients underwent 24 hours of cooling followed by 12 hours of controlled rewarming. Three patients underwent <1.5 hours of hypothermia due to clinical or technical issues. We also developed an antishivering regimen using buspirone and meperidine administered prophylactically to suppress shivering. The endovascular cooling catheter was well tolerated, with acceptable adverse event rates. Increasing the duration of hypothermia administration from 12 hours to 24 hours did not appear to increase the incidence or severity of adverse effects. Endovascular cooling with a proactive antishivering regimen can be accomplished in awake stroke patients. Further studies are needed to establish the safety and efficacy of this approach.

  6. Lesion locations influencing baseline severity and early recovery in ischaemic stroke

    NARCIS (Netherlands)

    Bentley, P.; Kumar, G.; Rinne, P.; Buddha, S.; Kallingal, J.; Hookway, C.; Sharma, P.; Mehta, A.; Beckmann, C.F.

    2014-01-01

    Background and purpose: Strokes caused by lesions to certain brain areas are associated with poor outcome, which is important both prognostically and to understand the neural basis for recovery. However, lesion anatomy associations with outcome may occur because of effects on baseline severity

  7. Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers.

    Science.gov (United States)

    Yang, Li; Zhao, Qiuli; Zhu, Xuemei; Shen, Xiaoying; Zhu, Yulan; Yang, Liu; Gao, Wei; Li, Minghui

    2017-08-01

    Many factors influence pre-hospital delays in the event of stroke. This study aimed to develop and evaluate a comprehensive educational program for decreasing pre-hospital delays in high-risk stroke population. We enrolled 220 high-risk stroke population and caregivers from six urban communities in Harbin from May 2013 to May 2015, and randomly divided them into intervention and control groups. We implemented a comprehensive educational program (intervention group), comprising public lectures, instructional brochures, case videos, simulations, and role-playing from May 2013 to May 2015. We delivered conventional oral education in the control group. We compared stroke pre-hospital delay behavioral intention (SPDBI), pre-hospital stroke symptom coping test (PSSCT), and stroke pre-symptoms alert test (SPSAT) results between the groups before and 6, 12, and 18 months after health intervention. There were significant differences between before and after intervention (P pre-hospital delays.

  8. Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program.

    Science.gov (United States)

    Güngen, Belma Doğan; Tunç, Abdulkadir; Aras, Yeşim Güzey; Gündoğdu, Aslı Aksoy; Güngen, Adil Can; Bal, Serdar

    2017-07-11

    The aim of this study was to investigate the predictors of intensive care unit (ICU) admission and mortality among stroke patients and the effects of a pulmonary rehabilitation program on stroke patients. This prospective study enrolled 181 acute ischemic stroke patients aged between 40 and 90 years. Demographical characteristics, laboratory tests, diffusion-weighed magnetic resonance imaging (DWI-MRI) time, nutritional status, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin scale (MRS) scores were recorded for all patients. One-hundred patients participated in the pulmonary rehabilitation program, 81 of whom served as a control group. Statistically, one- and three-month mortality was associated with NIHSS and MRS scores at admission and three months (pstroke patients. We believe that a pulmonary rehabilitation program, in addition to general stroke rehabilitation programs, can play a critical role in improving survival and functional outcomes. NCT03195907 . Trial registration date: 21.06.2017 'Retrospectively registered'.

  9. Effectiveness of a Danish early year preschool program

    DEFF Research Database (Denmark)

    Jensen, Bente; Holm, Anders; Bremberg, Sven

    2013-01-01

    A significant number of studies indicate that early year preschool programs lead to positive long-term effects. Systematic quality improvement of early year preschool may enhance these outcomes. The ASP Program was built on this principle. In this program preschool staff are supported...... in their efforts to critically reflect on current practices and to change these. A randomized controlled study was carried out in Denmark from September 2006 to May 2008. The study encompassed 2323 children in 59 preschools in two municipalities. Children were assessed using the Strength and Difficulties...

  10. National Institutes of Health Stroke Scale (NIHSS) as An Early Predictor of Poststroke Dysphagia.

    Science.gov (United States)

    Jeyaseelan, Rebecca D; Vargo, Mary M; Chae, John

    2015-06-01

    Despite the availability of multiple comprehensive screening methods to detect dysphagia during acute stroke care, consensus is lacking as to the best practice. Our previous study demonstrated favorable sensitivity of the Functional Independence Measure (FIM) compared with a bedside 3-sip test. However, the FIM is challenging to administer during acute stroke care. The National Institutes of Health Stroke Scale (NIHSS) is administered routinely in the emergency department. To evaluate the utility of the NIHSS as a predictor of clinically relevant poststroke dysphagia compared with FIM data in the same cohort. Retrospective analysis. Academic medical center. Individuals with acute stroke who were admitted for acute care and later transferred to acute rehabilitation within the same institution. Clinically relevant dysphagia was defined as aspiration on modified barium swallow or laryngeal penetration on modified barium swallow requiring diet change, or aspiration pneumonia. NIHSS and FIM scores were compiled for all patients. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for NIHSS and FIM. Sensitivity and specificity of different values of NIHSS and FIM were analyzed via receiver operator characteristic curves. Of 290 patients admitted to acute stroke rehabilitation, 88 (30%) manifested clinically relevant dysphagia during their rehabilitation stay. Sensitivity analyses suggested cut-off values for the NIHSS and the FIM of >9 and 9 and FIM dysphagia. Although the NIHSS clinical test characteristics are not as favorable as the FIM, NIHSS appears to be more sensitive than some other reported methods such as a 3-sip water test. Further study into development of paradigms that incorporate NIHSS into initial assessment of dysphagia risk may be appropriate. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  11. A comparative study of the effects of trunk exercise program in aquatic and land-based therapy on gait in hemiplegic stroke patients.

    Science.gov (United States)

    Park, Byoung-Sun; Noh, Ji-Woong; Kim, Mee-Young; Lee, Lim-Kyu; Yang, Seung-Min; Lee, Won-Deok; Shin, Yong-Sub; Kim, Ju-Hyun; Lee, Jeong-Uk; Kwak, Taek-Yong; Lee, Tae-Hyun; Park, Jaehong; Kim, Junghwan

    2016-06-01

    [Purpose] The purpose of this study was to compare the effects of aquatic and land-based trunk exercise program on gait in stroke patients. [Subjects and Methods] The subjects were 28 hemiplegic stroke patients (20 males, 8 females). The subjects performed a trunk exercise program for a total of four weeks. [Results] Walking speed and cycle, stance phase and stride length of the affected side, and the symmetry index of the stance phase significantly improved after the aquatic and land-based trunk exercise program. [Conclusion] These results suggest that the aquatic and land-based trunk exercise program may help improve gait performance ability after stroke.

  12. No effects of anodal transcranial direct stimulation on language abilities in early rehabilitation of post-stroke aphasic patients.

    Science.gov (United States)

    Polanowska, K E; Leśniak, M; Seniów, J B; Członkowska, A

    2013-01-01

    Recent research suggests that an increased level of stroke-affected left hemisphere cortical (especially frontal) excitability is associated with better language improvement in aphasic patients. Anodal transcranial direct current stimulation (A-tDCS), increasing cortical activity, may facilitate perilesional left hemisphere recruitment to subserve language processing and enhance effects of behavioural therapy. The aim of the study (randomized, double-blind, sham-controlled) was to evaluate the effectiveness of repeated A-tDCS over Broca area as a strategy to enhance aphasia recovery during early post-stroke rehabilitation. Thirty-seven participants with moderate or severe aphasia were randomized to receive 15 consecutive daily sessions of A-tDCS (1 mA, 10 min; experimental group, n = 18) or sham stimulation (1 mA, 25 s; control group, n = 19) followed by language therapy. Effects of tDCS were assessed using the Boston Diagnostic Aphasia Examination, performed before and after the rehabilitation, and three months later. The results did not confirm a positive impact of repeated A-tDCS, preceding language therapy, on language abilities in our patients. Although both groups improved after the therapy, there were no statistically significant differences between groups in either short-term or long-term tDCS effects. Effect sizes for the experimental group, at post-treatment and the 3-month follow-up, were slightly higher than in controls but insufficient to infer any beneficial influence of the applied intervention. The findings do not support A-tDCS functional benefits during early rehabilitation of post-stroke aphasia. Further research is needed to explore the effectiveness of this kind of neuromodulation.

  13. Preliminary study of time maximum intensity projection computed tomography imaging for the detection of early ischemic change in patient with acute ischemic stroke.

    Science.gov (United States)

    Murayama, Kazuhiro; Suzuki, Shigetaka; Matsukiyo, Ryo; Takenaka, Akinori; Hayakawa, Motoharu; Tsutsumi, Takashi; Fujii, Kenji; Katada, Kazuhiro; Toyama, Hiroshi

    2018-03-01

    Noncontrast computed tomography (NCCT) has been used for the detection of early ischemic change (EIC); however, correct interpretation of NCCT findings requires much clinical experience. This study aimed to assess the accuracy of time maximum intensity projection computed tomography technique (tMIP), which reflects the maximum value for the time phase direction from the dynamic volume data for each projected plane, for detection of EIC, against that of NCCT.Retrospective review of NCCT, cerebral blood volume in CT perfusion (CTP-CBV), and tMIP of 186 lesions from 280 regions evaluated by Alberta Stroke Program Early CT Score (ASPECTS) in 14 patients with acute middle cerebral artery stroke who had undergone whole-brain CTP using 320-row area detector CT was performed. Four radiologists reviewed EIC on NCCT, CTP-CBV, and tMIP in each ASPECTS region at onset using the continuous certainty factor method. Receiver operating characteristic analysis was performed to compare the relative performance for detection of EIC. The correlations were evaluated.tMIP-color showed the best discriminative value for detection of EIC. There were significant differences in the area under the curve for NCCT and tMIP-color, CTP-CBV (P < .05). Scatter plots of ASPECTS showed a positive significant correlation between NCCT, tMIP-gray, tMIP-color, and the follow-up study (NCCT, r = 0.32, P = .0166; tMIP-gray, r = 0.44, P = .0007; tMIP-color, r = 0.34, P = .0104).Because tMIP provides a high contrast parenchymal image with anatomical and vascular information in 1 sequential scan, it showed greater accuracy for detection of EIC and predicted the final infarct extent more accurately than NCCT based on ASPECTS.

  14. 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.

  15. Preliminary experience on early mechanical recanalization of middle cerebral artery for acute ischemic stroke and literature review

    International Nuclear Information System (INIS)

    Bai Weixing; Li Tianxiao; Zhu Liangfu; Xue Jiangyu; Wang Ziliang

    2012-01-01

    Objective: To evaluate the feasibility,efficacy and complication of early middle cerebral artery (MCA) mechanical recanalization (MER) for treatment of acute ischemic stroke. Methods: Seven cases undergone MER of MCA for the treatment of acute cerebral infarct were retrospectively reviewed and analyzed, including the etiology, mechanism, Qureshi grading scale, location and size of infarcts, NIHSS score of pre and post procedure, endovascular technique and complications. Referring to the literature, the indications of MCA recanalization were further identified. Results: A total of 7 cases with mean age of 48 yrs were reviewed, which included 3 cases of atherosclerotic thrombosis and 4 embolic cases with pre NIHSS score ranging from 3 to 22. Mechanical recanalization succeeded in 6 cases, but 2 cases of cardiogenic embolism died of intracranial hemorrhage postoperatively. Favorable clinical outcomes were achieved in 4 cases whereas 1 deteriorated. Overall complications seemed to be consistent with literatures reviewed. Conclusions: Early MER of MCA may benefit to a certain subset of acute ischemia stroke patients, however, embolic cases, elder patients and those with severe neurologic deficits are often accompanied by higher complications and unfavorable outcome. (authors)

  16. The Feasibility of a Customized, In-Home, Game-Based Stroke Exercise Program Using the Microsoft Kinect Sensor

    Directory of Open Access Journals (Sweden)

    Rachel Proffitt

    2015-11-01

    Full Text Available The objective of this study was to determine the feasibility of a 6-week, game-based, in-home telerehabilitation exercise program using the Microsoft Kinect® for individuals with chronic stroke. Four participants with chronic stroke completed the intervention based on games designed with the customized Mystic Isle software. The games were tailored to each participant’s specific rehabilitation needs to facilitate the attainment of individualized goals determined through the Canadian Occupational Performance Measure. Likert scale questionnaires assessed the feasibility and utility of the game-based intervention. Supplementary clinical outcome data were collected. All participants played the games with moderately high enjoyment. Participant feedback helped identify barriers to use (especially, limited free time and possible improvements. An in-home, customized, virtual reality game intervention to provide rehabilitative exercises for persons with chronic stroke is practicable. However, future studies are necessary to determine the intervention’s impact on participant function, activity, and involvement.

  17. Comparison of the effects of high- and low-frequency repetitive transcranial magnetic stimulation on upper limb hemiparesis in the early phase of stroke.

    Science.gov (United States)

    Sasaki, Nobuyuki; Mizutani, Saneyuki; Kakuda, Wataru; Abo, Masahiro

    2013-05-01

    Recently, high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and low-frequency rTMS (LF-rTMS) are reported to improve motor function significantly in chronic hemiparetic stroke patients. However, few studies have investigated the safety and efficacy of these rTMS modalities introduced during the early phase of stroke. The purpose of this study was to clarify the rTMS modality that is more beneficial for upper limb hemiparesis in the early phase of stroke using a randomized controlled trial. Twenty-nine patients with a hemispheric stroke lesion in the early phase of stroke were examined. Patients were randomly assigned into 3 groups: the HF-rTMS group (10 Hz rTMS to the lesional hemisphere [n = 9]), the LF-rTMS group (1 Hz rTMS to the nonlesional hemisphere [n = 11]), and the sham stimulation group [n = 9]). Patients received sessions for 5 consecutive days. Grip strength and tapping frequency were assessed before and after the intervention. Motor improvement of the affected upper limb after intervention was compared among the 3 groups. All patients completed the 5-day protocol. Both the HF-rTMS and LF-rTMS groups had significant increases in both grip strength and tapping frequency. Comparison of the extent of improvement showed a more significant increase in grip strength and tapping frequency in the HF-rTMS group compared to the sham stimulation group (each P stimulation group. HF-rTMS applied to the lesional hemisphere in the early phase of stroke was more beneficial for motor improvement of the affected upper limb than LF-rTMS. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. A large web-based observer reliability study of early ischaemic signs on computed tomography. The Acute Cerebral CT Evaluation of Stroke Study (ACCESS.

    Directory of Open Access Journals (Sweden)

    Joanna M Wardlaw

    Full Text Available BACKGROUND: Early signs of ischaemic stroke on computerised tomography (CT scanning are subtle but CT is the most widely available diagnostic test for stroke. Scoring methods that code for the extent of brain ischaemia may improve stroke diagnosis and quantification of the impact of ischaemia. METHODOLOGY AND PRINCIPAL FINDINGS: We showed CT scans from patients with acute ischaemic stroke (n = 32, with different patient characteristics and ischaemia signs to doctors in stroke-related specialties world-wide over the web. CT scans were shown twice, randomly and blindly. Observers entered their scan readings, including early ischaemic signs by three scoring methods, into the web database. We compared observers' scorings to a reference standard neuroradiologist using area under receiver operator characteristic curve (AUC analysis, Cronbach's alpha and logistic regression to determine the effect of scales, patient, scan and observer variables on detection of early ischaemic changes. Amongst 258 readers representing 33 nationalities and six specialties, the AUCs comparing readers with the reference standard detection of ischaemic signs were similar for all scales and both occasions. Being a neuroradiologist, slower scan reading, more pronounced ischaemic signs and later time to CT all improved detection of early ischaemic signs and agreement on the rating scales. Scan quality, stroke severity and number of years of training did not affect agreement. CONCLUSIONS: Large-scale observer reliability studies are possible using web-based tools and inform routine practice. Slower scan reading and use of CT infarct rating scales improve detection of acute ischaemic signs and should be encouraged to improve stroke diagnosis.

  19. Risk of Nonfatal Stroke in Type 2 Diabetes Mellitus Patients: A Retrospective Comparison Between Disease Management Programs and Standard Care.

    Science.gov (United States)

    Wiefarn, Stefan; Heumann, Christian; Rettelbach, Anja; Kostev, Karel

    2017-07-01

    The present retrospective study examines the influence of disease management programs on nonfatal stroke in type 2 diabetes mellitus (T2DM) patients in Germany. The evaluation is based on retrospective patient data from the Disease Analyzer (IMS Health). The analysis included 169 414 T2DM patients aged 40 years and older with an initial prescription of antihyperglycemic therapy between January 2004 and December 2014. A total of 86 713 patients participated in a disease management program (DMP) for T2DM and 82 701 patients received standard care. The main outcome measure of this study was nonfatal stroke. Kaplan-Meier curves of DMP and SC patients were compared using log rank test. The Cox proportional hazards model was used to provide an adjusted estimate of the DMP effect. It is apparent from the baseline characteristics that the general health of patients receiving standard care was poorer than that of patients participating in a DMP. The baseline HbA1c value was 7.6% in the DMP group and 7.8% in the SC group. Furthermore, the SC group had a higher proportion of preexisting conditions, such as coronary heart disease (CHD), peripheral arterial occlusive disease (pAOD), and renal insufficiency. The proportion of patients who received insulin in first year therapy was higher in the SC group. Time to event analysis showed that DMP was associated with a delayed occurrence of stroke, because stroke occurred an average of 350 days later in DMP patients than in patients receiving SC (DMP: 1.216 days, RV: 866 days). The Cox model with covariable adjustment confirmed the significant association of DMPs with nonfatal stroke in patients with type 2 diabetes mellitus (HR 0.71; 95% CI: 0.69-0.74). The present study indicates that DMPs are positively associated with stroke. The possible reasons for this must be verified in further studies.

  20. Incorporating robotic-assisted telerehabilitation in a home program to improve arm function following stroke: a case study

    Science.gov (United States)

    Linder, Susan M.; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Rosenfeldt, Anson B.; Clark, Cindy; Wolf, Steven L.; Alberts, Jay L.

    2013-01-01

    Background and Purpose After stroke, many individuals lack resources to receive the intensive rehabilitation thought to improve upper extremity motor function. This case study describes the application of a telerehabilitation intervention using a portable robotic device combined with a home exercise program (HEP) designed to improve upper extremity function. Case Description The participant was a 54 year-old male, 22 weeks following right medullary pyramidal ischemic infarct. At baseline, he exhibited residual paresis of the left upper extremity resulting in impaired motor control consistent with a flexion synergistic pattern, scoring 22/66 on the Fugl-Meyer Motor Assessment (FMA). Intervention The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period. Outcomes The participant demonstrated an improvement of 26 points on the Action Research Arm Test, 5 points on the Functional Ability Scale portion of the Wolf Motor Function Test (WMFT), and 20 points on the FMA, all of which surpassed the minimal clinically important difference (MCID). Of the 17 tasks of the WMFT, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his stroke recovery on the Stroke Impact Scale quality of life questionnaire from 40/100 to 65/100. His score on the Center for Epidemiologic Studies Depression Scale improved by 19 points. Discussion This case demonstrates that robotic-assisted therapy paired with a HEP can be successfully delivered within a home environment to a person with stroke. Robotic assisted therapy may be a feasible and efficacious adjunct to a HEP program to elicit substantial improvements in upper extremity motor function especially in those persons with stroke who lack access to stroke rehabilitation centers. Video Abstract available (See Video, Supplemental Digital Content 1.) for more insights from the

  1. Long-term effects of a group support program and an individual support program for informal caregivers of stroke patients : which caregivers benefit the most?

    NARCIS (Netherlands)

    van den Heuvel, ETP; de Witte, LP; Stewart, RE; Schure, LM; Sanderman, R; Meyboom-de Jong, B

    In this article, we report the long-term outcomes of an intervention for informal caregivers who are the main provider of stroke survivors' emotional and physical support. Based on the stress-coping theory of Lazarus and Folkman two intervention designs were developed: a group support program and

  2. The utility of first-pass perfusion CT in hyperacute ischemic stroke: early experience

    International Nuclear Information System (INIS)

    Lee, Tae Jin; Lee, Myeong Sub; Kim, Myung Soon; Hong, In Soo; Lee, Young Han; Lee, Ji Yong; Whang, Kum

    2003-01-01

    To evaluate the findings of first-pass perfusion CT in hyperacute stroke patients and to determine the relationship between a perfusion map and final infarct outcome. Thirty-five patients admitted with ischemic stroke within six hours of the onset of symptoms underwent conventional cerebral CT immediately followed by first-pass perfusion CT. Nineteen underwent follow-up CT or MRI, and three types of dynamic perfusion map-cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) - were evaluated by two radiologists. In these 19 patients, initial perfusion maps correlated with final infarct size, determined during follow-up studies. In all 35 patients, major large vessel perfusion abnormalities [middle cerebral artery - MCA MCA and anterior cerebral artery - ACA (n=2); posterior cerebral artery - PCA (n=8)] were detected. On first-pass perfusion maps depicting CBF and MTT, all lesions were detected, and CBF and delayed MTT values were recorded. CBV maps showed variable findings. In all 19 patients who were followed up, the final infarct size of perfusion abnormalities was less than that depicted on CBF and MTT maps, and similar to or much greater than that seen on CBV maps. First-pass perfusion CT scanning is a practical, rapid and advanced imaging technique. In hyperacute stroke patients, it provides important and reliable hemodynamic information as to which brain tissue is salvageable by thrombolytic therapy, and predicts outcome of such treatment

  3. The Transiting Exoplanet Community Early Release Science Program for JWST

    Science.gov (United States)

    Batalha, Natalie Marie; Bean, Jacob; Stevenson, Kevin; Sing, David; Crossfield, Ian; Knutson, Heather; Line, Michael; Kreidberg, Laura; Desert, Jean-Michel; Wakeford, Hannah R.; Crouzet, Nicolas; Moses, Julianne; Benneke, Björn; Kempton, Eliza; Berta-Thompson, Zach; Lopez-Morales, Mercedes; Parmentier, Vivien; Gibson, Neale; Schlawin, Everett; Fraine, Jonathan; Kendrew, Sarah; Transiting Exoplanet ERS Team

    2018-01-01

    A community working group was formed in October 2016 to consider early release science with the James Webb Space Telescope that broadly benefits the transiting exoplanet community. Over 100 exoplanet scientists worked collaboratively to identify targets that are observable at the initiation of science operations, yield high SNR with a single event, have substantial scientific merit, and have known spectroscopic features identified by prior observations. The working group developed a program that yields representative datasets for primary transit, secondary eclipse, and phase curve observations using the most promising instrument modes for high-precision spectroscopic timeseries (NIRISS-SOSS, NIRCam, NIRSPec, and MIRI-LRS). The centerpiece of the program is an open data challenge that promotes community engagement and leads to a deeper understanding of the JWST instruments as early as possible in the mission. The program is managed under the premise of open science in order to maximize the value of the early release science observations for the transiting exoplanet community.

  4. Feasibility of a 6-month exercise and recreation program to improve executive functioning and memory in individuals with chronic stroke.

    Science.gov (United States)

    Rand, Debbie; Eng, Janice J; Liu-Ambrose, Teresa; Tawashy, Amira E

    2010-10-01

    Physical activity is beneficial for improving cognitive function in healthy older adults. However, research results on the benefits of physical activity on cognitive performance after stroke are limited. To determine if a combined exercise and recreation program can improve the executive functioning and memory of individuals with chronic stroke. In all, 11 ambulatory participants with chronic stroke (mean age 67 ± 10.8 years) participated in a 6-month program of exercise for 2 hours and recreation for 1 hour weekly. Executive functions and memory were assessed at baseline and at 3 and 6 months by a battery of standard neuropsychological tests, including response inhibition, cognitive flexibility, dual task (motor plus cognitive), and memory. Motor ability was also assessed. Nonparametric statistics were used to obtain the differences between the 3 assessments. At baseline, substantial deficits in all aspects of executive functioning were revealed. From baseline to 3 months, the mean improvement was 10% ± 14% for the dual task (Walking While Talking), -3% ± 22% (χ(2) = 2.4; P > .05) for response inhibition (Stroop Test), and 61% ± 69% for memory (Rey Auditory Verbal Learning Test-long delay). From baseline to 6 months, the mean improvement was 7% ± 7.5% for response inhibition (Stroop Test). In addition, knee strength and walking speed improved significantly at 3 months. This pilot study suggests that exercise and recreation may improve memory and executive functions of community-dwelling individuals with stroke. Further studies require a larger sample size and a control group.

  5. Effectiveness of a Web-Based Health Education Program to Promote Oral Hygiene Care Among Stroke Survivors: Randomized Controlled Trial.

    Science.gov (United States)

    Ab Malik, Normaliza; Mohamad Yatim, Sa'ari; Lam, Otto Lok Tao; Jin, Lijian; McGrath, Colman Patrick Joseph

    2017-03-31

    Oral hygiene care is of key importance among stroke patients to prevent complications that may compromise rehabilitation or potentially give rise to life-threatening infections such as aspiration pneumonia. The aim of this study was to evaluate the effectiveness of a Web-based continuing professional development (CPD) program on "general intention" of the health carers to perform daily mouth cleaning for stroke patients using the theory of planned behavior (TPB). A double-blind cluster randomized controlled trial was conducted among 547 stroke care providers across 10 hospitals in Malaysia. The centers were block randomized to receive either (1) test intervention (a Web-based CPD program on providing oral hygiene care to stroke patients using TPB) or (2) control intervention (a Web-based CPD program not specific to oral hygiene). Domains of TPB: "attitude," "subjective norm" (SN), "perceived behavior control" (PBC), "general intention" (GI), and "knowledge" related to providing oral hygiene care were assessed preintervention and at 1 month and 6 months postintervention. The overall response rate was 68.2% (373/547). At 1 month, between the test and control groups, there was a significant difference in changes in scores of attitude (P=.004) and subjective norm (P=.01), but not in other TPB domains (GI, P=.11; PBC, P=.51; or knowledge, P=.08). At 6 months, there were significant differences in changes in scores of GI (P=.003), attitude (P=.009), SN (Poral hygiene care among stroke carers for their patients. Changing subjective norms and perceived behavioral control are key factors associated with changes in general intention to provide oral hygiene care. National Medical Research Register, Malaysia NMRR-13-1540-18833 (IIR); https://www.nmrr.gov.my/ fwbLoginPage.jsp. ©Normaliza Ab Malik, Sa'ari Mohamad Yatim, Otto Lok Tao Lam, Lijian Jin, Colman Patrick Joseph McGrath. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 31.03.2017.

  6. Early programming of the IGF-I axis

    DEFF Research Database (Denmark)

    Larnkjær, Anni; Ingstrup, Helga Kristensen; Schack-Nielsen, Lene

    2009-01-01

    -I production. Conversely, studies suggest that later in childhood, those breastfed are taller and have higher IGF-I levels. Therefore, it has been suggested that the IGF-I axis may be programmed by diet during infancy. The association between IGF-I in infancy and later life is not known. OBJECTIVE: To examine......=-0.26, P=0.043, and n=109). CONCLUSION: The results support the hypothesis that the IGF-I axis can be programmed early in life....

  7. Effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients.

    Science.gov (United States)

    Lee, In-Wook; Kim, Yong-Nam; Lee, Dong-Kyu

    2015-07-01

    [Purpose] This study aimed to assess the effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients. [Subjects] Twenty stroke patients were randomly assigned to two groups 10 to an experimental group that performed a virtual reality exercise program accompanied by cognitive tasks and 10 to a control group. The control group performed a proprioceptive neuromuscular facilitation exercise program. Balance was measured with the Berg Balance Scale. Gait was assessed using the Timed Up and Go Test. The paired t-test was used to compare groups before and after the experiment. The independent t-test was conducted to assess differences in the degree of change between the two groups before and after the experiment. [Results] Within-group comparison in the experimental group showed significant differences in the Berg Balance Scale and Timed Up and Go Test. In a comparison between groups, the differences in the Berg Balance Scale and Timed Up and Go Test in the experimental group appeared significant compared with the control group. [Conclusion] The results of the experiment indicate that a virtual reality exercise program accompanied by cognitive tasks has a positive effect on the balance and gait of stroke patients.

  8. A Description of the Hawthorn Center Early Intervention Program.

    Science.gov (United States)

    Glovinsky, Ira; Keller, Jackie

    An early intervention project for preschool handicapped children is described. Specific program goals (including improved functioning in social, emotional, communication, and preacademic areas) are listed, and roles of the interdisciplinary staff members are considered. Among evaluation approaches discussed are psychological measures, family…

  9. Father Involvement in Early Childhood Programs: Review of the Literature

    Science.gov (United States)

    Palm, Glen; Fagan, Jay

    2008-01-01

    Father involvement in early childhood programs (ECPs) has increased rapidly during the past 10-15 years. This review of our understanding of the current state of father involvement in ECPs employs two theoretical frameworks: ecological perspective and situated fathering. We draw from the research and practice literature to understand the current…

  10. Early intervention for stuttering: similarities and differences between two programs

    OpenAIRE

    Aumont-Boucand, V.; Millard, S.; Packman, A.

    2014-01-01

    In this paper, two proponents of different approaches to early stuttering discuss how they would manage a hypothetical case of stuttering in a preschool-age girl. Two evidence-based approaches are discussed: Palin Parent-Child Interaction Therapy and the Lidcombe Program. This paper arose from an oral discussion session held at the International Fluency Association Conference in Tours, France in 2012.

  11. Effects of botulinum toxin type A for spastic foot in post-stroke patients enrolled in a rehabilitation program

    Directory of Open Access Journals (Sweden)

    Leonardo Halley Carvalho Pimentel

    2014-01-01

    Full Text Available The objective of this study was to evaluate the effects of botulinum toxin type A (BTX-A on spastic foot in stroke patients in a rehabilitation program. Method: Hemiparetic stroke patients (n=21 enrolled in a rehabilitation program were divided into two groups. The first group (n=11 received a total of 300UI BTX-A, and the second group (n=10 received 100 UI BTX-A. All patients were assessed at baseline and 2, 4, 8 and 12 weeks after injection for Modified Ashworth Score, time walking 10 meters, and the Functional Independence Measure (mFIM motor score. Results: The higher-dose group exhibited a significant improvement in spasticity, and both groups showed an improvement in time walking 10 meters and mFIM, with no significant differences between them. Conclusions: Our findings suggest that gains in gait velocity and functional independence were not correlated to BTX-A dose.

  12. An Early Mobilization Protocol Successfully Delivers More and Earlier Therapy to Acute Stroke Patients: Further Results From Phase II of AVERT.

    NARCIS (Netherlands)

    van Wijk, Renske; Cumming, T.; Churilov, L.; Donnan, G.; Bernhardt, J.

    2012-01-01

    Background: The optimal physical therapy dose in acute stroke care is unknown. The authors hypothesized that physical therapy would be significantly different between treatment arms in a trial of very early and frequent mobilization (VEM) and that immobility-related adverse events would be

  13. The Next Step in Understanding Impaired Reactive Balance Control in People With Stroke: The Role of Defective Early Automatic Postural Responses

    NARCIS (Netherlands)

    Kam, D. de; Roelofs, J.M.B.; Bruijnes, A.; Geurts, A.C.; Weerdesteyn, V.G.M.

    2017-01-01

    BACKGROUND AND OBJECTIVE: Postural muscle responses are often impaired after stroke. We aimed to identify the contribution of deficits in very early postural responses to poorer reactive balance capacity, with a particular focus on reactive stepping as a key strategy for avoiding falls. METHODS: A

  14. 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.

  15. Post-acute referral of stroke victims in a French urban area: Results of a specific program.

    Science.gov (United States)

    Cassoudesalle, H; Nozères, A; Petit, H; Cressot, V; Muller, F; Rouanet, F; Sibon, I; Joseph, P-A; Dehail, P

    2016-09-01

    The main objective of this study was to describe the distribution of referrals offered to patients assessed in the "Post-Acute Stroke program" of Bordeaux University Hospital (France). This program was developed in 2008 to organize the dispensation of care in rehabilitation units specialized in neurological diseases. This was a single-centre observational study. Between July 2008 and December 2012, data on the number of stroke patients hospitalized at the Bordeaux University Hospital and their post-acute referral were collected from the local hospital discharge database. Some of these patients were assessed by Physical Rehabilitation and Medicine physicians participating in the program. Proposed and actual referrals, time from admission to assessment and functional status were also collected. Among 4189 stroke patients, 1465 (35%) survivors were assessed, of whom 932 (22.2%) were discharged to inpatient rehabilitation facilities. There were no patients discharged to this type of unit without an assessment. Among the 1465 patients who were assessed, 57.2% were referred to specialized rehabilitation units, 6.3% were discharged to non-specialized rehabilitation units and 26% returned home directly. The median total length of stay in acute units varied from 10 to 15days depending on referral orientation. Patients that were assessed were more likely to be transferred to specialized rehabilitation units than to non-specialized rehabilitation units. The Post-Acute Stroke program has the particularity of combining private and public specialized rehabilitation units in a common collaborative referral system while retaining the control and flexibility of personalised referral for each patient in the light of local care availability. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. Early administration of pyrrolidine dithiocarbamate extends the therapeutic time window of tissue plasminogen activator in a male rat model of embolic stroke.

