WorldWideScience

Sample records for stroke recovery methods

  1. Novel Methods to Study Aphasia Recovery after Stroke

    DEFF Research Database (Denmark)

    Hartwigsen, Gesa; Siebner, Hartwig R

    2013-01-01

    The neural mechanisms that support aphasia recovery are not yet fully understood. It has been argued that the functional reorganization of language networks after left-hemisphere stroke may engage perilesional left brain areas as well as homologous right-hemisphere regions. In this chapter, we...... that language recovery after stroke may integrate left- as well as right-hemisphere brain regions to a different degree over the time course of recovery. Although the results of these preliminary studies provide some evidence that noninvasive brain stimulation may promote aphasia recovery, the reported effect...

  2. 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.

  3. Recovery of Dysphagia in Lateral Medullary Stroke

    Directory of Open Access Journals (Sweden)

    Hitesh Gupta

    2014-01-01

    Full Text Available Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

  4. Recovery of Gait After Stroke: What Changes?

    NARCIS (Netherlands)

    Buurke, Jaap; Nene, A.V.; Kwakkel, Gert; Erren-Wolters, Victorien; IJzerman, Maarten Joost; Hermens, Hermanus J.

    2008-01-01

    Background. Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking. Objective . The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles

  5. Recovery of gait after stroke: what changes?

    NARCIS (Netherlands)

    Buurke, J.H.; Nene, A.V.; Kwakkel, G.; Erren-Wolters, V.; IJzerman, M.J.; Hermens, H.J.

    2008-01-01

    Background. Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking. Objective. The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles

  6. Recovery of gait after stroke: what changes?

    NARCIS (Netherlands)

    Buurke, Jaap; Nene, A.V.; Kwakkel, G.; Erren-Wolters, V.; IJzerman, Maarten Joost; Hermens, Hermanus J.

    2008-01-01

    Background. Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking. Objective . The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles

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

    Science.gov (United States)

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

    2017-07-01

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

  8. Functional connectivity metrics during stroke recovery

    DEFF Research Database (Denmark)

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

    2010-01-01

    We explore functional connectivity in nine subjects measured with 1 5T fMRI-BOLD in a longitudinal study of recovery from unilateral stroke affecting the motor area (Small et al, 2002) We found that several measures of complexity of covariance matrices show strong correlations with behavioral mea...... sensitivity maps for the linear and quadratic discriminants indicate brain regions involved in changes in functional connectivity These regions are highly variable across subjects, but include the cerebellum and the motor area contralateral to the lesion......We explore functional connectivity in nine subjects measured with 1 5T fMRI-BOLD in a longitudinal study of recovery from unilateral stroke affecting the motor area (Small et al, 2002) We found that several measures of complexity of covariance matrices show strong correlations with behavioral...... measures of recovery In Schmah et al (2010), we applied Linear and Quadratic Discriminants (LD and QD) computed on a principal components (PC) subspace to classify the fMRI volumes into "early" and "late" sessions We demonstrated excellent classification accuracy with QD but not LD, indicating...

  9. A working model of stroke recovery from rehabilitation robotics practitioners.

    Science.gov (United States)

    Krebs, Hermano Igo; Volpe, Bruce; Hogan, Neville

    2009-02-25

    We reviewed some of our initial insights about the process of upper-limb behavioral recovery following stroke. Evidence to date indicates that intensity, task specificity, active engagement, and focusing training on motor coordination are key factors enabling efficacious recovery. On modeling, experience with over 400 stroke patients has suggested a working model of recovery similar to implicit motor learning. Ultimately, we plan to apply these insights in the development of customized training paradigms to enhance recovery.

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

    African Journals Online (AJOL)

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

  11. Cognitive recovery after stroke : A 2-year follow-up

    NARCIS (Netherlands)

    Hochstenbach, JB; Mulder, TW; Den Otter, R.

    2003-01-01

    Objectives: To determine (1) whether long-term improvement of cognitive function takes place after stroke and (2) which clinical factors influence cognitive recovery. Design: Cohort study with patients who were assessed at 2.3 and 27.7 months after stroke. Setting: Home-based stroke patients.

  12. Poststroke Trajectories: The Process of Recovery Over the Longer Term Following Stroke.

    Science.gov (United States)

    Hawkins, Rebecca J; Jowett, Adam; Godfrey, Mary; Mellish, Kirste; Young, John; Farrin, Amanda; Holloway, Ivana; Hewison, Jenny; Forster, Anne

    2017-01-01

    We adopted a grounded theory approach to explore the process of recovery experienced by stroke survivors over the longer term who were living in the community in the United Kingdom, and the interacting factors that are understood to have shaped their recovery trajectories. We used a combination of qualitative methods. From the accounts of 22 purposively sampled stroke survivors, four different recovery trajectories were evident: (a) meaningful recovery, (b) cycles of recovery and decline, (c) ongoing disruption, (d) gradual, ongoing decline. Building on the concept of the illness trajectory, our findings demonstrate how multiple, interacting factors shape the process and meaning of recovery over time. Such factors included conception of recovery and meanings given to the changing self, the meanings and consequences of health and illness experiences across the life course, loss, sense of agency, and enacting relationships. Awareness of the process of recovery will help professionals better support stroke survivors.

  13. Mapping cortical hand motor representation using TMS: A method to assess brain plasticity and a surrogate marker for recovery of function after stroke?

    Science.gov (United States)

    Lüdemann-Podubecká, Jitka; Nowak, Dennis Alexander

    2016-10-01

    Stroke is associated with reorganization within motor areas of both hemispheres. Mapping the cortical hand motor representation using transcranial magnetic stimulation may help to understand the relationship between motor cortex reorganization and motor recovery of the affected hand after stroke. A standardized review of the pertinent literature was performed. We identified 20 trials, which analyzed the relationship between the extent and/or location of cortical hand motor representation using transcranial magnetic stimulation and motor function and recovery of the affected hand. Several correlations were found between cortical reorganization and measures of hand motor impairment and recovery. A better understanding of the relationships between the extent and location of cortical hand motor representation and the motor impairment and motor recovery of the affected hand after stroke may contribute to a targeted use of non-invasive brain stimulation protocols. In the future motor mapping may help to guide brain stimulation techniques to the most effective motor area in an affected individual. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Factors Affecting the Ability of the Stroke Survivor to Drive Their Own Recovery outside of Therapy during Inpatient Stroke Rehabilitation

    Science.gov (United States)

    Brauer, Sandra G.; Kuys, Suzanne S.; Lord, Matthew; Hayward, Kathryn S.

    2014-01-01

    Aim. To explore factors affecting the ability of the stroke survivor to drive their own recovery outside of therapy during inpatient rehabilitation. Method. One-on-one, in-depth interviews with stroke survivors (n = 7) and their main carer (n = 6), along with two focus groups with clinical staff (n = 20). Data was thematically analysed according to group. Results. Stroke survivors perceived “dealing with loss,” whilst concurrently “building motivation and hope” for recovery affected their ability to drive their own recovery outside of therapy. In addition, they reported a “lack of opportunities” outside of therapy, with subsequent time described as “dead and wasted.” Main carers perceived stroke survivors felt “out of control … at everyone's mercy” and lacked knowledge of “what to do and why” outside of therapy. Clinical staff perceived the stroke survivor's ability to drive their own recovery was limited by the lack of “another place to go” and the “passive rehab culture and environment.” Discussion. To enable the stroke survivor to drive their own recovery outside of therapy, there is a need to increase opportunities for practice and promote active engagement. Suggested strategies include building the stroke survivor's motivation and knowledge, creating an enriched environment, and developing daily routines to provide structure outside of therapy time. PMID:24800104

  15. Factors Affecting the Ability of the Stroke Survivor to Drive Their Own Recovery outside of Therapy during Inpatient Stroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Xue Wen Eng

    2014-01-01

    Full Text Available Aim. To explore factors affecting the ability of the stroke survivor to drive their own recovery outside of therapy during inpatient rehabilitation. Method. One-on-one, in-depth interviews with stroke survivors (n=7 and their main carer (n=6, along with two focus groups with clinical staff (n=20. Data was thematically analysed according to group. Results. Stroke survivors perceived “dealing with loss,” whilst concurrently “building motivation and hope” for recovery affected their ability to drive their own recovery outside of therapy. In addition, they reported a “lack of opportunities” outside of therapy, with subsequent time described as “dead and wasted.” Main carers perceived stroke survivors felt “out of control … at everyone’s mercy” and lacked knowledge of “what to do and why” outside of therapy. Clinical staff perceived the stroke survivor’s ability to drive their own recovery was limited by the lack of “another place to go” and the “passive rehab culture and environment.” Discussion. To enable the stroke survivor to drive their own recovery outside of therapy, there is a need to increase opportunities for practice and promote active engagement. Suggested strategies include building the stroke survivor’s motivation and knowledge, creating an enriched environment, and developing daily routines to provide structure outside of therapy time.

  16. Changes of motor recovery in chronic stroke patients

    Directory of Open Access Journals (Sweden)

    Rodríguez-Lázaro, Álvaro Enrique

    2016-04-01

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

  17. Enhancing the Alignment of the Preclinical and Clinical Stroke Recovery Research Pipeline: Consensus-Based Core Recommendations From the Stroke Recovery and Rehabilitation Roundtable Translational Working Group.

    Science.gov (United States)

    Corbett, Dale; Carmichael, S Thomas; Murphy, Timothy H; Jones, Theresa A; Schwab, Martin E; Jolkkonen, Jukka; Clarkson, Andrew N; Dancause, Numa; Weiloch, Tadeusz; Johansen-Berg, Heidi; Nilsson, Michael; McCullough, Louise D; Joy, Mary T

    2017-08-01

    Stroke recovery research involves distinct biological and clinical targets compared to the study of acute stroke. Guidelines are proposed for the pre-clinical modeling of stroke recovery and for the alignment of pre-clinical studies to clinical trials in stroke recovery.

  18. Recovery of Dysphagia in Lateral Medullary Stroke

    OpenAIRE

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia...

  19. Recovery After Stroke: Coping with Emotions

    Science.gov (United States)

    ... act. Depression can take hold right after a stroke, during rehabilitation (rehab) or after you go home. It can ... and an important part of recovering from a stroke. Through rehabilitation, you relearn basic skills such as talking, eating, ...

  20. Critical Periods after Stroke Study: Translating animal stroke recovery experiments into a clinical trial

    Directory of Open Access Journals (Sweden)

    Alexander W Dromerick

    2015-04-01

    Full Text Available Introduction: 795,000 Americans will have a stroke this year, and half will have a chronic hemiparesis. Substantial animal literature suggests that the mammalian brain has much potential to recover from acute injury using mechanisms of neuroplasticity, and that these mechanisms can be accessed using training paradigms and neurotransmitter manipulation. However, most of these findings have not been tested or confirmed in the rehabilitation setting, in large part because of the challenges in translating a conceptually straightforward laboratory experiment into a meaningful and rigorous clinical trial in humans. Through presentation of methods for a Phase II trial, we discuss these issues and describe our approach. Methods: In rodents there is compelling evidence for timing effects in rehabilitation; motor training delivered at certain times after stroke may be more effective than the same training delivered earlier or later, suggesting that there is a critical or sensitive period for strongest rehabilitation training effects. If analogous critical/sensitive periods can be identified after human stroke, then existing clinical resources can be better utilized to promote recovery. The Critical Periods after Stroke Study (CPASS is a phase II randomized, controlled trial designed to explore whether such a sensitive period exists. We will randomize 64 persons to receive an additional 20 hours of upper extremity therapy either immediately upon rehab admission, 2-3 months after stroke onset, 6 months after onset, or to an observation-only control group. The primary outcome measure will be the Action Research Arm Test at one year. Blood will be drawn at up to 3 time points for later biomarker studies. Conclusion: CPASS is an example of the translation of rodent motor recovery experiments into the clinical setting; data obtained from this single site randomized controlled trial will be used to finalize the design of a Phase III trial.

  1. Critical periods after stroke study: translating animal stroke recovery experiments into a clinical trial

    Science.gov (United States)

    Dromerick, Alexander W.; Edwardson, Matthew A.; Edwards, Dorothy F.; Giannetti, Margot L.; Barth, Jessica; Brady, Kathaleen P.; Chan, Evan; Tan, Ming T.; Tamboli, Irfan; Chia, Ruth; Orquiza, Michael; Padilla, Robert M.; Cheema, Amrita K.; Mapstone, Mark E.; Fiandaca, Massimo S.; Federoff, Howard J.; Newport, Elissa L.