    Science.gov (United States)

    Wang, Zhongxing; Shan, Weiran; Cao, Jiangbei; Wintermark, Max; Huang, Wenqi; Zuo, Zhiyi

    2018-03-01

    Tissue plasminogen activator (tPA) is used in fewer than 4% of patients after ischemic stroke because of its narrow therapeutic time window. We tested whether pyrrolidine dithiocarbamate (PDTC), a drug with multiple mechanisms to provide neuroprotection, can be used to extend the therapeutic time window of tPA. Three-month-old male Sprague-Dawley rats were subjected to embolic stroke in the area supplied by the right middle cerebral artery. tPA at 10 mg/kg was given intravenously 4 h after the onset of stroke. PDTC at 50 mg/kg was given via gastric gavage at 30 min or 4 h after the onset of stroke. Two days after the stroke, neurological outcome was evaluated and the right frontal cortex area 1 (Fr1), an ischemic penumbral region, was harvested for analysis. PDTC given at 30 min after the stroke reduced infarct volumes and improved neurological functions no matter whether the rats received tPA. PDTC also reduced tPA-increased hemorrhagic volumes. Consistent with these results, PDTC in the presence or absence of tPA treatment attenuated the increase of proinflammatory cytokines, oxidative stress and matrix metalloprotease 2 activity in the right Fr1. However, PDTC given at 4 h after the onset of stroke did not improve the neurological outcome of rats treated with or without tPA. Our results suggest that PDTC given at an early time point but not in a delayed phase provides neuroprotection against embolic stroke and may be used to extend the therapeutic time window of tPA. © 2017 Wiley Periodicals, Inc.

  17. Preschool Early Literacy Programs in Ontario Public Libraries

    Directory of Open Access Journals (Sweden)

    Shelley Stagg Peterson

    2012-12-01

    Full Text Available This paper reports on research examining how library staff in 10 Ontario libraries’ preschool literacy programs support three- and four-year-old children’s early literacy and school readiness as well as their parents’ and caregivers’ literacy interactions with their children. Multiple data sources included surveys of 82 parents/caregivers, observations of a sample of 65 of the 198 children at the sessions we visited, and interviews with10 library staff. Observations were analyzed for evidence of children’s development of print motivation, phonological awareness, vocabulary, narrative skills, and print awareness: early literacy skills and knowledge that have been shown to be reliably and significantly correlated with future reading success. Analysis of the observational and interview data showed that the programs have been very successful in fostering children’s readiness to participate in school activities and their motivation to read. Participating children learned new vocabulary, demonstrated an awareness of rhymes and sounds of language, and showed an understanding of books that were read by library staff: all early literacy behaviours that are foundational to later literacy development. The programs have also provided parents/caregivers with new ways to interact with children to engage them with books and with print at home. The development of children’s school readiness skills and parents’ awareness of how to support their children’s literacy are outcomes extending beyond library staff goals for their library programs and should be included in literature advertising the programs. Print awareness is an area of literacy development that library staff could encourage to a greater extent, however. Very few instances of such behaviour were observed, with most of the observations taking place in two of the preschool early literacy programs. Concomitantly, developing children’s print awareness is a recommended topic for

  18. Development of Pyriform Sinus Suctioning Programs for Aspiration Pneumonia Prevention During the Acute Stroke.

    Science.gov (United States)

    Inui, Yuki; Kamakura, Yayoi; Fukada, Junko; Yoneda, Masahiko; Kataoka, Emiko; Usami, Yasuko; Sugiura, Miki; Nagatani, Tetsuya; Seki, Yukio; Hatano, Norikazu; Yasui, Keizo

    2017-12-01

    Aspiration due to dysphagia is a factor associated with pneumonia during acute stroke. In such cases, it is likely that secretions in the pyriform sinuses enter the laryngeal inlet. The present study was based on the idea that it is possible to reduce aspiration pneumonia by periodically suctioning and removing such secretions (pyriform sinus suctioning), a study was conducted in a single facility. The incidence of pneumonia as a dependent variable was compared between before (control) and after (intervention group) intervention with pyriform sinus suctioning as an independent variable. With a view of unifying the quality and frequency of intervention, two programs to: initially confirm the safety of such suctioning; subsequently enhance/evaluate knowledge and skills related to the procedure (educational); and specify conditions for the implementation and criteria for determining its appropriateness (practical), were developed. The study involved 33 (mean age: 74.6 ± 12.4) and 30 (80.0 ± 8.8) control and intervention group members, respectively, 25 (83.3%) of the latter were treated with pyriform sinus suctioning for 5 days after a stroke. Pneumonia developed in 7 (21.2%) and 2 (6.7%) of the former and latter, respectively. As individuals with a Japan Coma Scale (JCS) score of III or a midline shift on head CT tend to develop pharyngeal dysphagia, the patients were also divided into 2 groups to compare the incidence of pneumonia based on the risk level: low: Japan Coma Scale scores of I-II without a midline shift on head CT; and high: scores of II-III with it. In the latter, the incidence after intervention was markedly lower (p = 0.06, φ = 0.326), while the former did not show changes (p = 0.574, φ = 0.066), supporting the effectiveness of pyriform sinus suctioning to prevent aspiration pneumonia among patients with a low risk level.

  19. Rehabilitation of a patient with stroke

    Directory of Open Access Journals (Sweden)

    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.

  20. Body mass index in early and middle adult life: prospective associations with myocardial infarction, stroke and diabetes over a 30-year period: the British Regional Heart Study.

    Science.gov (United States)

    Owen, Christopher G; Kapetanakis, Venediktos V; Rudnicka, Alicja R; Wathern, Andrea K; Lennon, Lucy; Papacosta, Olia; Cook, Derek G; Wannamethee, S Goya; Whincup, Peter H

    2015-09-15

    Adiposity in middle age is an established risk factor for cardiovascular disease and type 2 diabetes; less is known about the impact of adiposity from early adult life. We examined the effects of high body mass index (BMI) in early and middle adulthood on myocardial infarction (MI), stroke and diabetes risks. A prospective cohort study. 7735 men with BMI measured in middle age (40-59 years) and BMI ascertained at 21 years from military records or participant recall. 30-year follow-up data for type 2 diabetes, MI and stroke incidence; Cox proportional hazards models were used to examine the effect of BMI at both ages on these outcomes, adjusted for age and smoking status. Among 4846 (63%) men (with complete data), a 1 kg/m(2) higher BMI at 21 years was associated with a 6% (95% CI 4% to 9%) higher type 2 diabetes risk, compared with a 21% (95% CI 18% to 24%) higher diabetes risk for a 1 kg/m(2) higher BMI in middle age (hazard ratio (HR) 1.21, 95% CI 1.18 to 1.24). Higher BMI in middle age was associated with a 6% (95% CI 4% to 8%) increase in MI and a 4% (95% CI 1% to 7%) increase in stroke; BMI at 21 years showed no associations with MI or stroke risk. Higher BMI at 21 years of age is associated with later diabetes incidence but not MI or stroke, while higher BMI in middle age is strongly associated with all outcomes. Early obesity prevention may reduce later type 2 diabetes risk, more than MI and stroke. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Stroke Treatments

    Science.gov (United States)

    ... Month Infographic Stroke Hero F.A.S.T. Quiz Stroke Treatment Stroke used to rank fourth in leading causes of ... type of treatment depends on the type of stroke. Ischemic stroke happens when a clot blocks a ...

  2. [The effectiveness of early rehabilitation of the patients presenting with ischemic stroke].

    Science.gov (United States)

    Kulishova, T V; Shinkorenko, O V

    2014-01-01

    In this paper we evaluate the clinical effectiveness of rehabilitation of 92 patients who survived after acute ischemic stroke and received the combined treatment with the use of transcranial magnetic stimulation (the study group, n=32). The first control group (n=30) included the patients given transcranial magnetic stimulation in the function of placebo (n=30) and the second control group was comprised of the patients who received low-frequency magnetic therapy (n=30). The course of transcranial magnetic stimulation (TMS) resulted in the significant regression of the locomotor deficiency in the patients of the study group compared with those in both control groups (χ2>3,8). In addition, a significant decrease in anxiety and depression was documented in the patients of the study group. Dynamics of these characteristics in the patients of the control groups group was significantly less pronounced (χ2>3,8). The well apparent improvement of the cognitive function evaluated with the help of the MMSE test was observed in the patients of the study group and control group 2, but this effect of transcranial magnetic stimulation was significantly more pronounced than that of low-frequency magnetic therapy (χ2>3,8). Transcranial magnetic stimulation significantly normalized cerebral hemodynamics on the side of the stroke-affected hemisphere and improved the daily activities of the patients. Studying the long-term results within 6 months after the onset of rehabilitation in the hospital environment, most patients rated their health with improving. The evaluation of long-term results of the treatment during the 6 month rehabilitation period demonstrated that the majority of the patients reported the marked improvement of their health status.

  3. Uric Acid Therapy Prevents Early Ischemic Stroke Progression: A Tertiary Analysis of the URICO-ICTUS Trial (Efficacy Study of Combined Treatment With Uric Acid and r-tPA in Acute Ischemic Stroke).

    Science.gov (United States)

    Amaro, Sergio; Laredo, Carlos; Renú, Arturo; Llull, Laura; Rudilosso, Salvatore; Obach, Víctor; Urra, Xabier; Planas, Anna M; Chamorro, Ángel

    2016-11-01

    Identification of neuroprotective therapies in acute ischemic stroke is imperative. We report a predefined analysis of the URICO-ICTUS trial (Efficacy Study of Combined Treatment With Uric Acid and r-tPA in Acute Ischemic Stroke) assessing the efficacy of uric acid (UA) compared with placebo to prevent early ischemic worsening (EIW) and the relevance of collateral circulation. URICO-ICTUS was a double-blind, placebo-controlled, phase 2b trial where a total of 411 patients treated with alteplase within 4.5 hours of stroke onset were randomized (1:1) to receive UA 1000 mg (n=211) or placebo (n=200) before the end of alteplase infusion. EIW defined an increment ≥4 points in the National Institutes of Health Stroke Scale score within 72 hours of treatment in the absence of hemorrhage or recurrent stroke. Logistic regression models assessed the interaction between therapy and the collateral circulation in 112 patients who had a pretreatment computed tomographic angiography. EIW occurred in 2 of 149 (1%) patients with good outcome and 23 of 262 (9%) patients with poor outcome (χ 2 ; P=0.002). EIW occurred in 7 of 204 (3%) patients treated with UA and in 18 of 200 (9%) patients treated with placebo (χ 2 ; P=0.01). There was a significant interaction between the efficacy of UA to prevent EIW and collaterals (P=0.029), with lower incidence in patients with good collaterals treated with UA compared with placebo (2% versus 15%, respectively; P=0.048). UA therapy may prevent EIW after acute stroke in thrombolysed patients. Optimal access of UA to its molecular targets through appropriate collaterals may modify the magnitude of the neuroprotective effect. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00860366. © 2016 American Heart Association, Inc.

  4. Transition to Adolescence Program: A Program To Empower Early Adolescent Girls.

    Science.gov (United States)

    Saitzyk, Arlene R.; Poorman, Michele

    As girls approach early adolescence they begin to experience losses in self-competence and in authenticity in relationships. These girls hide their strengths for the sake of relationships. This study attempts to change this phenomenon through a 13-week small group intervention program, The Transition to Adolescence Program (TAP). TAP encourages…

  5. Early time course of N-acetylaspartate, creatine and phosphocreatine, and compounds containing choline in the brain after acute stroke. A proton magnetic resonance spectroscopy study

    DEFF Research Database (Denmark)

    Gideon, P; Henriksen, O; Sperling, B

    1992-01-01

    BACKGROUND AND PURPOSE: The early time course after acute stroke of cerebral N-acetylaspartate, creatine and phosphocreatine, and compounds containing choline was studied in vivo by means of localized water-suppressed proton magnetic resonance spectroscopy. METHODS: Eight patients with acute stroke...... were studied serially in the acute phase, 1 week after, and 2-4 weeks after the onset of clinical symptoms. Ten healthy volunteers served as controls. A stimulated echo (STEAM) sequence was used for measurement of the brain metabolites in a volume of interest located within the infarcted area...

  6. The Classroom Teacher and the Early Language Teacher Partnership: A Collaborative Teaching Model for Early Language Programs

    Science.gov (United States)

    Carracelas-Juncal, Carmen

    2010-01-01

    The demands on the early language teacher and the limited lesson time seem to be some of the reasons for the lack of learners' engagement in interpersonal communication in early language programs. Although the research on the role of the classroom teacher in early language programs is scarce, there is evidence that the classroom teacher can play a…

  7. [Effectiveness of an early discharge program after normal childbirth].

    Science.gov (United States)

    Teulón González, M; Martínez Pillado, M; Cuadrado Martín, M M; Rivero Martín, M J; Cerezuela Requena, J F

    To implement a program of early hospital discharge after an uncomplicated birth, in order to improve the effectiveness, as well as ensuring clinical safety and patient acceptability. Descriptive study of the effectiveness of an early discharge program after uncomplicated delivery between February 2012 and September 2013. The populations are post-partum women and newborns admitted to the University Hospital of Fuenlabrada, with a duration of less than 24h after uncomplicated delivery that met the defined inclusion criteria. Satisfaction was assessed using a Likert scale. The effectiveness of the program was monitored by safety indicators, productivity, adaptation, and continuity of care. A total of 20% of cases capable of early discharge from Fuenlabrada University Hospital completed the program. Almost all (94%) were normal deliveries. The 188 cases included were from 911 patients with uncomplicated childbirth, accounting for 6.5% of the 2,857 total births. The mean stay of patients included showed a decrease of 50% (2.4 to 1.2 days). All patients received continuity of care after hospital discharge. The review consultation was reprogrammed for 4.8% of cases, with 2% of patients re-admitted within 96h. with no serious problems. Four newborns (2%) required attention in the emergency department (mother or newborn) before 96h. The assessment of patient satisfaction achieved a score of 4.5 out of 5. The program achieved a decrease in the average stay by 50%, favouring the autonomy of midwives. This acceptance level is in line with similar interventions. The deployment of the program may be useful for other changes in care processes. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Early Stroke Rehabilitation of the Upper Limb Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation-Robotic Arm.

    Science.gov (United States)

    Qian, Qiuyang; Hu, Xiaoling; Lai, Qian; Ng, Stephanie C; Zheng, Yongping; Poon, Waisang

    2017-01-01

    Effective poststroke motor rehabilitation depends on repeated limb practice with voluntary efforts. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robot arm was designed for the multi-joint physical training on the elbow, the wrist, and the fingers. To investigate the training effects of the device-assisted approach on subacute stroke patients and to compare the effects with those achieved by the traditional physical treatments. This study was a pilot randomized controlled trial with a 3-month follow-up. Subacute stroke participants were randomly assigned into two groups, and then received 20-session upper limb training with the EMG-driven NMES-robotic arm (NMES-robot group, n  = 14) or the time-matched traditional therapy (the control, n  = 10). For the evaluation of the training effects, clinical assessments including Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), Action Research Arm Test (ARAT), and Function Independence Measurement (FIM) were conducted before, after the rehabilitation training, and 3 months later. Session-by-session EMG parameters in the NMES-robot group, including normalized co-contraction Indexes (CI) and EMG activation level of target muscles, were used to monitor the progress in muscular coordination patterns. Significant improvements were obtained in FMA (full score and shoulder/elbow), ARAT, and FIM [ P   0.279] for both groups. Significant improvement in FMA wrist/hand was only observed in the NMES-robot group ( P   0.24), and remained at an elevated level when assessed 3 months later. The EMG parameters indicated a release of muscle co-contraction in the muscle pairs of biceps brachii and flexor carpi radialis and biceps brachii and triceps brachii, as well as a reduction of muscle activation level in the wrist flexor in the NMES-robot group. The NMES-robot-assisted training was effective for early stroke upper limb rehabilitation and promoted independence in the daily

  9. Early Site Permit Demonstration Program: Plant parameters envelope report

    International Nuclear Information System (INIS)

    1993-03-01

    The Early Site Permit (ESP) Demonstration Program is the nuclear industry's initiative for piloting the early resolution of siting-related issues before the detailed design proceedings of the combined operating license review. The ESP Demonstration Program consists of three phases. The plant parameters envelopes task is part of Phase 1, which addresses the generic review of applicable federal regulations and develops criteria for safety and environmental assessment of potential sites. The plant parameters envelopes identify parameters that characterize the interface between an ALWR design and a potential site, and quantify the interface through values selected from the Utility Requirements Documents, vendor design information, or engineering assessments. When augmented with site-specific information, the plant parameters envelopes provide sufficient information to allow ESPs to be granted based on individual ALWR design information or enveloping design information for the evolutionary, passive, or generic ALWR plants. This document is expected to become a living document when used by future applicants

  10. Does a pre-hospital emergency pathway improve early diagnosis and referral in suspected stroke patients? – Study protocol of a cluster randomised trial [ISRCTN41456865

    Directory of Open Access Journals (Sweden)

    Lori Giuliano

    2005-10-01

    Full Text Available Abstract Background Early interventions proved to be able to improve prognosis in acute stroke patients. Prompt identification of symptoms, organised timely and efficient transportation towards appropriate facilities, become essential part of effective treatment. The implementation of an evidence based pre-hospital stroke care pathway may be a method for achieving the organizational standards required to grant appropriate care. We performed a systematic search for studies evaluating the effect of pre-hospital and emergency interventions for suspected stroke patients and we found that there seems to be only a few studies on the emergency field and none about implementation of clinical pathways. We will test the hypothesis that the adoption of emergency clinical pathway improves early diagnosis and referral in suspected stroke patients. We designed a cluster randomised controlled trial (C-RCT, the most powerful study design to assess the impact of complex interventions. The study was registered in the Current Controlled Trials Register: ISRCTN41456865 – Implementation of pre-hospital emergency pathway for stroke – a cluster randomised trial. Methods/design Two-arm cluster-randomised trial (C-RCT. 16 emergency services and 14 emergency rooms were randomised either to arm 1 (comprising a training module and administration of the guideline, or to arm 2 (no intervention, current practice. Arm 1 participants (152 physicians, 280 nurses, 50 drivers attended an interactive two sessions course with continuous medical education CME credits on the contents of the clinical pathway. We estimated that around 750 patients will be met by the services in the 6 months of observation. This duration allows recruiting a sample of patients sufficient to observe a 30% improvement in the proportion of appropriate diagnoses. Data collection will be performed using current information systems. Process outcomes will be measured at the cluster level six months after the

  11. [Precautionary study on acupuncture pretreatment for stroke at the early stage].

    Science.gov (United States)

    Yu, Nian-Tang; Han, Wei; Zhang, Ling; Zhu, Ling-Ling; Wang, Qing-Wei; Zhang, Guo-Qing; Liu, Bai-Yun

    2013-11-01

    To assess the clinical efficacy of acupuncture pretreatment for the prevention of stroke based on promoting the circulation of the Governor Vessel and regulating mentality, and explore its effect mechanism. Seventy cases of transient ischemic attack (TIA) were randomized into an acupuncture group (35 cases) and a western medicine group (35 cases). In the acupuncture group, acupuncture therapy of promoting the circulation of the Governor Vessel and regulating mentality was applied at Yaoyangguan (GV 3), Mingmen (GV 4), Zhiyang (GV 9), Shenzhu (GV 12), Dazhui (GV 14), Yamen (GV 15), Fengfu (GV 16), Baihui (GV 20) and Neck-Jiaji (EX-B 2). Acupuncture was given 6 times a week, at the interval of one day between two weeks. Totally, 21 days of treatment were taken as a session. In the western medicine group, aspirin enteric coated tablets were prescribed, 25 mg/tablet, 100 mg/day, once a night for oral administration, and 21 days of medication were taken as 1 session. There were 3 days at the interval between two sessions in each group and totally 2 sessions were required. Transcranial Doppler (TCD) was adopted before treatment and in two sessions of treatment to observe, mean flow velocity (Vm) of middle cerebral artery (MCA), vertebral artery (VA), basilar arte ry (BA) and pulsatility index (PI). The standard of the efficacy assessment of stroke aura was taken as the main efficacy index in the assessment of theraputic effect, the adverse reaction was observed. 1In TIA, MCA blood flow was accelerated in internal carotid system, and BA blood flow was accelerated in vertebral-basilar artery system. The treatments in the two groups enabled the blood flow in the responsible blood vessels slow down and the results in the acupuncture group L(60. 54+/-11.76)cm/s, (36. 17+/-8. 65)cm/s] were better than those in the western medicine group [(72. 34+/-9. 15)cm/s,(65. 23 +/-8. 99)cm/s] (Pacupuncture group [96. 77% (30/31),6. 45% (2/31)] were superior to the western medicine group

  12. Cognitive Impairments and Depressive Symptoms Did Not Impede Upper Extremity Recovery in a Clinical Repetitive Task Practice Program after Stroke

    Science.gov (United States)

    Skidmore, Elizabeth R.; Becker, James T.; Whyte, Ellen M.; Huber, Lynne M.; Waterstram, Laura F.; Ward, Amalie Andrew; Grattan, Emily S.; Holm, Margo B.

    2012-01-01

    Objective We examined whether cognitive impairments or depressive symptoms impeded improvement in upper extremity function in a clinical repetitive task practice program. Design Participants had mild to moderate upper extremity impairment after stroke (n=20). We characterized baseline cognitive function and depressive symptoms with the Repeatable Battery of Neuropsychological Status and the Hamilton Rating Scale for Depression. We measured upper extremity function at baseline, week 4 and week 24 with the Action Research Arm Test. Results Participants with and without cognitive impairments improved significantly over time (F1,17=84.48, pstroke (t17=.07, p=.95). Participants with and without depressive symptoms improved significantly over time (F1,18=86.29, pstroke (t17=.06, p=.95). Conclusions Preliminary findings suggest that cognitive impairments and depressive symptoms may not impede benefit from repetitive task practice after stroke. PMID:22311057

  13. [The Effect of a Movie-Based Nursing Intervention Program on Rehabilitation Motivation and Depression in Stroke Patients].

    Science.gov (United States)

    Kwon, Hye Kyung; Lee, Sook Ja

    2017-06-01

    The aim of this study was to develop and measure the effect of a movie-based-nursing intervention program designed to enhance motivation for rehabilitation and reduce depression levels in stroke patients. The study used a quasi-experimental, nonequivalent control group and a pretest-posttest design. The 60 research subjects were assigned to the experimental (n=30) or control group (n=30). The moviebased nursing intervention program was provided for the experimental group during 60-minute sessions held once per week for 10 weeks. The program consisted of patient education to strengthen motivation for rehabilitation and reduce depression, watching movies to identify role models, and group discussion to facilitate therapeutic interaction. After 10 weeks of participation in the movie-based nursing intervention program, the experimental group's rehabilitation motivation score was significantly higher, F=1161.54 (within groups df=49, between groups df=1), pnursing intervention program could be used for stroke patients experiencing psychological difficulties including reduced motivation for rehabilitation and increased depression during the rehabilitation process. © 2017 Korean Society of Nursing Science

  14. 2018 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)

    Powers, William J; Rabinstein, Alejandro A; Ackerson, Teri; Adeoye, Opeolu M; Bambakidis, Nicholas C; Becker, Kyra; Biller, José; Brown, Michael; Demaerschalk, Bart M; Hoh, Brian; Jauch, Edward C; Kidwell, Chelsea S; Leslie-Mazwi, Thabele M; Ovbiagele, Bruce; Scott, Phillip A; Sheth, Kevin N; Southerland, Andrew M; Summers, Deborah V; Tirschwell, David L

    2018-03-01

    The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight Committee and Stroke Council Leadership Committee. These guidelines use the American College of Cardiology/American Heart Association 2015 Class of Recommendations and Levels of Evidence and the new American Heart Association guidelines format. These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke. © 2018 American Heart Association, Inc.

  15. Clinical efficacy and prognostic indicators for lower limb pedalling exercise early after stroke: Study protocol for a pilot randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Myint Phyo

    2011-03-01

    Full Text Available Abstract Background It is known that repetitive, skilled, functional movement is beneficial in driving functional reorganisation of the brain early after stroke. This study will investigate a whether pedalling an upright, static exercise cycle, to provide such beneficial activity, will enhance recovery and b which stroke survivors might be able to participate in pedalling. Methods/Design Participants (n = 24 will be up to 30 days since stroke onset, with unilateral weakness and unable to walk without assistance. This study will use a modified exercise bicycle fitted with a UniCam crank. All participants will give informed consent, then undergo baseline measurements, and then attempt to pedal. Those able to pedal will be entered into a single-centre, observer-blinded randomised controlled trial (RCT. All participants will receive routine rehabilitation. The experimental group will, in addition, pedal daily for up to ten minutes, for up to ten working days. Prognostic indicators, measured at baseline, will be: site of stroke lesion, trunk control, ability to ambulate, and severity of lower limb paresis. The primary outcome for the RCT is ability to voluntarily contract paretic lower limb muscle, measured by the Motricity Index. Secondary outcomes include ability to ambulate and timing of onset and offset of activity in antagonist muscle groups during pedalling, measured by EMG. Discussion This protocol is for a trial of a novel therapy intervention. Findings will establish whether there is sufficient evidence of benefit to justify proceeding with further research into clinical efficacy of upright pedalling exercise early after stroke. Information on potential prognostic indicators will suggest which stroke survivors could benefit from the intervention. Trial Registration ISRCTN: ISRCTN45392701

  16. Feedback-controlled robotics-assisted treadmill exercise to assess and influence aerobic capacity early after stroke: a proof-of-concept study.

    Science.gov (United States)

    Stoller, Oliver; Schindelholz, Matthias; Bichsel, Lukas; Schuster, Corina; de Bie, Rob A; de Bruin, Eling D; Hunt, Kenneth J

    2014-07-01

    The majority of post-stroke individuals suffer from low exercise capacity as a secondary reaction to immobility. The aim of this study was to prove the concept of feedback-controlled robotics-assisted treadmill exercise (RATE) to assess aerobic capacity and guide cardiovascular exercise in severely impaired individuals early after stroke. Subjects underwent constant load and incremental exercise testing using a human-in-the-loop feedback system within a robotics-assisted exoskeleton (Lokomat, Hocoma AG, CH). Inclusion criteria were: stroke onset ≤8 weeks, stable medical condition, non-ambulatory status, moderate motor control of the lower limbs and appropriate cognitive function. Outcome measures included oxygen uptake kinetics, peak oxygen uptake (VO2peak), gas exchange threshold (GET), peak heart rate (HRpeak), peak work rate (Ppeak) and accuracy of reaching target work rate (P-RMSE). Three subjects (18-42 d post-stroke) were included. Oxygen uptake kinetics during constant load ranged from 42.0 to 60.2 s. Incremental exercise testing showed: VO2peak range 19.7-28.8 ml/min/kg, GET range 11.6-12.7 ml/min/kg, and HRpeak range 115-161 bpm. Ppeak range was 55.2-110.9 W and P-RMSE range was 3.8-7.5 W. The concept of feedback-controlled RATE for assessment of aerobic capacity and guidance of cardiovascular exercise is feasible. Further research is warranted to validate the method on a larger scale. Aerobic capacity is seriously reduced in post-stroke individuals as a secondary reaction to immobility. Robotics-assisted walking devices may have substantial clinical relevance regarding assessment and improvement of aerobic capacity early after stroke. Feedback-controlled robotics-assisted treadmill exercise represents a new concept for cardiovascular assessment and intervention protocols for severely impaired individuals.

  17. A randomized controlled trial of surface neuromuscular electrical stimulation applied early after acute stroke: effects on wrist pain, spasticity and contractures.

    Science.gov (United States)

    Malhotra, Shweta; Rosewilliam, Sheeba; Hermens, Hermie; Roffe, Christine; Jones, Peter; Pandyan, Anand David

    2013-07-01

    To investigate effects of surface neuromuscular electrical stimulation applied early after stroke to the wrist and finger extensor muscles on upper limb pain, spasticity and contractures in patients with no functional arm movement. Secondary analysis from a Phase II, randomized, controlled, single-blind study. An acute hospital stroke unit. Patients with no useful arm function within six weeks of a first stroke. Patients were randomized to treatment (30-minute sessions of surface neuromuscular stimulation to wrist and finger extensors and 45 minutes of physiotherapy) or control (45 minutes of physiotherapy) groups. All patients had access to routine care. Treatment was given for six weeks from recruitment. Ninety patients (49% male, median age 74 years (range 32-98), median time since stroke onset three weeks (range one to six weeks)) were included. Treatment compliance was variable (mean 28%). The treatment prevented the development of pain (mean difference in rate of change 0.4 units/week, 95% confidence interval (CI) 0.09 to 0.6). Treatment may have prevented a deterioration in contractures (quantified by measuring passive range of movement) in severely disabled patients (mean rate of deterioration -0.5 deg/week; 95% CI -0.9 to -0.06). There were no significant changes in stiffness and spasticity. Surface neuromuscular electrical stimulation reduces pain in stroke patients with a non-functional arm. There was some evidence that treatment with electrical stimulation was beneficial in reducing contractures. Treatment had no effect on spasticity.

  18. Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED).

    Science.gov (United States)

    Towfighi, Amytis; Cheng, Eric M; Ayala-Rivera, Monica; McCreath, Heather; Sanossian, Nerses; Dutta, Tara; Mehta, Bijal; Bryg, Robert; Rao, Neal; Song, Shlee; Razmara, Ali; Ramirez, Magaly; Sivers-Teixeira, Theresa; Tran, Jamie; Mojarro-Huang, Elizabeth; Montoya, Ana; Corrales, Marilyn; Martinez, Beatrice; Willis, Phyllis; Macias, Mireya; Ibrahim, Nancy; Wu, Shinyi; Wacksman, Jeremy; Haber, Hilary; Richards, Adam; Barry, Frances; Hill, Valerie; Mittman, Brian; Cunningham, William; Liu, Honghu; Ganz, David A; Factor, Diane; Vickrey, Barbara G

    2017-02-06

    Recurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population. In this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial

  19. Early carotid surgery in patients after acute ischemic stroke: is it safe? A retrospective analysis in a single center between early and delayed/deferred carotid surgery on 285 patients.

    Science.gov (United States)

    Ferrero, Emanuele; Ferri, Michelangelo; Viazzo, Andrea; Gaggiano, Andrea; Ferrero, Margherita; Maggio, Daniele; Berardi, Giuseppe; Pecchio, Alberto; Piazza, Salvatore; Cumbo, Pia; Nessi, Franco

    2010-10-01

    The early risk of stroke after transient ischemic attack (TIA)/stroke is of the order of 5-10% at 1 week and 10-20% at 3 months. Even if carotid endarterectomy (CEA) is the treatment of choice in symptomatic internal carotid artery stenosis, the timing of carotid intervention after acute stroke is not yet codified. The authors want to determinate whether early CEA is safely carried out in the first few hours (stroke/death) in these cases is comparable with the results of those treated by delayed/deferred surgery (range, 48 hours-24 weeks). In 4 years, the authors performed 1,184 CEA (285 symptomatic). Five groups were formed from 285 symptomatic patients, according to interval between TIA/stroke onset and performance of CEA: G1, less than 48 hours; G2, 48 hours-2 weeks; G3, 2-4 weeks; G4, 4-8 weeks; G5, 8-24 weeks. Surgery was never performed on patients with disabling neurological deficit (modified Rankin Scale, 5) at the time of admittance, cerebral lesions greater than 3 cm at magnetic resonance/computed tomography scan, presence or suspect of parenchymal hemorrhage associated with ischemic damage, condition considered unfit for surgery (American Society of Anesthesiology classification grade V), and occlusion of the cerebral middle artery. Neurological and diagnostic examinations (duplex-scanning and computed tomography/magnetic resonance scan) were used in determining the selection for early CEA. Cumulative TIA/stroke/death rate after CEA was 3.8% (11/285) and at 30 days was 2.8% (8/285). The cumulative TIA rate after CEA and at 30 days was 0% (0/285). The cumulative stroke rate after CEA was 3.5% (10/285) and at 30 days was 2.4% (7/285). The cumulative death rate after CEA and at 30 days was 0.3% (1/285). Stroke rate after CEA in each group was: G1 4.2% (3/70); G2 3.2% (2/61); G3 0% (0/22); G4 3.4% (1/29); G5 3.8% (4/103). Any statistically significant difference between G1 and the other four groups was not detected with regard to postoperative stroke: G1 (4

  20. Lasting effect of an oral hygiene care program for patients with stroke during in-hospital rehabilitation: a randomized single-center clinical trial.

    Science.gov (United States)

    Kim, Eun-Kyong; Park, Eun Young; Sa Gong, Jung-Whan; Jang, Sung-Ho; Choi, Youn-Hee; Lee, Hee-Kyung

    2017-11-01

    Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge. In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at three- to four-day intervals five times during the hospitalization period. After OHCP, oral hygiene status including the plaque index, calculus index, and O'Leary plaque index improved significantly in the intervention group, compared to the control group (p oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital. Implications for Rehabilitation Initial oral hygiene status and plaque control performance were poor in stroke patients who were in rehabilitation center. An oral hygiene care program during in-hospital rehabilitation was effective in improving oral hygiene status and plaque control performance among stroke patients at three months after discharge. Repeated tooth brushing education and professional tooth cleaning were necessary to improve plaque control performance of stroke patients.