    2015-01-01

    Introduction: Seven hundred ninety-five thousand Americans will have a stroke this year, and half will have a chronic hemiparesis. Substantial animal literature suggests that the mammalian brain has much potential to recover from acute injury using mechanisms of neuroplasticity, and that these mechanisms can be accessed using training paradigms and neurotransmitter manipulation. However, most of these findings have not been tested or confirmed in the rehabilitation setting, in large part because of the challenges in translating a conceptually straightforward laboratory experiment into a meaningful and rigorous clinical trial in humans. Through presentation of methods for a Phase II trial, we discuss these issues and describe our approach. Methods: In rodents there is compelling evidence for timing effects in rehabilitation; motor training delivered at certain times after stroke may be more effective than the same training delivered earlier or later, suggesting that there is a critical or sensitive period for strongest rehabilitation training effects. If analogous critical/sensitive periods can be identified after human stroke, then existing clinical resources can be better utilized to promote recovery. The Critical Periods after Stroke Study (CPASS) is a phase II randomized, controlled trial designed to explore whether such a sensitive period exists. We will randomize 64 persons to receive an additional 20 h of upper extremity therapy either immediately upon rehab admission, 2–3 months after stroke onset, 6 months after onset, or to an observation-only control group. The primary outcome measure will be the Action Research Arm Test (ARAT) at 1 year. Blood will be drawn at up to 3 time points for later biomarker studies. Conclusion: CPASS is an example of the translation of rodent motor recovery experiments into the clinical setting; data obtained from this single site randomized controlled trial will be used to finalize the design of a Phase III trial. PMID

  2. Neuroprotection and Stroke Rehabilitation: Modulation and Enhancement of Recovery

    Directory of Open Access Journals (Sweden)

    José Rafael Romero

    2006-01-01

    Full Text Available Recent advances in research are modifying our view of recovery after nervous system damage. New findings are changing previously held concepts and providing promising avenues for treatment of patients after stroke. This review discusses mechanisms of neuronal injury after brain ischemia and the attempts to study neuroprotection options based on such mechanisms. It also considers measures available at present to improve outcome after stroke and presents new areas of research, particularly stimulation techniques, neurogenesis and trophic factors to enhance recovery. In order to improve outcomes, medications that may be detrimental to recovery should be avoided, while symptomatic therapy of problems such as depression, pain syndromes and spasticity may contribute to better results. Continued surveillance and early treatment of complications associated with acute stroke, along with supportive care remain the mainstay of treatment for stroke patients in the recovery phase. Present research on limiting brain damage and improving recovery and plasticity enhance the prospects for better clinical treatments to improve recovery after stroke.

  3. Proportional Motor Recovery After Stroke: Implications for Trial Design.

    Science.gov (United States)

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

    2017-03-01

    Recovery of upper-limb motor impairment after first-ever ischemic stroke is proportional to the degree of initial impairment in patients with a functional corticospinal tract (CST). This study aimed to investigate whether proportional recovery occurs in a more clinically relevant sample including patients with intracerebral hemorrhage and previous stroke. Patients with upper-limb weakness were assessed 3 days and 3 months poststroke with the Fugl-Meyer scale. Transcranial magnetic stimulation was used to test CST function, and patients were dichotomized according to the presence of motor evoked potentials in the paretic wrist extensors. Linear regression modeling of Δ Fugl-Meyer score between 3 days and 3 months was performed, with predictors including initial impairment (66 - baseline Fugl-Meyer score), age, sex, stroke type, previous stroke, comorbidities, and upper-limb therapy dose. One hundred ninety-two patients were recruited, and 157 completed 3-month follow-up. Patients with a functional CST made a proportional recovery of 63% (95% confidence interval, 55%-70%) of initial motor impairment. The recovery of patients without a functional CST was not proportional to initial impairment and was reduced by greater CST damage. Recovery of motor impairment in patients with intact CST is proportional to initial impairment and unaffected by previous stroke, type of stroke, or upper-limb therapy dose. Novel interventions that interact with the neurobiological mechanisms of recovery are needed. The generalizability of proportional recovery is such that patients with intracerebral hemorrhage and previous stroke may usefully be included in interventional rehabilitation trials. URL: http://www.anzctr.org.au. Unique identifier: ANZCTR12611000755932. © 2017 American Heart Association, Inc.

  4. Neural Basis of Acquired Amusia and Its Recovery after Stroke.

    Science.gov (United States)

    Sihvonen, Aleksi J; Ripollés, Pablo; Leo, Vera; Rodríguez-Fornells, Antoni; Soinila, Seppo; Särkämö, Teppo

    2016-08-24

    Although acquired amusia is a relatively common disorder after stroke, its precise neuroanatomical basis is still unknown. To evaluate which brain regions form the neural substrate for acquired amusia and its recovery, we performed a voxel-based lesion-symptom mapping (VLSM) and morphometry (VBM) study with 77 human stroke subjects. Structural MRIs were acquired at acute and 6 month poststroke stages. Amusia and aphasia were behaviorally assessed at acute and 3 month poststroke stages using the Scale and Rhythm subtests of the Montreal Battery of Evaluation of Amusia (MBEA) and language tests. VLSM analyses indicated that amusia was associated with a lesion area comprising the superior temporal gyrus, Heschl's gyrus, insula, and striatum in the right hemisphere, clearly different from the lesion pattern associated with aphasia. Parametric analyses of MBEA Pitch and Rhythm scores showed extensive lesion overlap in the right striatum, as well as in the right Heschl's gyrus and superior temporal gyrus. Lesions associated with Rhythm scores extended more superiorly and posterolaterally. VBM analysis of volume changes from the acute to the 6 month stage showed a clear decrease in gray matter volume in the right superior and middle temporal gyri in nonrecovered amusic patients compared with nonamusic patients. This increased atrophy was more evident in anterior temporal areas in rhythm amusia and in posterior temporal and temporoparietal areas in pitch amusia. Overall, the results implicate right temporal and subcortical regions as the crucial neural substrate for acquired amusia and highlight the importance of different temporal lobe regions for the recovery of amusia after stroke. Lesion studies are essential in uncovering the brain regions causally linked to a given behavior or skill. For music perception ability, previous lesion studies of amusia have been methodologically limited in both spatial accuracy and time domain as well as by small sample sizes, providing

  5. Recovery After Stroke: Dealing with Pain

    Science.gov (United States)

    ... to the brain in response to touch, warmth, cold and other stimuli. But, the brain does not understand these signals correctly. Instead, it registers even slight sensations in the skin as painful. Stroke survivors with ...

  6. Motivational interviewing for improving recovery after stroke.

    Science.gov (United States)

    Cheng, Daobin; Qu, Zhanli; Huang, Jianyi; Xiao, Yousheng; Luo, Hongye; Wang, Jin

    2015-06-03

    Psychological problems are common complications following stroke that can cause stroke survivors to lack the motivation to take part in activities of daily living. Motivational interviewing provides a specific way for enhancing intrinsic motivation, which may help to improve activities of daily living for stroke survivors. To investigate the effect of motivational interviewing for improving activities of daily living after stroke. We searched the Cochrane Stroke Group's Trials Register (November 2014), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1), MEDLINE (1948 to March 2015), EMBASE (1980 to March 2015), CINAHL (1982 to March 2015), AMED (1985 to March 2015), PsycINFO (1806 to March 2015), PsycBITE (March 2015) and four Chinese databases. In an effort to identify further published, unpublished and ongoing trials, we searched ongoing trials registers and conference proceedings, checked reference lists, and contacted authors of relevant studies. Randomised controlled trials (RCTs) comparing motivational interviewing with no intervention, sham motivational interviewing or other psychological therapy for people with stroke were eligible. Two review authors independently selected studies for inclusion, extracted eligible data and assessed risk of bias. Outcome measures included activities of daily living, mood and death. One study involving a total of 411 participants, which compared motivational interviewing with usual care, met our inclusion criteria. The results of this review did not show significant differences between groups receiving motivational interviewing or usual stroke care for participants who were not dependent on others for activities of daily living, nor on the death rate after three-month and 12-month follow-up, but participants receiving motivational interviewing were more likely to have a normal mood than those who received usual care at three-months and 12-months follow-up. There is insufficient evidence to support

  7. Imaging network level language recovery after left PCA stroke.

    Science.gov (United States)

    Sebastian, Rajani; Long, Charltien; Purcell, Jeremy J; Faria, Andreia V; Lindquist, Martin; Jarso, Samson; Race, David; Davis, Cameron; Posner, Joseph; Wright, Amy; Hillis, Argye E

    2016-05-11

    The neural mechanisms that support aphasia recovery are not yet fully understood. Our goal was to evaluate longitudinal changes in naming recovery in participants with posterior cerebral artery (PCA) stroke using a case-by-case analysis. Using task based and resting state functional magnetic resonance imaging (fMRI) and detailed language testing, we longitudinally studied the recovery of the naming network in four participants with PCA stroke with naming deficits at the acute (0 week), sub acute (3-5 weeks), and chronic time point (5-7 months) post stroke. Behavioral and imaging analyses (task related and resting state functional connectivity) were carried out to elucidate longitudinal changes in naming recovery. Behavioral and imaging analysis revealed that an improvement in naming accuracy from the acute to the chronic stage was reflected by increased connectivity within and between left and right hemisphere "language" regions. One participant who had persistent moderate naming deficit showed weak and decreasing connectivity longitudinally within and between left and right hemisphere language regions. These findings emphasize a network view of aphasia recovery, and show that the degree of inter- and intra- hemispheric balance between the language-specific regions is necessary for optimal recovery of naming, at least in participants with PCA stroke.

  8. Neural basis of acquired amusia and its recovery after stroke

    OpenAIRE

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

    2016-01-01

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

  9. Spatial cognitive rehabilitation and motor recovery after stroke

    Science.gov (United States)

    Barrett, A.M.; Muzaffar, Tufail

    2014-01-01

    Purpose of review Stroke rehabilitation needs to take major steps forward to reduce functional disability for survivors. In this article, we suggest that spatial retraining might greatly increase the efficiency and efficacy of motor rehabilitation, directly addressing the burden and cost of paralysis after stroke. Recent findings Combining motor and cognitive treatment may be practical, as well as addressing needs after moderate–to-severe stroke. Spatial neglect could suppress motor recovery and reduce motor learning, even when patients receive appropriate rehabilitation to build strength, dexterity, and endurance. Spatial neglect rehabilitation acts to promote motor as well as visual-perceptual recovery. These findings, and previous underemphasized studies, make a strong case for combining spatial neglect treatment with traditional exercise training. Spatial neglect therapies might also help people who cannot participate in intensive movement therapies because of limited strength and endurance after stroke. Summary Spatial retraining, currently used selectively after right brain stroke, may be broadly useful after stroke to promote rapid motor recovery. PMID:25364954

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

    Directory of Open Access Journals (Sweden)

    Kiran Prakash Pappala

    2014-10-01

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

  11. Functional Recovery of the Paretic Upper Limb After Stroke: Who Regains Hand Capacity?

    NARCIS (Netherlands)

    Houwink, A.; Nijland, R.H.; Geurts, A.C.; Kwakkel, G.

    2013-01-01

    Objective: To describe recovery of upper limb capacity after stroke during inpatient rehabilitation based on the Stroke Upper Limb Capacity Scale (SULCS). Design: Prospective observational study. Setting: Inpatient department of a rehabilitation center. Participants: Patients with stroke (N=299)

  12. Functional recovery of the paretic upper limb after stroke: who regains hand capacity?

    NARCIS (Netherlands)

    Houwink, A.; Nijland, R.H.; Geurts, A.C.H.; Kwakkel, G.

    2013-01-01

    OBJECTIVE: To describe recovery of upper limb capacity after stroke during inpatient rehabilitation based on the Stroke Upper Limb Capacity Scale (SULCS). DESIGN: Prospective observational study. SETTING: Inpatient department of a rehabilitation center. PARTICIPANTS: Patients with stroke (N=299)

  13. Assessed and Emerging Biomarkers in Stroke and Training-Mediated Stroke Recovery: State of the Art

    Directory of Open Access Journals (Sweden)

    Marialuisa Gandolfi

    2017-01-01

    Full Text Available Since the increasing update of the biomolecular scientific literature, biomarkers in stroke have reached an outstanding and remarkable revision in the very recent years. Besides the diagnostic and prognostic role of some inflammatory markers, many further molecules and biological factors have been added to the list, including tissue derived cytokines, growth factor-like molecules, hormones, and microRNAs. The literatures on brain derived growth factor and other neuroimmune mediators, bone-skeletal muscle biomarkers, cellular and immunity biomarkers, and the role of microRNAs in stroke recovery were reviewed. To date, biomarkers represent a possible challenge in the diagnostic and prognostic evaluation of stroke onset, pathogenesis, and recovery. Many molecules are still under investigation and may become promising and encouraging biomarkers. Experimental and clinical research should increase this list and promote new discoveries in this field, to improve stroke diagnosis and treatment.

  14. Assessed and Emerging Biomarkers in Stroke and Training-Mediated Stroke Recovery: State of the Art

    Science.gov (United States)

    Vella, Antonio

    2017-01-01

    Since the increasing update of the biomolecular scientific literature, biomarkers in stroke have reached an outstanding and remarkable revision in the very recent years. Besides the diagnostic and prognostic role of some inflammatory markers, many further molecules and biological factors have been added to the list, including tissue derived cytokines, growth factor-like molecules, hormones, and microRNAs. The literatures on brain derived growth factor and other neuroimmune mediators, bone-skeletal muscle biomarkers, cellular and immunity biomarkers, and the role of microRNAs in stroke recovery were reviewed. To date, biomarkers represent a possible challenge in the diagnostic and prognostic evaluation of stroke onset, pathogenesis, and recovery. Many molecules are still under investigation and may become promising and encouraging biomarkers. Experimental and clinical research should increase this list and promote new discoveries in this field, to improve stroke diagnosis and treatment. PMID:28373915

  15. Spasticity, Motor Recovery, and Neural Plasticity after Stroke.

    Science.gov (United States)

    Li, Sheng

    2017-01-01

    Spasticity and weakness (spastic paresis) are the primary motor impairments after stroke and impose significant challenges for treatment and patient care. Spasticity emerges and disappears in the course of complete motor recovery. Spasticity and motor recovery are both related to neural plasticity after stroke. However, the relation between the two remains poorly understood among clinicians and researchers. Recovery of strength and motor function is mainly attributed to cortical plastic reorganization in the early recovery phase, while reticulospinal (RS) hyperexcitability as a result of maladaptive plasticity, is the most plausible mechanism for poststroke spasticity. It is important to differentiate and understand that motor recovery and spasticity have different underlying mechanisms. Facilitation and modulation of neural plasticity through rehabilitative strategies, such as early interventions with repetitive goal-oriented intensive therapy, appropriate non-invasive brain stimulation, and pharmacological agents, are the keys to promote motor recovery. Individualized rehabilitation protocols could be developed to utilize or avoid the maladaptive plasticity, such as RS hyperexcitability, in the course of motor recovery. Aggressive and appropriate spasticity management with botulinum toxin therapy is an example of how to create a transient plastic state of the neuromotor system that allows motor re-learning and recovery in chronic stages.

  16. Functional recovery differs between ischaemic and haemorrhagic stroke patients

    NARCIS (Netherlands)

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

    2008-01-01

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

  17. Functional recovery differs between ischaemic and haemorrhagic stroke patients

    NARCIS (Netherlands)

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

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

  18. Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review

    NARCIS (Netherlands)

    Kwakkel, G.; Kollen, B.J.; Krebs, H.I.

    2008-01-01

    Objective. The aim of the study was to present a systematic review of studies that investigate the effects of robot-assisted therapy on motor and functional recovery in patients with stroke. Methods. A database of articles published up to October 2006 was compiled using the following Medline key

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-07-01

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

  20. Neural correlates of longitudinal recovery of naming in stroke

    Directory of Open Access Journals (Sweden)

    Rajani Sebastian

    2015-05-01

    Our preliminary data suggests that recovery of naming is dynamic and may have different time courses in different individuals. Further, brain reorganization during language recovery may not proceed in three phases as proposed by Saur and colleagues. This finding is in line with the recent work from our lab, which examined recovery of language within the first two months after a stroke (Jarso et al., 2014. To further understand the processes involved in naming recovery, we are analyzing DTI and resting state fMRI data. It is hoped that the results from the multimodality imaging data will serve as the basis for targeted brain-based interventions for aphasia, which require an understanding of the anatomy of language networks, as well as the extent and timing of how these networks reorganize after injury.

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

    Science.gov (United States)

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

    2017-04-01

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

  2. AMPA receptor-induced local brain-derived neurotrophic factor signaling mediates motor recovery after stroke.

    Science.gov (United States)

    Clarkson, Andrew N; Overman, Justine J; Zhong, Sheng; Mueller, Rudolf; Lynch, Gary; Carmichael, S Thomas

    2011-03-09

    Stroke is the leading cause of adult disability. Recovery after stroke shares similar molecular and cellular properties with learning and memory. A main component of learning-induced plasticity involves signaling through AMPA receptors (AMPARs). We systematically tested the role of AMPAR function in motor recovery in a mouse model of focal stroke. AMPAR function controls functional recovery beginning 5 d after the stroke. Positive allosteric modulators of AMPARs enhance recovery of limb control when administered after a delay from the stroke. Conversely, AMPAR antagonists impair motor recovery. The contributions of AMPARs to recovery are mediated by release of brain-derived neurotrophic factor (BDNF) in periinfarct cortex, as blocking local BDNF function in periinfarct cortex blocks AMPAR-mediated recovery and prevents the normal pattern of motor recovery. In contrast to a delayed AMPAR role in motor recovery, early administration of AMPAR agonists after stroke increases stroke damage. These findings indicate that the role of glutamate signaling through the AMPAR changes over time in stroke: early potentiation of AMPAR signaling worsens stroke damage, whereas later potentiation of the same signaling system improves functional recovery.

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

    Science.gov (United States)

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

    2015-12-01

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

  4. Action research in rehabilitation with chronic stroke recovery

    DEFF Research Database (Denmark)

    Pedersen, Malene; Bundgaard, Tina H; Zeeman, Peter

    2016-01-01

    for these patients. OBJECTIVE: The purpose of this project is to describe the use of a specialized neuroplastic approach in combination with an already existing training program. METHODS: The project is designed as an action research project concerning four participants with chronic stroke. Through ten intervention......BACKGROUND: Chronic stroke patients are primarily referred to general rehabilitation, rather than to specific neurorehabilitation. Currently, there are no Danish clinical guidelines for chronic stroke, but recent research in neuroplasticity has contributed to possible rehabilitation interventions......, a neuroplastic focus has been added to their group training program including daily home training. Participants were tested before and after the intervention with MAS, DGI, 6MWT, SSQLS. RESULTS: All four participants improved their functional levels and their quality of life following the intervention...

  5. Inspiratory muscle training for the recovery of function after stroke.

    Science.gov (United States)

    Xiao, Yousheng; Luo, Man; Wang, Jin; Luo, Hongye

    2012-05-16

    Inspiratory muscle weakness has been observed in patients with stroke. Inspiratory muscle training is an intervention that has shown possible effects for functional recovery of patients with stroke. To investigate the effect and safety of inspiratory muscle training for improving activities of daily living, respiratory muscle function, quality of life and cardiorespiratory fitness after stroke. We searched the Cochrane Stroke Group's Trials Register (August 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, October Issue 4), MEDLINE (1948 to October 2011), EMBASE (1974 to October 2011), CINAHL (1982 to October 2011), AMED (1985 to October 2011), PEDro (October 2011) and four Chinese databases. In an effort to identify further published, unpublished and ongoing trials, we searched ongoing trials registers and conference proceedings, checked reference lists, and contacted authors of relevant studies and training devices manufactures. There were no language restrictions. Randomised controlled trials (RCTs) comparing inspiratory muscle training with no intervention, sham inspiratory muscle training or other cardiorespiratory training for patients with stroke were eligible. Two review authors independently assessed trial quality and extracted data. The primary outcomes were activities of daily living and respiratory muscle strength; the secondary outcomes were quality of life, cardiorespiratory fitness and adverse effects. We included two trials involving a total of 66 patients in this review. Pooling analyses of data was not possible due to considerable heterogeneity between the trials and a lack of data in both trials. One study found a significant increase in respiratory muscle strength favouring inspiratory muscle training over sham inspiratory muscle training, but there was no significant difference between groups on quality of life. The other study showed that patients receiving inspiratory muscle training were more

  6. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery

    Directory of Open Access Journals (Sweden)

    Samar M Hatem

    2016-09-01

    Full Text Available Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients’ mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed.At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.

  7. Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery

    Science.gov (United States)

    Hatem, Samar M.; Saussez, Geoffroy; della Faille, Margaux; Prist, Vincent; Zhang, Xue; Dispa, Delphine; Bleyenheuft, Yannick

    2016-01-01

    Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients' mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation. PMID:27679565

  8. Magnesium fluoride recovery method

    International Nuclear Information System (INIS)

    Gay, R.L.; McKenzie, D.E.

    1989-01-01

    A method of obtaining magnesium fluoride substantially free from radioactive uranium from a slag formed in the production of metallic uranium by the reduction of depleted uranium tetrafluoride with metallic magnesium in a retort wherein the slag contains the free metals magnesium and uranium and also oxides and fluorides of the metals. The slag having a radioactivity level of at least about 7,000 rhoCi/gm. The method comprises the steps of: grinding the slag to a median particle size of about 200 microns; contacting the ground slag in a reaction zone with an acid having a strength of from about 0.5 to 1.5 N for a time of from about 4 to about 20 hours in the presence of a catalytic amount of iron; removing the liquid product; treating the particulate solid product; repeating the last two steps at least one more time to produce a solid residue consisting essentially of magnesium fluoride substantially free of uranium and having a residual radioactivity level of less than about 1000 rhoCi/gm

  9. Effectiveness of Commercial Gaming-Based Virtual Reality Movement Therapy on Functional Recovery of Upper Extremity in Subacute Stroke Patients

    OpenAIRE

    Choi, Jun Hwan; Han, Eun Young; Kim, Bo Ryun; Kim, Sun Mi; Im, Sang Hee; Lee, So Young; Hyun, Chul Woong

    2014-01-01

    Objective To investigate the effectiveness of commercial gaming-based virtual reality (VR) therapy on the recovery of paretic upper extremity in subacute stroke patients. Methods Twenty patients with the first-onset subacute stroke were enrolled and randomly assigned to the case group (n=10) and the control group (n=10). Primary outcome was measured by the upper limb score through the Fugl-Meyer Assessment (FMA-UL) for the motor function of both upper extremities. Secondary outcomes were asse...

  10. Efficiency of drug therapy in complex rehabilitation of patients in late recovery period of stroke

    OpenAIRE

    Dilshod Sagatov

    2011-01-01

    Clinical and neurological studies in 73 patients (44 men and 29 women) with the consequences of ischemic stroke in late recovery period were performed. Dopplerographic and electroencephalographic parameters before and after the rehabilitation measures were examined. In this study, we assessed the therapeutic effect of nootropics in drug rehabilitation with the inclusion of Nootropil and Cavinton Forte in late stroke recovery period.

  11. What determines good recovery in patients with the most severe strokes?

    DEFF Research Database (Denmark)

    Jørgensen, H S; Reith, J; Nakayama, H

    1999-01-01

    Even patients with the most severe strokes sometimes experience a remarkably good recovery. We evaluated possible predictors of a good outcome to search for new therapeutic strategies.......Even patients with the most severe strokes sometimes experience a remarkably good recovery. We evaluated possible predictors of a good outcome to search for new therapeutic strategies....

  12. Enhancement Of Motor Recovery Through Left Dorsolateral Prefrontal Cortex Stimulation After Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Shahram Oveisgharan

    2017-02-01

    Full Text Available Background: Two previous studies, which investigated transcranial direct current stimulation (tDCS use in motor recovery after acute ischemic stroke, did not show tDCS to be effective in this regard. We speculated that additional left dorsolateral prefrontal cortex ‎(DLPFC ‎stimulation may enhance post stroke motor recovery.  ‎ Methods: In the present randomized clinical trial, 20 acute ischemic stroke patients were recruited. Patients received real motor cortex (M1 stimulation in both arms of the trial. The two arms differed in terms of real vs. sham stimulation over the left DLPFC‎. Motor component of the Fugl-Meyer upper extremity assessment (FM and Action Research Arm Test (ARAT scores were used to assess primary outcomes, and non-linear mixed effects models were used for data analyses. Results: Primary outcome measures improved more and faster among the real stimulation group. During the first days of stimulations, sham group’s FM scores increased 1.2 scores per day, while real group’s scores increased 1.7 scores per day (P = 0.003. In the following days, FM improvement decelerated in both groups. Based on the derived models, a hypothetical stroke patient with baseline FM score of 15 improves to 32 in the sham stimulation group and to 41 in the real stimulation group within the first month after stroke. Models with ARAT scores yielded nearly similar results. Conclusion: The current study results showed that left DLPFC‎ stimulation in conjunction with M1 stimulation resulted in better motor recovery than M1 stimulation alone.