  1. Epigenetic Changes in the Methylation Patterns of KCNQ1 and WT1 after a Weight Loss Intervention Program in Obese Stroke Patients.

    Science.gov (United States)

    Abete, Itziar; Gómez-Úriz, Ana M; Mansego, María L; De Arce, Ana; Goyenechea, Estíbaliz; Blázquez, Vanessa; Martínez-Zabaleta, Maria T; González-Muniesa, Pedro; López De Munain, Adolfo; Martínez, J Alfredo; Campión, Javier; Milagro, Fermin I

    2015-01-01

    Ischemic stroke patients often show high concentrations of circulating inflammatory markers that are associated with increased risk of recurrence. Epigenetic mechanisms could be involved in obesity, inflammation and stroke. The objective of this research was to investigate, in obese patients suffering a previous stroke, the effects of a nutritional program on anthropometric and biochemical variables, and on the methylation patterns of two stroke-related genes (KCNQ1: potassium channel, voltage gated KQT-like subfamily Q, member 1; and WT1: Wilms tumor 1). Twenty-two ischemic stroke patients were compared with a control group composed of eighteen obese subjects with similar age and body mass index ranges. Both groups followed a 20-week nutritional program based on an energy-restricted balanced diet with high adherence to the Mediterranean dietary pattern. The intervention significantly improved anthropometric and metabolic variables, such as the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and C-reactive protein concentration, in ischemic stroke patients, and was accompanied by changes in the methylation patterns of both stroke-related genes, which correlated with anthropometric and biochemical variables.

  2. Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke.

    Science.gov (United States)

    Smith, Eric E; Kent, David M; Bulsara, Ketan R; Leung, Lester Y; Lichtman, Judith H; Reeves, Mathew J; Towfighi, Amytis; Whiteley, William N; Zahuranec, Darin B

    2018-03-01

    Dysphagia screening protocols have been recommended to identify patients at risk for aspiration. The American Heart Association convened an evidence review committee to systematically review evidence for the effectiveness of dysphagia screening protocols to reduce the risk of pneumonia, death, or dependency after stroke. The Medline, Embase, and Cochrane databases were searched on November 1, 2016, to identify randomized controlled trials (RCTs) comparing dysphagia screening protocols or quality interventions with increased dysphagia screening rates and reporting outcomes of pneumonia, death, or dependency. Three RCTs were identified. One RCT found that a combined nursing quality improvement intervention targeting fever and glucose management and dysphagia screening reduced death and dependency but without reducing the pneumonia rate. Another RCT failed to find evidence that pneumonia rates were reduced by adding the cough reflex to routine dysphagia screening. A smaller RCT randomly assigned 2 hospital wards to a stroke care pathway including dysphagia screening or regular care and found that patients on the stroke care pathway were less likely to require intubation and mechanical ventilation; however, the study was small and at risk for bias. There were insufficient RCT data to determine the effect of dysphagia screening protocols on reducing the rates of pneumonia, death, or dependency after stroke. Additional trials are needed to compare the validity, feasibility, and clinical effectiveness of different screening methods for dysphagia. © 2018 American Heart Association, Inc.

  3. The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: A randomized controlled study.

    Science.gov (United States)

    Umay, Ebru K; Yaylaci, Atilay; Saylam, Guleser; Gundogdu, Ibrahim; Gurcay, Eda; Akcapinar, Dehen; Kirac, Zeynep

    2017-01-01

    Dysphagia is a serious cause of morbidity and mortality in stroke patients. As the first study in literature, we aimed to evaluate the effects of sensory-level electrical stimulation (SES) to bilateral masseter muscles in early stroke patients with dysphagia. This study was conducted at the Physical Medicine and Rehabilitation Clinic of our hospital between 2013 and 2015. Ninety-eight patients with dysphagia within the first month after ischemic stroke were included in this study. Patients were evaluated by bedside screening tests (Bedside Dysphagia Score, Neurological Examination Dysphagia Score, Total Dysphagia Score, and Mann Assessment of Swallowing Ability test) and by flexible fibreoptic endoscopic evaluation of swallowing (FEES) methods. All patients were included in a traditional swallowing therapy. Patients were divided into two groups, namely the "stimulation group" and "sham group." SES was applied to bilateral masseter muscles. Evaluation parameters were compared between the groups before and after therapy. The Friedman test, Wilcoxon Signed Rank test, Mann-Whitney U test, and Fisher exact test were used in this study. There was a significant improvement in dysphagia severity scores evaluated by bedside screening tests and FEES in cognitive and total functionality levels except in motor functional independence level in the stimulation group. In the sham group, there were no significant changes in the evaluation parameters. SES applied to bilateral masseter muscles may provide an effective treatment for both dysphagia and cognitive function in early stroke patients.

  4. Effects of a training program based on the proprioceptive neuromuscular facilitation method on post-stroke motor recovery: a preliminary study.

    Science.gov (United States)

    Ribeiro, Tatiana Souza; de Sousa e Silva, Emília Márcia Gomes; Sousa Silva, Wagner Henrique; de Alencar Caldas, Vescia Vieira; Silva, Diana Lídice Araújo; Costa Cavalcanti, Fabrícia Azevedo; Lindquist, Ana Raquel Rodrigues

    2014-10-01

    This preliminary study sought to analyze the effects of a training program based on the Proprioceptive Neuromuscular Facilitation (PNF) method on motor recovery of individuals with chronic post-stroke hemiparesis. Eleven individuals with chronic hemiparesis (mean lesion time of 19.64 months) after unilateral and non-recurrent stroke underwent training based on PNF method for twelve sessions, being evaluated for motor function - using the Stroke Rehabilitation Assessment of Movement (STREAM) instrument; functionality, by the Functional Independence Measure (FIM); and gait kinematic (using the Qualisys Motion Capture System), at baseline and post-training. Significant changes in FIM (from median 67 to median 68; P = .043) and STREAM scores (from median 47 to median 55; P = .003) were observed. Data showed significant changes in motor function and functionality after training, suggesting that this program can be useful for rehabilitation of chronic stroke survivors. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Early Life Nutrition, Epigenetics and Programming of Later Life Disease

    Directory of Open Access Journals (Sweden)

    Mark H. Vickers

    2014-06-01

    Full Text Available The global pandemic of obesity and type 2 diabetes is often causally linked to marked changes in diet and lifestyle; namely marked increases in dietary intakes of high energy diets and concomitant reductions in physical activity levels. However, less attention has been paid to the role of developmental plasticity and alterations in phenotypic outcomes resulting from altered environmental conditions during the early life period. Human and experimental animal studies have highlighted the link between alterations in the early life environment and increased risk of obesity and metabolic disorders in later life. This link is conceptualised as the developmental programming hypothesis whereby environmental influences during critical periods of developmental plasticity can elicit lifelong effects on the health and well-being of the offspring. In particular, the nutritional environment in which the fetus or infant develops influences the risk of metabolic disorders in offspring. The late onset of such diseases in response to earlier transient experiences has led to the suggestion that developmental programming may have an epigenetic component, as epigenetic marks such as DNA methylation or histone tail modifications could provide a persistent memory of earlier nutritional states. Moreover, evidence exists, at least from animal models, that such epigenetic programming should be viewed as a transgenerational phenomenon. However, the mechanisms by which early environmental insults can have long-term effects on offspring are relatively unclear. Thus far, these mechanisms include permanent structural changes to the organ caused by suboptimal levels of an important factor during a critical developmental period, changes in gene expression caused by epigenetic modifications (including DNA methylation, histone modification, and microRNA and permanent changes in cellular ageing. A better understanding of the epigenetic basis of developmental programming and how

  6. Early life nutrition, epigenetics and programming of later life disease.

    Science.gov (United States)

    Vickers, Mark H

    2014-06-02

    The global pandemic of obesity and type 2 diabetes is often causally linked to marked changes in diet and lifestyle; namely marked increases in dietary intakes of high energy diets and concomitant reductions in physical activity levels. However, less attention has been paid to the role of developmental plasticity and alterations in phenotypic outcomes resulting from altered environmental conditions during the early life period. Human and experimental animal studies have highlighted the link between alterations in the early life environment and increased risk of obesity and metabolic disorders in later life. This link is conceptualised as the developmental programming hypothesis whereby environmental influences during critical periods of developmental plasticity can elicit lifelong effects on the health and well-being of the offspring. In particular, the nutritional environment in which the fetus or infant develops influences the risk of metabolic disorders in offspring. The late onset of such diseases in response to earlier transient experiences has led to the suggestion that developmental programming may have an epigenetic component, as epigenetic marks such as DNA methylation or histone tail modifications could provide a persistent memory of earlier nutritional states. Moreover, evidence exists, at least from animal models, that such epigenetic programming should be viewed as a transgenerational phenomenon. However, the mechanisms by which early environmental insults can have long-term effects on offspring are relatively unclear. Thus far, these mechanisms include permanent structural changes to the organ caused by suboptimal levels of an important factor during a critical developmental period, changes in gene expression caused by epigenetic modifications (including DNA methylation, histone modification, and microRNA) and permanent changes in cellular ageing. A better understanding of the epigenetic basis of developmental programming and how these effects may be

  7. Comparison of Two Post-Stroke Rehabilitation Programs: A Follow-Up Study among Primary versus Specialized Health Care.

    Directory of Open Access Journals (Sweden)

    Remedios López-Liria

    Full Text Available To compare home-based rehabilitation (RITH and standard outpatient rehabilitation in a hospital setting, in terms of improving the functional recovery and quality of life of stroke patients.This was a prospective cohort study in Andalusia (Spain.One hundred and forty-five patients completed the outcome data.Daily activities were measured by the Barthel index, Canadian Neurological Scale (to assess mental state, Tinetti scale (balance and gait, and Short Form Health Survey-36 (SF-36 to compare the quality of life.No statistically significant differences were found between the two groups regarding the clinical characteristics of patients in the initial measurement, except for age and mental state (younger and with greater neurological impairment in the hospital group. After physical therapy, both groups showed statistically significant improvements from baseline in each of the measures. These improvements were better in RITH patients than in the hospital patients on all functionality scales with a smaller number of sessions.Home rehabilitation is at least as effective as the outpatient rehabilitation programs in a hospital setting, in terms of recovery of functionality in post-stroke patients. Overall quality of life is severely impaired in both groups, as stroke is a very disabling disease that radically affects patients' lives.

  8. Comparison of Two Post-Stroke Rehabilitation Programs: A Follow-Up Study among Primary versus Specialized Health Care.

    Science.gov (United States)

    López-Liria, Remedios; Vega-Ramírez, Francisco Antonio; Rocamora-Pérez, Patricia; Aguilar-Parra, José Manuel; Padilla-Góngora, David

    2016-01-01

    To compare home-based rehabilitation (RITH) and standard outpatient rehabilitation in a hospital setting, in terms of improving the functional recovery and quality of life of stroke patients. This was a prospective cohort study in Andalusia (Spain). One hundred and forty-five patients completed the outcome data. Daily activities were measured by the Barthel index, Canadian Neurological Scale (to assess mental state), Tinetti scale (balance and gait), and Short Form Health Survey-36 (SF-36 to compare the quality of life). No statistically significant differences were found between the two groups regarding the clinical characteristics of patients in the initial measurement, except for age and mental state (younger and with greater neurological impairment in the hospital group). After physical therapy, both groups showed statistically significant improvements from baseline in each of the measures. These improvements were better in RITH patients than in the hospital patients on all functionality scales with a smaller number of sessions. Home rehabilitation is at least as effective as the outpatient rehabilitation programs in a hospital setting, in terms of recovery of functionality in post-stroke patients. Overall quality of life is severely impaired in both groups, as stroke is a very disabling disease that radically affects patients' lives.

  9. A retrospective observational study of functional outcomes, length of stay, and discharge disposition after an inpatient stroke rehabilitation program in Saudi Arabia.

    Science.gov (United States)

    Bindawas, Saad M; Mawajdeh, Hussam; Vennu, Vishal; Alhaidary, Hisham

    2016-08-01

    Functional outcomes, length of stay (LOS), and discharge disposition have become frequent outcome measures among stroke patients after rehabilitation programs. To examine the trends of changes in functional outcomes, LOS, and discharge disposition in stroke patients discharged from an inpatient rehabilitation facility.All patients (n = 432) were admitted to a tertiary inpatient rehabilitation hospital in Riyadh, Saudi Arabia with stroke diagnoses from November 2008 to December 2014. The functional independence measure (FIM) instrument used to assess the patient's functional status. The LOS was measured as the number of days the patients spent in the hospital from the day of admission to the day of discharge. The FIM efficiency was used to measure the patient's rehabilitation progress. All of the variables of the prospectively collected data were retrospectively analyzed.There were significant changes by years in the total FIM ranging from 23 to 29 (P stroke have improved after an inpatient stroke rehabilitation program between 2008 and 2014 even with a constant LOS. Discharge disposition has remained unstable over this period. To improve the efficiency of the stroke rehabilitation program in Saudi Arabia, there is a need to decrease the LOS and emphasize a comprehensive interdisciplinary approach.

  10. Effect of a Structured Sensory Stimulation Program on the Sensory Function of Patients with Stroke-induced Disorder of Consciousness

    Directory of Open Access Journals (Sweden)

    Khadijeh Sargolzaei

    2017-07-01

    Full Text Available Background: About 50% of stroke patients suffer from the disorder of consciousness with such adverse effects as sensory deprivation. The provision of a care program consisting of simple and safe stimulations can prevent sensory deprivation and improve the patient’s sensory function. Aim: This study aimed to determine the effect of structured sensory stimulation program on the sensory function of the patients with stroke-induced disorder of consciousness. Method: This randomized clinical trial was conducted on 80 patients with stroke-induced disorder of consciousness admitted to the Intensive Care Unit and Emergency Department of Ghaem Hospital, Mashhad, Iran, in 2016. The participants were randomly assigned into two groups of control and intervention. The patients in the intervention group were subjected to a sensory stimulation program consisting of auditory, visual, olfactory, gustatory, tactile, and motor stimulations for 14 consecutive days. The sensory function was measured every day before and after the intervention using the Sensory Modality Assessment and Rehabilitation Technique (SMART instrument. On the other hand, the control group received the routine care. The data were analyzed in the SPSS version 11.5 using the Mann-Whitney test, Chi-square test, and independent t-test. Results: According to the results, the patients in the intervention and control groups had the mean ages of 66.2±8.9 and 63.8±10.8, respectively. The pre-intervention SMART scores of the two groups were homogenous (P=0.23. However, the independent t-test showed that the final SMART score was significantly higher (P

  11. Blink Reflex as a Complementary Test to MRI in Early Detection of Brainstem Infarctions: Comparison of Blink Reflex Abnormalities in Anterior Versus Posterior Circulation Strokes

    Directory of Open Access Journals (Sweden)

    K Basiri

    2004-08-01

    Full Text Available Background: Early detection of vertebro-basilar insufficiency is of paramount importance. Brain MRI was the only method of diagnosis for many years, but in addition to high cost and delay in report, it may not detect all brain stem lesions. In this study Blink reflex (BR was evaluated as a complementary test to MRI. Methods: Fifty-four patients were studied [27 anterior circulation stroke patients (ACSP and 27 posterior circulation stroke patients (PCSP]. MRI was performed within the first week after the onset of stroke. Nineteen age and sex matched healthy people enrolled as controls. BR was performed within the first 24 hours of the onset. Frequency of abnormal blink reflex in ACSP and PCSP was compared with MRI findings. Then abnormal responses in two groups were compared by chi-square test. Results: In both ACSP and PCSP, two patients had normal BR responses, and in 25 patients R1 or R2 components of blink responses were absent or prolonged (92.5%. R1was absent or delayed in 16 PCSP, but it was abnormal in only two ACSP (P < 0.001. Abnormal R2 responses were detected in 22 PCSP and 24 ACSP. Conclusion: BR abnormalities had high correlation with MRI findings in PCSP (92.5% BR can be performed within the first 24 hours of onset of stroke, and its results is available immediately. This test is easy to perform and comfortable for the patient, has low cost, and is available every where. Therefore we introduced BR as a complementary (but not replacing test to MRI in early detection of brainstem infarctions. Comparison of BR responses in ACSP and PCSP showed that abnormalities of R1 responses had high accuracy in differentiation between anterior and posterior circulation strokes. We concluded that BR responses not only can detect brainstem infarctions rapidly and readily in its early stages, but also can differentiate ACSP from PCSP with high accuracy. Keywords: Blink Reflex, Anterior Circulation Stroke, Posterior Circulation Stroke Patients

  12. THE EARLY VIOLENCE PREVENTION: REVISION OF PROGRAMS AND INTERVENTION MODALITIES

    Directory of Open Access Journals (Sweden)

    JUANITA HENAO ESCOBAR

    2005-07-01

    Full Text Available The article presents a review of different kinds of international early violence prevention-intervention programs,which have shown effectiveness in the reduction of preschooler’s aggression, and in some cases, in the prevention ofviolent behavior during adolescence and youth. The central matter of this article is what we can learn from theexperiences on this field of knowledge around the world. First, the target intervention problem is presented andframed in the colombian context. After presenting the main research findings about aggressive behavior in childrenand the risk factors associated with it, the related intervention modalities will be analyzed and described. Finally, thearticle derives some pragmatic conclusions and recommendations.

  13. Integrated Pest Management: A Curriculum for Early Care and Education Programs

    Science.gov (United States)

    California Childcare Health Program, 2011

    2011-01-01

    This "Integrated Pest Management Toolkit for Early Care and Education Programs" presents practical information about using integrated pest management (IPM) to prevent and manage pest problems in early care and education programs. This curriculum will help people in early care and education programs learn how to keep pests out of early…

  14. Improvement in visibility and detectability of early sign of acute stroke in nonenhanced CT images by using an adaptive partial smoothing filter

    International Nuclear Information System (INIS)

    Takahashi, Noriyuki; Ishii, Kiyoshi; Kamio, Souichiro; Lee, Yongbum; Tsai, Du-Yih

    2005-01-01

    Detection of early infarct signs on nonenhanced CT is mandatory in patients with acute ischemic stroke. Loss of the gray-white matter interface at the lentiform nucleus or the insular ribbon has been an important early infarct sign, which affects decisions on thrombolytic therapy. However, its detection is difficult, since early infarct sign is of subtle hypoattenuation. To improve the detectability of early infarct sign, image processing that could reduce local noise while preserving edges is desirable. To examine this issue, we devised an adaptive partial smoothing filter (APSF). Since the APSF markedly improves visibility of the normal gray-white matter interface, loss of the gray-white matter interface due to hypoattenuation could be more easily detected. The APSF was applied to clinical CT images in hyperacute stroke patients. Our preliminary results showed that the visibility and detectability of early infarct signs was much improved. To validate the usefulness of the proposed method, two commonly used smoothing filters were also employed for comparison. The results demonstrated the superiority of the APSF. Our proposed APSF can improve the visibility of the gray-white matter interface, thereby enhancing the detectability of early infarct signs. (author)

  15. Early Mortality and Associated Factors among Patients with Stroke Admitted to a Large Teaching Hospital in Tanzania.

    Science.gov (United States)

    Okeng'o, Kigocha; Chillo, Pilly; Gray, William K; Walker, Richard W; Matuja, William

    2017-04-01

    Stroke is a major cause of death worldwide and 85.5% of stroke deaths occur in low- and middle-income countries due to stroke. The aim of this study was to investigate correlates and predictors of 30-day mortality in stroke patients in urban Tanzania. A prospective 30-day follow-up study was conducted at the Muhimbili National Hospital, Dar es Salaam, Tanzania. We recruited all patients with stroke seen at the Emergency Medicine Department and medical wards. Patients underwent medical history and physical examination including full neurological examination. For those who met the criteria for the diagnosis of stroke according to the World Health Organization, further data were collected, including cholesterol, creatinine, fasting blood glucose, full blood picture, human immunodeficiency virus serology, and electrocardiogram. Patients were followed up at 30 days from the date of stroke onset. The date and the cause of death of those participants who died within 30 days of stroke onset were recorded. A total of 224 patients were recruited into the study, with follow-up data available on 186 (83.0%). At 30 days post stroke, 124 patients (66.7%) were still alive. Mortality was significantly higher among stroke patients who were over 65 years of age. Of the 62 who died, 54% died of aspiration pneumonia and 21% of septicemia. Patients with infection were 4.4 times more likely to die than thosewithout (P = .001). Poststroke mortality rates were high. Many deaths were potentially preventable. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  16. Does Attendance in Early Education Predict Attendance in Elementary School? An Analysis of DCPS's Early Education Program. Research Report

    Science.gov (United States)

    Dubay, Lisa; Holla, Nikhil

    2016-01-01

    Enrollment in early childhood education programs can be an important stepping stone to higher educational achievement, particularly for low-income children. However, children cannot succeed in these programs unless they are present. The Early Childhood Education Division (ECED) in the District of Columbia Public Schools (DCPS) has identified…

  17. Impact of Pretreatment Noncontrast CT Alberta Stroke Program Early CT Score on Clinical Outcome After Intra-Arterial Stroke Therapy

    NARCIS (Netherlands)

    Yoo, Albert J.; Zaidat, Osama O.; Chaudhry, Zeshan A.; Berkhemer, Olvert A.; González, R. Gilberto; Goyal, Mayank; Demchuk, Andrew M.; Menon, Bijoy K.; Mualem, Elan; Ueda, Dawn; Buell, Hope; Sit, Siu Po; Bose, Arani

    2014-01-01

    The efficacy of intra-arterial treatment remains uncertain. Because most centers performing IAT use noncontrast CT (NCCT) imaging, it is critical to understand the impact of NCCT findings on treatment outcomes. This study aimed to compare functional independence and safety among patients undergoing

  18. Early Childhood Program Participation, Results from the National Household Education Surveys Program of 2016. First Look. NCES 2017-101

    Science.gov (United States)

    Corcoran, Lisa; Steinley, Katrina

    2017-01-01

    This report presents findings from the Early Childhood Program Participation Survey of the National Household Education Surveys Program of 2016 (NHES:2016). The Early Childhood Program Participation Survey collected data on children's participation in relative care, nonrelative care, and center-based care arrangements. It also collected…

  19. Rising statin use and effect on ischemic stroke outcome

    Directory of Open Access Journals (Sweden)

    Haymore Joseph

    2004-03-01

    Full Text Available Abstract Background Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors have neuroprotective effects in experimental stroke models and are commonly prescribed in clinical practice. The aim of this study was to determine if patients taking statins before hospital admission for stroke had an improved clinical outcome. Methods This was an observational study of 436 patients admitted to the National Institutes of Health Suburban Hospital Stroke Program between July 2000 and December 2002. Self-reported risk factors for stroke were obtained on admission. Stroke severity was determined by the admission National Institutes of Health Stroke Scale score. Good outcome was defined as a Rankin score Results There were 436 patients with a final diagnosis of ischemic stroke; statin data were available for 433 of them. A total of 95/433 (22% of patients were taking a statin when they were admitted, rising from 16% in 2000 to 26% in 2002. Fifty-one percent of patients taking statins had a good outcome compared to 38% of patients not taking statins (p = 0.03. After adjustment for confounding factors, statin pretreatment was associated with a 2.9 odds (95% CI: 1.2–6.7 of a good outcome at the time of hospital discharge. Conclusions The proportion of patients taking statins when they are admitted with stroke is rising rapidly. Statin pretreatment was significantly associated with an improved functional outcome at discharge. This finding could support the early initiation of statin therapy after stroke.

  20. [Evaluation of patient satisfaction after stroke rehabilitation program. Validation study for the Spanish version of the Satisfaction Pound Scale].

    Science.gov (United States)

    Aguirrezabal Juaristi, Aizpea; Ferrer Fores, Montse; Marco Navarro, Ester; Mojal García, Sergi; Vilagut Saiz, Gemma; Duarte Oller, Esther

    2016-11-18

    The Satisfaction Pound Scale is a specific questionnaire to evaluate satisfaction with the rehabilitation program after a stroke. The aim of this study was to adapt this scale to Spanish and to evaluate its metric characteristics. The adaptation included translation and back-translation methods. Metric characteristics were evaluated in 74 patients, all of whom were administered the Satisfaction Pound Scale and the Short Form 36 (SF-36). The statistical model was tested by confirmatory factor analysis (CFA). Reliability was determined through Cronbach alpha coefficient and a test-retest procedure. Construct validity was assessed by means of correlations between the satisfaction scale and the SF-36. Adjustment indicators in the CFA were very good. Reproducibility test showed correlations higher than 0.85, and all correlations between SF-36 dimensions and the satisfaction scale were lower than 0.2, in accordance with the hypotheses raised. The Spanish version of the Satisfaction Pounds Scale is reliable and valid, therefore it is a useful tool to assess satisfaction with the post-stroke rehabilitation program in our area. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  1. C-Reactive Protein Can Be an Early Predictor of Poststroke Apathy in Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Chen, Liping; Xiong, Siqing; Liu, Yi; Lin, Meiqing; Wang, Jirui; Zhong, Renjia; Zhao, Jiuhan; Liu, Wenjing; Zhu, Lu; Shang, Xiuli

    2018-03-13

    Apathy is a multidimensional syndrome referring to a primary lack of motivation that occurs frequently in survivors of stroke. Higher C-reactive protein (CRP) level was associated with higher apathy scores among Alzheimer disease cases. However, data on the relationship between CRP levels and apathy in patients with stroke are lacking. So, we hypothesized an association between CRP and poststroke apathy (PSA). Two hundred ninety-two consecutive patients with stroke were recruited within 7 days after stroke. Apathy symptoms were assessed at baseline and at 1, 3, and 6 months after stoke using the Apathy Evaluation Scale-Clinical (AES-C). Demographic and clinical information were obtained using the National Institutes of Health Stroke Scale (NIHSS) scores, Barthel Index (BI) scores, Mini-Mental State Examination (MMSE) scores, Hamilton Depression Scale (HAMD) scores, and Hamilton Anxiety Scale (HAMA) scores. CRP was measured at baseline. The presence and the location of infarcts were evaluated using magnetic resonance imaging. Apathy at baseline was significantly associated with body mass index (BMI), NIHSS, BI, MMSE, HAMD, and CRP (P < .05) upon admission. PSA at 6 months was significantly associated with elevated CRP concentrations, high AES-C score, and low BI score (P < .05) upon admission. The AES-C scores peaked 3 months after stroke, but then abated over 6 months. CRP, BMI, MMSE, depression, and disability are closely related to apathy during the acute stage of ischemic stroke. Lower BI scores, higher CRP concentrations, and apathy in acute stroke phase increased the risk of PSA at 6 months. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. Early clinical exposure program in learning renal physiology.

    Science.gov (United States)

    Dehghan, Arman; Amini, Mitra; Sagheb, Mohammad Mahdi; Shidmoosavi, Seyed Mostafa; Nabeiei, Parisa

    2017-10-01

    Teaching renal physiology for undergraduate medical students in an understandable way using methods which improve their deep learning has always been a problem. In this study, Early Clinical Exposure (ECE) was used in teaching renal physiology for the second year medical students in Shiraz Medical School. This article aims to introduce and develop this program and also measure the attitude of medical students toward ECE in learning renal physiology. This is a mixed method study conducted on 120 second year undergraduate students. After performing the course, both qualitative and quantitative methods were used for measuring the viewpoints of the students. In the qualitative part, 10 high rank medical students were selected. These students participated in brain storming sessions to express their opinion about the program based on the strengths and weaknesses. For trustworthiness of the qualitative part, member check and peer check were done. In the quantitative part, a researcher-made questionnaire was used based on the objectives of the program in a 4 point Likert scale. The validity of questionnaire was determined by medical education experts and reliability was determined after a pilot study. Based on the results of the quantitative part of the study, 98 percent of the students stated that the ECE program was generally a useful program. In the qualitative part, the students' comments were obtained. The benefits of the program were summarized in 4 main themes. These themes are "understanding of renal physiology", "Integration of basic and clinical knowledge", "Improvement of attitude toward importance of physiology", and "encouragement to study". In response to the questions about negetive aspects of this program in qualitative part, the two main themes were insufficient time and large grup size. Students reported that ECE was useful, but they stated that they needed to have more encounter with patients and more hospital teaching. The results also reveal that this

  3. Early clinical exposure program in learning renal physiology

    Directory of Open Access Journals (Sweden)

    ARMAN DEHGHAN

    2017-10-01

    Full Text Available Introduction: Teaching renal physiology for undergraduate medical students in an understandable way using methods which improve their deep learning has always been a problem. In this study, Early Clinical Exposure (ECE was used in teaching renal physiology for the second year medical students in Shiraz Medical School. This article aims to introduce and develop this program and also measure the attitude of medical students toward ECE in learning renal physiology. Methods: This is a mixed method study conducted on 120 second year undergraduate students. After performing the course, both qualitative and quantitative methods were used for measuring the viewpoints of the students. In the qualitative part, 10 high rank medical students were selected. These students participated in brain storming sessions to express their opinion about the program based on the strengths and weaknesses. For trustworthiness of the qualitative part, member check and peer check were done. In the quantitative part, a researcher-made questionnaire was used based on the objectives of the program in a 4 point Likert scale. The validity of questionnaire was determined by medical education experts and reliability was determined after a pilot study. Results: Based on the results of the quantitative part of the study, 98 percent of the students stated that the ECE program was generally a useful program. In the qualitative part, the students’ comments were obtained. The benefits of the program were summarized in 4 main themes. These themes are “understanding of renal physiology”, “Integration of basic and clinical knowledge”, “Improvement of attitude toward importance of physiology”, and “encouragement to study”. In response to the questions about negetive aspects of this program in qualitative part, the two main themes were insufficient time and large grup size. Conclusion: Students reported that ECE was useful, but they stated that they needed to have more

  4. Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort.

    Directory of Open Access Journals (Sweden)

    Mi Kyoung Son

    Full Text Available Atrial fibrillation (AF is a major risk factor for ischemic stroke and associated with a 5-fold higher risk of stroke. In this retrospective cohort study, the incidence of and risk factors for ischemic stroke in patients with AF were identified. All patients (≥30 years old without previous stroke who were diagnosed with AF in 2007-2013 were selected from the National Health Insurance Service-National Sample Cohort. To identify factors that influenced ischemic stroke risk, Cox proportional hazard regression analysis was conducted. During a mean follow-up duration of 3.2 years, 1022 (9.6% patients were diagnosed with ischemic stroke. The overall incidence rate of ischemic stroke was 30.8/1000 person-years. Of all the ischemic stroke that occurred during the follow-up period, 61.0% occurred within 1-year after AF diagnosis. Of the patients with CHA2DS2-VASc score of ≥2, only 13.6% were receiving warfarin therapy within 30 days after AF diagnosis. Relative to no antithrombotic therapy, warfarin treatment for >90 days before the index event (ischemic stroke in stroke patients and death/study end in non-stroke patients associated with decreased ischemic stroke risk (Hazard Ratio = 0.41, 95%confidence intervals = 0.32-0.53. Heart failure, hypertension, and diabetes mellitus associated with greater ischemic stroke risk. AF patients in Korea had a higher ischemic stroke incidence rate than patients in other countries and ischemic stroke commonly occurred at early phase after AF diagnosis. Long-term (>90 days continuous warfarin treatment may be beneficial for AF patients. However, warfarin treatment rates were very low. To prevent stroke, programs that actively detect AF and provide anticoagulation therapy are needed.

  5. A clinical study on acupuncture in combination with routine rehabilitation therapy for early pain recovery of post-stroke shoulder-hand syndrome.

    Science.gov (United States)

    Zheng, Jinling; Wu, Qinglian; Wang, Lu; Guo, Ting

    2018-02-01

    The clinical effect of acupuncture in combination with rehabilitation therapy for post-stroke shoulder-hand syndrome (SHS) was explored. Patients (178) with post-stroke SHS who received treatment in the Dalian Second Hospital from March 2012 to March 2016 were included in this study. The patients were divided into experimental group (89 cases) and control group (89 cases). Patients in the control group received rehabilitation therapy, while those in the treatment group received acupuncture treatment in addition to rehabilitation therapy. Visual analogue scale (VAS) was applied to assess the pain degree of patients. Fugl-Meyer assessment (FMA), functional comprehensive assessment (FCA) and assessment of quality of life (QoL) were used to evaluate rehabilitation condition of the patients. Early pain relief, rehabilitation of upper extremity motor function and improvement of QoL after treatment were compared between the two groups. The scores of VAS, FMA, FCA and QoL showed obvious differences between the two groups after treatment (Prehabilitation therapy can improve early pain and rehabilitation significantly and enhance QoL for patients with post-stroke SHS, which is worthy of being widely used in clinical practice.

  6. The Effectiveness of Functional Electrical Stimulation Based on a Normal Gait Pattern on Subjects with Early Stroke: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Zhimei Tan

    2014-01-01

    Full Text Available Objective. To investigate the effectiveness of four-channel FES based on a normal gait pattern on improving functional ability in subjects early after ischemic stroke. Methods. Forty-five subjects were randomly assigned into a four-channel FES group (n=16, a placebo group (n=15, or a dual-channel group (n=14. Stimulation lasted for 30 min in each session with 1 session/day, 5 days a week for 3 weeks. All subjects were assessed at baseline, at 3 weeks of treatment, and at 3 months after the treatment had finished. The assessments included Fugl-Meyer Assessment (FMA, the Postural Assessment Scale for Stroke Patients (PASS, Berg Balance Scale (BBS, Functional Ambulation Category (FAC, and the Modified Barthel Index (MBI. Results. All 3 groups demonstrated significant improvements in all outcome measurements from pre- to posttreatment and further gains at followup. The score of FMA and MBI improved significantly in the four-channel group at the end of the 3 weeks of training. And the scores of PASS, BBS, MBI, and FAC in the four-channel group were significantly higher than those of the placebo group. Conclusions. This study indicated that four-channel FES can improve motor function, balance, walking ability, and performance of activities of daily living in subjects with early ischemic stroke.