  13. Neuroimaging of stroke recovery from aphasia - Insights into plasticity of the human language network.

    Science.gov (United States)

    Hartwigsen, Gesa; Saur, Dorothee

    2017-11-23

    The role of left and right hemisphere brain regions in language recovery after stroke-induced aphasia remains controversial. Here, we summarize how neuroimaging studies increase the current understanding of functional interactions, reorganization and plasticity in the language network. We first discuss the temporal dynamics across the time course of language recovery, with a main focus on longitudinal studies from the acute to the chronic phase after stroke. These studies show that the functional contribution of perilesional and spared left hemisphere as well as contralesional right hemisphere regions to language recovery changes over time. The second section introduces critical variables and recent advances on early prediction of subsequent outcome. In the third section, we outline how multi-method approaches that combine neuroimaging techniques with non-invasive brain stimulation elucidate mechanisms of plasticity and reorganization in the language network. These approaches provide novel insights into general mechanisms of plasticity in the language network and might ultimately support recovery processes during speech and language therapy. Finally, the neurobiological correlates of therapy-induced plasticity are discussed. We argue that future studies should integrate individualized approaches that might vary the combination of language therapy with specific non-invasive brain stimulation protocols across the time course of recovery. The way forward will include the combination of such approaches with large data sets obtained from multicentre studies. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Using mixed methods to evaluate efficacy and user expectations of a virtual reality-based training system for upper-limb recovery in patients after stroke: a study protocol for a randomised controlled trial.

    Science.gov (United States)

    Schuster-Amft, Corina; Eng, Kynan; Lehmann, Isabelle; Schmid, Ludwig; Kobashi, Nagisa; Thaler, Irène; Verra, Martin L; Henneke, Andrea; Signer, Sandra; McCaskey, Michael; Kiper, Daniel

    2014-09-06

    In recent years, virtual reality has been introduced to neurorehabilitation, in particular with the intention of improving upper-limb training options and facilitating motor function recovery. The proposed study incorporates a quantitative part and a qualitative part, termed a mixed-methods approach: (1) a quantitative investigation of the efficacy of virtual reality training compared to conventional therapy in upper-limb motor function are investigated, (2a) a qualitative investigation of patients' experiences and expectations of virtual reality training and (2b) a qualitative investigation of therapists' experiences using the virtual reality training system in the therapy setting. At three participating clinics, 60 patients at least 6 months after stroke onset will be randomly allocated to an experimental virtual reality group (EG) or to a control group that will receive conventional physiotherapy or occupational therapy (16 sessions, 45 minutes each, over the course of 4 weeks). Using custom data gloves, patients' finger and arm movements will be displayed in real time on a monitor, and they will move and manipulate objects in various virtual environments. A blinded assessor will test patients' motor and cognitive performance twice before, once during, and twice after the 4-week intervention. The primary outcome measure is the Box and Block Test. Secondary outcome measures are the Chedoke-McMaster Stroke Assessments (hand, arm and shoulder pain subscales), the Chedoke-McMaster Arm and Hand Activity Inventory, the Line Bisection Test, the Stroke Impact Scale, the MiniMentalState Examination and the Extended Barthel Index. Semistructured face-to-face interviews will be conducted with patients in the EG after intervention finalization with a focus on the patients' expectations and experiences regarding the virtual reality training. Therapists' perspectives on virtual reality training will be reviewed in three focus groups comprising four to six occupational

  15. Cryostimulation improves recovery from oropharyngeal dysphagia after stroke

    Directory of Open Access Journals (Sweden)

    Silva, Ana Maria Toniolo da

    2013-01-01

    Full Text Available Introduction: Stroke is considered one of the most frequent neurological causes of oropharyngeal dysphagia. Aim: To determine the effect of cryostimulation on oropharyngeal sensitivity and, subsequently, on the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. Methods: Clinical and experimental study. The study enrolled 7 adult subjects, 6 men and 1 woman ranging from 28 to 64 years of age, with a diagnosis of stroke and current oropharyngeal dysphagia without any other underlying disease. The selected subjects underwent speech-language pathology evaluation and videofluoroscopic assessment of the dysphagia. The subjects were then treated with cryostimulation consisting of 10 applications to each structure (anterior faucial pillar, posterior oropharyngeal wall, soft palate, and back tongue 3 times a day (for a total of 30 daily applications per structure for 4 consecutive days. The patients were then re-evaluated based on the same criteria. The pre- and post-cryostimulation results of the clinical and videofluoroscopic evaluations were analyzed descriptively and statistically using Student's t-test and Fisher's exact test. Results: Cryostimulation had beneficial effects on oropharyngeal sensitivity in 6 of the 7 subjects. There was also a significant improvement in swallowing and in the premature escape in six subjects. Conclusion: Cryostimulation increased sensitivity and subsequently improved the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. These effects were evident by both speech-language pathology and videofluoroscopic evaluation.

  16. Recovery of Motor Imagery Ability in Stroke Patients

    Directory of Open Access Journals (Sweden)

    Sjoerd de Vries

    2011-01-01

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

  17. Recovery of an injured fornix in a stroke patient.

    Science.gov (United States)

    Yeo, Sang Seok; Jang, Sung Ho

    2013-11-01

    Knowledge about recovery of an injured fornix following brain injury is limited. We describe here a patient who showed recovery of an injured fornix following stroke. A 57-year-old female patient underwent coiling for a ruptured anterior communicating cerebral artery aneurysm, and conservative management for subarachnoid and intraventricular haemorrhage. The patient showed severe cognitive impairment 6 weeks after onset. However, her cognition showed continuous improvement with time; based on the Mini-Mental State Examination and the Memory Assessment Scale, her cognition was within the normal range 7 months after onset. Findings from diffusion tensor tractography at 6 weeks and 7 months showed discontinuations in both columns of the fornix. The proximal portion of both crus also showed discontinuation on diffusion tensor tractography at 6 weeks and 7 months; however, on 7-month diffusion tensor tractography, the end of the fornical body was shown to be connected to the splenium of the corpus callosum and then branched to the right medial temporal lobe and right thalamus. The unusual neural connection between the injured fornix and the thalamus appears to be a recovery phenomenon, which allows the injured fornix and the medial temporal lobe to obtain cholinergic innervation from cholinergic nuclei in the brainstem rather than from cholinergic nuclei in the basal forebrain.

  18. Forced Aerobic Exercise Enhances Motor Recovery After Stroke: A Case Report

    Science.gov (United States)

    Rosenfeldt, Anson B.; Rasanow, Matthew; Alberts, Jay L.

    2015-01-01

    OBJECTIVE. Previously, we demonstrated that forced aerobic exercise (FE) increases the pattern of neural activation in Parkinson’s disease. We sought to evaluate whether FE, when coupled with repetitive task practice, could promote motor recovery poststroke. METHOD. A 46-yr-old man with ischemic stroke exhibited chronic residual upper-extremity deficits, scoring 35/66 on the Fugl-Meyer Assessment (FMA) at baseline. He completed 24 training sessions comprising 45 min of FE on a motorized stationary bicycle followed by 45 min of upper-extremity repetitive task practice. RESULTS. From baseline to end of treatment, the FMA score improved by 20 points, perceived level of recovery on the Stroke Impact Scale increased by 20 percentage points, and cardiovascular function measured by peak oxygen uptake improved 30%. These improvements persisted 4 wk after the intervention ceased. CONCLUSION. FE may be a safe and feasible rehabilitation approach to augment recovery of motor and nonmotor function while improving aerobic fitness in people with chronic stroke. PMID:26114455

  19. 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.

  20. Effects of the Bad Ragaz Ring Method on muscle activation of the lower limbs and balance ability in chronic stroke: A randomised controlled trial

    OpenAIRE

    Hyun-Gyu Cha, PT, PhD; Young-Jun Shin, PT, MS; Myoung-Kwon Kim, PT, PhD

    2017-01-01

    Background: Recovery of balance and walking abilities is important for the rehabilitation of stroke patients. Objectives: To evaluate the effects of the Bad Ragaz Ring method on functional recovery in chronic stroke patients. Methods: Twenty-two chronic stroke patients were randomly assigned to two groups: a Bad Ragaz Ring method group (the experimental group) or a control group. Stroke patients in the experimental group underwent Bad Ragaz Ring exercise and comprehensive rehabilitation thera...

  1. Themes and strategies for studying the biology of stroke recovery in the poststroke epoch.

    Science.gov (United States)

    Carmichael, S Thomas

    2008-04-01

    This review will focus on the emerging principles of neural repair after stroke, and on the overlap between cellular mechanisms of neural repair in stroke and clinical principles of recovery and rehabilitation. Stroke induces axonal sprouting and neurogenesis. Axonal sprouting occurs in tissue adjacent to the stroke and its connected cortical areas, and from sites that are contralateral to the infarct. Neurogenesis produces newly born immature neurons in peri-infarct striatum and cortex. Stimulation of both axonal sprouting and neurogenesis is associated with improved recovery in animal models of stroke. A unique cellular environment in the poststroke brain supports neural repair: an association of angiogenic and remodeling blood vessels with newly born immature neurons in a neurovasclar niche. Controversies in the field of neural repair after stroke persist, and relate to the locations of axonal sprouting in animal models of stroke and how these correlate to patterns of human remapping and recovery, and to the different models of stroke used in studies of neurogenesis. On a cellular level, the phenomenology of neural repair after stroke has been defined and unique regenerative environments in the poststroke brain identified. As the field moves toward specific studies of causal mechanisms in poststroke repair, it will need to maintain a perspective of the animal models suited to the study of neural repair after stroke as they relate to the patterns of recovery in humans in this disease.

  2. The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties.

    Science.gov (United States)

    Gladstone, David J; Danells, Cynthia J; Black, Sandra E

    2002-09-01

    Measurement of recovery after stroke is becoming increasingly important with the advent of new treatment options under investigation in stroke rehabilitation research. The Fugl-Meyer scale was developed as the first quantitative evaluative instrument for measuring sensorimotor stroke recovery, based on Twitchell and Brunnstrom's concept of sequential stages of motor return in the hemiplegic stroke patient. The Fugl-Meyer is a well-designed, feasible and efficient clinical examination method that has been tested widely in the stroke population. Its primary value is the 100-point motor domain, which has received the most extensive evaluation. Excellent interrater and intrarater reliability and construct validity have been demonstrated, and preliminary evidence suggests that the Fugl-Meyer assessment is responsive to change. Limitations of the motor domain include a ceiling effect, omission of some potentially relevant items, and weighting of the arm more than the leg. Further study should test performance of this scale in specific subgroups of stroke patients and better define its criterion validity, sensitivity to change, and minimal clinically important difference. Based on the available evidence, the Fugl-Meyer motor scale is recommended highly as a clinical and research tool for evaluating changes in motor impairment following stroke.

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

    Science.gov (United States)

    Shah, Priyanka P; Szaflarski, Jerzy P; Allendorfer, Jane; Hamilton, Roy H

    2013-12-24

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

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

    Directory of Open Access Journals (Sweden)

    Priyanka eShah

    2013-12-01

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

  5. Improving post-stroke recovery: the role of the multidisciplinary health care team.

    Science.gov (United States)

    Clarke, David J; Forster, Anne

    2015-01-01

    Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway.

  6. The role of sleep in recovery following ischemic stroke: A review of human and animal data

    Directory of Open Access Journals (Sweden)

    Simone B. Duss

    2017-01-01

    Full Text Available Despite advancements in understanding the pathophysiology of stroke and the state of the art in acute management of afflicted patients as well as in subsequent neurorehabilitation training, stroke remains the most common neurological cause of long-term disability in adulthood. To enhance stroke patients’ independence and well-being it is necessary, therefore, to consider and develop new therapeutic strategies and approaches. We postulate that sleep might play a pivotal role in neurorehabilitation following stroke. Over the last two decades compelling evidence for a major function of sleep in neuroplasticity and neural network reorganization underlying learning and memory has evolved. Training and learning of new motor skills and knowledge can modulate the characteristics of subsequent sleep, which additionally can improve memory performance. While healthy sleep appears to support neuroplasticity resulting in improved learning and memory, disturbed sleep following stroke in animals and humans can impair stroke outcome. In addition, sleep disorders such as sleep disordered breathing, insomnia, and restless legs syndrome are frequent in stroke patients and associated with worse recovery outcomes. Studies investigating the evolution of post-stroke sleep changes suggest that these changes might also reflect neural network reorganization underlying functional recovery. Experimental and clinical studies provide evidence that pharmacological sleep promotion in rodents and treatment of sleep disorders in humans improves functional outcome following stroke. Taken together, there is accumulating evidence that sleep represents a “plasticity state” in the process of recovery following ischemic stroke. However, to test the key role of sleep and sleep disorders for stroke recovery and to better understand the underlying molecular mechanisms, experimental research and large-scale prospective studies in humans are necessary. The effects of hospital

  7. Effect of motor relearning programme on motor function recovery of acute stroke patients with hemiplegia

    Directory of Open Access Journals (Sweden)