  7. Early Site Permit Demonstration Program: Recommendations for communication activities and public participation in the Early Site Permit Demonstration Program

    International Nuclear Information System (INIS)

    1993-01-01

    On October 24, 1992, President Bush signed into law the National Energy Policy Act of 1992. The bill is a sweeping, comprehensive overhaul of the Nation's energy laws, the first in more than a decade. Among other provisions, the National Energy Policy Act reforms the licensing process for new nuclear power plants by adopting a new approach developed by the US Nuclear Regulatory Commission (NRC) in 1989, and upheld in court in 1992. The NRC 10 CFR Part 52 rule is a three-step process that guarantees public participation at each step. The steps are: early site permit approval; standard design certifications; and, combined construction/operating licenses for nuclear power reactors. Licensing reform increases an organization's ability to respond to future baseload electricity generation needs with less financial risk for ratepayers and the organization. Costly delays can be avoided because design, safety and siting issues will be resolved before a company starts to build a plant. Specifically, early site permit approval allows for site suitability and acceptability issues to be addressed prior to an organization's commitment to build a plant. Responsibility for site-specific activities, including communications and public participation, rests with those organizations selected to try out early site approval. This plan has been prepared to assist those companies (referred to as sponsoring organizations) in planning their communications and public involvement programs. It provides research findings, information and recommendations to be used by organizations as a resource and starting point in developing their own plans

  8. Early Site Permit Demonstration Program: Recommendations for communication activities and public participation in the Early Site Permit Demonstration Program

    Energy Technology Data Exchange (ETDEWEB)

    1993-01-27

    On October 24, 1992, President Bush signed into law the National Energy Policy Act of 1992. The bill is a sweeping, comprehensive overhaul of the Nation`s energy laws, the first in more than a decade. Among other provisions, the National Energy Policy Act reforms the licensing process for new nuclear power plants by adopting a new approach developed by the US Nuclear Regulatory Commission (NRC) in 1989, and upheld in court in 1992. The NRC 10 CFR Part 52 rule is a three-step process that guarantees public participation at each step. The steps are: early site permit approval; standard design certifications; and, combined construction/operating licenses for nuclear power reactors. Licensing reform increases an organization`s ability to respond to future baseload electricity generation needs with less financial risk for ratepayers and the organization. Costly delays can be avoided because design, safety and siting issues will be resolved before a company starts to build a plant. Specifically, early site permit approval allows for site suitability and acceptability issues to be addressed prior to an organization`s commitment to build a plant. Responsibility for site-specific activities, including communications and public participation, rests with those organizations selected to try out early site approval. This plan has been prepared to assist those companies (referred to as sponsoring organizations) in planning their communications and public involvement programs. It provides research findings, information and recommendations to be used by organizations as a resource and starting point in developing their own plans.

  9. Lifetime stress cumulatively programs brain transcriptome and impedes stroke recovery: benefit of sensory stimulation.

    Directory of Open Access Journals (Sweden)

    Fabíola C R Zucchi

    Full Text Available Prenatal stress (PS represents a critical variable affecting lifetime health trajectories, metabolic and vascular functions. Beneficial experiences may attenuate the effects of PS and its programming of health outcomes in later life. Here we investigated in a rat model (1 if PS modulates recovery following cortical ischemia in adulthood; (2 if a second hit by adult stress (AS exaggerates stress responses and ischemic damage; and (3 if tactile stimulation (TS attenuates the cumulative effects of PS and AS. Prenatally stressed and non-stressed adult male rats underwent focal ischemic motor cortex lesion and were tested in skilled reaching and skilled walking tasks. Two groups of rats experienced recurrent restraint stress in adulthood and one of these groups also underwent daily TS therapy. Animals that experienced both PS and AS displayed the most severe motor disabilities after lesion. By contrast, TS promoted recovery from ischemic lesion and reduced hypothalamic-pituitary-adrenal axis activity. The data also showed that cumulative effects of adverse and beneficial lifespan experiences interact with disease outcomes and brain plasticity through the modulation of gene expression. Microarray analysis of the lesion motor cortex revealed that cumulative PS and AS interact with genes related to growth factors and transcription factors, which were not affected by PS or lesion alone. TS in PS+AS animals reverted these changes, suggesting a critical role for these factors in activity-dependent motor cortical reorganization after ischemic lesion. These findings suggest that beneficial experience later in life can moderate adverse consequences of early programming to improve cerebrovascular health.

  10. Lifetime Stress Cumulatively Programs Brain Transcriptome and Impedes Stroke Recovery: Benefit of Sensory Stimulation

    Science.gov (United States)

    Zucchi, Fabíola C. R.; Yao, Youli; Ilnytskyy, Yaroslav; Robbins, Jerrah C.; Soltanpour, Nasrin; Kovalchuk, Igor; Kovalchuk, Olga; Metz, Gerlinde A. S.

    2014-01-01

    Prenatal stress (PS) represents a critical variable affecting lifetime health trajectories, metabolic and vascular functions. Beneficial experiences may attenuate the effects of PS and its programming of health outcomes in later life. Here we investigated in a rat model (1) if PS modulates recovery following cortical ischemia in adulthood; (2) if a second hit by adult stress (AS) exaggerates stress responses and ischemic damage; and (3) if tactile stimulation (TS) attenuates the cumulative effects of PS and AS. Prenatally stressed and non-stressed adult male rats underwent focal ischemic motor cortex lesion and were tested in skilled reaching and skilled walking tasks. Two groups of rats experienced recurrent restraint stress in adulthood and one of these groups also underwent daily TS therapy. Animals that experienced both PS and AS displayed the most severe motor disabilities after lesion. By contrast, TS promoted recovery from ischemic lesion and reduced hypothalamic-pituitary-adrenal axis activity. The data also showed that cumulative effects of adverse and beneficial lifespan experiences interact with disease outcomes and brain plasticity through the modulation of gene expression. Microarray analysis of the lesion motor cortex revealed that cumulative PS and AS interact with genes related to growth factors and transcription factors, which were not affected by PS or lesion alone. TS in PS+AS animals reverted these changes, suggesting a critical role for these factors in activity-dependent motor cortical reorganization after ischemic lesion. These findings suggest that beneficial experience later in life can moderate adverse consequences of early programming to improve cerebrovascular health. PMID:24651125

  11. Stroke rehabilitation.

    Science.gov (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

    2011-05-14

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Intracranial Pressure Elevation 24 Hours after Ischemic Stroke in Aged Rats is Prevented by Early, Short Hypothermia Treatment

    Directory of Open Access Journals (Sweden)

    Lucy Anne Murtha

    2016-05-01

    Full Text Available Stroke is predominantly a senescent disease, yet most preclinical studies investigate treatment in young animals. We recently demonstrated that short-duration hypothermia-treatment completely prevented the dramatic intracranial pressure (ICP rise seen post-stroke in young rats. Here, our aim was to investigate whether a similar ICP rise occurs in aged rats and to determine whether short-duration hypothermia is an effective treatment in aged animals. Experimental Middle Cerebral Artery occlusion (MCAo - 3 hour occlusion was performed on male Wistar rats aged 19-20 months. At one hour after stroke-onset, rats were randomized to 2.5 hours hypothermia-treatment (32.5 °C or normothermia (37 °C. ICP was monitored at baseline, for 3.5 hours post-occlusion, and at 24 hours post-stroke. Infarct and edema volumes were calculated from histology. Baseline pre-stroke ICP was 11.2 ± 3.3 mmHg across all animals. Twenty-four hours post-stroke, ICP was significantly higher in normothermic animals compared to hypothermia-treated animals (27.4 ± 18.2 mmHg vs. 8.0 ± 5.0 mmHg, p = 0.03. Infarct and edema volumes were not significantly different between groups. These data demonstrate ICP may also increase 24 hours post-stroke in aged rats, and that short-duration hypothermia treatment has a profound and sustained preventative effect. These findings may have important implications for the use of hypothermia in clinical trials of aged stroke patients.

  13. Kids Identifying and Defeating Stroke (KIDS): development and implementation of a multiethnic health education intervention to increase stroke awareness among middle school students and their parents.

    Science.gov (United States)

    Mullen Conley, Kathleen; Juhl Majersik, Jennifer; Gonzales, Nicole R; Maddox, Katherine E; Pary, Jennifer K; Brown, Devin L; Moyé, Lemuel A; Espinosa, Nina; Grotta, James C; Morgenstern, Lewis B

    2010-01-01

    The Kids Identifying and Defeating Stroke (KIDS) project is a 3-year prospective, randomized, controlled, multiethnic school-based intervention study. Project goals include increasing knowledge of stroke signs and treatment and intention to immediately call 911 among Mexican American (MA) and non-Hispanic White (NHW) middle school students and their parents. This article describes the design, implementation, and interim evaluation of this theory-based intervention. Intervention students received a culturally appropriate stroke education program divided into four 50-minute classes each year during the sixth, seventh, and eighth grades. Each class session also included a homework assignment that involved the students' parents or other adult partners. Interim-test results indicate that this educational intervention was successful in improving students' stroke symptom and treatment knowledge and intent to call 911 upon witnessing a stroke compared with controls. The authors conclude that this school-based educational intervention to reduce delay time to hospital arrival for stroke shows early promise.

  14. Effects of combining high- and low-frequency repetitive transcranial magnetic stimulation on upper limb hemiparesis in the early phase of stroke.

    Science.gov (United States)

    Long, Hua; Wang, Hongbin; Zhao, Chenguang; Duan, Qiang; Feng, Feng; Hui, Nan; Mao, Li; Liu, Huiling; Mou, Xiang; Yuan, Hua

    2018-01-01

    Both high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and low-frequency rTMS (LF-rTMS) are reported to benefit upper limb motor function rehabilitation in patients with stroke. However, the efficacy of combining LF- and HF-rTMS (LF-HF rTMS) has not been adequately explored, especially in the early phase of stroke. To compare the effects of LF- and LF-HF rTMS on the upper limb motor function in the early phase post stroke. Sixty-two patients were randomly assigned to three groups: LF-rTMS group (1 Hz rTMS to the contralesional hemisphere), LF-HF rTMS group (1 Hz rTMS to the contralesional hemisphere followed by 10 Hz rTMS to the lesional hemisphere) and sham group. The patients received the same conventional rehabilitation accompanied with sessions of rTMS for 15 consecutive days. The upper limb motor function was evaluated using the Fugl-Meyer Assessment (FMA) and the Wolf Motor Function Test (WMFT) before the first session, after the last session, and at 3 months after the last session. All patients finished the study without any adverse reaction. Three groups exhibited improvement in terms of the FMA score and the log WMFT time at the end of the treatment and 3 months later. Better improvement was found in the LF-HF rTMS group than in the LF-rTMS and sham groups. The results indicated that both LF- and LF-HF rTMS were effective in promoting upper limb motor recovery in patients with acute stroke. Combining HF- and LF-rTMS protocol in the present study is tolerable and more beneficial for motor improvement than the unilateral use of LF-rTMS alone.

  15. Accelerating Science with the NERSC Burst Buffer Early User Program

    Energy Technology Data Exchange (ETDEWEB)

    Bhimji, Wahid [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Bard, Debbie [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Romanus, Melissa [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Rutgers Univ., New Brunswick, NJ (United States); Paul, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Ovsyannikov, Andrey [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Friesen, Brian [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Bryson, Matt [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Correa, Joaquin [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Lockwood, Glenn K. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Tsulaia, Vakho [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Byna, Suren [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Farrell, Steve [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Gursoy, Doga [Argonne National Lab. (ANL), Argonne, IL (United States). Advanced Photon Source (APS); Daley, Chris [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Beckner, Vince [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Van Straalen, Brian [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Trebotich, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Tull, Craig [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Weber, Gunther H. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Wright, Nicholas J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Antypas, Katie [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Prabhat, none [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2016-01-01

    NVRAM-based Burst Buffers are an important part of the emerging HPC storage landscape. The National Energy Research Scientific Computing Center (NERSC) at Lawrence Berkeley National Laboratory recently installed one of the first Burst Buffer systems as part of its new Cori supercomputer, collaborating with Cray on the development of the DataWarp software. NERSC has a diverse user base comprised of over 6500 users in 700 different projects spanning a wide variety of scientific computing applications. The use-cases of the Burst Buffer at NERSC are therefore also considerable and diverse. We describe here performance measurements and lessons learned from the Burst Buffer Early User Program at NERSC, which selected a number of research projects to gain early access to the Burst Buffer and exercise its capability to enable new scientific advancements. To the best of our knowledge this is the first time a Burst Buffer has been stressed at scale by diverse, real user workloads and therefore these lessons will be of considerable benefit to shaping the developing use of Burst Buffers at HPC centers.

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

    Science.gov (United States)

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

    2012-01-01

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

  17. 76 FR 12978 - Advisory Committee on the Maternal, Infant and Early Childhood Home Visiting Program Evaluation...

    Science.gov (United States)

    2011-03-09

    ... and Early Childhood Home Visiting Program Evaluation will meet for its first session on Wednesday... Administration for Children and Families Advisory Committee on the Maternal, Infant and Early Childhood Home...: Advisory Committee on the Maternal, Infant and Early Childhood Home Visiting Program Evaluation. Date and...

  18. Evaluation of a four month rehabilitation program for stroke patients with balance problems and binocular visual dysfunction.

    Science.gov (United States)

    Schow, Trine; Harris, Paul; Teasdale, Thomas William; Rasmussen, Morten Arendt

    2016-04-06

    Balance problems and binocular visual dysfunction (BVD) are common problems after stroke, however evidence of an effective rehabilitation method are limited. To evaluate the effect of a four-month rehabilitation program for individuals with balance problems and BVD after a stroke. About 40 sessions of 1.5 hours duration over four months with visual therapy and balance rehabilitation, was provided to all 29 participants, aged 18-67 years, in groups of 7-8 individuals. Several measures for BVD, balance, gait, Health Related Quality Of Life (HRQoL) and functional recovery were used at baseline, at the end of training and at a six-month follow up (FU). We found significant improvements in stereopsis, vergence, saccadic movements, burden of binocular visual symptoms, balance and gait speed, fatigue, HRQoL and functional recovery. Moreover, 60% of the participants were in employment at the six-month FU, compared to only 23% before training. All improvements were sustained at the six-month FU. Although a control group is lacking, the evidence suggests that the positive improvement is a result of the combined visual and balance training. The combination of balance and visual training appears to facilitate changes at a multimodal level affecting several functions important in daily life.

  19. The Transiting Exoplanet Community Early Release Science Program

    Science.gov (United States)

    Batalha, Natalie; Bean, Jacob; Stevenson, Kevin; Alam, M.; Batalha, N.; Benneke, B.; Berta-Thompson, Z.; Blecic, J.; Bruno, G.; Carter, A.; Chapman, J.; Crossfield, I.; Crouzet, N.; Decin, L.; Demory, B.; Desert, J.; Dragomir, D.; Evans, T.; Fortney, J.; Fraine, J.; Gao, P.; Garcia Munoz, A.; Gibson, N.; Goyal, J.; Harrington, J.; Heng, K.; Hu, R.; Kempton, E.; Kendrew, S.; Kilpatrick, B.; Knutson, H.; Kreidberg, L.; Krick, J.; Lagage, P.; Lendl, M.; Line, M.; Lopez-Morales, M.; Louden, T.; Madhusudhan, N.; Mandell, A.; Mansfield, M.; May, E.; Morello, G.; Morley, C.; Moses, J.; Nikolov, N.; Parmentier, V.; Redfield, S.; Roberts, J.; Schlawin, E.; Showman, A.; Sing, D.; Spake, J.; Swain, M.; Todorov, K.; Tsiaras, A.; Venot, O.; Waalkes, W.; Wakeford, H.; Wheatley, P.; Zellem, R.

    2017-11-01

    JWST presents the opportunity to transform our understanding of planets and the origins of life by revealing the atmospheric compositions, structures, and dynamics of transiting exoplanets in unprecedented detail. However, the high-precision, time-series observations required for such investigations have unique technical challenges, and our prior experience with HST, Spitzer, and Kepler indicates that there will be a steep learning curve when JWST becomes operational. We propose an ERS program to accelerate the acquisition and diffusion of technical expertise for transiting exoplanet observations with JWST. This program will also provide a compelling set of representative datasets, which will enable immediate scientific breakthroughs. We will exercise the time-series modes of all four instruments that have been identified as the consensus highest priority by the community, observe the full suite of transiting planet characterization geometries (transits, eclipses, and phase curves), and target planets with host stars that span an illustrative range of brightnesses. The proposed observations were defined through an inclusive and transparent process that had participation from JWST instrument experts and international leaders in transiting exoplanet studies. The targets have been vetted with previous measurements, will be observable early in the mission, and have exceptional scientific merit. We will engage the community with a two-phase Data Challenge that culminates with the delivery of planetary spectra, time series instrument performance reports, and open-source data analysis toolkits.

  20. Awareness of risk factors and warning signs of stroke in a Nigeria university.

    Science.gov (United States)

    Obembe, Adebimpe O; Olaogun, Matthew O; Bamikole, Adesola A; Komolafe, Morenikeji A; Odetunde, Marufat O

    2014-04-01

    Rapid access to medical services which is an important predictor of treatment and rehabilitation outcome requires that there is an understanding of stroke risk factors and early warning signs. This study assessed awareness of stroke risk factors and warning signs among students and staff of Obafemi Awolowo University, Nigeria. This was a cross sectional survey involving 994 (500 students and 494 staff) respondents. Information on the awareness of stroke risk factors and warning signs was collected with the aid of a structured questionnaire. Descriptive and inferential statistics were used for data analysis. Weakness (66.2%) was the most commonly identified warning sign of stroke with more staff (69.8%) identifying correctly than students (62.6%). Hypertension (83.4%) was the most commonly identified stroke risk factor, with more staff (91.7%) identifying correctly than students (83.2%). There were significant differences (p stress and obesity), and warning signs (dizziness, numbness, weakness, headache and vision problems) between students and staff. Predictors for adequate awareness of both stroke risk factors and warning signs were younger age, smoking history and higher educational level. Majority of the respondents recognized individual important stroke risk factors and warning signs, but few recognized multiple stroke risk factors and warning signs. Awareness programs on stroke should be organized, even in communities with educated people to increase public awareness on the prevention of stroke and on the reduction of morbidity in the survivors. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. [Visual dependence after recent stroke].

    Science.gov (United States)

    Bonan, I; Derighetti, F; Gellez-Leman, M-C; Bradaï, N; Yelnik, A

    2006-05-01

    After chronic stroke, inability to use pertinent somatosensory or vestibular information have been described. The aim of the study was to determine whether visual dependence occurred early after stroke before rehabilitation. Thirty patients with recent hemiplegia (16 right and 14 left hemispheric stroke) performed the rod and frame test (RFT). Patients were asked to adjust the rod to the vertical position under 3 conditions: basically, with a frame tilted 18 degrees to the right and then with the frame tilted to the left. Bias in each condition (mean, SD) was recorded and compared to adjustments of the rod by 23 controls. Motor control, sensibility, functional level (functional independence measure), age, neglect, and then balance by the postural assessment scale for stroke were assessed. Fifty-six per cent (17/30) of patients but only 26% of controls were influenced by the tilt of the frame on the 2 sides (visual dependence). No correlation was found between visual dependence and the characteristics of the patients. Many patients with recent hemiplegia seem to rely on visual input. The mechanisms of such visual dependence are discussed. Rehabilitation programs should take into account the possible impairment of sensory organisation and should include exercises to be performed under visual disturbances.

  2. Improving public education about stroke.

    Science.gov (United States)

    Alberts, Mark J

    2012-09-01

    Stroke is a common and serious disease. Most studies have shown that basic public knowledge about what a stroke is, symptoms of a stroke, and the proper reaction to a stroke is quite deficient. The fact that a stroke affects cognitive, communicative, and motor functions may partially explain the poor reaction to acute stroke symptoms. Several educational studies, using diverse formats and messaging paradigms, have been shown to positively affect public knowledge of stroke symptoms. Such efforts have often used mass media public education campaigns with an emphasis on recognizing symptoms of an acute stroke. Some have been able to demonstrate an increase in the chance of patients (or by-standers) calling 911 and seeking emergency care. However, many programs were of brief duration, and their long-term benefits are uncertain. Continual educational efforts will be needed to improve stroke knowledge and increase the percentage of patients who seek emergency care. © 2012 New York Academy of Sciences.

  3. Effects of a "test in-train out" walking program versus supervised standard rehabilitation in chronic stroke patients: a feasibility and pilot randomized study.

    Science.gov (United States)

    Malagoni, Anna M; Cavazza, Stefano; Ferraresi, Giovanni; Grassi, Guido; Felisatti, Michele; Lamberti, Nicola; Basaglia, Nino; Manfredini, Fabio

    2016-06-01

    The loss of normal ambulatory function after stroke, besides causing disability, leads to progressive deconditioning and exposes patients to increased risk of cardiovascular diseases and recurrent stroke. Conventional rehabilitation is mainly limited to the subacute period after stroke. Effective, safe and sustainable interventions for patients and healthcare system, including the long-term, should be identified. To verify the feasibility, safety and preliminary efficacy of an original home-based rehabilitation model compared to a standard supervised program in chronic hemiplegic stroke survivors. Pilot, two-arm, parallel group, randomized, controlled clinical trial. Community-dwelling poststroke patient/Hospital. Twelve chronic hemiplegic stroke patients (age=66.5±11.9 years, males, N.=9). Participants were randomly assigned for a 10-week period to a structured home-based exercise program (N.=6) and a standard supervised group-setting program (N.=6). The feasibility outcomes included adherence to interventions, retention rate and safety. Satisfaction was also evaluated by the Client Satisfaction Questionnaire. Efficacy was assessed by the 6-minute walk test, Timed Up and Go and Stair Climb tests. The impact on Quality-of-life was estimated using the physical activity domain of the Short Form-36 questionnaire. Operators' time consuming was also calculated. Adherence was 91% in the home-based exercise group and 92% in the standard supervised group. The retention rate was 100%, with no adverse events reported and high satisfaction scores for both interventions. 6-minute walk test and physical activity domain significantly increased in both groups (P=0.03). Timed Up and Go improved in both groups, significantly for the home-based exercise group (P=0.03) while Stair Climb remained stable. Time required to operators to implement the home-based exercise program was 15 hours vs. 30 hours for the standard supervised one. In a sample of hemiplegic chronic stroke patients

  4. 34 CFR 674.58 - Cancellation for service in an early childhood education program.

    Science.gov (United States)

    2010-07-01

    ... service. (c)(1) “Head Start” is a preschool program carried out under the Head Start Act (subchapter B... pre-kindergarten program is a State-funded program that serves children from birth through age six and addresses the children's cognitive (including language, early literacy, and early mathematics), social...

  5. Creating, Constructing, and Cultivating Professional Development within a Reggio-Inspired Early Childhood Education Program

    Science.gov (United States)

    Haigh, Karen M.

    2009-01-01

    The study examined the professional development system of an early childhood education program which was influenced by the Reggio Emilia Approach to early learning. This multi-site program thrived within low-income, inner-city communities of Chicago. Literature connected to the program's historical context of the Settlement House and the Reggio…

  6. Full Day Early Learning Kindergarten Program Team: Perspectives from the Principal

    Science.gov (United States)

    Shahbazi, Sara; Salinitri, Geri

    2016-01-01

    The Full Day Early Learning Kindergarten (FDK) Program has expanded the role of the principal and has altered the teaching dynamics of the classroom with the introduction of an early years team. The early years team consists of a certified teacher with the Ontario College of Teachers and a registered early childhood educator from the College of…

  7. Preventing stroke

    Science.gov (United States)

    ... A.M. Editorial team. Related MedlinePlus Health Topics Hemorrhagic Stroke Ischemic Stroke Stroke Browse the Encyclopedia A.D. ... any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should ...

  8. Stroke Rehabilitation

    Science.gov (United States)

    A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lost because of ... them relearn those skills. The effects of a stroke depend on which area of the brain was ...

  9. PECULIARITIES OF THE CLINICAL COURSE OF THE EARLY RECOVERY PERIOD IN THE CEREBRAL ISCHEMIC HEMISPHERIC STROKE ON THE BACKGROUND OF THE COMPLEX REHABILITATION MEASURES

    Directory of Open Access Journals (Sweden)

    S. A. Medvedkova

    2014-12-01

    Full Text Available Aim. The important problem of the modern angioneurology is the diagnostics and treatment of cerebral stroke. Rehabilitation measures, especially during the early recovery period, are one of the strategic courses in the struggle against it. Methods and results. The clinical-paraclinical study of 81 patients has been made for the purpose of the determination of clinical peculiarities of the course of the early recovery period in the cerebral hemispheric ischemic stroke patients on the background of the complex rehabilitation measures. It was determined, that majority of the patients the debut of the disease appeared only in the nidal deficiency with the gradual start in the active time of the day. The functional outcome and indices of the quality of life, as well as the level of the dependence of the outside help were substantially up to the evidence of the neurological deficit during the acuity of the disease. Conclusion. The best dynamics of the reconstruction of clinical-neurological disorders, indices of the level of invalidization, as well as indices of the quality of life of patients in the early recovery period have been defined on the background of complex neurometabolic therapy.

  10. Child-Mediated Stroke Communication: Findings from Hip Hop Stroke

    Science.gov (United States)

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

    2011-01-01

    Background and Purpose Low thrombolysis rates for acute ischemic stroke is linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether “Child-Mediated Stroke Communication” (CMSC) could improve stroke literacy parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke (HHS). Methods Parents of children aged 9 to 12 years from two public schools in Harlem, NYC, were recruited to participate in stroke literacy questionnaires before and after their child’s participation in HHS, a novel CMSC intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week following the intervention. Results Fifth and Sixth grade students (n =182) were enrolled into HHS. 102 parents were approached in person to participate; 75 opted to participate and 71 completed both pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program: before the program, 3 parents of 75 (3.9%) were able to identify the five cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911), compared to 21 of 71 parents (29.6%) post-intervention (pstroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that schoolchildren aged 9-12 may be effective conduits of critical stroke knowledge to their Parents. PMID:22033995

  11. Severe cerebral white matter lesions in ischemic stroke patients are associated with less time spent at home and early institutionalization.

    Science.gov (United States)

    Sibolt, Gerli; Curtze, Sami; Melkas, Susanna; Pohjasvaara, Tarja; Kaste, Markku; Karhunen, Pekka J; Oksala, Niku K J; Erkinjuntti, Timo

    2015-12-01

    Cerebral white matter lesions are one imaging surrogate for cerebral small vessel disease. These white matter lesions are associated with increased morbidity and mortality in both the general population and ischemic stroke patients. To investigate whether severe white matter lesions in a cohort of ischemic stroke patients are associated with fewer days spent at home and earlier permanent institutionalization. We included 391 consecutive patients aged 55-85 years with ischemic stroke admitted to the Helsinki University Central Hospital (the Stroke Aging Memory cohort) with a 21-year follow-up. Hospitalization and nursing home admissions were reviewed from national registers.white matter lesions were rated using magnetic resonance imaging performed three-months poststroke, dichotomized as none-to-moderate and severe. Kaplan-Meier plots log-rank and binary logistic regression (odds ratio) and Cox multivariable proportional hazards model were used to study the association of white matter lesions with days spent at home and the time of permanent institutionalization. Hazards and odds ratio with their 95% confidence intervals are reported. Severe white matter lesions were associated with fewer days spent at home, and more frequent, and earlier permanent institutionalization (1487 vs. 2354 days; log-rank P institutionalization within five-years (odds ratio 2·29; confidence interval 1·23-4·29), and increased hazards ratio of permanent institutionalization during 21 years of follow-up (1·64; confidence interval 1·119-2·26). After ischemic stroke, patients with severe white matter lesions spend fewer days at home and become permanently institutionalized earlier, especially within the first five-years. © 2015 World Stroke Organization.

  12. RETRACTED: Early hyperbaric oxygen therapy may improve the long term neurological consequences of diabetic patients suffering from hemorrhagic stroke.

    Science.gov (United States)

    Xu, Qian; Wei, Yi-Ting; Fan, Shuang-Bo; Wang, Liang; Zhou, Xiao-Ping

    2017-03-22

    This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of Neuroscience Letters has learned that text throughout this paper duplicates, or nearly duplicates, text in an earlier paper by others (Rusyniak DE, Kirk MA, May JD, Kao LW, Brizendine EJ, Welch JL, Cordell WH, Alonso RJ; Hyperbaric Oxygen in Acute Ischemic Stroke Trial Pilot Study, Stroke. 2003 Feb;34(2):571-4). Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  13. Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability.

    Science.gov (United States)

    Stoller, Oliver; de Bruin, Eling D; Schindelholz, Matthias; Schuster-Amft, Corina; de Bie, Rob A; Hunt, Kenneth J

    2014-10-11

    Exercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke. 20 subjects (age 44-84 years, body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability. Peak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC =0.82), relative peak oxygen uptake (ICC =0.72), peak work rate (ICC =0.91), peak heart rate (ICC =0.80), absolute gas exchange threshold (ICC =0.91), relative gas exchange threshold (ICC =0.88), oxygen cost of work (ICC =0.87), oxygen pulse at peak oxygen uptake (ICC =0.92), ventilation rate versus carbon dioxide output slope (ICC =0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied. This study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate

  14. Gait Performance and Lower-Limb Muscle Strength Improved in Both Upper-Limb and Lower-Limb Isokinetic Training Programs in Individuals with Chronic Stroke

    OpenAIRE

    Marie-Hélène Milot; Sylvie Nadeau; Denis Gravel; Daniel Bourbonnais

    2013-01-01

    Background. Limited improvement in gait performance has been noted after training despite a significant increase in strength of the affected lower-limb muscles after stroke. A mismatch between the training program and the requirements of gait could explain this finding. Objective. To compare the impact of a training program, matching the requirements of the muscle groups involved in the energy generation of gait, to a control intervention, on gait performance and strength. Methods. 30 individ...