    Min GUAN

    2017-03-01

    Full Text Available Objective To explore the effect of motor relearning programme (MRP on motor function recovery of patients with hemiplegia after acute strokeMethods A total of 64 hemiplegic patients with acute stroke (duration ≤ 14 d were randomly divided into 2 groups: control group (N = 32 and observation group (N = 32. Control group received routine drug therapy and conventional rehabilitation training, and observation group was treated by routine therapy and MRP training. Fugl-Meyer Assessment Scale - Balance (FMA - Balance, Modified Rivermead Mobility Index (MRMI and modified Barthel Index (mBI were used to assess the motor function of patients in both groups before and after treatment.  Results All patients successfully completed the rehabilitation training without severe adverse events. A few patients felt fatigue occasionally after training and recovered after rest. Compared to before treatment, the FMA-Balance score (P = 0.000, MRMI score (P = 0.000 and mBI score (P = 0.000 after treatment in both groups were significantly increased. Compared to control group, the FMA-Balance score (P = 0.031, MRMI score (P = 0.013 and mBI score (P = 0.049 after treatment in observation group were significantly increased.  Conclusions MRP training in the early stage of stroke is beneficial to the recovery of motor function of patients. DOI: 10.3969/j.issn.1672-6731.2017.03.007

  8. The impact of recovery of visuo-spatial neglect on motor recovery of the upper paretic limb after stroke.

    Directory of Open Access Journals (Sweden)

    Tanja C W Nijboer

    Full Text Available The aim of the current study was to investigate the longitudinal relationship between improvements of synergism and strength of the upper paretic limb and severity of visuo-spatial neglect during the first 52 weeks post-stroke. The longitudinal association between severity of VSN and motor impairment using Fugl Meyer motor score and Motricity Index of the arm was measured in an intensive repeated measurement design including 18 measurement sessions for each subject. Neglect was assessed using the letter cancellation test applied in a prospective cohort of 101 ischemic, first-ever, hemispheric stroke patients. All time-dependent measures were taken weekly, starting within 14 days post-stroke. From week 10 to 20 biweekly measurements are obtained. The longitudinal relationship of (biweekly time on improvement of motor functions and severity of neglect was investigated using random coefficient analysis and trend analyses. Fifty-one of the 101 stroke patients showed neglect at stroke onset. Less improvement of synergism and strength of the upper paretic limb was associated with more severe neglect. This association was most pronounced in the first 10 weeks post-stroke. The seemingly suppressive effect of neglect on upper-limb motor recovery appears to take place mainly during spontaneous neurological recovery of first 10 weeks post-stroke. This finding suggests that damage to large-scale white matter tracts of especially the perceptual-attention networks suppress recovery of other networks at distance in the brain suggesting a common underlying mechanism.

  9. Effects of Acupuncture on the Recovery Outcomes of Stroke Survivors with Shoulder Pain: A Systematic Review

    OpenAIRE

    Janita Pak Chun Chau; Suzanne Hoi Shan Lo; Xingfeng Yu; Kai Chow Choi; Alexander Yuk Lun Lau; Alexander Yuk Lun Lau; Justin Che Yuen Wu; Justin Che Yuen Wu; Vivian Wing Yan Lee; William Hoi Ngai Cheung; Jessica Yuet Ling Ching; Jessica Yuet Ling Ching; David R. Thompson

    2018-01-01

    BackgroundPoststroke shoulder pain limits stroke survivors’ physical functioning, impairs their ability to perform daily activities, and compromises their quality of life. The use of acupuncture to manage shoulder pain after a stroke is believed to free the blockage of energy flow and produce analgesic effects, but the evidence is unclear. We therefore conducted a systematic review to summarize the current evidence on the effects of acupuncture on the recovery outcomes of stroke survivors wit...

  10. Effects of acupuncture on the recovery outcomes of stroke survivors with shoulder pain: A systematic review

    OpenAIRE

    Chau, Janita Pak Chun; Lo, Suzanne Hoi Shan; Yu, Xingfeng; Choi, Kai Chow; Lau, Alexander Yuk Lun; Wu, Justin Che Yuen; Lee, Vivian Wing Yan; Cheung, William Hoi Ngai; Ching, Jessica Yuet Ling; Thompson, David R.

    2018-01-01

    Background: Poststroke shoulder pain limits stroke survivors' physical functioning, impairs their ability to perform daily activities, and compromises their quality of life. The use of acupuncture to manage shoulder pain after a stroke is believed to free the blockage of energy flow and produce analgesic effects, but the evidence is unclear. We therefore conducted a systematic review to summarize the current evidence on the effects of acupuncture on the recovery outcomes of stroke survivors w...

  11. functional motor recovery in stroke survivors-determinants in a sub

    African Journals Online (AJOL)

    2014-04-01

    Apr 1, 2014 ... giving a drop-out rate of one in four (1:4) and all enrollees were only admitted and discharged patients in the stroke unit. Stroke type was categorised as cerebral infarct and intracerebral haemorrhage. Operationally functional motor recovery was defined by at least a two point reduction in modified.

  12. Functional recovery of gait and joint kinematics after right hemispheric stroke

    NARCIS (Netherlands)

    Huitema, RB; Mulder, T; Brouwer, WH; Dekker, R; Postema, K; Hof, A.L.

    2004-01-01

    Objective: To gain insight into the relation between changes in gait patterns over time and functional recovery of walking ability in stroke patients. Design: Cohort study. Setting: Inpatient rehabilitation center of a university hospital in the Netherlands. Participants: Thirteen stroke patients

  13. Effect of vitamin C supplementation on stroke recovery: A case-control study

    Directory of Open Access Journals (Sweden)

    Meheroz H Rabadi

    2007-04-01

    Full Text Available Meheroz H Rabadi1, Bruce S Kristal2,31Burke Rehabilitation Hospital, an affiliate of Weill Medical College of Cornell Medical College, White Plains, NY, USA; 2Burke Medical Research Institute, an affiliate of Weill Medical College of Cornell Medical College, White Plains, NY, USA; 3Department of Neuroscience, Cornell University Medical College, White Plains, NY, USABackground and purpose: Epidemiological studies have associated increased dietary intake of antioxidants (vitamin C, E, and β-carotene in preventing and decreasing the extent of ischemic brain injury. The effect of vitamin C supplementation on functional recovery after stroke has not been studied. Method: In this retrospective, case-control study of 23 patients with ischemic stroke taking vitamin C were identified and matched for age, sex, onset to admission, and admission total functional independence measure (TFIM with 23 patients with ischemic stroke not taking Vitamin C supplementation. Vitamin C 1000 mg daily was prescribed on admission to our unit mainly to patients who were undernourished (defined as significant weight loss and/or 90% or less ideal body weight for age and sex and those with pressure sores. The outcome measures were: change in the TFIM, FIM-Cognition (FIM-Cog, and FIM-Motor sub-scores, discharge disposition, and length of stay (LOS.Results: The change in TFIM (20 ± 13 standard deviation [SD] vs. 26 ± 6, p = 0.20, FIM-Cog (3 ± 3 SD vs. 4 ± 5, p = 0.41, FIM-Motor (15 ± 11 SD vs. 20 ± 13, p = 0.21 sub-scores were less in the vitamin C treated group, but these differences did not reach statistical significance. Similarly, no significant differences were found in LOS (21 ± 9 SD vs. 23 ± 9, p = 0.59, and discharge disposition (home/institution (9/10 vs. 13/9, p = 0.60 between the vitamin C and the control groups.Conclusion: This study suggests vitamin C supplementation did not enhance functional recovery in undernourished ischemic stroke patients

  14. Does spasticity interfere with functional recovery after stroke? A novel approach to understand, measure and treat spasticity after acute stroke

    NARCIS (Netherlands)

    Malhotra, S.; Malhotra, Shweta

    2013-01-01

    The principal aim of this thesis is on identifying if spasticity on the wrist after an acute stroke interferes with functional recovery of the upper limb.This randomized study demonstrated that sNMES treatment along with standardized upper limb therapy improves muscle strength for wrist extension

  15. Effectiveness of motor imagery or mental practice in functional recovery after stroke: a systematic review.

    Science.gov (United States)

    García Carrasco, D; Aboitiz Cantalapiedra, J

    2016-01-01

    In recent decades, many stroke rehabilitation methods have been developed. Mental practice (MP) is a dynamic state in which the subject evokes an imaginary representation of a motor action or skill in order to learn or perfect that action. Although functional imaging has shown that MP produces similar cortical activation patterns to those of movement, the clinical effectiveness of such methods in rehabilitation and functional recovery has yet to be demonstrated. Systematic search of all clinical studies published in the main scientific databases between December 2011 and October 2012 concerning mental practice in stroke rehabilitation. We selected 23 clinical trials testing different MP protocols in patients with hemiparesis. MP is effective when used in conjunction with conventional physical therapy for functional rehabilitation of both upper and lower limbs, as well as for the recovery of daily activities and skills. Owing to the heterogeneity of the studies with regard to the intervention protocol, specific imagery technique, time spent practicing, patient characteristics, etc., more studies are needed in order to determine the optimal treatment protocol and patient profile. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  16. Axial diffusivity changes in the motor pathway above stroke foci and functional recovery after subcortical infarction.

    Science.gov (United States)

    Liu, Gang; Peng, Kangqiang; Dang, Chao; Tan, Shuangquan; Chen, Hongbing; Xie, Chuanmiao; Xing, Shihui; Zeng, Jinsheng

    2018-01-01

    Secondary degeneration of the fiber tract of the motor pathway below infarct foci and functional recovery after stroke have been well demonstrated, but the role of the fiber tract above stroke foci remains unclear. This study aimed to investigate diffusion changes in motor fibers above the lesion and identify predictors of motor improvement within 12 weeks after subcortical infarction. Diffusion tensor imaging and the Fugl-Meyer (FM) scale were conducted 1, 4, and 12 weeks (W) after a subcortical infarct. Proportional recovery model residuals were used to assign patients to proportional recovery and poor recovery groups. Region of interest analysis was used to assess diffusion changes in the motor pathway above and below a stroke lesion. Multivariable linear regression was employed to identify predictors of motor improvement within 12 weeks after stroke. Axial diffusivity (AD) in the underlying white matter of the ipsilesional primary motor area (PMA) and cerebral peduncle (CP) in both proportional and poor recovery groups was lower at W1 compared to the controls and values in the contralesional PMA and CP (all P < 0.05). Subsequently, AD in the ipsilesional CP became relatively stable, while AD in the ipsilesional PMA significantly increased from W4 to W12 after stroke (P < 0.05). In all of the patients, changes in the FM scores were greater in those with higher changes in AD of the ipsilesional PMA. Only initial impairment or lesion volume was predictive of motor improvement within 12 weeks after stroke in patients with proportional or poor recovery. Increases of AD in the motor pathway above stroke foci may be associated with motor recovery after subcortical infarction. Early measurement of diffusion metrics in the ipsilesional non-ischemic motor pathway has limited value in predicting future motor improvement patterns (proportional or poor recovery).

  17. Rethinking Recovery: Incorporating Holistic Nursing Perspectives in Post-Stroke Care

    Science.gov (United States)

    Peterson-Burch, Frances; Reuter-Rice, Karin; Barr, Taura L.

    2016-01-01

    Stroke is a life changing experience. Current treatments focus on treating the condition, rather than the whole person. The goal of this report is to communicate the benefits of a holistic approach to the treatment and recovery of stroke. Our intent is to begin a conversation to transform our approach to stroke care to focus on the whole person, body, mind and spirit. Wellness approaches are fiscally responsible ways of providing holistic care for patients and their family members to help them achieve optimal individualized recovery. Very few multidimensional programs for wellness exist for stroke and brain injury patients. Given the changes in healthcare and the call to action set forth in the Institute of Medicine's 2010 report, it would behoove us to consider holistic approaches to stroke care and research programs. Nurses are uniquely positioned to implement multidisciplinary, innovative holistic approaches to address solutions for issues in stroke care. Wellness is a critically important area of stroke care and an opportunity for research. As both patient advocates and nurses with personal experiences, we hope this commentary stimulates conversation around developing and testing multi-dimensional holistic programs of wellness for stroke prevention, treatment, and recovery. PMID:27902520

  18. Diagnosis of acute ischaemic stroke with fluid-attenuated inversion recovery and diffusion-weighted sequences

    International Nuclear Information System (INIS)

    Oppenheim, C.; Dormont, D.; Lehericy, S.; Marsault, C.; Logak, M.; Manai, R.; Samson, Y.; Rancurel, G.

    2000-01-01

    We evaluated the feasibility and use of diffusion-weighted and fluid-attenuated inversion-recovery pulse sequences performed as an emergency for patients with acute ischaemic stroke. A 5-min MRI session was designed as an emergency diagnostic procedure for patients admitted with suspected acute ischaemic stroke. We reviewed routine clinical implementation of the procedure, and its sensitivity and specificity for acute ischaemic stroke over the first 8 months. We imaged 91 patients (80 min to 48 h following the onset of stroke). Clinical deficit had resolved in less than 3 h in 15 patients, and the remaining 76 were classified as stroke (59) or stroke-like (17) after hospital discharge. Sensitivity of MRI for acute ischaemic stroke was 98 %, specificity 100 %. MRI provided an immediate and accurate picture of the number, site, size and age of ischaemic lesions in stroke and simplified diagnosis in stroke-like episodes. The feasibility and high diagnostic accuracy of emergency MRI in acute stroke strongly support its routine use in a stroke centre. (orig.)

  19. Relationship between leukocyte kinetics and behavioral tests changes in the inflammatory process of hemorrhagic stroke recovery.

    Science.gov (United States)

    Yabluchanskiy, Andriy; Sawle, Philip; Homer-Vanniasinkam, Shervanthi; Green, Colin J; Motterlini, Roberto

    2010-12-01

    In this study, we investigated the inflammatory response to hemorrhagic stroke (HS) as the main mechanism of brain functional recovery. Sprague-Dawley rats (n = 24) underwent surgery with sterile saline (control group, n = 12) and collagenase IV-S (stroke group, n = 12) being injected into the right striatum. White blood cell analysis, histological and immunohistological examination of the brain slices, as well as densitometric analysis of polymorphonuclear and microglial cells/macrophages were correlated with behavioral tests, and the data were subjected to appropriate statistical processing. The results indicate a strong correlation between polymorphonuclear and mononuclear changes in the blood and the zone of hemorrhagic stroke with behavioral tests of functional brain recovery. We propose that the inflammatory response is determined by kinetics of polymorphonuclear and mononuclear cells in both the blood and the hemorrhagic stroke zone. Kinetics of these cells is followed by the restoration of functions, and the maximum functional recovery is observed by the time polymorphonuclear and mononuclear stages have completed. With the development of inflammation and leukocyte kinetics, it is possible to predict functional recovery of hemorrhagic stroke. Improvement of the degree and rate of hemorrhagic stroke functional recovery may be achieved by therapeutic interventions into the inflammatory mechanisms influencing polymorphonuclear and mononuclear cell kinetics.

  20. Plasminogen deficiency causes reduced corticospinal axonal plasticity and functional recovery after stroke in mice.

    Directory of Open Access Journals (Sweden)

    Zhongwu Liu

    Full Text Available Tissue plasminogen activator (tPA has been implicated in neurite outgrowth and neurological recovery post stroke. tPA converts the zymogen plasminogen (Plg into plasmin. In this study, using plasminogen knockout (Plg-/- mice and their Plg-native littermates (Plg+/+, we investigated the role of Plg in axonal remodeling and neurological recovery after stroke. Plg+/+ and Plg-/- mice (n = 10/group were subjected to permanent intraluminal monofilament middle cerebral artery occlusion (MCAo. A foot-fault test and a single pellet reaching test were performed prior to and on day 3 after stroke, and weekly thereafter to monitor functional deficit and recovery. Biotinylated dextran amine (BDA was injected into the left motor cortex to anterogradely label the corticospinal tract (CST. Animals were euthanized 4 weeks after stroke. Neurite outgrowth was also measured in primary cultured cortical neurons harvested from Plg+/+ and Plg-/- embryos. In Plg+/+ mice, the motor functional deficiency after stroke progressively recovered with time. In contrast, recovery in Plg-/- mice was significantly impaired compared to Plg+/+ mice (p0.82, p<0.01. Plg-/- neurons exhibited significantly reduced neurite outgrowth. Our data suggest that plasminogen-dependent proteolysis has a beneficial effect during neurological recovery after stroke, at least in part, by promoting axonal remodeling in the denervated spinal cord.

  1. Effects of Acupuncture on the Recovery Outcomes of Stroke Survivors with Shoulder Pain: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Janita Pak Chun Chau

    2018-01-01

    Full Text Available BackgroundPoststroke shoulder pain limits stroke survivors’ physical functioning, impairs their ability to perform daily activities, and compromises their quality of life. The use of acupuncture to manage shoulder pain after a stroke is believed to free the blockage of energy flow and produce analgesic effects, but the evidence is unclear. We therefore conducted a systematic review to summarize the current evidence on the effects of acupuncture on the recovery outcomes of stroke survivors with shoulder pain.MethodsFourteen English and Chinese databases were searched for data from January 2009 to August 2017. The review included adult participants with a clinical diagnosis of ischemic or hemorrhagic stroke who had developed shoulder pain and had undergone conventional acupuncture, electroacupuncture, fire needle acupuncture, or warm needle acupuncture. The participants in the comparison group received the usual stroke care only.ResultsTwenty-nine randomized controlled trials were included. Most studies were assessed as having a substantial risk of bias. Moreover, due to the high heterogeneity of the acupuncture therapies examined, pooling the results in a meta-analysis was not appropriate. A narrative summary of the results is thus presented. The review showed that conventional acupuncture can be associated with benefits in reducing pain and edema and improving upper extremity function and physical function. The effects of conventional acupuncture on improving shoulder range of motion (ROM are in doubt because this outcome was only examined in two trials. Electroacupuncture might be effective in reducing shoulder pain and improving upper extremity function, and conclusions on the effects of electroacupuncture on edema, shoulder ROM, and physical function cannot be drawn due to the limited number of eligible trials. The evidence to support the use of fire needle or warm needle acupuncture in stroke survivors with shoulder pain is also

  2. Factors Associated With Ischemic Stroke Survival and Recovery in Older Adults.

    Science.gov (United States)

    Winovich, Divya Thekkethala; Longstreth, William T; Arnold, Alice M; Varadhan, Ravi; Zeki Al Hazzouri, Adina; Cushman, Mary; Newman, Anne B; Odden, Michelle C

    2017-07-01

    Little is known about factors that predispose older adults to poor recovery after a stroke. In this study, we sought to evaluate prestroke measures of frailty and related factors as markers of vulnerability to poor outcomes after ischemic stroke. In participants aged 65 to 99 years with incident ischemic strokes from the Cardiovascular Health Study, we evaluated the association of several risk factors (frailty, frailty components, C-reactive protein, interleukin-6, and cystatin C) assessed before stroke with stroke outcomes of survival, cognitive decline (≥5 points on Modified Mini-Mental State Examination), and activities of daily living decline (increase in limitations). Among 717 participants with incident ischemic stroke with survival data, slow walking speed, low grip strength, and cystatin C were independently associated with shorter survival. Among participants stroke. Inflammation, kidney function, and frailty also seemed to be determinants of survival and recovery after an ischemic stroke. These markers of vulnerability may identify targets for differing pre and poststroke medical management and rehabilitation among older adults at risk of poor stroke outcomes. © 2017 American Heart Association, Inc.

  3. Robotic Measurement of Arm Movements After Stroke Establishes Biomarkers of Motor Recovery

    Science.gov (United States)

    Krebs, Hermano I.; Krams, Michael; Agrafiotis, Dimitris K.; DiBernardo, Allitia; Chavez, Juan C.; Littman, Gary S.; Yang, Eric; Byttebier, Geert; Dipietro, Laura; Rykman, Avrielle; McArthur, Kate; Hajjar, Karim; Lees, Kennedy R.; Volpe, Bruce T.

    2015-01-01

    Background and Purpose Because robotic devices record the kinematics and kinetics of human movements with high resolution, we hypothesized that robotic measures collected longitudinally in patients after stroke would bear a significant relationship to standard clinical outcome measures and, therefore, might provide superior biomarkers. Methods In patients with moderate-to-severe acute ischemic stroke, we used clinical scales and robotic devices to measure arm movement 7, 14, 21, 30, and 90 days after the event at 2 clinical sites. The robots are interactive devices that measure speed, position, and force so that calculated kinematic and kinetic parameters could be compared with clinical assessments. Results Among 208 patients, robotic measures predicted well the clinical measures (cross-validated R2 of modified Rankin scale=0.60; National Institutes of Health Stroke Scale=0.63; Fugl-Meyer=0.73; Motor Power=0.75). When suitably scaled and combined by an artificial neural network, the robotic measures demonstrated greater sensitivity in measuring the recovery of patients from day 7 to day 90 (increased standardized effect=1.47). Conclusions These results demonstrate that robotic measures of motor performance will more than adequately capture outcome, and the altered effect size will reduce the required sample size. Reducing sample size will likely improve study efficiency. PMID:24335224

  4. [NDT-Bobath method used in the rehabilitation of patients with a history of ischemic stroke].

    Science.gov (United States)

    Klimkiewicz, Paulina; Kubsik, Anna; Woldańska-Okońska, Marta

    2012-01-01

    Ischemic stroke is the third leading cause of death and disability in human. The vitally important problem after ischemic stroke is hemiparesis of the body. The most common methods used in improving the mobility of patients after ischemic stroke is a Bobath-NDT (Neuro-Developmental Treatment - Bobath), which initiated the Berta and Karel Bobath for children with cerebral palsy. It is a method designed to neurophysiological recovery of these vital functions that the patient was lost due to illness, and wants it back.

  5. Long-term recovery trajectory after stroke: an ongoing negotiation between body, participation and self.

    Science.gov (United States)

    Arntzen, Cathrine; Borg, Tove; Hamran, Torunn

    2015-01-01

    Research has mainly focused on the first year of recovery trajectory after stroke, but there is limited knowledge about how stroke survivors manage their long-term everyday lives. This study seeks to fill this gap by exploring the long-term (1-13 years) negotiations of stroke survivors when they experience progress, wellbeing and faith in the future. Repeated in-depth interviews were conducted with nine people living with moderate impairment after stroke and their closest relatives. Concepts from phenomenology and critical psychology constituted the frame of reference of the study. The long-term stroke recovery trajectory can be understood as a process of struggling to overcome tensions between three phenomena under ongoing change: the lived body, participation in everyday life and sense of self. During the recovery process, stroke survivors experience progress, well-being and faith in the future when moving towards renewed relationships, characterised by (1) a modified habitual body, (2) repositioned participation in specific everyday life contexts and (3) a transformed sense of self. This study stresses the importance of developing new forms of professional support during the long-term recovery trajectory, to stimulate and increase interaction and coherence in the relationship between the stroke survivor's bodily perception, participation in everyday life and sense of self. The study deepening how the long-term recovery trajectory after stroke is about ongoing embodied, practical and socially situated negotiations. The study demonstrates that the recovery trajectory is a long term process of learning where the stroke survivor, as an embodied agent, gradually modifies new bodily habits, re-position participation and transforming of the self. Health personnel are usually available in the acute and early rehabilitation period. The three phenomenons under ongoing change; "body", "participation" and "self" are at this point just about being moved toward a renewed and

  6. Hydrogel-delivered brain-derived neurotrophic factor promotes tissue repair and recovery after stroke.

    Science.gov (United States)

    Cook, Douglas J; Nguyen, Cynthia; Chun, Hyun N; L Llorente, Irene; Chiu, Abraham S; Machnicki, Michal; Zarembinski, Thomas I; Carmichael, S Thomas

    2017-03-01

    Stroke is the leading cause of adult disability. Systemic delivery of candidate neural repair therapies is limited by the blood-brain barrier and off-target effects. We tested a bioengineering approach for local depot release of BDNF from the infarct cavity for neural repair in chronic periods after stroke. The brain release levels of a hyaluronic acid hydrogel + BDNF were tested in several stroke models in mouse (strains C57Bl/6, DBA) and non-human primate ( Macaca fascicularis) and tracked with MRI. The behavioral recovery effects of hydrogel + BDNF and the effects on tissue repair outcomes were determined. Hydrogel-delivered BDNF diffuses from the stroke cavity into peri-infarct tissue over 3 weeks in two mouse stroke models, compared with 1 week for direct BDNF injection. Hydrogel delivery of BDNF promotes recovery of motor function. Mapping of motor system connections indicates that hydrogel-BDNF induces axonal sprouting within existing cortical and cortico-striatal systems. Pharmacogenetic studies show that hydrogel-BDNF induces the initial migration of immature neurons into the peri-infarct cortex and their long-term survival. In chronic stroke in the non-human primate, hydrogel-released BDNF can be detected up to 2 cm from the infarct, a distance relevant to human functional recovery in stroke. The hydrogel can be tracked by MRI in mouse and primate.

  7. Principles of proportional recovery after stroke generalize to neglect and aphasia.

    Science.gov (United States)

    Marchi, N A; Ptak, R; Di Pietro, M; Schnider, A; Guggisberg, A G

    2017-08-01

    Motor recovery after stroke can be characterized into two different patterns. A majority of patients recover about 70% of initial impairment, whereas some patients with severe initial deficits show little or no improvement. Here, we investigated whether recovery from visuospatial neglect and aphasia is also separated into two different groups and whether similar proportions of recovery can be expected for the two cognitive functions. We assessed 35 patients with neglect and 14 patients with aphasia at 3 weeks and 3 months after stroke using standardized tests. Recovery patterns were classified with hierarchical clustering and the proportion of recovery was estimated from initial impairment using a linear regression analysis. Patients were reliably clustered into two different groups. For patients in the first cluster (n = 40), recovery followed a linear model where improvement was proportional to initial impairment and achieved 71% of maximal possible recovery for both cognitive deficits. Patients in the second cluster (n = 9) exhibited poor recovery (aphasia after stroke shows the same dichotomy and proportionality as observed in motor recovery. This is suggestive of common underlying principles of plasticity, which apply to motor and cognitive functions. © 2017 EAN.