  15. Ideal timing to transfer from an acute care hospital to an interdisciplinary inpatient rehabilitation program following a stroke: an exploratory study

    Directory of Open Access Journals (Sweden)

    Nadeau Sylvie

    2006-11-01

    Full Text Available Abstract Background Timely accessibility to organized inpatient stroke rehabilitation services may become compromised since the demand for rehabilitation services following stroke is rapidly growing with no promise of additional resources. This often leads to prolonged lengths of stays in acute care facilities for individuals surviving a stroke. It is believed that this delay spent in acute care facilities may inhibit the crucial motor recovery process taking place shortly after a stroke. It is important to document the ideal timing to initiate intensive inpatient stroke rehabilitation after the neurological event. Therefore, the objective of this study was to examine the specific influence of short, moderate and long onset-admission intervals (OAI on rehabilitation outcomes across homogeneous subgroups of patients who were admitted to a standardized interdisciplinary inpatient stroke rehabilitation program. Methods A total of 418 patients discharged from the inpatient neurological rehabilitation program at the Montreal Rehabilitation Hospital Network after a first stroke (79% of all cases reviewed were included in this retrospective study. After conducting a matching procedure across these patients based on the degree of disability, gender, and age, a total of 40 homogeneous triads (n = 120 were formed according to the three OAI subgroups: short (less than 20 days, moderate (between 20 and 40 days or long (over 40 days; maximum of 70 days OAI subgroups. The rehabilitation outcomes (admission and discharge Functional Independence Measure scores (FIM, absolute and relative FIM gain scores, rehabilitation length of stay, efficiency scores were evaluated to test for differences between the three OAI subgroups. Results Analysis revealed that the three OAI subgroups were comparable for all rehabilitation outcomes studied. No statistical difference was found for admission (P = 0.305–0.972 and discharge (P = 0.083–0.367 FIM scores, absolute (P = 0

  16. Controlled Education of patients after Stroke (CEOPS)- nurse-led multimodal and long-term interventional program involving a patient's caregiver to optimize secondary prevention of stroke: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Mendyk, Anne-Marie; Duhamel, Alain; Bejot, Yannick; Leys, Didier; Derex, Laurent; Dereeper, Olivier; Detante, Olivier; Garcia, Pierre-Yves; Godefroy, Olivier; Montoro, Francisco Macian; Neau, Jean-Philippe; Richard, Sébastien; Rosolacci, Thierry; Sibon, Igor; Sablot, Denis; Timsit, Serge; Zuber, Mathieu; Cordonnier, Charlotte; Bordet, Régis

    2018-02-22

    Setting up a follow-up secondary prevention program after stroke is difficult due to motor and cognitive impairment, but necessary to prevent recurrence and improve patients' quality of life. To involve a referent nurse and a caregiver from the patient's social circle in nurse-led multimodal and long-term management of risk factors after stroke could be an advantage due to their easier access to the patient and family. The aim of this study is to compare the benefit of optimized follow up by nursing personnel from the vascular neurology department including therapeutic follow up, and an interventional program directed to the patient and a caregiving member of their social circle, as compared with typical follow up in order to develop a specific follow-up program of secondary prevention of stroke. The design is a randomized, controlled, clinical trial conducted in the French Stroke Unit of the Strokavenir network. In total, 410 patients will be recruited and randomized in optimized follow up or usual follow up for 2 years. In both group, patients will be seen by a neurologist at 6, 12 and 24 months. The optimized follow up will include follow up by a nurse from the vascular neurology department, including therapeutic follow up, and a training program on secondary prevention directed to the patient and a caregiving member of their social circle. After discharge, a monthly telephone interview, in the first year and every 3 months in the second year, will be performed by the nurse. At 6, 12 and 24 month, the nurse will give the patient and caregiver another training session. Usual follow up is only done by the patient's general practitioner, after classical information on secondary prevention of risk factors during hospitalization. The primary outcome measure is blood pressure measured after the first year of follow up. Blood pressure will be measured by nursing personnel who do not know the group into which the patient has been randomized. Secondary endpoints are

  17. Early Site Permit Demonstration Program: Regulatory criteria evaluation report

    International Nuclear Information System (INIS)

    1993-03-01

    The primary objective of the Early Site Plan Demonstration Program (ESPDP) is to demonstrate successfully the use of 10CFR52 to obtain ESPs for one or more US sites for one (or more) ALWR nuclear power plants. It is anticipated that preparation of the ESP application and interaction with NRC during the application review process will result not only in an ESP for the applicant(s) but also in the development of criteria and definition of processes, setting the precedent that facilitates ESPs for subsequent ESP applications. Because siting regulatory processes and acceptance criteria are contained in over 100 separate documents, comprehensive licensing and technical reviews were performed to establish whether the requirements and documentation are self-consistent, whether the acceptance criteria are sufficiently well-defined and clear, and whether the licensing process leading to the issuance of an ESP is unambiguously specified. This document provides appendices C and D of this report. Appendix C contains data from the licensing and technical reviews; Appendix D contains technology toolkit data sheets

  18. Early Site Permit Demonstration Program: Regulatory criteria evaluation report

    International Nuclear Information System (INIS)

    1993-03-01

    The primary objective of the Early Site Plan Demonstration Program (ESPDP) is to demonstrate successfully the use of 10CFR52 to obtain ESPs for one or more US sites for one (or more) ALWR nuclear power plants. It is anticipated that preparation of the ESP application and interaction with NRC during the application review process will result not only in an ESP for the applicant(s) but also in the development of criteria and definition of processes, setting the precedent that facilitates ESPs for subsequent ESP applications. Because siting regulatory processes and acceptance criteria are contained in over 100 separate documents, comprehensive licensing and technical reviews were performed to establish whether the requirements and documentation are self-consistent, whether the acceptance criteria are sufficiently well-defined and clear, and whether the licensing process leading to the issuance of an ESP is unambiguously specified. This document provides appendices A and B of this report. Appendix A contains a list of regulations, regulatory guidance, and acceptance criteria; Appendix B contains a cross-reference index of siting-related documentation

  19. Gait training assisted by multi-channel functional electrical stimulation early after stroke: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    van Bloemendaal, Maijke; Bus, Sicco A.; de Boer, Charlotte E.; Nollet, Frans; Geurts, Alexander C. H.; Beelen, Anita

    2016-01-01

    Many stroke survivors suffer from paresis of lower limb muscles, resulting in compensatory gait patterns characterised by asymmetries in spatial and temporal parameters and reduced walking capacity. Functional electrical stimulation has been used to improve walking capacity, but evidence is mostly

  20. Usability of videogame-based dexterity training in the early rehabilitation phase of stroke patients : A pilot study

    NARCIS (Netherlands)

    Vanbellingen, Tim; Filius, Suzanne J.; Nyffeler, Thomas; van Wegen, Erwin E.H.

    2017-01-01

    Background: Approximately 70-80% of stroke survivors have limited activities of daily living, mainly due to dexterous problems. Videogame-based training (VBT) along with virtual reality seems to be beneficial to train upper limb function. Objective: To evaluate the usability of VBT using the Leap

  1. High mortality among children with sickle cell anemia and overt stroke who discontinue blood transfusion after transition to an adult program.

    Science.gov (United States)

    McLaughlin, Joseph F; Ballas, Samir K

    2016-05-01

    Chronic blood transfusion is the standard of care in the management of overt stroke due to sickle cell anemia (SS) to prevent recurrence of stroke. The problem arises when children are transitioned to adult care where blood transfusion may be discontinued. The purpose of this study was to report the outcome of 22 patients with SS and overt stroke who were transitioned to our adult program between 1993 and 2009. Transitioned patients were kept on chronic blood transfusion they had as children. Blood bank data were performed and computerized according to FDA and AABB regulations. Records were kept prospectively. Blood counts and percent hemoglobin (Hb)S were obtained before and after transfusion. HbS was kept below 30% after transfusion. Metabolic profiles were obtained every 6 months or more often if needed. Statistical analysis was by the two-tailed t-test. Patients who were compliant with blood transfusion were rarely hospitalized for painful crises. Alloimmunization and iron overload were the major complications of blood transfusion. Eight patients who refused to be maintained on chronic blood transfusion or who were noncompliant died within 1 to 5 years after transition. Causes of death included stroke in two, sudden in three, and multiorgan failure in three. The overall rate of death after transition was 36% and the major cause was discontinuation of blood transfusion. Efforts must be made to maintain adequate chronic simple or exchange blood transfusion for children with SS and stroke after transition to adult care. © 2015 AABB.

  2. Computerised mirror therapy with Augmented Reflection Technology for early stroke rehabilitation: clinical feasibility and integration as an adjunct therapy.

    Science.gov (United States)

    Hoermann, Simon; Ferreira Dos Santos, Luara; Morkisch, Nadine; Jettkowski, Katrin; Sillis, Moran; Devan, Hemakumar; Kanagasabai, Parimala S; Schmidt, Henning; Krüger, Jörg; Dohle, Christian; Regenbrecht, Holger; Hale, Leigh; Cutfield, Nicholas J

    2017-07-01

    New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke. We evaluated components of the therapeutic intervention, from the patients' and the therapists' points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals. The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted. Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients. Implications for Rehabilitation Computerised Mirror Therapy is feasible for clinical use Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation.

  3. The Danish Stroke Registry

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. STUDY POPULATION: All patients with acute stroke (from 2003) or TIA (from 2013) treated...... at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. MAIN VARIABLES: The registry holds prospectively collected data on key processes...... of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients...

  4. Put Your Robot In, Put Your Robot Out: Sequencing through Programming Robots in Early Childhood

    Science.gov (United States)

    Kazakoff, Elizabeth R.; Bers, Marina Umaschi

    2014-01-01

    This article examines the impact of programming robots on sequencing ability in early childhood. Thirty-four children (ages 4.5-6.5 years) participated in computer programming activities with a developmentally appropriate tool, CHERP, specifically designed to program a robot's behaviors. The children learned to build and program robots over three…

  5. Novel noise reduction filter for improving visibility of early computed tomography signs of hyperacute stroke. Evaluation of the filter's performance. Preliminary clinical experience

    International Nuclear Information System (INIS)

    Takahashi, Noriyuki; Ishii, Kiyoshi; Lee, Y.; Tsai, D.Y.

    2007-01-01

    The aim of this study was to evaluate the performance of a novel noise reduction filter for improving the visibility of early computed tomography (CT) signs of hyperacute stroke on nonenhanced CT images. Fourteen patients with a middle cerebral artery occlusion within 4.5 h after onset were evaluated. The signal-to-noise ratio (SNR) of the processed images with the noise reduction filter and that of original images were measured. Two neuroradiologists visually rated all the processed and original images on the visibility of normal and abnormal gray-white matter interfaces. The SNR value of the processed images was approximately eight times as high as that of the original images, and a 87% reduction of noise was achieved using this technique. For the visual assessment, the results showed that the visibility of normal gray-white matter interface and that of the loss of the gray-white matter interface were significantly improved using the proposed method (P<0.05). The noise reduction filter proposed in the present study has the potential to improve the visibility of early CT signs of hyperacute stroke on nonenhanced CT images. (author)

  6. [Influence chronopharmacology therapy methionine (melaxen) on the dynamics of sleep disturbance, cognitive and emotional disorders, brain-derived neurotrophic factor (BDNF) in patients with cerebral stroke in the early and late recovery periods].

    Science.gov (United States)

    Kostenko, E V

    To study the efficacy of melaxen on the dynamics of sleep disturbance, cognitive and emotional disorders, BDNF and the level of secretion of melatonin (6-SOMT) in patients with stroke in the early and late recovery phase. One hundred and ten patients in the rehabilitation period of stroke (mean age of 58.4±6.4 years), including 60 patients in the early recovery phase (group 1) and 50 patients in the late phase (group 2), were studied. Patients received melaxen in dose of 3 mg/day for 3 months along with standard treatment. The efficacy of therapy was assessed by the dynamics of sleep disorders, emotional status, dynamics of serum BDNF levels, 6-SOMT concentration in the urine. The study has demonstrated the high efficacy of melaxen in the rehabilitation of patients in early and late recovery phase of stroke. The drug significantly increased the BDNF level that correlated with improved sleep, emotional status, quality of life of patients.

  7. Paediatric stroke

    African Journals Online (AJOL)

    2011-04-02

    Apr 2, 2011 ... Ischemic Stroke Registry yielded an incidence of 3.3 cases per 100 000 children per year, of ... Neonatal stroke. The newborn period confers the highest risk period for childhood ischaemic stroke. Focal patterns of ischaemic brain injury to the perinatal brain are .... family history of young stroke/ thrombosis.

  8. Perceived Autonomy Support in the NIMH RAISE Early Treatment Program.

    Science.gov (United States)

    Browne, Julia; Penn, David L; Bauer, Daniel J; Meyer-Kalos, Piper; Mueser, Kim T; Robinson, Delbert G; Addington, Jean; Schooler, Nina R; Glynn, Shirley M; Gingerich, Susan; Marcy, Patricia; Kane, John M

    2017-09-01

    This study examined perceived support for autonomy-the extent to which individuals feel empowered and supported to make informed choices-among participants in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). The aims of this study were to evaluate whether NAVIGATE, the active treatment studied in RAISE ETP, was associated with greater improvements in perceived autonomy support over the two-year intervention, compared with community care, and to examine associations between perceived autonomy support and quality of life and symptoms over time and across treatment groups. This study examined perceived autonomy support among the 404 individuals with first-episode psychosis who participated in the RAISE ETP trial (NAVIGATE, N=223; community care, N=181). Three-level conditional linear growth modeling was used given the nested data structure. The results indicated that perceived autonomy support increased significantly over time for those in NAVIGATE but not in community care. Once treatment began, higher perceived autonomy support was related to higher quality of life at six, 12, and 18 months in NAVIGATE and at 12, 18, and 24 months in community care. Higher perceived autonomy support was related to improved scores on total symptoms and on excited symptoms regardless of treatment group and time. Overall, perceived autonomy support increased in NAVIGATE but not for those in community care and was related to improved quality of life and symptoms across both treatment groups. Future research should examine the impact of perceived autonomy support on a wider array of outcomes, including engagement, medication adherence, and functioning.

  9. Rescue localized intra-arterial thrombolysis for hyperacute MCA ischemic stroke patients after early non-responsive intravenous tissue plasminogen activator therapy

    International Nuclear Information System (INIS)

    Kim, Dong Joon; Kim, Dong Ik; Kim, Seo Hyun; Lee, Kyung Yeol; Heo, Ji Hoe; Han, Sang Won

    2005-01-01

    The outcome of patients who show no early response to intravenous (i.v.) tissue plasminogen activator (tPA) therapy is poor. The objective of this study was to evaluate the feasibility of rescue localized intra-arterial thrombolysis (LIT) therapy for acute ischemic stroke patients after an early non-responsive i.v. tPA therapy. Patients with proximal MCA occlusions who were treated by LIT (n=10) after failure of early response [no improvement or improvement of National Institute of Health Stroke Scale (NIHSS) scores of ≤3] to i.v. tPA therapy (0.9 mg/kg - 10% bolus and 90% i.v. infusion over 60 min) were selected. The recanalization rates, incidence of post-thrombolysis hemorrhage and clinical outcomes [baseline and discharge NIHSS scores, mortality, 3 months Barthel index (BI) and modified Rankin score (mRS)] were evaluated. Rescue LIT therapy was performed on ten MCA occlusion patients (male:female=3:7, mean age 71 years). The mean time between the initiation of i.v. tPA therapy and the initiation of intra-arterial urokinase (i.a. UK) was 117±25.0 min [time to i.v. tPA 137±32 min; time to digital subtraction angiography (DSA) 221±42 min; time to i.a. UK 260±46 min]. The baseline NIHSS scores showed significant improvement at discharge (median from 18 to 6). Symptomatic hemorrhage and, consequent, mortality were noted in 2/10 (20%) patients. Three months good outcome was noted in 4/10 (40%, mRS 0-2) and 3/10 (30%, BI ≥95). In conclusion, rescue LIT therapy can be considered as a treatment option for patients not showing early response to full dose i.v. tPA therapy. Larger scale studies for further validation of this protocol may be necessary. (orig.)

  10. FAST INdiCATE Trial protocol. Clinical efficacy of functional strength training for upper limb motor recovery early after stroke: neural correlates and prognostic indicators.

    Science.gov (United States)

    Pomeroy, Valerie M; Ward, Nick S; Johansen-Berg, Heidi; van Vliet, Paulette; Burridge, Jane; Hunter, Susan M; Lemon, Roger N; Rothwell, John; Weir, Christopher J; Wing, Alan; Walker, Andrew A; Kennedy, Niamh; Barton, Garry; Greenwood, Richard J; McConnachie, Alex

    2014-02-01

    Functional strength training in addition to conventional physical therapy could enhance upper limb recovery early after stroke more than movement performance therapy plus conventional physical therapy. To determine (a) the relative clinical efficacy of conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy for upper limb recovery; (b) the neural correlates of response to conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy; (c) whether any one or combination of baseline measures predict motor improvement in response to conventional physical therapy combined with functional strength training or conventional physical therapy combined with movement performance therapy. Randomized, controlled, observer-blind trial. The sample will consist of 288 participants with upper limb paresis resulting from a stroke that occurred within the previous 60 days. All will be allocated to conventional physical therapy combined with functional strength training or conventional physical therapy combined with movement performance therapy. Functional strength training and movement performance therapy will be undertaken for up to 1·5 h/day, five-days/week for six-weeks. Measurements will be undertaken before randomization, six-weeks thereafter, and six-months after stroke. Primary efficacy outcome will be the Action Research Arm Test. Explanatory measurements will include voxel-wise estimates of brain activity during hand movement, brain white matter integrity (fractional anisotropy), and brain-muscle connectivity (e.g. latency of motor evoked potentials). The primary clinical efficacy analysis will compare treatment groups using a multilevel normal linear model adjusting for stratification variables and for which therapist administered the treatment. Effect of conventional physical therapy combined

  11. Feasibility and outcomes of a classical Pilates program on lower extremity strength, posture, balance, gait, and quality of life in someone with impairments due to a stroke.

    Science.gov (United States)

    Shea, Sarah; Moriello, Gabriele

    2014-07-01

    Pilates is a method that can potentially be used for stroke rehabilitation to address impairments in gait, balance, strength, and posture. The purpose of this case report was to document the feasibility of using Pilates and to describe outcomes of a 9-month program on lower extremity strength, balance, posture, gait, and quality of life in an individual with stroke. The participant was taught Pilates exercises up to two times per week for nine months in addition to traditional rehabilitation in the United States. Outcomes were assessed using the Berg Balance Scale (BBS), Stroke Impact Scale (SIS), GAITRite System(®), 5 repetition sit-to-stand test (STST), and flexicurve. Improvements were found in balance, lower extremity strength, and quality of life. Posture and gait speed remained the same. While these changes cannot be specifically attributed to the intervention, Pilates may have added to his overall rehabilitation program and with some modifications was feasible to use in someone with a stroke. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Examining the Association between the "Imagination Library" Early Childhood Literacy Program and Kindergarten Readiness

    Science.gov (United States)

    Samiei, Shahin; Bush, Andrew J.; Sell, Marie; Imig, Doug

    2016-01-01

    This study evaluated participation in the "Imagination Library" early childhood literacy enrichment program and children's pre-literacy and pre-numeracy skills at kindergarten entry in an urban school district. Previous studies have demonstrated that program participation is associated with greater early childhood reading practices.…

  13. A Community-Based Early Intervention Program for Toddlers with Autism Spectrum Disorders

    Science.gov (United States)

    Rollins, Pamela Rosenthal; Campbell, Michelle; Hoffman, Renee Thibodeau; Self, Kayli

    2016-01-01

    This study examined Pathways Early Autism Intervention, a community-based, parent-mediated, intensive behavioral and developmental intervention program for children with autism spectrum disorders that could be used as a model for state-funded early intervention programs. A single-subject, multiple-baseline, across-participants design was used.…

  14. An Evaluation of the Savannah Early College Program: An Action Oriented Research Approach

    Science.gov (United States)

    Kearse, Douglas

    2013-01-01

    The Savannah Early College Program (SECP) opened its doors in August 2007 to make a difference in the lives of all students who enrolled. Its primary mission was to combine academic rigor and support to help students enter college early and graduate from high school with up to 2 years of college credit. Since SECP joined the Early College High…

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

    Science.gov (United States)

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

    2013-12-01

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

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

    Directory of Open Access Journals (Sweden)

    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. [Functional electrical stimulation based on a working pattern influences function of lower extremity in subjects with early stroke and effects on diffusion tensor imaging: a randomized controlled trial].

    Science.gov (United States)

    Chen, Danfeng; Yan, Tiebin; Li, Guandong; Li, Fangming; Liang, Qitang

    2014-10-14

    To explore the possible mechanisms for improving lower extremity motor function in patients with early stroke through combining magnetic resonance diffusion tensor imaging (DTI) technology and functional electrical stimulation (FES) based on human walking patterns. From August 2012 to September 2013, a total of 48 eligible patients were stratified according to age, gender, disease course, Brunnstrom staging and types of stroke. And the Minimize software was used to divided them randomly into four-channel FES group (n = 18), dual-channel FES group (n = 15) and comfort stimulation group (n = 15). For all three groups, general medication and standard rehabilitation were provided. Based on normal walking pattern design of FES treatment, four-channel FES groups received the stimulations of quadriceps, hamstring, anterior tibialis and medial gastrocnemius. For the dual-channel FES group, the stimulations of tibialis anterior, peroneus longus and peroneus brevis muscles were applied. In comfort electrical stimulation group, the electrode positions were identical to the stimulation group, but there was no current output during stimulation. Before and after 3-week treatment, three groups received weekly rehabilitation evaluations of Fugl-Meyer assessment (FMA), posture assessment of stroke scale (PASS), Brunel balance assessment (BBA), Berg balance scale (BBS) and modified Barthel index (MBI). Before and after treatment, DTI examination was performed for some patients. Among three groups, general patient profiles and pre-treatment evaluations showed no significant difference. For intra-group comparisons versus pre-treatment, at week 1, 2 and 3, the scores of PASS, BBA, BBS, FMA and MBI had statistically significant differences (P stimulation group. When dual-channel FES and comfort stimulation groups were compared, MBI had significant statistical difference [(60 ± 17) vs (47 ± 20), P stimulation group respectively. When dual-channel FES and comfort stimulation groups were

  18. The Littlest Historians: Early Years Programming in History Museums

    Science.gov (United States)

    Leftwich, Mariruth; Haywood, Clare

    2016-01-01

    Working with children under five years old and the adults that accompany them is a rapidly growing area within the museum and wider cultural sector, with important emphasis being placed on early learning in both the United Kingdom and United States. For history museums in particular, early learning offers a unique set of questions and challenges,…

  19. A Pilot Telerehabilitation Program: Delivering Early Intervention Services to Rural Families

    Directory of Open Access Journals (Sweden)

    Jana Cason

    2009-09-01

    Full Text Available The enTECH Telerehabilitation Program explored the use of telerehabilitation as an alternative service delivery model for early intervention therapy services. Utilizing the Kentucky Telehealth Network, two families living in rural Kentucky received occupational therapy services over a 12-week period. Following program implementation, qualitative data was collected using participant journals and interviews. Data analysis identified three thematic categories related to the program: benefits/strengths, challenges/weaknesses, and recommendations for program improvement. Results of the program evaluation indicated that telerehabilitation has the potential to cost-effectively meet the therapeutic needs of children living in rural areas where provider shortages exist. The enTECH Telerehabilitation Program serves as a model for how telerehabilitation can be used to deliver early intervention services to ameliorate health disparities and improve access to rehabilitation services. Keywords: Telerehabilitation, Occupational Therapy, Rural, Early Intervention, Children, Program Evaluation, Cost Analysis

  20. How Does Early Feedback in an Online Programming Course Change Problem Solving?

    Science.gov (United States)

    Ebrahimi, Alireza

    2012-01-01

    How does early feedback change the programming problem solving in an online environment and help students choose correct approaches? This study was conducted in a sample of students learning programming in an online course entitled Introduction to C++ and OOP (Object Oriented Programming) using the ANGEL learning management system platform. My…

  1. Is Something Better than Nothing? An Evaluation of Early Childhood Programs in Cambodia

    Science.gov (United States)

    Rao, Nirmala; Sun, Jin; Pearson, Veronica; Pearson, Emma; Liu, Hongyun; Constas, Mark A.; Engle, Patrice L.

    2012-01-01

    This study evaluated the relative effectiveness of home-based, community-based, and state-run early childhood programs across Cambodia. A total of 880 five-year-olds (55% girls) from 6 rural provinces in Cambodia attending State Preschools, Community Preschools, Home-Based Programs, or no programs were assessed twice using the Cambodian…

  2. 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

  3. A randomized trial of the effects of an aquatic exercise program on depression, anxiety levels, and functional capacity in of people who suffered an ischemic stroke.

    Science.gov (United States)

    Aidar, Felipe J; Jacó de Oliveira, Ricardo; Gama de Matos, Dihogo; Chilibeck, Philip D; de Souza, Raphael F; Carneiro, André L; Machado Reis, Victor

    2017-05-09

    Aquatic exercise programs are used in rehabilitation and might help to reduce disability after stroke. This was a randomized intervention trial to assess the influence of an aquatic exercise program on people suffering from depression and anxiety after ischemic stroke. Participants were randomized to an experimental group (EG) composed of 19 individuals (51.8 ± 8.5 years; ten males and nine females), and a control group (CG) composed of 17 people (52.7 ± 6.7 years; nine males and eight females). The aquatic exercise program consisted of two sessions per week, each lasting between 45 and 60 minutes and divided into 5 to 10 minutes exercise sections during 12 weeks. The State-Trait Anxiety Inventory (STAI) was used to determine anxiety levels while the Beck Depression Inventory was used as a self-assessment of depression. EG improved measures of depression, anxiety trait and anxiety state between pre- and post-treatment, with no changes in CG. EG improved in all tests related to functional capacity compared to CG. The practice of aquatic exercises promotes improvements in the levels of depression and anxiety in people who suffered an ischemic stroke.

  4. Efficacy of early administration of escitalopram on depressive and emotional symptoms and neurological dysfunction after stroke: a multicentre, double-blind, randomised, placebo-controlled study.

    Science.gov (United States)

    Kim, Jong S; Lee, Eun-Jae; Chang, Dae-Il; Park, Jong-Ho; Ahn, Seong Hwan; Cha, Jae-Kwan; Heo, Ji Hoe; Sohn, Sung-Il; Lee, Byung-Chul; Kim, Dong-Eog; Kim, Hahn Young; Kim, Seongheon; Kwon, Do-Young; Kim, Jei; Seo, Woo-Keun; Lee, Jun; Park, Sang-Won; Koh, Seong-Ho; Kim, Jin Young; Choi-Kwon, Smi

    2017-01-01

    Mood and emotional disturbances are common in patients with stroke, and adversely affect the clinical outcome. We aimed to evaluate the efficacy of early administration of escitalopram to reduce moderate or severe depressive symptoms and improve emotional and neurological dysfunction in patients with stroke. This was a placebo controlled, double-blind trial done at 17 centres in South Korea. Patients who had had an acute stroke within the past 21 days were randomly assigned in a 1:1 ratio to receive oral escitalopram (10 mg/day) or placebo for 3 months. Randomisation was done with permuted blocks stratified by centre, via a web-based system. The primary endpoint was the frequency of moderate or severe depressive symptoms (Montgomery-Åsberg Depression Rating Scale [MADRS] ≥16). Endpoints were assessed at 3 months after randomisation in the full analysis set (patients who took study medication and underwent assessment of primary endpoint after randomisation), in all patients who were enrolled and randomly assigned (intention to treat), and in all patients who completed the trial (per-protocol analysis). This trial is registered with ClinicalTrials.gov, number NCT01278498. Between Jan 27, 2011, and June 30, 2014, 478 patients were assigned to placebo (n=237) or escitalopram (n=241); 405 were included in the full analysis set (195 in the placebo group, 210 in the escitalopram group). The primary outcome did not differ by study group in the full analysis set (25 [13%] patients in the placebo group vs 27 [13%] in the escitalopram group; odds ratio [OR] 1·00, 95% CI 0·56-1·80; p>0·99) or in the intention-to-treat analysis (34 [14%] vs 35 [15%]; OR 1·01, 95% CI 0·61-1·69, p=0·96). The study medication was generally well tolerated; the most common adverse events were constipation (14 [6%] patients who received placebo vs 14 [6%] who received escitalopram), muscle pain (16 [7%] vs ten [4%]), and insomnia (12 [5%] vs 12 [5%]). Diarrhoea was more common in the

  5. Effect of motor relearning program poststem cell therapy in chronic stroke

    Directory of Open Access Journals (Sweden)

    Jorida Fernandes

    2017-01-01

    Full Text Available A 59-year-old male, with chronic hemiplegia, received the first dose of stem cell therapy 1 year back. Physiotherapy was started immediately. The patient was evaluated using Fugl-Meyer assessment scale and functional independence measure before and after physiotherapy. After 6 months of physiotherapy intervention using motor relearning program, improvements were observed in the motor outcome with significant changes in the upper extremity, especially the hand component.

  6. The Current State of Early Childhood Education Programs: How Early Childhood Center Directors Manage Their Human Resources

    Science.gov (United States)

    Arend, Lauren E.

    2010-01-01

    Purpose: Research in the field of early childhood education (ECE) demonstrated the association between skilled directors and high quality programs. Still, most state licensing requirements do not delineate the requisite knowledge or experience necessary to be an effective director. Many ECE directors advance to their position directly from the…

  7. [Acupuncture treatment programs for post-stroke motor rehabilitation in community hospitals: study protocol of a multicenter, randomized, controlled trial].

    Science.gov (United States)

    Fu, Qin-hui; Pei, Jian; Jia, Qi; Song, Yi; Gu, Yue-hua; You, Xiao-xin

    2012-05-01

    Stroke is responsible for increasingly high rates of mortality and disability worldwide. Approximately two million people suffer from stroke for the first time in China each year. The high incidence (50%) of post-stroke disability brings a heavy burden to patients and their caregivers. Acupuncture has been widely used in the communities for post-stroke rehabilitation in China. The objective of this trial is to apply our acupuncture research achievement to treatment and evaluation of post-stroke hemiplegic patients in community. A multicenter, randomized, controlled trial will be performed in Longhua Hospital and a number of community health service centers in Shanghai. A total of 124 patients (estimated sample size) with post-stroke hemiplegia will be randomly divided into an acupuncture group and a control group. The patients undergoing randomization should be stratified according to National Institutes of Health Stroke Scale score at baseline. Within the acupuncture group, different acupuncture protocols are administered to patients with flaccid paralysis or spastic paralysis based on the Ashworth Scale. Patients in the acupuncture group will also be treated with comprehensive rehabilitation therapy. The control group will be treated with comprehensive rehabilitation therapy only. The primary outcome measures are the Simplified Fugl-Meyer Motor Scale, the Modified Barthel Index, and the Burden of Stroke Scale. Secondary outcome measures are the modified Rankin Scale, the modified Ashworth Scale and the Stroke Scale of Traditional Chinese Medicine. Outcome measures will be performed after 4 and 8 weeks of treatment. The patients will be followed up after 6 months. The results of this study are expected to demonstrate that our standardized acupuncture protocol for treating and evaluating post-stroke hemiplegic patients will improve motor function and lessen the burden of post-stroke patients within the communities. This will provide the evidence to support

  8. Improving Stroke Management through Specialized Stroke Units in ...

    African Journals Online (AJOL)

    ... rehabilitation of the stroke patient. The establishment of stroke units has been found to improve the survival of patients and significantly reduce disability by rendering holistic care. Early intervention to rapidly restore and maintain blood supply to the ischemic area in the brain, minimize brain damage and hence impairment ...

  9. Comparison between mini mental state examination (MMSE) and Montreal cognitive assessment Indonesian version (MoCA-Ina) as an early detection of cognitive impairments in post-stroke patients

    Science.gov (United States)

    Lestari, S.; Mistivani, I.; Rumende, C. M.; Kusumaningsih, W.

    2017-08-01

    Mild cognitive impairment (MCI) is defined as cognitive impairment that may never develop into dementia. Cognitive impairment is one long-term complication of a stroke. The Mini Mental State Examination (MMSE), which is commonly used as a screening tool for cognitive impairment, has a low sensitivity to detect cognitive impairment, especially MCI. Alternatively, the Montreal Cognitive Assessment Indonesian version (MoCA-Ina) has been reported to have a higher sensitivity than the MMSE. The aim of this study was to compare the proportion of MCI identified between the MMSE and MoCA-Ina in stroke patients. This was a cross-sectional study of stroke outpatients who attended the Polyclinic Neuromuscular Division, Rehabilitation Department, and Polyclinic Stroke, Neurology Department Cipto Mangunkusumo General Hospital, Jakarta. The proportion of MCI identified using the MMSE was 31.03% compared to 72.41% when using the MoCA-Ina. This difference was statistically significant (Fisher’s exact test, p = 0.033). The proportion of MCI in stroke patients was higher when using the MoCA-Ina compared to the MMSE. The MoCA-Ina should be used as an alternative in the early detection of MCI in stroke patients, especially those undergoing rehabilitation.

  10. Primary stroke prevention for sickle cell disease in north-east Italy: the role of ethnic issues in establishing a Transcranial Doppler screening program

    Directory of Open Access Journals (Sweden)

    Pierobon Marta

    2009-06-01

    Full Text Available Abstract Background Stroke is a serious complication of sickle cell disease (SCD in children. Transcranic Doppler (TCD is a well-established predictor of future cerebrovascular symptoms: a blood flow velocity >200 cm/sec in the Middle Cerebral Artery (MCA correlates with a high risk of stroke in cohorts of African-american HbS/HbS patients. In North-East Italy the recent increase in SCD patients is mainly due to immigration from Africa. A comprehensive care program for children with SCD was established in our Center since 2004, but a wide and routine screening for Primary stroke prevention needs to be developed. Methods In order to verify the feasibility of TCD and Transcranial color coded Sonography (TCCS screening in our setting and the applicability of international reference values of blood velocities to our population of African immigrants with HbS/HbS SCD, we performed TCD and TCCD in 12 HbS/HbS African children and two groups of age-matched controls of Caucasian and African origin respectively. TCD and TCCS were performed on the same day of the scheduled routine hematologic visit after parental education. Results All parents accepted to perform the sonography to their children. TCD and TCCD were performed in all patients and an adequate temporal window could be obtained in all of them. Pulsatility index and depth values in both the MCA and the Basilar Artery (BA were similar at TCD and TCCS evaluation in the three groups while time-average maximum velocities (TAMM, peak systolic velocity and diastolic velocity in the MCA and BA were higher in the patients' group on both TCD and TCCS evaluation. African and Caucasian healthy controls had similar lower values. Conclusion Our preliminary data set the base to further evaluate the implementation of a primary stroke prevention program in our setting of HbS/HbS African immigrants and HbS/beta thalassemia Italians. Parental education-preferably in the native language- on stroke risk and

  11. Effect of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Naming Abilities in Early-Stroke Aphasic Patients: A Prospective, Randomized, Double-Blind Sham-Controlled Study

    Directory of Open Access Journals (Sweden)

    Konrad Waldowski

    2012-01-01

    Full Text Available Background and Purpose. Functional brain imaging studies with aphasia patients have shown increased cortical activation in the right hemisphere language homologues, which hypothetically may represent a maladaptive strategy that interferes with aphasia recovery. The aim of this study was to investigate whether low-frequency repetitive transcranial magnetic stimulation (rTMS over the Broca’s homologues in combination with speech/language therapy improves naming in early-stroke aphasia patients. Methods. 26 right-handed aphasic patients in the early stage (up to 12 weeks of a first-ever left hemisphere ischemic stroke were randomized to receive speech and language therapy combined with real or sham rTMS. Prior to each 45-minute therapeutic session (15 sessions, 5 days a week, 30 minutes of 1-Hz rTMS was applied. Outcome measures were obtained at baseline, immediately after 3 weeks of experimental treatment and 15 weeks; posttreatment using the Computerized Picture Naming Test. Results. Although both groups significantly improved their naming abilities after treatment, no significant differences were noted between the rTMS and sham stimulation groups. The additional analyses have revealed that the rTMS subgroup with a lesion including the anterior part of language area showed greater improvement primarily in naming reaction time 15 weeks after completion of the therapeutic treatment. Improvement was also demonstrated in functional communication abilities. Conclusions. Inhibitory rTMS of the unaffected right inferior frontal gyrus area in combination with speech and language therapy cannot be assumed as an effective method for all poststroke aphasia patients. The treatment seems to be beneficial for patients with frontal language area damage, mostly in the distant time after finishing rTMS procedure.