  8. 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 ...

  9. Role of ankle foot orthosis in improving locomotion and functional recovery in patients with stroke: A prospective rehabilitation study

    OpenAIRE

    Sankaranarayan, H.; Gupta, Anupam; Khanna, Meeka; Taly, Arun B.; Thennarasu, K.

    2016-01-01

    Objective: To study role of ankle foot orthosis (AFO) in improving locomotion and functional recovery after stroke. Setting: Neurological Rehabilitation Department of a university research tertiary hospital. Patients and Methods: AFO and activity based rehabilitation. Main Outcome Measures: Distance (meters) covered during the 6-minute walk test (6MWT) and speed (meter/second) during the 10-meter walk test. Functional abilities assessed using Functional Independence Measure (FIM®). Results: ...

  10. Motor Recovery of the Affected Hand in Subacute Stroke Correlates with Changes of Contralesional Cortical Hand Motor Representation

    Directory of Open Access Journals (Sweden)

    Jitka Veldema

    2017-01-01

    Full Text Available Objective. To investigate the relationship between changes of cortical hand motor representation and motor recovery of the affected hand in subacute stroke. Methods. 17 patients with motor impairment of the affected hand were enrolled in an in-patient neurological rehabilitation program. Hand motor function tests (Wolf Motor Function Test, Action Research Arm Test and neurophysiological evaluations (resting motor threshold, motor evoked potentials, motor map area size, motor map area volume, and motor map area location were obtained from both hands and hemispheres at baseline and two, four, and six weeks of in-patient rehabilitation. Results. There was a wide spectrum of hand motor impairment at baseline and hand motor recovery over time. Hand motor function and recovery correlated significantly with (i reduction of cortical excitability, (ii reduction in size and volume of cortical hand motor representation, and (iii a medial and anterior shift of the center of gravity of cortical hand motor representation within the contralesional hemisphere. Conclusion. Recovery of motor function of the affected hand after stroke is accompanied by definite changes in excitability, size, volume, and location of hand motor representation over the contralesional primary motor cortex. These measures may serve as surrogate markers for the outcome of hand motor rehabilitation after stroke.

  11. Improving post-stroke recovery: the role of the multidisciplinary health care team

    Directory of Open Access Journals (Sweden)

    Clarke DJ

    2015-09-01

    Full Text Available David J Clarke, Anne Forster Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK Abstract: Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway. Keywords: stroke care, rehabilitation, multidisciplinary, interdisciplinary, team working

  12. Functional connectivity changes in the language network during stroke recovery.

    Science.gov (United States)

    Nair, Veena A; Young, Brittany M; La, Christian; Reiter, Peter; Nadkarni, Tanvi N; Song, Jie; Vergun, Svyatoslav; Addepally, Naga Saranya; Mylavarapu, Krishna; Swartz, Jennifer L; Jensen, Matthew B; Chacon, Marcus R; Sattin, Justin A; Prabhakaran, Vivek

    2015-02-01

    Several neuroimaging studies have examined language reorganization in stroke patients with aphasia. However, few studies have examined language reorganization in stroke patients without aphasia. Here, we investigated functional connectivity (FC) changes after stroke in the language network using resting-state fMRI and performance on a verbal fluency (VF) task in patients without clinically documented language deficits. Early-stage ischemic stroke patients (N = 26) (average 5 days from onset), 14 of whom were tested at a later stage (average 4.5 months from onset), 26 age-matched healthy control subjects (HCs), and 12 patients with cerebrovascular risk factors (patients at risk, PR) participated in this study. We examined FC of the language network with 23 seed regions based on a previous study. We evaluated patients' behavioral performance on a VF task and correlation between brain resting-state FC (rsFC) and behavior. Compared to HCs, early stroke patients showed significantly decreased rsFC in the language network but no difference with respect to PR. Early stroke patients showed significant differences in performance on the VF task compared to HCs but not PR. Late-stage patients compared to HCs and PR showed no differences in brain rsFC in the language network and significantly stronger connections compared to early-stage patients. Behavioral differences persisted in the late stage compared to HCs. Change in specific connection strengths correlated with changes in behavior from early to late stage. These results show decreased rsFC in the language network and verbal fluency deficits in early stroke patients without clinically documented language deficits.

  13. The sigma-1 receptor enhances brain plasticity and functional recovery after experimental stroke

    DEFF Research Database (Denmark)

    Ruscher, Karsten; Shamloo, Mehrdad; Rickhag, Karl Mattias

    2011-01-01

    Stroke leads to brain damage with subsequent slow and incomplete recovery of lost brain functions. Enriched housing of stroke-injured rats provides multi-modal sensorimotor stimulation, which improves recovery, although the specific mechanisms involved have not been identified. In rats housed......)piperazine dihydrochloride, an agonist of the sigma-1 receptor, starting two days after injury, enhanced the recovery of lost sensorimotor function without decreasing infarct size. The sigma-1 receptor was found in the galactocerebroside enriched membrane microdomains of reactive astrocytes and in neurons. Sigma-1 receptor...... of biomolecules required for brain repair, thereby stimulating brain plasticity. Pharmacological targeting of the sigma-1 receptor provides new opportunities for stroke treatment beyond the therapeutic window of neuroprotection....

  14. Protein supplementation may enhance the spontaneous recovery of neurological alterations in patients with ischaemic stroke.

    Science.gov (United States)

    Aquilani, Roberto; Scocchi, Marco; Iadarola, Paolo; Franciscone, Piero; Verri, Manuela; Boschi, Federica; Pasini, Evasio; Viglio, Simona

    2008-12-01

    To determine whether protein supplementation could enhance neurological recovery in subacute patients with ischaemic stroke. Alimentation-independent patients with ischaemic stroke were randomly allocated to either 21 days of protein supplementation (protein-supplemented group; n=20) or to a spontaneous diet only (control group; n=21) in order to investigate the recovery of neurological changes (measured using the National Institute of Health (NIH) Stroke Scale). Tertiary care rehabilitation in Italy. Forty-two patients (27 male and 15 female; 66.4 +/- 11 years) 16 +/-2 days after the acute event. Supplementation with a hyperproteic nutritional formula (10% protein). NIH Stroke Scale and protein intake. At admission to rehabilitation, both groups of patients were homogeneous for demographic, clinical and functional characteristics. After 21 days from the start of the protocol, the NIH Stroke Scale was found to be enhanced in the group with supplemental proteins (-4.4 +/- 1.5 score versus -3 +/- 1.4 of control group; Pneurological recovery in subacute patients with ischaemic stroke.

  15. Motor function recovery of people of mature years after stroke by means of physical rehabilitation

    Directory of Open Access Journals (Sweden)

    T.E. Khristova

    2013-02-01

    Full Text Available The results of applying the complex technology of physical rehabilitation are described for patients with cerebral ischemic stroke during the phase of in-patient rehabilitation. The experiment involved 36 male patients aged 45-50 years. The rehabilitation program included treatment by changing position, complex of therapeutic gymnastics (based on sanogenetic approach to the problem of motor function recovery in accordance with the stages of postnatal ontogenesis, magnetic therapy, thermotherapy of large joints of the affected extremities. Findings show that the use of the mentioned methods of treatment leads to increase of the range of motion in the hip and shoulder joints: passive of 15-20%, and active of 10-30%, muscle strength of 10-30%, improvement of motor activity indices (scale of Bobaht and quality of life (scale of Barthel.

  16. Walking recovery after an acute stroke: assessment with a new functional classification and the Barthel Index.

    Science.gov (United States)

    Viosca, Enrique; Lafuente, Rubén; Martínez, José L; Almagro, Pedro L; Gracia, Antonio; González, Carmen

    2005-06-01

    To investigate walking recovery after an acute stroke by using both a new functional classification and the Barthel Index, and to identify factors associated with good recovery. A 1-year inception cohort study. In- and outpatient setting in a district hospital. Twenty-six patients with a prognosis of intermediate walking recovery. Conventional physical rehabilitation under professional supervision. Walking capacity was assessed with a new classification scale and the Barthel Index during 5 patient evolution stages (admission to the hospital, hospital and physiotherapy discharge, clinical review, end of study). We also assessed the severity of the paresis of the affected lower limb, the time lapse between the stroke until the recovery of the weight-bearing capacity of the affected leg, and finally the time until standing balance was regained. We detected improvement in walking capacity throughout the follow-up process with our new classification scale, but not with the Barthel Index. Significant improvements were observed from the initial assessment, from 1 month onward, and from 3 to 12 months. The functional level of the final ambulation correlated negatively and significantly with the initial time to achieve weight-bearing capacity on the affected leg and also with the standing balance. There was also a significant correlation with the severity of lower-extremity paresis. Patients experienced an improvement in walking recovery throughout the first year after their stroke. The early weight-bearing capacity of the affected leg and standing balance were associated with higher walking levels 1 year after the stroke.

  17. Combined pharmacological and motor training interventions for recovery of upper limb function in subacute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Ioana Stanescu

    2017-05-01

    Full Text Available Motor deficit, especially in the upper limb, is the primary contributor in post-stroke disability. Recovery of motor function relies on neural plasticity – cortical plastic reorganization – a spontaneous process, which could be enhanced from early phases by rehabilitative strategies. The subacute stage after stroke is the critical period during which the brain is most receptive to rehabilitation strategies. Based on the recent results of 2 trials in stroke rehabilitation using pharmacological intervention with Cerebrolysin in combination with standardized kinesitherapy, we conducted a pilot study of 4 consecutive patients with acute ischemic stroke, treated with Cerebrolysin for 28 days after stroke, and with intensive task-specific kinesitherapy from day 7 to day 28 after stroke. We assessed stroke severity with NIHSS score, upper limb function with ARAT (Action Research Arm Test score, disability with modified Rankin scale and patient’s autonomy with Barthel Index, at day 0 and day 30 after stroke. After 28 days of combined therapy all 4 patients improved, most significant improvement was seen in upper limb function, measured by ARAT score and in autonomy measured by Barthel Index.

  18. Treatment and partial recovery of ischemic stroke hemiplegy through acupuncture

    Directory of Open Access Journals (Sweden)

    David Gonçalves Nordon

    2011-06-01

    Full Text Available ABSTRACT We present the case of a patient with hemiplegy and dysphonia due to an ischemic stroke in the pons who was treated through classical systemic and scalpean acupuncture and electroacupuncture, presenting considerable improvement in speaking, walking and moving her right arm after three months of treatment.

  19. Parietal operculum and motor cortex activities predict motor recovery in moderate to severe stroke

    Directory of Open Access Journals (Sweden)

    Firdaus Fabrice Hannanu

    2017-01-01

    In subacute stroke, fMRI brain activity related to passive movement measured in a sensorimotor network defined by activity during voluntary movement predicted motor recovery better than baseline motor-FMS alone. Furthermore, fMRI sensorimotor network activity measures considered alone allowed excellent clinical recovery prediction and may provide reliable biomarkers for assessing new therapies in clinical trial contexts. Our findings suggest that neural reorganization related to motor recovery from moderate to severe stroke results from balanced changes in ipsilesional MI (BA4a and a set of phylogenetically more archaic sensorimotor regions in the ventral sensorimotor trend, in which OP1 and OP4 processes may complement the ipsilesional dorsal motor cortex in achieving compensatory sensorimotor recovery.

  20. Quantifying motor recovery after stroke using independent vector analysis and graph-theoretical analysis

    Directory of Open Access Journals (Sweden)

    Jonathan Laney

    2015-01-01

    Full Text Available The assessment of neuroplasticity after stroke through functional magnetic resonance imaging (fMRI analysis is a developing field where the objective is to better understand the neural process of recovery and to better target rehabilitation interventions. The challenge in this population stems from the large amount of individual spatial variability and the need to summarize entire brain maps by generating simple, yet discriminating features to highlight differences in functional connectivity. Independent vector analysis (IVA has been shown to provide superior performance in preserving subject variability when compared with widely used methods such as group independent component analysis. Hence, in this paper, graph-theoretical (GT analysis is applied to IVA-generated components to effectively exploit the individual subjects' connectivity to produce discriminative features. The analysis is performed on fMRI data collected from individuals with chronic stroke both before and after a 6-week arm and hand rehabilitation intervention. Resulting GT features are shown to capture connectivity changes that are not evident through direct comparison of the group t-maps. The GT features revealed increased small worldness across components and greater centrality in key motor networks as a result of the intervention, suggesting improved efficiency in neural communication. Clinically, these results bring forth new possibilities as a means to observe the neural processes underlying improvements in motor function.