  12. Effects of a 6-Week Aquatic Treadmill Exercise Program on Cardiorespiratory Fitness and Walking Endurance in Subacute Stroke Patients: A PILOT TRIAL.

    Science.gov (United States)

    Han, Eun Young; Im, Sang Hee

    2017-03-15

    To assess the feasibility and safety of a 6-week course of water walking performed using a motorized aquatic treadmill in individuals with subacute stroke for cardiorespiratory fitness, walking endurance, and activities of daily living. Twenty subacute stroke patents were randomly assigned to aquatic treadmill exercise (ATE) or land-based exercise (LBE). The ATE group (n = 10) performed water-based aerobic exercise on a motorized aquatic treadmill, and the LBE group (n = 10) performed land-based aerobic exercise on a cycle ergometer. Both groups performed aerobic exercise for 30 minutes, 5 times per week for 6 weeks. Primary outcome measures were 6-minute walk test for walking endurance and cardiopulmonary fitness parameters of a symptom-limited exercise tolerance test, and secondary measures were Korean version of the Modified Barthel Index (K-MBI) for activities of daily living. All variables were assessed at baseline and at the end of the intervention. The ATE group showed significant improvements in 6-minute walk test (P = .005), peak oxygen uptake (V·o2peak; P = .005), peak heart rate (P = .007), exercise tolerance test duration (P = .005), and K-MBI (P = .008). The LBE group showed a significant improvement only in K-MBI (P = .012). In addition, improvement in V·o2peak was greater in the ATE than in the LBE group. This preliminary study showed that a 6-week ATE program improved peak aerobic capacity and walking endurance in patients with subacute stroke. The improvement in V·o2peak after an ATE exercise program was greater than that observed after an LBE program. Therefore, ATE effectively improves cardiopulmonary fitness in patients with subacute stroke.

  13. Ischemic Stroke

    Science.gov (United States)

    ... Workplace Giving Fundraise Planned Giving Corporate Giving Cause Marketing Join your team, your way! The Stroke Challenge ... Your Technology Guide High Blood Pressure and Stroke Importance of Physical Activity See More Multimedia Las minorías ...

  14. Stroke - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100218.htm Stroke - series—Part 1 To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Ischemic Stroke A.D.A.M., Inc. is accredited by ...

  15. Quality and best practices in early childhood programs: perceptions ...

    African Journals Online (AJOL)

    Definitions of quality in early childhood education (ECE) has predominantly adopted a developmental perspective, where quality care is that which promotes optimal child outcomes in all domains of development. This study investigates Developmentally Appropriate Practice (DAP), an approach designed to promote young ...

  16. The Importance of Father Involvement in Early Childhood Programs

    Science.gov (United States)

    Ancell, Katherine S.; Bruns, Deborah A.; Chitiyo, Jonathan

    2018-01-01

    Active family involvement in Early Childhood Special Education (ECSE) is regarded as a beneficial factor in young children's learning and development. One definition of family involvement is the active role parents take in their child's development and the knowledge and participation they share with professionals who are part of the child's daily…

  17. Sensitive Situations. The DLM Early Childhood Program Professional Library.

    Science.gov (United States)

    Schiller, Pam

    Teachers know how to educate young children, but many feel ill-prepared when faced with students' emotional issues in the classroom. This book is intended as a resource for early childhood teachers who find themselves in the middle of such "sensitive situations." The information is presented by using a fictional, but typical, scenario…

  18. Labor and Population Program: Analyzing the Costs and Benefits of Early Childhood Interventions

    National Research Council Canada - National Science Library

    2001-01-01

    As they pay more attention to accountability, funders and implementers of early childhood interventions are becoming more interested in comparing the benefits their programs produce and the costs they incur...

  19. Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke.

    Science.gov (United States)

    Smith, Eric E; Kent, David M; Bulsara, Ketan R; Leung, Lester Y; Lichtman, Judith H; Reeves, Mathew J; Towfighi, Amytis; Whiteley, William N; Zahuranec, Darin B

    2018-03-01

    Endovascular thrombectomy is a highly efficacious treatment for large vessel occlusion (LVO). LVO prediction instruments, based on stroke signs and symptoms, have been proposed to identify stroke patients with LVO for rapid transport to endovascular thrombectomy-capable hospitals. This evidence review committee was commissioned by the American Heart Association/American Stroke Association to systematically review evidence for the accuracy of LVO prediction instruments. Medline, Embase, and Cochrane databases were searched on October 27, 2016. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy-2 tool. Thirty-six relevant studies were identified. Most studies (21 of 36) recruited patients with ischemic stroke, with few studies in the prehospital setting (4 of 36) and in populations that included hemorrhagic stroke or stroke mimics (12 of 36). The most frequently studied prediction instrument was the National Institutes of Health Stroke Scale. Most studies had either some risk of bias or unclear risk of bias. Reported discrimination of LVO mostly ranged from 0.70 to 0.85, as measured by the C statistic. In meta-analysis, sensitivity was as high as 87% and specificity was as high as 90%, but no threshold on any instruments predicted LVO with both high sensitivity and specificity. With a positive LVO prediction test, the probability of LVO could be 50% to 60% (depending on the LVO prevalence in the population), but the probability of LVO with a negative test could still be ≥10%. No scale predicted LVO with both high sensitivity and high specificity. Systems that use LVO prediction instruments for triage will miss some patients with LVO and milder stroke. More prospective studies are needed to assess the accuracy of LVO prediction instruments in the prehospital setting in all patients with suspected stroke, including patients with hemorrhagic stroke and stroke mimics. © 2018 American Heart Association, Inc.

  20. 34 CFR 303.1 - Purpose of the early intervention program for infants and toddlers with disabilities.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Purpose of the early intervention program for infants... EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES General Purpose, Eligibility, and Other General Provisions § 303.1 Purpose of the early intervention program for infants and...

  1. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

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

  2. An Eccentrically Biased Rehabilitation Program Early after TKA Surgery

    Directory of Open Access Journals (Sweden)

    Robin L. Marcus

    2011-01-01

    Full Text Available Rehabilitation services are less-studied aspects of the management following total knee arthroplasty (TKA despite long-term suboptimal physical functioning and chronic deficits in muscle function. This paper describes the preliminary findings of a six-week (12 session eccentrically-biased rehabilitation program targeted at deficits in physical function and muscle function, initiated one month following surgery. A quasiexperimental, one group, pretest-posttest study with thirteen individuals (6 female, 7 male; mean age 57±7 years examined the effectiveness of an eccentrically-biased rehabilitation program. The program resulted in improvements in the primary physical function endpoints (SF-36 physical component summary and the six-minute walk test with increases of 59% and 47%, respectively. Muscle function endpoints (knee extension strength and power also increased 107% and 93%, respectively. Eccentrically-biased exercise used as an addition to rehabilitation may help amplify and accelerate physical function following TKA surgery.

  3. Effects of Family Functioning and Parenting Style on Early Entrants' Academic Performance and Program Completion

    Science.gov (United States)

    Huey, Erron L.; Sayler, Michael F.; Rinn, Anne N.

    2013-01-01

    The purpose of the current study was to examine the predictive nature of parenting style and overall family environment on the academic performance and program completion of early college entrants. Furthermore, gender and family form were examined as possible moderators to these relationships. A total of 88 early college entrants participated in…

  4. Early Childhood Educators and the FIS Grant Program: An Interview with Naomi Karp.

    Science.gov (United States)

    ERIC Clearinghouse on Elementary and Early Childhood Education, Champaign, IL.

    Naomi Karp is the Director of the National Institute on Early Childhood Development and Education (ECI) in the Office of Educational Research and Improvement (OERI) in the U.S. Department of Education. This interview concerns funding for early childhood education research through OERI's Field-Initiated Studies (FIS) Grant Program. Questions…

  5. Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients : a systematic review

    NARCIS (Netherlands)

    Kosse, Nienke M.; Dutmer, Alisa L.; Dasenbrock, Lena; Bauer, Juergen M.; Lamoth, Claudine J. C.

    2013-01-01

    Background: Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical

  6. Incorporating Early Learning Strategies in the School Improvement Grants (SIG) Program

    Science.gov (United States)

    Connors-Tadros, Lori; Dunn, Lenay; Martella, Jana; McCauley, Carlas

    2015-01-01

    The Center on Enhancing Early Learning Outcomes (CEELO) and the Center on School Turnaround (CST) collaborated to develop case studies of three selected schools receiving SIG funds that have, with the support of their districts, promoted the use of early childhood programming (PK-3) as a key strategy in their schools' turnaround models. The goal…

  7. Programming of hippocampal structure and function by early-life stress: Opportunities for nutritional intervention

    NARCIS (Netherlands)

    Naninck, E.F.G.

    2015-01-01

    Early-life is a critical developmental phase during which brain structure and function are shaped 'for life'. When early-life is disturbed by stress-exposure, this lastingly programs our brains and is associated with impaired cognition and predisposition to psychopathology in adulthood.

  8. Evaluation of Effects of the Clovis - Portales Bilingual Early Childhood Program: Final Report, 1972-73.

    Science.gov (United States)

    Askins, Billy E.; Alford, Gay

    Initiated in 1972, the Bilingual Early Childhood Program (BECP) serves as early intervention for 3- and 4-year-old children in Clovis and Portales, New Mexico (40 children at each site). Target group children were predominantly from Spanish-speaking backgrounds and were selected as participants using guideline requirements of language, background,…

  9. Early Childhood Development Policy and Programming in India: Critical Issues and Directions for Paradigm Change

    Science.gov (United States)

    Sharma, Adarsh; Sen, Rekha Sharma; Gulati, Renu

    2008-01-01

    The critical importance of the early childhood years and the rights perspective to human development has made policy and programming for early childhood development an imperative for every nation. In India, poverty, changing economic and social structures resulting in the breakdown of traditional coping mechanisms and family care systems, and the…

  10. Family history as a risk factor for early-onset stroke/transient ischemic attack among adults in the United States.

    Science.gov (United States)

    Mvundura, Mercy; McGruder, Henraya; Khoury, Muin J; Valdez, Rodolfo; Yoon, Paula W

    2010-01-01

    Stroke is a major cause of morbidity and death in the United States. We tested the association between familial risk for stroke and prevalence of the disease among US adults and assessed the use of family history of stroke as a risk assessment tool for the disease. Using data from the 2005 HealthStyles survey (n = 4,819), we explored the association between familial stroke risk (stratified as high, moderate or low) and the prevalence of stroke and related health conditions. We evaluated the clinical validity (sensitivity, specificity) of family history of stroke as an indicator of stroke risk. Stroke and the related medical conditions were self-reported. Independent of other risk factors, people with a high familial risk for stroke were 4 times more likely to have had a stroke (95% confidence interval, CI, 2.6-6.0) than people with moderate or low familial risk. They were also 1.3 times (95% CI 1.1-1.6) more likely to have high blood pressure and 1.5 times (95% CI 1.3-2.0) more likely to have congestive heart failure. The sensitivity and specificity of using family history alone, high blood pressure alone or both risk factors to estimate stroke risk were 52 and 83%, 53 and 74%, and 29 and 95%, respectively. Despite several limitations typical of self-reported surveys, we find that in this sample of US adults, family history of stroke was significantly associated with the risk for stroke and high blood pressure as well as related conditions. Family history of stroke, alone or combined with other risk factors, can be a useful tool in assessing stroke risk among US adults. Copyright © 2009 S. Karger AG, Basel.

  11. [The role of physical exercises in the improvement of cognitive functions in patients who survived stroke, in the early rehabilitative period].

    Science.gov (United States)

    Boĭko, E A; Kulishova, T V; Shumakher, G I; Iusupkhodzhaev, R V

    2008-01-01

    The objective of this work was to evaluate the efficacy of a complex of physical therapy exercises "Brain gymnastics" in post-stroke patients. Eighty three such patients enrolled in the study were randomly allocated to two groups. The program of physical rehabilitation for patients comprising one group (n = 41) included regular exercises with elements of "brain gymnastics" whereas patients of the other group (n = 41) received standard rehabilitative treatment. Patients of group 1 enjoyed improvement of cognitive functions, mood, and quality of life. Disturbances of short-term memory and voluntary attention were partly corrected, astheno-neurotic reactions and manifestations of advantage by illness became less apparent than in the control group while the level of self-assessment increased. None of the patients in group 1 exhibited undesirable reactions to the offered treatment.

  12. Secular trends in ischemic stroke subtypes and stroke risk factors.

    Science.gov (United States)

    Bogiatzi, Chrysi; Hackam, Daniel G; McLeod, A Ian; Spence, J David

    2014-11-01

    Early diagnosis and treatment of a stroke improves patient outcomes, and knowledge of the cause of the initial event is crucial to identification of the appropriate therapy to maximally reduce risk of recurrence. Assumptions based on historical frequency of ischemic subtypes may need revision if stroke subtypes are changing as a result of recent changes in therapy, such as increased use of statins. We analyzed secular trends in stroke risk factors and ischemic stroke subtypes among patients with transient ischemic attack or minor or moderate stroke referred to an urgent transient ischemic attack clinic from 2002 to 2012. There was a significant decline in low-density lipoprotein cholesterol and blood pressure, associated with a significant decline in large artery stroke and small vessel stroke. The proportion of cardioembolic stroke increased from 26% in 2002 to 56% in 2012 (Prisk factors was observed, with a significant decline in stroke/transient ischemic attack caused by large artery atherosclerosis and small vessel disease. As a result, cardioembolic stroke/transient ischemic attack has increased significantly. Our findings suggest that more intensive investigation for cardiac sources of embolism and greater use of anticoagulation may be warranted. © 2014 American Heart Association, Inc.

  13. ESCAPS study protocol: a feasibility randomised controlled trial of 'Early electrical stimulation to the wrist extensors and wrist flexors to prevent the post-stroke complications of pain and contractures in the paretic arm'.

    Science.gov (United States)

    Fletcher-Smith, Joanna C; Walker, Dawn-Marie; Sprigg, Nikola; James, Marilyn; Walker, Marion F; Allatt, Kate; Mehta, Rajnikant; Pandyan, Anand D

    2016-01-04

    Approximately 70% of patients with stroke experience impaired arm function, which is persistent and disabling for an estimated 40%. Loss of function reduces independence in daily activities and impacts on quality of life. Muscles in those who do not recover functional movement in the stroke affected arm are at risk of atrophy and contractures, which can be established as early as 6 weeks following stroke. Pain is also common. This study aims to evaluate the feasibility of a randomised controlled trial to test the efficacy and cost-effectiveness of delivering early intensive electrical stimulation (ES) to prevent post-stroke complications in the paretic upper limb. This is a feasibility randomised controlled trial (n=40) with embedded qualitative studies (patient/carer interviews and therapist focus groups) and feasibility economic evaluation. Patients will be recruited from the Stroke Unit at the Nottingham University Hospitals National Health Service (NHS) Trust within 72 h after stroke. Participants will be randomised to receive usual care or usual care and early ES to the wrist flexors and extensors for 30 min twice a day, 5 days a week for 3 months. The initial treatment(s) will be delivered by an occupational therapist or physiotherapist who will then train the patient and/or their nominated carer to self-manage subsequent treatments. This study has been granted ethical approval by the National Research Ethics Service, East Midlands Nottingham1 Research Ethics Committee (ref: 15/EM/0006). To our knowledge, this is the first study of its kind of the early application (within 72 h post-stroke) of ES to both the wrist extensors and wrist flexors of stroke survivors with upper limb impairment. The results will inform the design of a definitive randomised controlled trial. Dissemination will include 2 peer-reviewed journal publications and presentations at national conferences. ISRCTN1648908; Pre-results. Clinicaltrials.gov ID: NCT02324634. Published by the BMJ

  14. Generalization of Parenting Skills: An Early Intervention Program.

    Science.gov (United States)

    Lowry, Mark A.; Whitman, Thomas L.

    1989-01-01

    In a short-term, intensive parent-training program, mothers of developmentally delayed infants are shown how to teach their children toy play behaviors. This study evaluates intervention effects on parents and children, with a focus on maternal behaviors. Results indicate improved maternal teaching behavior and generalizability of positive…

  15. An Early Assessment of Reagan Defense Policy and Programs.

    Science.gov (United States)

    Oliver, James K.

    1990-01-01

    Assesses Reagan's defense policy and programs, contending that arms control negotiations were not integral to the administration's policies. Discusses the reestablishment of public support for U.S. globalism, and examines the use of U.S. military forces during the Reagan years. Analyzes Reagan's efforts at breaking the Vietnam Syndrome. (RW)

  16. A pilot study: portable out-of-center sleep testing as an early sleep apnea screening tool in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Chernyshev OY

    2015-10-01

    subjects with an AHI ≥15 on PSG, OCST parameters were as follows: sensitivity 100%, specificity 83.3%, PPV 81.8%, and NPV 100%. Bland–Altman plotting showed an overall diagnostic agreement between OCST and PSG modalities for an AHI cutoff >5, despite fine-grained differences in estimated AHIs. Conclusion: Compared with PSG, OCST provides similar diagnostic information when run simultaneously in AIS patients. OCST is a reliable screening tool for early diagnosis of OSA in AIS patients. Keywords: portable clinical screening, obstructive sleep apnea diagnosis, acute ischemic stroke, sleep testing in stroke, acute sleep medicine

  17. Early Career Hire Rapid Training and Development Program: Status Report

    Science.gov (United States)

    Riley, Betsy N.; Solish, Benjamin S.; Halatek, Lauren; Rieber, Richard R.

    2009-01-01

    The aging of the industrialized workforce, particularly in the aerospace industry, has resulted in a very large generation gap in the workforce. The disproportionate size of Baby Boomers, increasing longevity and declining birth rates has made this phenomenon a reality that no organization can ignore. It is now critical that aerospace organizations prepare themselves for this watershed transformation in the workforce and take the initiative to prepare the incoming workforce with the skills and knowledge necessary to stay at the forefront. Last year the Jet Propulsion Laboratory launched a pioneering training program, known as Phaeton, to provide the knowledge, practice, experience, mentoring opportunities, and project life cycle exposure to our incoming generation of engineers. After 14 months of operation, now is the time to discuss the preliminary results of this new program.

  18. Effects on Reading of an Early Intervention Program for Children at Risk of Learning Difficulties

    Science.gov (United States)

    González-Valenzuela, María-José; Martín-Ruiz, Isaías

    2017-01-01

    The study aimed to analyze the effects on reading of an early oral and written language intervention program for Spanish children at risk of learning difficulties. The goal of this classroom-based program was to prioritize a systematic approach to reading and writing and to foster phonological knowledge and the development of oral language…

  19. Early Careerist Interest and Participation in Health Care Leadership Development Programs.

    Science.gov (United States)

    Thompson, Jon M; Temple, April

    2015-01-01

    Health care organizations are increasingly embracing leadership development programs. These programs include a variety of specific activities, such as formally structured leadership development, as well as mentoring, personal development and coaching, 360-degree feedback, and job enlargement, in order to increase the leadership skills of managers and high-potential staff. However, there is a lack of information on how early careerists in health care management view these programs and the degree to which they participate. This article reports on a study undertaken to determine how early careerists working in health care organizations view leadership development programs and their participation in such programs offered by their employers. Study findings are based on a survey of 126 early careerists who are graduates of an undergraduate health services administration program. We found varying levels of interest and participation in specific leadership development activities. In addition, we found that respondents with graduate degrees and those with higher compensation were more likely to participate in selected leadership development program activities. Implications of study findings for health care organizations and early careerists in the offering of, and participation in, leadership development programs are discussed.

  20. Pilot-Testing CATCH Early Childhood: A Preschool-Based Healthy Nutrition and Physical Activity Program

    Science.gov (United States)

    Sharma, Shreela; Chuang, Ru-Jye; Hedberg, Ann Marie

    2011-01-01

    Background: The literature on theoretically-based programs targeting healthy nutrition and physical activity in preschools is scarce. Purpose: To pilot test CATCH Early Childhood (CEC), a preschool-based nutrition and physical activity program among children ages three to five in Head Start. Methods: The study was conducted in two Head Start…

  1. Early Intervention Aquatics: A Program for Children with Autism and Their Families

    Science.gov (United States)

    Prupas, Andrea; Harvey, William J.; Benjamin, Janet

    2006-01-01

    The article describes an early intervention approach to aquatics for preschool children with autism. The Aquatic Nursery program successfully taught both the children and their parents to become involved in swimming. Specific programming details are provided in relation to people with autism, and particular attention is paid to aquatic skill…

  2. Standards & Procedures for Voluntary Accreditation of Early Childhood Education Programs in Missouri.

    Science.gov (United States)

    Missouri State Dept. of Elementary and Secondary Education, Jefferson City.

    Missouri has no laws or state regulations establishing accreditation requirements for early childhood education programs. State statutes authorize the Division of Family Services, Department of Social Services to license day care programs that operate more than 4 hours a day. However, these statutes presently exempt from licensure day care…

  3. The Resolved Stellar Populations Early Release Science Program

    Science.gov (United States)

    Weisz, Daniel; Anderson, J.; Boyer, M.; Cole, A.; Dolphin, A.; Geha, M.; Kalirai, J.; Kallivayalil, N.; McQuinn, K.; Sandstrom, K.; Williams, B.

    2017-11-01

    We propose to obtain deep multi-band NIRCam and NIRISS imaging of three resolved stellar systems within 1 Mpc (NOI 104). We will use this broad science program to optimize observational setups and to develop data reduction techniques that will be common to JWST studies of resolved stellar populations. We will combine our expertise in HST resolved star studies with these observations to design, test, and release point spread function (PSF) fitting software specific to JWST. PSF photometry is at the heart of resolved stellar populations studies, but is not part of the standard JWST reduction pipeline. Our program will establish JWST-optimized methodologies in six scientific areas: star formation histories, measurement of the sub-Solar mass stellar IMF, extinction maps, evolved stars, proper motions, and globular clusters, all of which will be common pursuits for JWST in the local Universe. Our observations of globular cluster M92, ultra-faint dwarf Draco II, and star-forming dwarf WLM, will be of high archival value for other science such as calibrating stellar evolution models, measuring properties of variable stars, and searching for metal-poor stars. We will release the results of our program, including PSF fitting software, matched HST and JWST catalogs, clear documentation, and step-by-step tutorials (e.g., Jupyter notebooks) for data reduction and science application, to the community prior to the Cycle 2 Call for Proposals. We will host a workshop to help community members plan their Cycle 2 observations of resolved stars. Our program will provide blueprints for the community to efficiently reduce and analyze JWST observations of resolved stellar populations.

  4. Sleep Problems and Early Developmental Delay: Implications for Early Intervention Programs

    Science.gov (United States)

    Bonuck, Karen; Grant, Roy

    2012-01-01

    Sleep disorders negatively impact behavior, cognition, and growth--the same areas targeted by early intervention. Conversely, developmental delays and disabilities may themselves precipitate sleep disorders. Young children with developmental delays experience sleep disorders at a higher rate than do typically developing children; the most common…

  5. Efficacy of Feedback-Controlled Robotics-Assisted Treadmill Exercise to Improve Cardiovascular Fitness Early After Stroke: A Randomized Controlled Pilot Trial.

    Science.gov (United States)

    Stoller, Oliver; de Bruin, Eling D; Schindelholz, Matthias; Schuster-Amft, Corina; de Bie, Rob A; Hunt, Kenneth J

    2015-07-01

    Cardiovascular fitness is greatly reduced after stroke. Although individuals with mild to moderate impairments benefit from conventional cardiovascular exercise interventions, there is a lack of effective approaches for persons with severely impaired physical function. This randomized controlled pilot trial investigated efficacy and feasibility of feedback-controlled robotics-assisted treadmill exercise (FC-RATE) for cardiovascular rehabilitation in persons with severe impairments early after stroke. Twenty individuals (age 61 ± 11 years; 52 ± 31 days poststroke) with severe motor limitations (Functional Ambulation Classification 0-2) were recruited for FC-RATE or conventional robotics-assisted treadmill exercise (RATE) (4 weeks, 3 × 30-minute sessions/wk). Outcome measures focused on peak cardiopulmonary performance parameters, training intensity, and feasibility, with examiners blinded to allocation. All 14 allocated participants (70% of recruited) completed the intervention (7/group, withdrawals unrelated to intervention), without serious adverse events occurring. Cardiovascular fitness increased significantly in both groups, with peak oxygen uptake increasing from 14.6 to 17.7 mL · kg · min (+17.8%) after 4 weeks (45.8%-55.7% of predicted maximal aerobic capacity; time effect P = 0.01; no group-time interaction). Training intensity (% heart rate reserve) was significantly higher for FC-RATE (40% ± 3%) than for conventional RATE (14% ± 2%) (P = 0.001). Substantive overall increases in the main cardiopulmonary performance parameters were observed, but there were no significant between-group differences when comparing FC-RATE and conventional RATE. Feedback-controlled robotics-assisted treadmill exercise significantly increased exercise intensity, but recommended intensity levels for cardiovascular training were not consistently achieved. Future research should focus on appropriate algorithms within advanced robotic systems to promote optimal cardiovascular

  6. Early life nutritional programming of health and disease in The Gambia.

    Science.gov (United States)

    Moore, S E

    2016-04-01

    Exposures during the early life (periconceptional, prenatal and early postnatal) period are increasingly recognized as playing an important role in the aetiology of chronic non-communicable diseases (NCD), including coronary heart disease, stroke, hypertension, Type 2 diabetes and osteoporosis. The 'Developmental Origins of Health and Disease' (DOHaD) hypothesis states that these disorders originate through unbalanced nutrition early in life and risk is highest when there is a 'mismatch' between the early- and later-life environments. Thus, the DOHaD hypothesis would predict highest risk in countries where an excess of infants are born with low birth weight and where there is a rapid transition to nutritional adequacy or excess in adulthood. Here, I will review data from work conducted in rural Gambia, West Africa. Using demographic data dating back to the 1940s, the follow-up of randomized controlled trials of nutritional supplementation in pregnancy and the 'experiment of nature' that seasonality in this region provides, we have investigated the DOHaD hypothesis in a population with high rates of maternal and infant under-nutrition, a high burden from infectious disease, and an emerging risk of NCDs.

  7. A Pilot Telerehabilitation Program: Delivering Early Intervention Services to Rural Families

    Science.gov (United States)

    Cason, Jana

    2009-01-01

    The enTECH Telerehabilitation Program explored the use of telerehabilitation as an alternative service delivery model for early intervention therapy services. Utilizing the Kentucky Telehealth Network, two families living in rural Kentucky received occupational therapy services over a 12-week period. Following program implementation, qualitative data was collected using participant journals and interviews. Data analysis identified three thematic categories related to the program: benefits/strengths, challenges/weaknesses, and recommendations for program improvement. Results of the program evaluation indicated that telerehabilitation has the potential to cost-effectively meet the therapeutic needs of children living in rural areas where provider shortages exist. The enTECH Telerehabilitation Program serves as a model for how telerehabilitation can be used to deliver early intervention services to ameliorate health disparities and improve access to rehabilitation services. PMID:25945160

  8. A pilot telerehabilitation program: delivering early intervention services to rural families.

    Science.gov (United States)

    Cason, Jana

    2009-01-01

    The enTECH Telerehabilitation Program explored the use of telerehabilitation as an alternative service delivery model for early intervention therapy services. Utilizing the Kentucky Telehealth Network, two families living in rural Kentucky received occupational therapy services over a 12-week period. Following program implementation, qualitative data was collected using participant journals and interviews. Data analysis identified three thematic categories related to the program: benefits/strengths, challenges/weaknesses, and recommendations for program improvement. Results of the program evaluation indicated that telerehabilitation has the potential to cost-effectively meet the therapeutic needs of children living in rural areas where provider shortages exist. The enTECH Telerehabilitation Program serves as a model for how telerehabilitation can be used to deliver early intervention services to ameliorate health disparities and improve access to rehabilitation services.

  9. The PRE-hospital Stroke Treatment Organization.

    Science.gov (United States)

    Audebert, Heinrich; Fassbender, Klaus; Hussain, M Shazam; Ebinger, Martin; Turc, Guillaume; Uchino, Ken; Davis, Stephen; Alexandrov, Anne; Grotta, James

    2017-12-01

    Background The PRE-hospital Stroke Treatment Organization was formed in 2016 as an international consortium of medical practitioners involved in pre-hospital treatment of patients with acute stroke. Aims PRE-hospital Stroke Treatment Organization's mission is to improve stroke outcomes by supporting research and advocacy for pre-hospital stroke treatment in Mobile Stroke Units. PRE-hospital Stroke Treatment Organization will provide a platform to enhance collaborative research across the spectrum of acute stroke management in the pre-hospital setting. PRE-hospital Stroke Treatment Organization will also facilitate the appropriate proliferation and distribution of Mobile Stroke Units by providing a forum for professional communication, resource for public education, and stimulus for government, industry, and philanthropic support. Summary of review In this "white paper", we describe the evidence supporting pre-hospital stroke treatment, progress to date, practical issues such as application in various environments and staffing, planned research initiatives, and organizational structure. Conclusions PRE-hospital Stroke Treatment Organization is not-for-profit, with membership open to anyone involved (or hoping to become involved) in pre-hospital stroke care. PRE-hospital Stroke Treatment Organization has a Steering Committee comprised of members from Europe, U.S., Canada, Australia, and other regions having a Mobile Stroke Unit in operation. PRE-hospital Stroke Treatment Organization convenes satellite meetings for membership at the International Stroke Conference and European Stroke Congress each year to address the PRE-hospital Stroke Treatment Organization mission. The first research collaborations agreed upon are to: (1) develop a list of common data elements to be collected by all Mobile Stroke Unit programs and entered into a common research database, and (2) develop a protocol for investigating the natural history of hyper-acute Intracerebral Hemorrhage.

  10. Early experience with community implementation of thrombolysis three to 4.5 hours after acute ischemic stroke.

    Science.gov (United States)

    Alias, Mathew; Staff, Ilene; McCullough, Louise D

    2011-10-01

    The therapeutic time window for IV thrombolytic treatment was recently extended at Hartford Hospital to 4.5-hours. We assessed the safety and efficacy of delayed thrombolysis. All patients given IV tPA for acute ischemic stroke (AIS) since 2006 were assessed. The risk of sICH in patients given tPA hours vs > three-hours from onset of symptoms and acute change in NIH Stoke Scale (NIHSS) was evaluated. sICH rates were higher in patients who received IVtPA > three-hours (7.7%, n=39) compared to patients treated in the zero to three-hour window (4.0%, n=251; P = 0.30) but this was not statistically significant. Administration of tPA in the three to 4.5-hour window appears to be a safe alternative for patients presenting after three-hours. Caution is advised however, as sICH rates trended higher in patients in the three to 4.5-hour cohort.

  11. Theoretical constructs for early intervention programs in mathematics:

    DEFF Research Database (Denmark)

    Lindenskov, Lena; Kirsted, Katrine

    2017-01-01

    “There is nothing so practical as a good theory”. The statement from Kurt Lewin is frequently cited, also in mathematics education. The statement invites for and requires close cooperation between different agents, whatever their own specific relation to practice and theory is...... theory?” and “What makes a good theory good for whom?” This paper explores this variation of how theory is perceived by mathematics teachers and by mathematics researchers involved in a developmental project on early intervention in mathematics education in Denmark. The paper exemplifies how agents....... It is not a straightforward endeavour. One reason is that the term theory as well as the term practice may very well be given different meanings by different agents. This variation is in our view to be considered in “implementation research” and Lewin’s statement ought to be qualified by two questions “Who cares for a good...

  12. A Pilot Telerehabilitation Program: Delivering Early Intervention Services to Rural Families

    OpenAIRE

    Cason, Jana

    2009-01-01

    The enTECH Telerehabilitation Program explored the use of telerehabilitation as an alternative service delivery model for early intervention therapy services. Utilizing the Kentucky Telehealth Network, two families living in rural Kentucky received occupational therapy services over a 12-week period. Following program implementation, qualitative data was collected using participant journals and interviews. Data analysis identified three thematic categories related to the program: benefits/str...

  13. THE EARLY FORMATIONS OF THE COMMUNIST PROGRAM TO BRAZIL

    Directory of Open Access Journals (Sweden)

    João Quartim de Moraes

    2010-08-01

    Full Text Available For Marx & Engels, communism is not a project, but a real movement of which the presupposition is the development of capitalism. The Brazilian Communist Party (PCB, as far back as 1924, offered an original contribution to the analysis of Brazilian society. The meeting of positivism and communism in the late 1920´s is the most advanced expression of Brazil´s leftist political culture. In the following decades, most communist intellectuals were leading figures in the elaboration of the national-democratic program of Brazil´s social revolution.

  14. Continuity and Change from Full-Inclusion Early Childhood Programs through the Early Elementary Period

    Science.gov (United States)

    Guralnick, Michael J.; Neville, Brian; Hammond, Mary A.; Connor, Robert T.

    2008-01-01

    A large and well-characterized group of children with mild developmental delays initially enrolled in full-inclusion preschool or kindergarten programs was followed for 3 years. Changes in the type of inclusive placements as children transitioned to first and second grades were monitored, and associations between placement type and child and…

  15. Early Site Permit Demonstration Program: Station design alternatives report

    International Nuclear Information System (INIS)

    1993-03-01

    This report provides the results of investigating the basis for including Station Design Alternatives (SDAs) in the regulatory guidance given for nuclear plant environmental reports (ERs), explains approaches or processes for evaluating SDAs at the early site permit (ESP) stage, and applies one of the processes to each of the ten systems or subsystems considered as SDAS. The key objective o this report s to demonstrate an adequate examination of alternatives can be performed without the extensive development f design data. The report discusses the Composite Suitability Approach and the Established Cutoff Approach in evaluating station design alternatives and selects one of these approaches to evaluate alternatives for each of the plant or station that were considered. Four types of ALWRs have been considered due to the availability of extensive plant data: System 80+, AP600, Advanced Boiling Reactor (ABWR), and Simplified Boiling Water Reactor (SBWR). This report demonstrates the feasibility of evaluating station design alternatives when reactor design detail has not been determined, quantitatively compares the potential ental impacts of alternatives, and focuses the ultimate selection of a alternative on cost and applicant-specific factors. The range of alternatives system is deliberately limited to a reasonable number to demonstrate the or to the three most commonly used at operating plants

  16. Early CT perfusion mismatch in acute stroke is not time-dependent but relies on collateralization grade.

    Science.gov (United States)

    von Baumgarten, Louisa; Thierfelder, Kolja M; Beyer, Sebastian E; Baumann, Alena B; Bollwein, Christine; Janssen, Hendrik; Reiser, Maximilian F; Straube, Andreas; Sommer, Wieland H

    2016-04-01

    Factors that determine the extent of the penumbra in the initial diagnostic workup using whole brain CT Perfusion (WB-CTP) remain unclear. The purpose of the current study was to determine a possible dependency of the initial mismatch size between cerebral blood flow (CBF) and cerebral blood volume (CBV) from time after symptom onset, leptomeningeal collateralization, and occlusion localization in acute middle cerebral artery (MCA) infarctions. Out of an existing cohort of 992 consecutive patients receiving multiparametric CT scans including WB-CTP due to suspected stroke, we included patients who had (1) a witnessed time of symptom onset, (2) an infarction of the MCA territory as documented by follow-up imaging, and (3) an initial CBF volume of >10 ml. CBF and CBV lesion sizes, collateralization grade, and the site of occlusion were determined. We included 103 patients. Univariate analysis showed that time from symptom onset (168 +/- 91.2 min) did not correlate with relative or absolute mismatch volumes (p = 0.458 and p = 0.921). Higher collateralization gradings were associated with small absolute mismatch volumes (p = 0.004 and p mismatch volumes (p = 0.004). Multivariate analysis confirmed that ICA occlusion was associated with large absolute mismatch volumes (p = 0.005), and high collateral grade was associated with small absolute mismatch volumes (p = 0.017). There is no significant correlation between initial CTP mismatch and time after symptom onset. Predictors of mismatch size include the extent of the collaterals and a proximal location of the occlusion.

  17. Early CT perfusion mismatch in acute stroke is not time-dependent but relies on collateralization grade

    Energy Technology Data Exchange (ETDEWEB)

    Baumgarten, Louisa von; Straube, Andreas [University of Munich Hospitals, Department of Neurology, Munich (Germany); Thierfelder, Kolja M.; Beyer, Sebastian E.; Baumann, Alena B.; Bollwein, Christine; Reiser, Maximilian F.; Sommer, Wieland H. [Ludwig-Maximilians-University Hospital Munich, Institute for Clinical Radiology, Munich (Germany); Janssen, Hendrik [Ludwig-Maximilians-University Hospital Munich, Department of Neuroradiology, Munich (Germany)

    2016-04-15

    Factors that determine the extent of the penumbra in the initial diagnostic workup using whole brain CT Perfusion (WB-CTP) remain unclear. The purpose of the current study was to determine a possible dependency of the initial mismatch size between cerebral blood flow (CBF) and cerebral blood volume (CBV) from time after symptom onset, leptomeningeal collateralization, and occlusion localization in acute middle cerebral artery (MCA) infarctions. Out of an existing cohort of 992 consecutive patients receiving multiparametric CT scans including WB-CTP due to suspected stroke, we included patients who had (1) a witnessed time of symptom onset, (2) an infarction of the MCA territory as documented by follow-up imaging, and (3) an initial CBF volume of >10 ml. CBF and CBV lesion sizes, collateralization grade, and the site of occlusion were determined. We included 103 patients. Univariate analysis showed that time from symptom onset (168 +/- 91.2 min) did not correlate with relative or absolute mismatch volumes (p = 0.458 and p = 0.921). Higher collateralization gradings were associated with small absolute mismatch volumes (p = 0.004 and p < 0.001). Internal carotid artery (ICA) occlusions were associated with large absolute mismatch volumes (p = 0.004). Multivariate analysis confirmed that ICA occlusion was associated with large absolute mismatch volumes (p = 0.005), and high collateral grade was associated with small absolute mismatch volumes (p = 0.017). There is no significant correlation between initial CTP mismatch and time after symptom onset. Predictors of mismatch size include the extent of the collaterals and a proximal location of the occlusion. (orig.)

  18. Combining Fast-Walking Training and a Step Activity Monitoring Program to Improve Daily Walking Activity After Stroke: A Preliminary Study.

    Science.gov (United States)

    Danks, Kelly A; Pohlig, Ryan; Reisman, Darcy S

    2016-09-01

    To determine preliminary efficacy and to identify baseline characteristics predicting who would benefit most from fast walking training plus a step activity monitoring program (FAST+SAM) compared with fast walking training (FAST) alone in persons with chronic stroke. Randomized controlled trial with blinded assessors. Outpatient clinical research laboratory. Individuals (N=37) >6 months poststroke. Subjects were assigned to either FAST, which was walking training at their fastest possible speed on the treadmill (30min) and overground 3 times per week for 12 weeks, or FAST+SAM. The step activity monitoring program consisted of daily step monitoring with an activity monitor, goal setting, and identification of barriers to activity and strategies to overcome barriers. Daily step activity metrics (steps/day [SPD], time walking per day), walking speed, and 6-minute walk test (6MWT) distance. There was a significant effect of time for both groups, with all outcomes improving from pre- to posttraining (all P values program to a fast walking training intervention may be most effective in persons with chronic stroke who have initial low levels of walking endurance and activity. Regardless of baseline performance, the FAST+SAM intervention was more effective for improving walking endurance. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  19. Does a cycling program combined with education and followed by coaching promote physical activity in subacute stroke patients? A randomized controlled trial.

    Science.gov (United States)

    Vanroy, Christel; Vanlandewijck, Yves; Cras, Patrick; Truijen, Steven; Vissers, Dirk; Swinnen, Anke; Bosmans, Matthieu; Wouters, Kristien; Feys, Hilde

    2017-11-05

    To investigate the effects of a three month active cycling program followed by coaching on physical activity in subacute stroke patients. Patients (n = 59; mean age =65.4 ± 10.3) aged ≤80 years with first stroke and able to cycle at 50 revolutions/minute enrolled 3-10 weeks post stroke. Patients were randomly allocated to three month active cycling group (n = 33) or to a control group (n = 26), 3 x 30 minutes training/week. Afterwards, the active cycling group was randomized into a coaching (n = 15) versus non-coaching group (n = 16) for nine months. Physical activity was measured by objective and self-reported measures, which were taken before/after the active cycling program and during six and 12 months, except the Baecke-questionnaire, which was used at baseline and 12 months. A significant difference was found in Baecke/sport (95% confidence interval: 0.06, 2.24; p = 0.039) between the active cycling group and the control group, in patients with severe motor function deficits at baseline. Patients in the control group performed significant less sports at 12 months (mean Baecke/sport baseline =3.07 ± 1.21, mean Baecke/sport 12months  = 1.43 ± 0.98; p = 0.01). Furthermore, all groups showed significant changes over time in all measures at three months (except: Physical Activity Scale for Individuals with Physical Disabilities, diary/Mets*minutes-moderate) and 12 month and additionally in a subgroup with severe motor function deficits (except diary Mets*minutes-sedentary). When active cycling combined with education is used in subacute patients with severe motor function deficits, more sport participation might be observed after one year. No other significant group differences were found over time. In all groups, however, patients showed significant improvement over time in physical activity measures. Future work is needed to explore the most effective coaching approach after an aerobic training

  20. Testing of a Hybrid FES-Robot Assisted Hand Motor Training Program in Sub-Acute Stroke Survivors

    Directory of Open Access Journals (Sweden)

    GRIGORAS, A. V.

    2016-11-01

    Full Text Available While hands-on therapy is the most commonly used technique for upper limb rehabilitation after stroke, it requires a therapist and residual activity and is best suited for active-assisted exercises. Robotic therapy on the other hand, can provide intention driven training in a motivating environment. We compared a robotic and standard therapy group, allowing intention driven finger flexion/extention respectively active-assisted exercises and a standard therapy only group. A total of 25 patients, 2 to 6 months post–stroke, with moderate motor deficit (Fugl-Meyer Assessment or FMA between 15 and 50, were randomly assigned in one of the groups. Patients practiced 30 minutes of hands-on therapy each day for 2 weeks with a supplementary 30 minutes of robotic therapy each day for patients in the experimental group. Subjects were evaluated using the FMA, Box and Blocks test (BBT and Stroke Impact Scale (SIS before and after the treatment. Patients in the experimental group showed higher average gain in all tests than those in the control group but only the SIS average gain was on the limit of statistical significance. This study shows the potential efficacy of robotic therapy for hand rehabilitation in subacute stroke patients.

  1. Early Care and Education--What It Costs. Volume 2. Budget Series: Full-Day, Year-Round Early Childhood Program

    Science.gov (United States)

    Child Care, Inc., 2007

    2007-01-01

    The research on early childhood education is clear: Programs must be of high quality to produce positive outcomes for children. This policy brief is the second in our series aimed at identifying the core components of successful early childhood programs and the costs associated with each component. In this case, we examine the costs of full-day,…

  2. Continuity and Change From Full-Inclusion Early Childhood Programs Through the Early Elementary Period

    OpenAIRE

    Guralnick, Michael J.; Neville, Brian; Hammond, Mary A.; Connor, Robert T.

    2008-01-01

    A large and well-characterized group of children with mild developmental delays initially enrolled in full-inclusion preschool or kindergarten programs was followed for 3 years. Changes in the type of inclusive placements as children transitioned to first and second grades were monitored, and associations between placement type and child and family characteristics were examined. Results revealed a high level of continuity in that most children remained in partial or full inclusion settings ov...

  3. Recovering after stroke

    Science.gov (United States)

    Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke; Stroke - recovery; CVA - recovery ... LIVE AFTER A STROKE Most people will need stroke rehabilitation (rehab) to help them recover after they leave ...

  4. Supervised toothbrushing programs in primary schools and early childhood settings: A scoping review.

    Science.gov (United States)

    Dickson-Swift, V; Kenny, A; Gussy, M; de Silva, A M; Farmer, J; Bracksley-O'Grady, S

    2017-12-01

    In this article we report the findings of a scoping review that aimed to identify and summarise the range of programs and guidelines available for toothbrushing programs in schools and early childhood settings. Dental caries is one of the most common preventable diseases affecting children worldwide. Untreated caries can impact on child health and wellbeing, development, socialisation and school attendance. Supervised toothbrushing programs in schools and other early childhood settings can be effective in improving the oral health of young children. There is limited understanding of the salient issues to consider when developing such programs or how they are best implemented in real world settings. A scoping review methodology was utilised to provide a summary of the guidelines and programs available. Key search terms were developed, mapped and utilised to identify guidelines and programs across 6 databases and key search engines. We located 26 programs and guidelines that met the inclusion and exclusion criteria for the review. These were collated and summarised across key countries and critical aspects of program development and implementation were identified. Toothbrush type and storage, toothpaste strength and method of dispensing, toothbrush storage, staff training and parental consent are key considerations that varied widely. Guidelines for supervised toothbrushing programs vary within and across countries due to differences in water fluoridation and availability of low fluoride toothpastes. The results of this review provide critical information to be considered when establishing and implementing toothbrushing programs in these settings. Copyright© 2017 Dennis Barber Ltd.

  5. Kids Identifying and Defeating Stroke (KIDS): Development and Implementation of a Multi-Ethnic Health Education Intervention to Increase Stroke Awareness Among Middle School Students and Their Parents

    Science.gov (United States)

    Conley, Kathleen M; Majersik, Jennifer; Gonzales, Nicole R; Maddox, Katherine E; Pary, Jennifer K; Brown, Devin L; Moyé, Lemuel A; Espinosa, Nina; Grotta, James C; Morgenstern, Lewis B

    2009-01-01

    The KIDS (Kids Identifying and Defeating Stroke) Program is a three-year prospective, randomized, controlled, multiethnic school-based intervention study. Program goals include increasing knowledge of stroke signs and treatment and intention to immediately call 911 among Mexican American (MA) and non-Hispanic white (NHW) middle school students and their parents. This article describes the design, implementation and interim evaluation of this theory-based intervention. Intervention students received a culturally appropriate stroke education program divided into four 50-minute classes each year during the 6th, 7th, and 8th grades. Each class session also included a homework assignment that involved the students’ parents or other adult partners. Interim-test results indicate that this educational intervention was successful in improving students’ stroke symptom and treatment knowledge and intent to call 911 upon witnessing a stroke compared with controls (p<0.001). We conclude that this school-based educational intervention to reduce delay time to hospital arrival for stroke shows early promise. PMID:18332150

  6. Clinical predictive value of the ABCD2 score for early risk of stroke in patients who have had transient ischaemic attack and who present to an Australian tertiary hospital.

    Science.gov (United States)

    Sanders, Lauren M; Srikanth, Velandai K; Psihogios, Helen; Wong, Kitty K; Ramsay, David; Phan, Thanh G

    2011-02-07

    To determine the predictive value of the ABCD(2) score for early risk of stroke in Australian patients who have had transient ischaemic attack (TIA). Cohort study of 512 consecutive patients with suspected TIA referred by the emergency department to the acute stroke unit (in accordance with the TIA pathway) of an urban tertiary hospital in Melbourne, Victoria, between 1 June 2004 and 30 November 2007. Overall accuracy, estimated by the area under the curve (AUC) of receiver operating characteristic plots (of true positive rate v false positive rate), and sensitivity, specificity, predictive values and likelihood ratios at prespecified cut-off ABCD(2) scores for stroke within 2, 7 and 90 days. 24 patients were excluded because their symptoms lasted more than 24 hours. All included patients were reviewed by a stroke physician; TIA was confirmed in 301/488 (61.7%). Most (289/301; 96.0%) had complete follow-up. Stroke occurred in 4/292 patients (1.37%; 95% CI, 0.37%-3.47%) within 2 days and 7/289 (2.42%; 95% CI, 0.98%-4.93%) within 90 days; no patient had a stroke between 2 and 7 days. The AUCs for stroke in patients with confirmed TIA were 0.80 (95% CI, 0.68-0.91) and 0.62 (95% CI, 0.40-0.83) for stroke within 2 days and 90 days, respectively. At a cut-off of ≥ 5, the ABCD(2) score had modest specificity for stroke within 2 days (0.58) and 90 days (0.58), but positive predictive values (2 days, 0.03; 90 days, 0.04) and positive likelihood ratios (2 days, 2.40; 90 days, 1.71) were both poor. The score performed similarly poorly at other prespecified cut-off scores. Given its poor predictive value, the use of the ABCD(2) score alone may not be dependable for guiding clinical treatment decisions or service organisation in an Australian tertiary setting. Validation in other Australian settings is recommended before it can be applied with confidence.

  7. The Source of Child Care Center Preschool Learning and Program Standards: Implications for Potential Early Learning Challenge Fund Grantees

    Science.gov (United States)

    Ackerman, Debra J.; Sansanelli, Rachel A.

    2010-01-01

    The proposed federal Early Learning Challenge Fund (ELCF) aims to improve the quality of early care and education programs by promoting the integration of more stringent program and early learning standards than are typically found in child care centers. ELCF grantees also must outline their plans for professional development and technical…

  8. Ezh2 Controls an Early Hematopoietic Program and Growth and Survival Signaling in Early T Cell Precursor Acute Lymphoblastic Leukemia

    Directory of Open Access Journals (Sweden)

    Etienne Danis

    2016-03-01

    Full Text Available Early T cell precursor acute lymphoblastic leukemia (ETP-ALL is an aggressive subtype of ALL distinguished by stem-cell-associated and myeloid transcriptional programs. Inactivating alterations of Polycomb repressive complex 2 components are frequent in human ETP-ALL, but their functional role is largely undefined. We have studied the involvement of Ezh2 in a murine model of NRASQ61K-driven leukemia that recapitulates phenotypic and transcriptional features of ETP-ALL. Homozygous inactivation of Ezh2 cooperated with oncogenic NRASQ61K to accelerate leukemia onset. Inactivation of Ezh2 accentuated expression of genes highly expressed in human ETP-ALL and in normal murine early thymic progenitors. Moreover, we found that Ezh2 contributes to the silencing of stem-cell- and early-progenitor-cell-associated genes. Loss of Ezh2 also resulted in increased activation of STAT3 by tyrosine 705 phosphorylation. Our data mechanistically link Ezh2 inactivation to stem-cell-associated transcriptional programs and increased growth/survival signaling, features that convey an adverse prognosis in patients.

  9. Carotid Web (Intimal Fibromuscular Dysplasia) Has High Stroke Recurrence Risk and Is Amenable to Stenting.

    Science.gov (United States)

    Haussen, Diogo C; Grossberg, Jonathan A; Bouslama, Mehdi; Pradilla, Gustavo; Belagaje, Samir; Bianchi, Nicolas; Allen, Jason W; Frankel, Michael; Nogueira, Raul G

    2017-11-01

    Carotid webs have been increasingly recognized as a cause of recurrent stroke, but evidence remains scarce. We aim to report the clinical outcomes and first series of carotid stenting in a cohort of patients with strokes from symptomatic carotid webs. Prospective and consecutive data of patients stroke admitted within September 2014 to May 2017. Carotid web was defined by a shelf-like/linear filling defect in the posterior internal carotid artery bulb by computed tomographic angiography. Twenty-four patients were identified (91.6% strokes/8.4% transient ischemic attacks [TIAs]). Median age was 46 (41-59) years, 61% were female, and 75% were black. Median National Institutes of Health Stroke Scale score was 10.5 (3.0-16.0) and ASPECTS (Alberta Stroke Program Early CT Score) was 8 (7-8). There were no parenchymal hemorrhages, and 96% of patients were independent at 3 months. All webs caused stroke/TIA involving the territory of the previously symptomatic web occurred in 7 (32%; 6 strokes/1 TIA) patients: 3 1 year of follow-up. Two recurrences occurred on dual antiplatelet therapy, 3 on antiplatelet monotherapy, 1 within 24 hours of thrombolysis, and 1 off antithrombotics. Median follow-up was 12.2 (8.0-18.0) months. Sixteen (66%) patients were stented at a median 12.2 (7.0-18.7) days after stroke with no periprocedural complications. No recurrent strokes/TIAs occurred in stented individuals (median follow-up of 4 [2.4-12.0] months). Carotid web is associated with high recurrent stroke/TIA risk, despite antithrombotic use, and is amenable to carotid stenting. © 2017 American Heart Association, Inc.

  10. Enhancing early child care quality and learning for toddlers at risk: the responsive early childhood program.

    Science.gov (United States)

    Landry, Susan H; Zucker, Tricia A; Taylor, Heather B; Swank, Paul R; Williams, Jeffrey M; Assel, Michael; Crawford, April; Huang, Weihua; Clancy-Menchetti, Jeanine; Lonigan, Christopher J; Phillips, Beth M; Eisenberg, Nancy; Spinrad, Tracy L; de Villiers, Jill; de Villiers, Peter; Barnes, Marcia; Starkey, Prentice; Klein, Alice

    2014-02-01

    Despite reports of positive effects of high-quality child care, few experimental studies have examined the process of improving low-quality center-based care for toddler-age children. In this article, we report intervention effects on child care teachers' behaviors and children's social, emotional, behavioral, early literacy, language, and math outcomes as well as the teacher-child relationship. The intervention targeted the use of a set of responsive teacher practices, derived from attachment and sociocultural theories, and a comprehensive curriculum. Sixty-five childcare classrooms serving low-income 2- and 3-year-old children were randomized into 3 conditions: business-as-usual control, Responsive Early Childhood Curriculum (RECC), and RECC plus explicit social-emotional classroom activities (RECC+). Classroom observations showed greater gains for RECC and RECC+ teachers' responsive practices including helping children manage their behavior, establishing a predictable schedule, and use of cognitively stimulating activities (e.g., shared book reading) compared with controls; however, teacher behaviors did not differ for focal areas such as sensitivity and positive discipline supports. Child assessments demonstrated that children in the interventions outperformed controls in areas of social and emotional development, although children's performance in control and intervention groups was similar for cognitive skills (language, literacy, and math). Results support the positive impact of responsive teachers and environments providing appropriate support for toddlers' social and emotional development. Possible explanations for the absence of systematic differences in children's cognitive skills are considered, including implications for practice and future research targeting low-income toddlers.

  11. Acute anti-inflammatory approaches to ischemic stroke

    OpenAIRE

    del Zoppo, Gregory J.

    2010-01-01

    In preparation for designing and undertaking trials of strategies that can modulate “innate inflammation” to improve outcomes of ischemic injury, consideration of approaches that have managed cellular inflammation in ischemic stroke are instructive. Robust experimental work has demonstrated the efficacy (and apparent safety) of targeting PMN leukocyte–endothelial cell interactions in the early moments following focal ischemia onset in model systems. Four clinical trial programs were undertake...

  12. Active Early: one-year policy intervention to increase physical activity among early care and education programs in Wisconsin

    Directory of Open Access Journals (Sweden)

    Tara L. LaRowe

    2016-07-01

    Full Text Available Abstract Background Early childcare and education (ECE is a prime setting for obesity prevention and the establishment of healthy behaviors. The objective of this quasi-experimental study was to examine the efficacy of the Active Early guide, which includes evidenced-based approaches, provider resources, and training, to improve physical activity opportunities through structured (i.e. teacher-led activity and environmental changes thereby increasing physical activity among children, ages 2–5 years, in the ECE setting. Methods Twenty ECE programs in Wisconsin, 7 family and 13 group, were included. An 80-page guide, Active Early, was developed by experts and statewide partners in the fields of ECE, public health, and physical activity and was revised by ECE providers prior to implementation. Over 12 months, ECE programs received on-site training and technical assistance to implement the strategies and resources provided in the Active Early guide. Main outcome measures included observed minutes of teacher-led physical activity, physical activity environment measured by the Environment and Policy Assessment and Observation (EPAO instrument, and child physical activity levels via accelerometry. All measures were collected at baseline, 6 months, and 12 months and were analyzed for changes over time. Results Observed teacher-led physical activity significantly increased from 30.9 ± 22.7 min at baseline to 82.3 ± 41.3 min at 12 months. The change in percent time children spent in sedentary activity decreased significantly after 12 months (−4.4 ± 14.2 % time, −29.2 ± 2.6 min, p < 0.02. Additionally, as teacher led-activity increased, percent time children were sedentary decreased (r = −0.37, p < 0.05 and percent time spent in light physical activity increased (r = 0.35, p < 0.05. Among all ECE programs, the physical activity environment improved significantly as indicated by multiple sub-scales of

  13. Active Early: one-year policy intervention to increase physical activity among early care and education programs in Wisconsin.

    Science.gov (United States)

    LaRowe, Tara L; Tomayko, Emily J; Meinen, Amy M; Hoiting, Jill; Saxler, Courtney; Cullen, Bridget

    2016-07-20

    Early childcare and education (ECE) is a prime setting for obesity prevention and the establishment of healthy behaviors. The objective of this quasi-experimental study was to examine the efficacy of the Active Early guide, which includes evidenced-based approaches, provider resources, and training, to improve physical activity opportunities through structured (i.e. teacher-led) activity and environmental changes thereby increasing physical activity among children, ages 2-5 years, in the ECE setting. Twenty ECE programs in Wisconsin, 7 family and 13 group, were included. An 80-page guide, Active Early, was developed by experts and statewide partners in the fields of ECE, public health, and physical activity and was revised by ECE providers prior to implementation. Over 12 months, ECE programs received on-site training and technical assistance to implement the strategies and resources provided in the Active Early guide. Main outcome measures included observed minutes of teacher-led physical activity, physical activity environment measured by the Environment and Policy Assessment and Observation (EPAO) instrument, and child physical activity levels via accelerometry. All measures were collected at baseline, 6 months, and 12 months and were analyzed for changes over time. Observed teacher-led physical activity significantly increased from 30.9 ± 22.7 min at baseline to 82.3 ± 41.3 min at 12 months. The change in percent time children spent in sedentary activity decreased significantly after 12 months (-4.4 ± 14.2 % time, -29.2 ± 2.6 min, p < 0.02). Additionally, as teacher led-activity increased, percent time children were sedentary decreased (r = -0.37, p < 0.05) and percent time spent in light physical activity increased (r = 0.35, p < 0.05). Among all ECE programs, the physical activity environment improved significantly as indicated by multiple sub-scales of the EPAO; scores showing the greatest increases were the

  14. Know Stroke: Know the Signs, Act in Time Video

    Medline Plus

    Full Text Available ... of Neurological Disorders and Stroke Search this site: Home About the Campaign Stroke Materials » Brochures » Toolkits and ... Programs » You are here: Know Stroke Home  » Stroke Materials  » ...

  15. 78 FR 31568 - Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV...

    Science.gov (United States)

    2013-05-24

    ... HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program.... ACTION: Notice of Ryan White HIV/AIDS Program Part C Early Intervention Services One-Time Noncompetitive... care services for persons living with HIV/AIDS, HRSA will provide a one-time noncompetitive Ryan White...

  16. 78 FR 10183 - Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV...

    Science.gov (United States)

    2013-02-13

    ... HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program.... ACTION: Notice of Ryan White HIV/AIDS Program Part C Early Intervention Services One-Time Noncompetitive... care services for persons living with HIV/AIDS, HRSA will provide one-time noncompetitive Ryan White...

  17. 78 FR 78976 - Ryan White HIV/AIDS Program Part C Early Intervention Services Grant Under the Ryan White HIV...

    Science.gov (United States)

    2013-12-27

    ... HIV/AIDS Program Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY...: Notice of Ryan White HIV/AIDS Program Part C Early Intervention Services One-Time Noncompetitive Award To... services for persons living with HIV/AIDS, HRSA will provide a one-time noncompetitive Ryan White HIV/AIDS...

  18. 78 FR 10182 - Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV...

    Science.gov (United States)

    2013-02-13

    ... HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program.... ACTION: Notice of Ryan White HIV/AIDS Program (Part C) Early Intervention Services One-Time... primary care services for persons living with HIV/AIDS, HRSA will provide one-time noncompetitive Part C...

  19. Stroke Rehabilitation

    Science.gov (United States)

    ... unique for each person. Although a majority of functional abilities may be restored soon after a stroke, recovery is an ongoing process. Effects of a Stroke Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body that may affect the whole ...

  20. Pediatric Stroke

    Science.gov (United States)

    ... of 3 and 10. In those with SCD, ischemic strokes most often occur in children under the age of 15 and adults over the age of 30, while hemorrhagic strokes most often occur in young adults between the ages of 20 and 30. ...

  1. Relationship between Risk Factor Control and Compliance with a Lifestyle Modification Program in the Stenting Aggressive Medical Management for Prevention of Recurrent Stroke in Intracranial Stenosis Trial.

    Science.gov (United States)

    Turan, Tanya N; Al Kasab, Sami; Nizam, Azhar; Lynn, Michael J; Harrell, Jamie; Derdeyn, Colin P; Fiorella, David; Janis, L Scott; Lane, Bethany F; Montgomery, Jean; Chimowitz, Marc I

    2018-03-01

    Lifestyle modification programs have improved the achievement of risk factor targets in a variety of clinical settings, including patients who have previously suffered a stroke or transient ischemic attack and those with multiple risk factors. Stenting Aggressive Medical Management for Prevention of Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) was the first vascular disease prevention trial to provide a commercially available lifestyle modification program to enhance risk factor control. We sought to determine the relationship between compliance with this program and risk factor control in SAMMPRIS. SAMMPRIS aggressive medical management included a telephonic lifestyle modification program provided free of charge to all subjects (n = 451) during their participation in the study. Subjects with fewer than 3 expected lifestyle-coaching calls were excluded from these analyses. Compliant subjects (n = 201) had  greater than or equal to 78.5% of calls (median % of completed/expected calls). Noncompliant subjects (n = 200) had less than 78.5% of calls or refused to participate. Mean risk factor values or % in-target for each risk factor was compared between compliant versus noncompliant subjects, using t tests and chi-square tests. Risk factor changes from baseline to follow-up were compared between the groups to account for baseline differences. Compliant subjects had better risk factor control throughout follow-up for low-density lipoprotein, systolic blood pressure (SBP), hemoglobin A1c (HgA1c), non-high-density lipoprotein, nonsmoking, and exercise than noncompliant subjects, but there was no difference for body mass index. After adjusting for baseline differences between the groups, compliant subjects had a greater change from baseline than noncompliant subjects for SBP did at 24 months and HgA1c at 6 months. SAMMPRIS subjects who were compliant with the lifestyle modification program had better risk factor control during the study for almost

  2. Stroke and Cerebrovascular Diseases Registry

    Science.gov (United States)

    2017-09-11

    Stroke; Acute Stroke; Acute Brain Injury; Ischemic Stroke; Hemorrhagic Stroke; Transient Ischemic Attack; Subarachnoid Hemorrhage; Cerebral Ischemia; Cerebral Infarction; Cerebral Stroke; Venous Sinus Thrombosis, Cranial

  3. Early experiences of computer‐aided assessment and administration when teaching computer programming

    OpenAIRE

    Benford, Steve; Burke, Edmund; Foxley, Eric; Gutteridge, Neil; Zin, Abdullah

    1993-01-01

    This paper describes early experiences with the Ceilidh system currently being piloted at over 30 institutions of higher education. Ceilidh is a course‐management system for teaching computer programming whose core is an auto‐assessment facility. This facility automatically marks students programs from a range of perspectives, and may be used in an iterative manner, enabling students to work towards a target level of attainment. Ceilidh also includes extensive course‐administration and progre...

  4. Early experiences of computer-aided assessment and administration when teaching computer programming

    OpenAIRE

    Abdullah Mohd Zin; Neil Gutteridge; Eric Foxley; Edmund Burke; Steve Benford

    1993-01-01

    This paper describes early experiences with the Ceilidh system currently being piloted at over 30 institutions of higher education. Ceilidh is a course-management system for teaching computer programming whose core is an auto-assessment facility. This facility automatically marks students programs from a range of perspectives, and may be used in an iterative manner, enabling students to work towards a target level of attainment. Ceilidh also includes extensive courseadministration and progres...

  5. The imaging of ischaemic stroke

    International Nuclear Information System (INIS)

    Hoggard, Nigel; Wilkinson, Iain D.; Griffiths, Paul D.

    2001-01-01

    Stroke is a clinical syndrome of a rapidly developing focal neurological deficit that may be classified for practical purposes into ischaemic and haemorrhagic. The role of imaging is to exclude mimics of ischaemic stroke or intracranial haemorrhage and confirm the presence of an ischaemic stroke. Computed tomography (CT) remains the investigation of choice to exclude acute intracranial haemorrhage but diffusion weighted magnetic resonance (MR) has proved to be a sensitive method of detecting early ischaemic infarction. Perfusion weighted MR allows further assessment at the same examination that could help guide the clinician in the risk/benefit analysis of treatment with thrombolytics or neuroprotective agents under evaluation. This can also be achieved with CT. This review article discusses the imaging of ischaemic stroke, relating the pathophysiology of stroke to it. It deals separately in more detail with these newer MR techniques. Hoggard, N. et al. (2001)

  6. Hip Hop Stroke: Study Protocol for a Randomized Controlled Trial to Address Stroke Literacy.

    Science.gov (United States)

    Williams, Olajide; Leighton-Herrmann, Ellyn; DeSorbo, Alexandra; Hecht, Mindy; Hedmann, Monique; Huq, Saima; Gerin, William; Chinchilli, Vernon; Ogedegbe, Gbenga; Noble, James

    2015-10-01

    Stroke is the fifth leading cause of death and the leading cause of serious long-term adult disability in the US. Acute stroke treatments with intravenous thrombolysis and endovascular therapy are proven to reduce disability, however a critical limitation on their effectiveness is the narrow time window for administration, which is 4.5 hours and 6 hours respectively from the onset of symptoms. Our overarching goal is to reduce pre-hospital delays to acute stroke treatments in economically disadvantaged minority communities where the greatest delays exist, using Hip Hop Stroke. Hip Hop Stroke (HHS) is a school-based, child-mediated, culturally-tailored stroke communication multimedia intervention developed using validated models of behavior change and designed to improve stroke literacy (knowledge of stroke symptoms, the urgent need to call 911, and prevention measures) of 4 th , 5 th and 6 th grade students and their parents residing in poor urban communities. Children in the intervention arm will receive the HHS intervention, while those in the attentional control arm will receive standardized nutrition education based on the USDA's MyPyramid program. Children will be trained and motivated to share stroke information with their parents or other adult caregiver. Both children and parents will complete a stroke knowledge assessment at baseline, immediately following the program, and at 3-months post-program. The primary outcome is the effect of the child mediation on parental stroke literacy. Stroke literate children, a captive audience in school systems, may represent a viable channel for spreading stroke information into households of poor urban communities where mass media stroke campaigns have shown the lowest penetration. These children may also call 911 when witnessing a stroke in their homes or communities. The HHS program may highlight the potential role of children in the chain of stroke recovery as a strategy for reducing prehospital delays to acute stroke

  7. Program of gastrointestinal rehabilitation and early postoperative enteral nutrition: a prospective study.

    Science.gov (United States)

    Martos-Benítez, Frank Daniel; Gutiérrez-Noyola, Anarelys; Soto-García, Andrés; González-Martínez, Iraida; Betancourt-Plaza, Ilionanys

    2018-02-10

    Nutritional depletion is commonly observed in patients undergoing surgical treatment for a gastrointestinal malignancy. An appropriate nutritional intervention could be associated with improved postoperative outcomes. The study was aimed to determine the effect of a program of gastrointestinal rehabilitation and early postoperative enteral nutrition upon complications and clinical outcomes in patients who experienced gastrointestinal surgery for cancer. This is a prospective study (2013 January-2015 December) of 465 consecutive patients submitted to gastrointestinal surgery for cancer and admitted to an Oncological Intensive Care Unit. The program of gastrointestinal rehabilitation and early postoperative enteral nutrition consisted on: (1) general rules: pain relive, early mobilization, antibiotic prophylaxis, deep vein thrombosis prophylaxis and respiratory physiotherapy; and (2) gastrointestinal rules: gastric protection, control of postoperative nausea and vomiting, early nasogastric tube remove and early enteral nutrition. The most frequent surgical sites were colorectal (44.9%), gynecological with intestinal suturing (15.7%) and esophagus/stomach (11.0%). Emergency surgery was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complications (19.2 vs. 10.2%; p = 0.030), respiratory complications (p = 0.040), delirium (p = 0.032), infectious complications (p = 0.047) and gastrointestinal complications (p < 0.001). Intensive care unit mortality (p = 0.018), length of intensive care unit stay (p < 0.001) and length of hospitalization (p < 0.001) were reduced as well. A program of gastrointestinal rehabilitation and early postoperative enteral nutrition is associated with reduced postoperative complications and improved clinical outcomes in patients undergoing gastrointestinal surgery for cancer.

  8. Health economics evaluation of a gastric cancer early detection and treatment program in China.

    Science.gov (United States)

    Li, Dan; Yuan, Yuan; Sun, Li-Ping; Fang, Xue; Zhou, Bao-Sen

    2014-01-01

    To use health economics methodology to assess the screening program on gastric cancer in Zhuanghe, China, so as to provide the basis for health decision on expanding the program of early detection and treatment. The expense of an early detection and treatment program for gastric cancer in patients found by screening, and also costs of traditional treatment in a hospital of Zhuanghe were assessed. Three major techniques of medical economics, namely cost-effective analysis (CEA), cost-benefit analysis (CBA) and cost-utility analysis (CUA), were used to assess the screening program. RESULTS from CEA showed that investing every 25, 235 Yuan on screening program in Zhuanghe area, one gastric cancer patient could be saved. Data from CUA showed that it was cost 1, 370 Yuan per QALY saved. RESULTS from CBA showed that: the total cost was 1,945,206 Yuan with a benefit as 8,669,709 Yuan and an CBR of 4.46. The early detection and treatment program of gastric cancer appears economic and society-beneficial. We suggest that it should be carry out in more high risk areas for gastric cancer.

  9. Predictors of Adherence to a Structured Exercise Program and Physical Activity Participation in Community Dwellers after Stroke

    Directory of Open Access Journals (Sweden)

    Anne Tiedemann

    2012-01-01

    Full Text Available Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years. Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%. Only one variable (slow choice stepping reaction time was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350. Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk or better quality of life (SF-12 score took more steps. A model including SF-12, maximal balance range, and 6-min walk accounted for 33% of the variance in average steps/day. Conclusions. The results suggest that better physical functioning and health status are predictors of average steps taken per day in stroke survivors and that predicting adherence to group exercise in this group is difficult.

  10. Two decades of nation-wide community-based stroke support - The Singapore National Stroke Association.

    Science.gov (United States)

    Venketasubramanian, Narayanaswamy; Yin, Ann; Lee, Lay B; De Silva, Deidre A

    2017-04-01

    The Singapore National Stroke Association, registered in 1996, offers support and information to stroke survivors and caregivers, and aims to raise public stroke awareness. In the last 20 years, we have developed programs to equip stroke survivors and caregivers with knowledge, life skills, comfort, and opportunities for socialization and reintegration. We have on-going public education and advocacy initiatives. Obtaining funding, member recruitment, volunteer retention, and leadership renewal are on-going challenges. Singapore National Stroke Association will continue to strive for the betterment of stroke survivors, their caregivers, and the public.

  11. Research on the Integrated Performance Assessment in an Early Foreign Language Learning Program

    Science.gov (United States)

    Davin, Kristin; Troyan, Francis J.; Donato, Richard; Hellman, Ashley

    2011-01-01

    This article reports on the implementation of the Integrated Performance Assessment (IPA) in an Early Foreign Language Learning program. The goal of this research was to examine the performance of grade 4 and 5 students of Spanish on the IPA. Performance across the three communicative tasks is described and modifications to IPA procedures based on…

  12. Lidcombe Program Webcam Treatment for Early Stuttering: A Randomized Controlled Trial

    Science.gov (United States)

    Bridgman, Kate; Onslow, Mark; O'Brian, Susan; Jones, Mark; Block, Susan

    2016-01-01

    Purpose: Webcam treatment is potentially useful for health care in cases of early stuttering in which clients are isolated from specialized treatment services for geographic and other reasons. The purpose of the present trial was to compare outcomes of clinic and webcam deliveries of the Lidcombe Program treatment (Packman et al., 2015) for early…

  13. 75 FR 3746 - Ryan White HIV/AIDS Part C Early Intervention Services (EIS) Program

    Science.gov (United States)

    2010-01-22

    ... HIV/AIDS Part C Early Intervention Services (EIS) Program AGENCY: Health Resources and Services...: Critical funding for HIV/AIDS care and treatment to the target populations in Orange County, Orlando..., 2010). The Orange County Health Department is known Statewide as an exceptional site for HIV/AIDS care...

  14. 78 FR 15959 - Proposed Collection; 60-day Comment Request: Early Career Reviewer Program Online Application...

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    2013-03-13

    ... Comment Request: Early Career Reviewer Program Online Application System--Center for Scientific Review... Scientific Review, the National Institutes of Health (NIH) will publish periodic summaries of proposed projects to be submitted to the Office of Management and Budget (OMB) for review and approval. Written...

  15. 78 FR 78369 - Submission for OMB Review; 30-Day Comment Request: Early Career Reviewer Program Online...

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    2013-12-26

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-Day Comment Request: Early Career Reviewer Program Online Application System--Center for Scientific Review (CSR) SUMMARY: Under the provisions of Section 3507(a)(1)(D) of the Paperwork Reduction Act...

  16. Early Retirement Incentive Programs for Teachers. Policy Issue Series No. 6.

    Science.gov (United States)

    Tarter, Scott; McCarthy, Martha

    The first section of this policy paper provides an overview of the historical development of early retirement incentive programs (ERIPs), the legal status of ERIPs under the Age Discrimination in Employment Act (ADEA), cost/benefit analyses involving ERIPs, and consideration of ERIPs in Indiana. The second section contains a brief synopsis of…

  17. 76 FR 22713 - Advisory Committee on the Maternal, Infant and Early Childhood Home Visiting Program Evaluation...

    Science.gov (United States)

    2011-04-22

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Administration for Children and Families Advisory Committee on the Maternal, Infant and Early Childhood Home... visiting program to Carlos Cano, Health Resources and Services Administration, at [email protected] . Comments...

  18. Clovis-Portales Bilingual Early Childhood Program: Second Year Evaluation Study (1973-74).

    Science.gov (United States)

    Askins, Billy E.; And Others

    This report describes and evaluates a bilingual early education intervention program, designed to provide children with successful experiences, using the concept of responsive environment in language development (English and Spanish) and in cognitive and affective development. Instructional, community-parental involvement, staff development, and…

  19. A Dialogue about an Award-Winning Evaluation of Minnesota's Early Childhood Family Education Program.

    Science.gov (United States)

    Mueller, Marsha R.; Fitzpatrick, Jody L.

    1998-01-01

    The evaluation of Minnesota's Early Childhood Family Education program is described, and a dialog between one of the evaluators and an editor of this journal provides further insight into the evaluation process. Noteworthy in this evaluation, called exemplary by the American Evaluation Association, was highly motivated collaboration of evaluation…

  20. Early Childhood Education Intervention Programs in the Netherlands: Still Searching for Empirical Evidence

    Science.gov (United States)

    Driessen, Geert

    2018-01-01

    Early childhood education (ECE) intervention programs nowadays are the core of the educational disadvantage policy in the Netherlands. They offer institutional compensatory activities to young children who lack educational stimulation in the home environment. Target groups mainly comprise children from deprived socioeconomic backgrounds and of…

  1. The Better Early Childhood Development Program: An Innovative Brazilian Public Policy

    Science.gov (United States)

    Schneider, Alessandra; Ramires, Vera Regina; Paiva, Maria da Graca Gomes; Almeida, Leila

    2009-01-01

    This paper presents the pioneering experience of the Programa Primeira Infancia Melhor (the Better Early Childhood Development Program), also known as "PIM" that has been developed since 2003 in the State of Rio Grande do Sul, Brazil. PIM's goal is to "provide guidance to families, based on their own culture and experiences, to…

  2. Webcam Delivery of the Lidcombe Program for Early Stuttering: A Phase I Clinical Trial

    Science.gov (United States)

    O'Brian, Sue; Smith, Kylie; Onslow, Mark

    2014-01-01

    Purpose: The Lidcombe Program is an operant treatment for early stuttering shown with meta-analysis to have a favorable odds ratio. However, many clients are unable to access the treatment because of distance and lifestyle factors. In this Phase I trial, we explored the potential efficacy, practicality, and viability of an Internet webcam Lidcombe…

  3. Audit of Gaining Early Awareness and Readiness for Undergraduate Programs. Final Audit Report.

    Science.gov (United States)

    Office of Inspector General (ED), Washington, DC.

    An audit was conducted to determine whether the U.S. Department of Education had implemented adequate management controls to administer the Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR UP) in accordance with legislative, regulatory, and internal administrative requirements. The focus was on the fiscal year 2000 grant…

  4. Early Reading Programs in High-Poverty Schools: Emerald Elementary Beats the Odds.

    Science.gov (United States)

    Fisher, Charles; Adler, Martha A.

    This report describes the early reading program in Emerald Elementary School, located in a Midwest urban fringe district. From 1996 through 1998, Emerald's students performed well above the district average or near the state average on reading achievement. During this period, the school had at least half of its students eligible for free or…

  5. Developmental Review in the Early and Periodic Screening, Diagnosis and Treatment Program. Final Report.

    Science.gov (United States)

    Huntington, Dorothy S.; And Others

    Reported are the recommendations resulting from a review of the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT). The concept of developmental assessment, as used in the EPSDT, is explained. The introduction provides a summary of the recommendations. Areas covered and for which recommendations are discussed include the role…

  6. The Impact of the Shifting Knowledge Base, from Development to Achievement, on Early Childhood Education Programs

    Science.gov (United States)

    Tyler, Kathleen P.

    2012-01-01

    Interest in child development as a knowledge base for early childhood education programs flourished in the 1970s as a result of the theories and philosophies of Jean Piaget and other cognitive developmentalists. During subsequent decades in America, reform movements emphasizing accountability and achievement became a political and social…

  7. Identifying Local Benefits of Early Childhood Development Programs Using Regional Modeling

    Science.gov (United States)

    Temple, Judy A.; Rolnick, Arthur J.

    2012-01-01

    This article presents a review of "Investing in Kids: Early Childhood Programs and Local Economic Development" by Timothy J. Bartik. Timothy Bartik's timely book contributes to an important conversation about the role of government in promoting investments in children in the years before traditional public schooling typically begins. Until…

  8. Effectiveness of Higher Diploma Program for Early Career Academics in Ethiopia

    Science.gov (United States)

    Gebru, Demewoz Admasu

    2016-01-01

    Unprecedented expansion of the public higher education sector in Ethiopia has brought about masses of early career academics (ECAs) to take up teaching and research in the sector. In recognition of a multitude of responsibilities and challenges these ECAs would face, a higher diploma program (HDP) was introduced in 2004 both for ECAs and senior…

  9. The Effect of Early Childhood Developmental Program Attendance on Future School Enrollment in Rural North India

    Science.gov (United States)

    Hazarika, Gautam; Viren, Vejoya

    2013-01-01

    This paper examines the effect of prior participation in early childhood developmental programs, considered endogenous, upon 7-18 years olds' school enrollment in rural North India. Analyses by age group of data from the World Bank's 1997-98 Survey of Living Conditions in Uttar Pradesh and Bihar reveal that 7-10 year olds, 11-14 year olds, and…

  10. An Alternative Preparation Program in Early Childhood Education: Description and Comparison of Alternative and Traditional Students.

    Science.gov (United States)

    Guyton, Edith; And Others

    1993-01-01

    Students entering traditional and nontraditional early childhood teacher preparation programs completed the Educational Attitudes Inventory, Teacher Certification Test, and Efficacy Scale. Mean personal teaching efficacy scores were significantly higher for traditional students. Nontraditional students tended to be males, minorities, and older,…

  11. Improving Empathy and Communication Skills of Visually Impaired Early Adolescents through a Psycho-Education Program

    Science.gov (United States)

    Yildiz, Mehmet Ali; Duy, Baki

    2013-01-01

    The purpose of this study was to investigate the effectiveness of an interpersonal communication skills psycho-education program to improve empathy and communication skills of visually impaired adolescents. Participants of the study were sixteen early adolescents schooling in an elementary school for visually impaired youth in Diyarbakir. The…

  12. Reducing Early Childhood Tooth Decay: Strategies for State Medicaid and CHIP Dental Program Managers

    OpenAIRE

    Colin Reusch; Meg Booth; Leslie Foster

    2015-01-01

    Young children who are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) can be at risk for developing early childhood caries (ECC). ECC is a chronic bacterial infection that causes severe tooth decay and can begin to develop before baby teeth erupt.

  13. Cost-Effectiveness Analysis of Early Reading Programs: A Demonstration with Recommendations for Future Research

    Science.gov (United States)

    Hollands, Fiona M.; Kieffer, Michael J.; Shand, Robert; Pan, Yilin; Cheng, Henan; Levin, Henry M.

    2016-01-01

    We review the value of cost-effectiveness analysis for evaluation and decision making with respect to educational programs and discuss its application to early reading interventions. We describe the conditions for a rigorous cost-effectiveness analysis and illustrate the challenges of applying the method in practice, providing examples of programs…

  14. South Korean Early Childhood Education Teachers' Perceptions of Program-Wide Positive Behavior Support

    Science.gov (United States)

    Noh, Jina; Steed, Elizabeth A.; Kim, Kyungmin

    2016-01-01

    The authors conducted a survey of 169 South Korean early childhood education teachers regarding the importance and implementation of strategies associated with the Program-Wide Positive Behavior Support (PWPBS) framework (L. Fox & M. L. Hemmeter, 2009) to support social competence and prevent young children's challenging behavior. Analyses…

  15. Contributions of an artistic educational program for older people with early dementia: an exploratory qualitative study.

    Science.gov (United States)

    Ullán, Ana M; Belver, Manuel H; Badía, Marta; Moreno, Carmen; Garrido, Eugenio; Gómez-Isla, José; Gonzalez-Ingelmo, Elena; Delgado, Juan; Serrano, Isabel; Herrero, Carmen; Manzanera, Paloma; Tejedor, Laura

    2013-07-01

    To describe a contemporary artistic educational program based on photographic cyanotype techniques and to present the results of the program carried out with older people with early dementia. We determined whether these people could participate in the program, their viewpoint about it, and what this program could contribute to their experience. Twenty-one people diagnosed with mild or moderate dementia participated in a series of artistic education workshops. While conducting the workshops, participant observation was carried out, and the participants' engagement was assessed. Upon completing the series, five focus groups were held with the participants with dementia, and another focus group with their professional caretakers. We observed the participants' high level of commitment to the activity and their interest in learning new things. We also observed the participants' satisfaction during the creative process and with their results. The artistic activities not only reinforced the feelings of capacity of the participants with early dementia but also transmitted a positive image of them. Dementia was not an obstacle to participation in the program, which was an opportunity for creativity, learning, enjoyment, and communication for people with dementia. In the authors' opinion, facilitating access to art and artistic education to people with early dementia can contribute to enforcing their rights and to improving the care system.

  16. Effects of a school-based stroke education program on stroke-related knowledge and behaviour modification-school class based intervention study for elementary school students and parental guardians in a Japanese rural area.

    Science.gov (United States)

    Kato, Suzuka; Okamura, Tomonori; Kuwabara, Kazuyo; Takekawa, Hidehiro; Nagao, Masanori; Umesawa, Mitsumasa; Sugiyama, Daisuke; Miyamatsu, Naomi; Hino, Tenyu; Wada, Shinichi; Arimizu, Takuro; Takebayashi, Toru; Kobashi, Gen; Hirata, Koichi; Yokota, Chiaki; Minematsu, Kazuo

    2017-12-21

    This study aimed to determine the effect of a stroke education programme on elementary school students and their parental guardians in a rural area in Japan that has high stroke mortality. School class based intervention study. Eleven public elementary schools in Tochigi Prefecture, Japan. 268 students aged 11-12 years and 267 parental guardians. Students received lessons about stroke featuring animated cartoons and were instructed to communicate their knowledge about stroke to their parental guardians using material (comic books) distributed in the lessons. Stroke knowledge (symptoms, risk factors and attitude towards stroke) and behavioural change for risk factors were assessed at baseline, immediately after the programme and at 3 months. We also evaluated behavioural change for risk factors among parental guardians. The percentage of students with all correct answers for stroke symptoms, risk factors and the recommended response to stroke was significantly increased at 3 months P<0.001). We observed a significant increase in the percentage of guardians who chose all correct symptoms (P<0.001: 61.0% vs 85.4%) and risk factors (P<0.001: 41.2% vs 59.9%) at 3 months compared with baseline. The percentage of parental guardians with a high behavioural response to improving risk factors was significantly increased at 3 months compared with baseline (P<0.001). In a rural population with high stroke mortality, stroke education can improve knowledge about stroke in elementary school students and their parental guardians. We conducted the intervention as a part of compulsory education; this study was not a clinical trial. This study was approved by the Ethics Committee of the National Cerebral and Cardiovascular Center (M27-026). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Estimated effects of the National Breast and Cervical Cancer Early Detection Program on breast cancer mortality.

    Science.gov (United States)

    Hoerger, Thomas J; Ekwueme, Donatus U; Miller, Jacqueline W; Uzunangelov, Vladislav; Hall, Ingrid J; Segel, Joel; Royalty, Janet; Gardner, James G; Smith, Judith Lee; Li, Chunyu

    2011-04-01

    The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast cancer screening to medically underserved, low-income women aged 40-64 years. No study has evaluated NBCCEDP's effect on breast cancer mortality. This study estimates life-years saved by NBCCEDP breast cancer screening compared with screening in the absence of NBCCEDP and with no screening. A breast cancer simulation model based on existing Cancer Intervention and Surveillance Modeling Network models was constructed. The screening module from these models was modified to reflect screening frequency for NBCCEDP participants. Screening data for uninsured women represented what would have happened without the program. Separate simulations were performed for women who received NBCCEDP (Program) screening, women who potentially received screening without the program (No Program), and women who received no screening (No Screening). The impact of NBCCEDP was estimated as the difference in life-years between the Program and No Program, and the Program and No Screening scenarios. The analysis was performed in 2008-2009. Among 1.8 million women who were screened between 1991 and 2006, the Program saved 100,800 life-years compared with No Program and 369,000 life-years compared with No Screening. Per woman screened, the Program saved 0.056 life-years (95% CI=0.031, 0.081) compared with No Program and 0.206 life-years (95% CI=0.177, 0.234) compared with No Screening. Per woman with invasive breast cancer and screen-detected invasive cancer, the Program saved 0.41 and 0.71 life-years, respectively, compared with No Program. These estimates suggest that NBCCEDP breast cancer screening has reduced mortality among medically uninsured and underinsured low-income women. Published by Elsevier Inc.

  18. Translation and validation of the Malay version of the Stroke Knowledge Test

    Directory of Open Access Journals (Sweden)

    Siti Noorkhairina Sowtali

    2016-04-01

    Conclusions: Malay version Stroke Knowledge Test was a valid and reliable tool to assess educational needs and to evaluate stroke knowledge among participants of group-based stroke education programs in Malaysia.

  19. Relationship of melatonin and serotonin levels with clinical neurological data in patients with cerebral ischemic hemispheric stroke during the early recovery stage of disease

    Directory of Open Access Journals (Sweden)

    S. O. Medvedkova

    2017-06-01

    Full Text Available The aim of the research is the improvement of diagnostic measures in patients with cerebral ischemic hemispheric stroke (CIHS on the basis of melatonin and serotonin plasma levels study in relation with evidence of neurologic impairment, level of functional independence, level of disability and their dynamics during the early recovery period of the disease. Materials and Methods. The complex clinical and paraclinical study of 77 patients (the average age 57,9±0,9 years was done in the early recovery period of the CIHS. The study of all patients was complex clinic and paraclinical: test according to National Institute of Health Stroke Scale (NIHSS, Barthel Index (BI, modified Rankin Scale (mRS was done on the 10th, 30th, 90th and 180th day of the disease; computer tomography of cerebrum was made on the first day of the disease; melatonin serum concentration and serotonin plasma level were determined on the 10th and 30th day from the onset of the CIHS. The melatonin/serotonin ratio (MSR = melatonin serum concentration / serotonin plasma level was also calculated. Results and Discussion. Statistical reliable relations between the following indications have been identified: «serotonin plasma level on the10th day - dynamics mRS score on the 30-90th day» (R=+0,37, p˂0,05, «melatonin serum concentration on the10th day - dynamics mRS score on the 30-90th day» (R=-0,23, p˂0,05,«MSR on the 10th day - dynamics mRS score on the 30-90th day» (R=-0,40, p˂0,05,«serotonin plasma level on the 30th day - BI score on the 90th day»(R=+0,38, p˂0,05,«serotonin plasma level on the 30th - BI score on the180th day»(R=+0,40, p˂0,05, «MSR on the 30th day - NIHSS score on the 180th day» (R=+0,29, p˂0,05, «MSR on the 30th day - mRS score on the 90th day» (R=+0,29, p˂0,05, «MSR on the 30th day - mRS score on the 180th day» (R=+0,32, p˂0,05, «MSR on the 30th day - BI score on the 90th day» (R=-0,42, p˂0,05, «MSR on the 30th day - BI score on the

  20. Effects of a 12-hour neuromuscular electrical stimulation treatment program on the recovery of upper extremity function in sub-acute stroke patients: a randomized controlled pilot trial.

    Science.gov (United States)

    Cui, Bao-Juan; Wang, Dao-Qing; Qiu, Jian-Qing; Huang, Lai-Gang; Zeng, Fan-Shuo; Zhang, Qi; Sun, Min; Liu, Ben-Ling; Sun, Qiang-San

    2015-07-01

    [Purpose] This study investigated the effects of a 12-hour neuromuscular electrical stimulation program in the evening hours on upper extremity function in sub-acute stroke patients. [Subjects and Methods] Forty-five subjects were randomized to one of three groups: 12-hour neuromuscular electrical stimulation group (n=15), which received 12 hours of neuromuscular electrical stimulation and conventional rehabilitation for the affected upper extremity; neuromuscular electrical stimulation group (n=15), which received 30 min of neuromuscular electrical stimulation and conventional rehabilitation; and control group (n=15), which received conventional rehabilitation only. The Fugl-Meyer assessment, Action Research Arm Test, and modified Ashworth scale were used to evaluate the effects before and after intervention, and 4 weeks later. [Results] The improvement in the distal (wrist-hand) components of the Fugl-Meyer assessment and Action Research Arm Test in the 12-hour neuromuscular electrical stimulation group was more significant than that in the neuromuscular electrical stimulation group. No significant difference was found between the two groups in the proximal component (shoulder-elbow) of the Fugl-Meyer assessment. [Conclusion] The 12-hour neuromuscular electrical stimulation group achieved better improvement in upper extremity motor function, especially in the wrist-hand function. This alternative therapeutic approach is easily applicable and can be used in stroke patients during rest or sleep.

  1. The Early Intervention Readiness Program (EIRP): A Post-ASD Diagnosis Family Support Program

    Science.gov (United States)

    Tolmie, Rhiannon S.; Bruck, Susan; Kerslake, Rachel

    2017-01-01

    A child's diagnosis with autism spectrum disorder (ASD) can be an extremely stressful time for families. Researchers suggest that the period immediately following ASD diagnosis is a key time for professionals to guide families by providing appropriate information about support options. This article describes a family support program, developed by…

  2. Predictors for Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke.

    Science.gov (United States)

    Hao, Yonggang; Yang, Dong; Wang, Huaiming; Zi, Wenjie; Zhang, Meng; Geng, Yu; Zhou, Zhiming; Wang, Wei; Xu, Haowen; Tian, Xiguang; Lv, Penghua; Liu, Yuxiu; Xiong, Yunyun; Liu, Xinfeng; Xu, Gelin

    2017-05-01

    Symptomatic intracranial hemorrhage (SICH) pose a major safety concern for endovascular treatment of acute ischemic stroke. This study aimed to evaluate the risk and related factors of SICH after endovascular treatment in a real-world practice. Patients with stroke treated with stent-like retrievers for recanalizing a blocked artery in anterior circulation were enrolled from 21 stroke centers in China. Intracranial hemorrhage was classified as symptomatic and asymptomatic ones according to Heidelberg Bleeding Classification. Logistic regression was used to identify predictors for SICH. Of the 632 enrolled patients, 101 (16.0%) were diagnosed with SICH within 72 hours after endovascular treatment. Ninety-day mortality was higher in patients with SICH than in patients without SICH (65.3% versus 18.8%; P 0.83 (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.24-3.46), pretreatment Alberta Stroke Program Early Computed Tomography Score of stroke of cardioembolism type (OR, 1.91; 95% CI, 1.13-3.25), poor collateral circulation (OR, 1.97; 95% CI, 1.16-3.36), delay from symptoms onset to groin puncture >270 minutes (OR, 1.70; 95% CI, 1.03-2.80), >3 passes with retriever (OR, 2.55; 95% CI, 1.40-4.65) were associated with SICH after endovascular treatment. Incidence of SICH after thrombectomy is higher in Asian patients with acute ischemic stroke. Cardioembolic stroke, poor collateral circulation, delayed endovascular treatment, multiple passes with stent retriever device, lower pretreatment Alberta Stroke Program Early Computed Tomography Score, higher baseline neutrophil ratio may increase the risk of SICH. © 2017 American Heart Association, Inc.

  3. Schools' Responses to Voucher Policy: Participation Decisions and Early Implementation Experiences in the Indiana Choice Scholarship Program

    Science.gov (United States)

    Austin, Megan J.

    2015-01-01

    Little is known about the supply side of voucher programs, despite schools' central role in program effectiveness. Using survey and interview data on the Indiana Choice Scholarship Program (ICSP), I analyze schools' participation decisions and early implementation experiences to understand better how schools respond to program regulations. I find…

  4. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.

    2008-01-01

    Stroke in childhood has gained increasingly more attention and is accepted as an important disease in childhood. The reasons for this severe event and the consequences for the rest of the life are totally different than for adults. This is also true for the diagnosis and therapy. This paper gives a comprehensive overview on the characteristics of pediatric stroke to assist radiologists in making a rapid and safe diagnosis in order to identify the underlying disease. (orig.) [de

  5. Association of body mass index and obesity measured in early childhood with risk of coronary heart disease and stroke in middle age: findings from the aberdeen children of the 1950s prospective cohort study.

    Science.gov (United States)

    Lawlor, Debbie A; Leon, David A

    2005-04-19

    There is concern that the childhood epidemic of obesity will result in increases in the risk of cardiovascular disease in the future; however, there is currently little direct evidence on this issue. We assessed the association of body mass index, measured when subjects were a mean age of 4.9 years old, with the future risk of coronary heart disease (CHD) and stroke in a large Scottish birth cohort (born in the 1950s) who have been linked to hospital admissions and mortality data. At the start of the follow-up period (1981), there were 11,106 (91%) members of the cohort alive and believed to be resident in Scotland. Over the follow-up period, they contributed 245,000 person-years of risk. Among these subjects, there were 302 (53 fatal) cases of CHD, 109 (4 fatal) cases of stroke, and 397 (57 fatal) cases of either a CHD or stroke. There was no association between childhood body mass index and CHD risk. There was no linear association between childhood body mass index and stroke risk, but those who were obese in childhood (top 2.5% of the body mass index distribution) compared with all others had an increased risk of stroke; the adjusted (for gender, father's occupational social class at birth, number of siblings, and birth weight) hazards ratio was 2.41 (95% CI 1.00 to 5.86). Body mass index in early childhood does not appear to be associated with increased CHD risk in later life.

  6. Gray-Matter Volume Estimate Score: A Novel Semi-Automatic Method Measuring Early Ischemic Change on CT

    OpenAIRE

    Song, Dongbeom; Lee, Kijeong; Kim, Eun Hye; Kim, Young Dae; Lee, Hye Sun; Kim, Jinkwon; Song, Tae-Jin; Ahn, Sung Soo; Nam, Hyo Suk; Heo, Ji Hoe

    2015-01-01

    Background and Purpose We developed a novel method named Gray-matter Volume Estimate Score (GRAVES), measuring early ischemic changes on Computed Tomography (CT) semi-automatically by computer software. This study aimed to compare GRAVES and Alberta Stroke Program Early CT Score (ASPECTS) with regards to outcome prediction and inter-rater agreement. Methods This was a retrospective cohort study. Among consecutive patients with ischemic stroke in the anterior circulation who received intra-art...

  7. What Does Attending Early Childhood Program Mean for Child Health in India?

    Science.gov (United States)

    Sarkar, Dipanwita; Sarkar, Jayanta

    2017-11-01

    The health impact of attending early childhood development programs in developing countries remains largely unknown. In this study, we focus on the health consequences of attending preschool programs in India. Using a unique longitudinal dataset, we allow for heterogeneity in the impact of preschool across the distribution of health outcomes while controlling for time-invariant unobservables. We detect unique temporal variation in the effect of preschool attendance - growth of preschool attendees is slower than non-attendees in various parts of the distributions of several anthropometric measures when evaluated in the early years between ages 1 and 5. This effect is likely to reverse in the longer term at age 8. The early years' adverse effect can be explained in part by over-attendance in the form of long daily hours, excessive attendance days, and early entry. The findings are insensitive to nutritional incentives like free meals provided in public schools. The growth-retarding effect remains robust for weight-for-age z-scores, implying that the impact of preschool attendance is not only heterogeneous, but differs across dimensions of health status. Our study highlights the need for strengthening the delivery of childhood programs in developing countries in order to prevent adverse health effects in the critical years. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  8. PPARs Link Early Life Nutritional Insults to Later Programmed Hypertension and Metabolic Syndrome.

    Science.gov (United States)

    Tain, You-Lin; Hsu, Chien-Ning; Chan, Julie Y H

    2015-12-24

    Hypertension is an important component of metabolic syndrome. Adulthood hypertension and metabolic syndrome can be programmed in response to nutritional insults in early life. Peroxisome proliferator-activated receptors (PPARs) serve as a nutrient-sensing signaling linking nutritional programming to hypertension and metabolic syndrome. All three members of PPARs, PPARα, PPARβ/δ, and PPARγ, are expressed in the kidney and involved in blood pressure control. This review provides an overview of potential clinical applications of targeting on the PPARs in the kidney to prevent programmed hypertension and metabolic syndrome, with an emphasis on the following areas: mechanistic insights to interpret programmed hypertension; the link between the PPARs, nutritional insults, and programmed hypertension and metabolic syndrome; the impact of PPAR signaling pathway in a maternal high-fructose model; and current experimental studies on early intervention by PPAR modulators to prevent programmed hypertension and metabolic syndrome. Animal studies employing a reprogramming strategy via targeting PPARs to prevent hypertension have demonstrated interesting results.