  1. Mental Practice Combined with Physical Practice to Enhance Hand Recovery in Stroke Patients

    Directory of Open Access Journals (Sweden)

    Hua Liu

    2014-01-01

    Full Text Available Objectives. To evaluate whether combining mental practice with physical practice training enhances hand function in patients with stroke. Methods. 10 for treatment and 10 for control were recruited for this pre/posttraining matched case control study. In the treatment group, subjects underwent combining mental practice with physical practice for four weeks. In the control group, subjects only participated in physical practice. Change of hand function and the number of activated voxels of the contralateral somatosensory motor cortex (SMC acquired by functional magnetic resonance imaging were measured. Results. After training, the Action Research Arm Test score increased by 12.65 for treatment and by 5.20 for control. There was a significant difference in the Action Research Arm Test score between the two groups (P=0.04. The activated voxels number of the contralateral SMC increased in both groups, but the activated voxels number in the contralateral SMC and the improvement of hand function for treatment were greater than for control. In the treatment group, the number of activated voxels of the contralateral SMC was positively correlated with better hand function scores. Conclusions. Combining mental practice with physical practice may be a more effective treatment strategy than physical training alone for hand recovery in stroke patients.

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

    Science.gov (United States)

    Mikołajewska, Emilia

    2013-01-01

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

  3. Role of dopamine on functional recovery in the contralateral hemisphere after focal stroke in the somatosensory cortex.

    Science.gov (United States)

    Obi, Kisho; Amano, Izuki; Takatsuru, Yusuke

    2018-01-01

    Functional recovery after a stroke is important for patients' quality of life. Not only medical care during the acute phase, but also rehabilitation during the chronic phase after a stroke is important. However, the mechanisms underlying functional recovery, particularly the chronic phase after stroke, are still not fully understood. Thus, further basic study on brain after focal stroke is necessary. In this study, we found that the concentration of dopamine (DA) increased during first week after a stroke in the hemisphere contralateral in the site of stroke by in vivo microdialysis. When we applied haloperidol (HPD), a potent DA receptor blocker, functional recovery was inhibited. Interestingly, administration of aripiprazole (ARP), a novel partial agonist of the DA receptor, during the chronic phase improved the remodeling of neuronal circuits in somatosensory cortex (SSC). These findings indicate that the DAergic system play a critical role in functional compensation by the non-infarcted hemisphere after a focal stroke in SSC. It is also revealed that administration of HPD/ARP to stroke patients affects functional recovery after a stroke, and stimulation of the DAergic system during the chronic phase of stroke potentially benefits stroke patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke.

    Science.gov (United States)

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

    2008-03-01

    We know from animal studies that a stimulating and enriched environment can enhance recovery after stroke, but little is known about the effects of an enriched sound environment on recovery from neural damage in humans. In humans, music listening activates a wide-spread bilateral network of brain regions related to attention, semantic processing, memory, motor functions, and emotional processing. Music exposure also enhances emotional and cognitive functioning in healthy subjects and in various clinical patient groups. The potential role of music in neurological rehabilitation, however, has not been systematically investigated. This single-blind, randomized, and controlled trial was designed to determine whether everyday music listening can facilitate the recovery of cognitive functions and mood after stroke. In the acute recovery phase, 60 patients with a left or right hemisphere middle cerebral artery (MCA) stroke were randomly assigned to a music group, a language group, or a control group. During the following two months, the music and language groups listened daily to self-selected music or audio books, respectively, while the control group received no listening material. In addition, all patients received standard medical care and rehabilitation. All patients underwent an extensive neuropsychological assessment, which included a wide range of cognitive tests as well as mood and quality of life questionnaires, one week (baseline), 3 months, and 6 months after the stroke. Fifty-four patients completed the study. Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups. The music group also experienced less depressed and confused mood than the control group. These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood. The neural mechanisms potentially

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

    Science.gov (United States)

    Smeda, John S; Daneshtalab, Noriko

    2017-09-01

    We assessed whether the superior restoration of cerebrovascular function after hemorrhagic stroke by losartan versus captopril treatment was due to better BP, uremia, uricaemia, or aldosterone control in Kyoto Wistar stroke-prone-hypertensive rats and evaluated whether elevated angiotensin II (A2) levels enhanced the effectiveness of losartan treatment. Constriction was studied in the middle cerebral arteries (MCAs) using a pressure myograph. Post-stroke survival increased from 21 to 310 and 189days respectively with losartan and captopril treatment. Neither treatment reduced BP, both reversed uremia and hyperaldosteronism equally after 7days. Plasma uric acid remained low. At stroke, MCA constriction to pressure (PDC), protein kinase C (PKC) activation, depolarization, and sarcoplasmic Ca 2+ were attenuated. Endothelial-dependent-vasodilation by bradykinin and endogenous NO release were lost. Both treatments recovered these functions within 7days. These functions deteriorated after 116days of captopril but not losartan treatment. Inhibiting A2 formation during losartan treatment didn't alter BP or vascular recovery. The superior recovery of PDC by losartan over captopril was not produced by better BP, uremia or aldosterone control or elevated A2. PDC recovery was associated with improved PKC function and enhanced basal NO release. The re-establishment of PDC could reduce cerebrovascular over-perfusion and hematoma expansion after stroke. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Acupuncture Enhances Effective Connectivity between Cerebellum and Primary Sensorimotor Cortex in Patients with Stable Recovery Stroke

    Directory of Open Access Journals (Sweden)

    Zijing Xie

    2014-01-01

    Full Text Available Recent neuroimaging studies have demonstrated that stimulation of acupuncture at motor-implicated acupoints modulates activities of brain areas relevant to the processing of motor functions. This study aims to investigate acupuncture-induced changes in effective connectivity among motor areas in hemiparetic stroke patients by using the multivariate Granger causal analysis. A total of 9 stable recovery stroke patients and 8 healthy controls were recruited and underwent three runs of fMRI scan: passive finger movements and resting state before and after manual acupuncture stimuli. Stroke patients showed significantly attenuated effective connectivity between cortical and subcortical areas during passive motor task, which indicates inefficient information transmissions between cortical and subcortical motor-related regions. Acupuncture at motor-implicated acupoints showed specific modulations of motor-related network in stroke patients relative to healthy control subjects. This specific modulation enhanced bidirectionally effective connectivity between the cerebellum and primary sensorimotor cortex in stroke patients, which may compensate for the attenuated effective connectivity between cortical and subcortical areas during passive motor task and, consequently, contribute to improvement of movement coordination and motor learning in subacute stroke patients. Our results suggested that further efficacy studies of acupuncture in motor recovery can focus on the improvement of movement coordination and motor learning during motor rehabilitation.

  7. 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

  8. Long-term administration of fluoxetine to improve motor recovery after stroke

    NARCIS (Netherlands)

    Berends, Hanneke I.; IJzerman, Maarten Joost; Movig, Kris L.L.; van Putten, Michel Johannes Antonius Maria

    2011-01-01

    Evaluation of: Chollet F. Tardy J., Albucher J.F. et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol. 10(2), 123–130 (2011). In this study, the authors examined the effects of administration of fluoxetine for 90 days on the

  9. Applications of Brain-Machine Interface Systems in Stroke Recovery and Rehabilitation.

    Science.gov (United States)

    Venkatakrishnan, Anusha; Francisco, Gerard E; Contreras-Vidal, Jose L

    2014-06-01

    Stroke is a leading cause of disability, significantly impacting the quality of life (QOL) in survivors, and rehabilitation remains the mainstay of treatment in these patients. Recent engineering and technological advances such as brain-machine interfaces (BMI) and robotic rehabilitative devices are promising to enhance stroke neu-rorehabilitation, to accelerate functional recovery and improve QOL. This review discusses the recent applications of BMI and robotic-assisted rehabilitation in stroke patients. We present the framework for integrated BMI and robotic-assisted therapies, and discuss their potential therapeutic, assistive and diagnostic functions in stroke rehabilitation. Finally, we conclude with an outlook on the potential challenges and future directions of these neurotechnologies, and their impact on clinical rehabilitation.

  10. Applications of Brain–Machine Interface Systems in Stroke Recovery and Rehabilitation

    Science.gov (United States)

    Francisco, Gerard E.; Contreras-Vidal, Jose L.

    2014-01-01

    Stroke is a leading cause of disability, significantly impacting the quality of life (QOL) in survivors, and rehabilitation remains the mainstay of treatment in these patients. Recent engineering and technological advances such as brain-machine interfaces (BMI) and robotic rehabilitative devices are promising to enhance stroke neu-rorehabilitation, to accelerate functional recovery and improve QOL. This review discusses the recent applications of BMI and robotic-assisted rehabilitation in stroke patients. We present the framework for integrated BMI and robotic-assisted therapies, and discuss their potential therapeutic, assistive and diagnostic functions in stroke rehabilitation. Finally, we conclude with an outlook on the potential challenges and future directions of these neurotechnologies, and their impact on clinical rehabilitation. PMID:25110624

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

    Directory of Open Access Journals (Sweden)

    Rymer W Zev

    2006-06-01

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

  12. Recovery of the 20 Hz Rebound to Tactile and Proprioceptive Stimulation after Stroke

    Directory of Open Access Journals (Sweden)

    Eeva Parkkonen

    2018-01-01

    Full Text Available Sensorimotor integration is closely linked to changes in motor-cortical excitability, observable in the modulation of the 20 Hz rhythm. After somatosensory stimulation, the rhythm transiently increases as a rebound that reflects motor-cortex inhibition. Stroke-induced alterations in afferent input likely affect motor-cortex excitability and motor recovery. To study the role of somatosensory afferents in motor-cortex excitability after stroke, we employed magnetoencephalographic recordings (MEG at 1–7 days, one month, and 12 months in 23 patients with stroke in the middle cerebral artery territory and 22 healthy controls. The modulation of the 20 Hz motor-cortical rhythm was evaluated to two different somatosensory stimuli, tactile stimulation, and passive movement of the index fingers. The rebound strengths to both stimuli were diminished in the acute phase compared to the controls and increased significantly during the first month after stroke. However, only the rebound amplitudes to tactile stimuli fully recovered within the follow-up period. The rebound strengths in the affected hemisphere to both stimuli correlated strongly with the clinical scores across the follow-up. The results show that changes in the 20 Hz rebound to both stimuli behave similarly and occur predominantly during the first month. The 20 Hz rebound is a potential marker for predicting motor recovery after stroke.

  13. Changes in structural integrity are correlated with motor and functional recovery after post-stroke rehabilitation.

    Science.gov (United States)

    Fan, Yang-teng; Lin, Keh-chung; Liu, Ho-ling; Chen, Yao-liang; Wu, Ching-yi

    2015-01-01

    Diffusion tensor imaging (DTI) studies indicate the structural integrity of the ipsilesional corticospinal tract (CST) and the transcallosal motor tract, which are closely linked to stroke recovery. However, the individual contribution of these 2 fibers on different levels of outcomes remains unclear. Here, we used DTI tractography to investigate whether structural changes of the ipsilesional CST and the transcallosal motor tracts associate with motor and functional recovery after stroke rehabilitation. Ten participants with post-acute stroke underwent the Fugl-Meyer Assessment (FMA), the Wolf Motor Function Test (WMFT), the Functional Independence Measure (FIM), and DTI before and after bilateral robotic training. All participants had marked improvements in motor performance, functional use of the affected arm, and independence in daily activities. Increased fractional anisotropy (FA) in the ipsilesional CST and the transcallosal motor tracts was noted from pre-treatment to the end of treatment. Participants with higher pre-to-post differences in FA values of the transcallosal motor tracts had greater gains in the WMFT and the FIM scores. A greater improvement on the FMA was coupled with increased FA changes along the ipsilesional CST. These findings suggest 2 different structural indicators for post-stroke recovery separately at the impairment-based and function-based levels.

  14. Impact of obstructive sleep apnea on neurological recovery after ischemic stroke: A prospective study.

    Science.gov (United States)

    Menon, D; Sukumaran, S; Varma, R; Radhakrishnan, A

    2017-11-01

    The presence of obstructive sleep apnea (OSA) has been found to adversely affect the neurological recovery after acute ischemic stroke (AIS) in previous observational studies. However, in most of these studies, diagnosis of OSA was based on oximetry data alone, raising concern in the accuracy of diagnosis as well as estimation of severity. Purpose of our study was to determine the prevalence and severity of OSA (based on polysomnography and American Association of Sleep Medicine [AASM] criteria) in patients with AIS and to compare the post-stroke neurological and functional outcome, in those with and without OSA. A prospective single-centre study was conducted over a period of eighteen months from January 2013. The demographic and clinical data were collected, and the etiology of stroke was classified according to TOAST classification. Subsequently, all selected patients (N=99) underwent premorbid sleep status assessment by Epworth Sleepiness Scale followed by polysomnography using Resmed ApneaLink polysomnograph. Data were analyzed to find out the prevalence and severity of OSA as well as its impact on neurological recovery as assessed by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) at different time points, starting from admission. There was a high prevalence of OSA (~60%) with a quarter of them having severe OSA. The OSA group had a significantly higher mean NIHSS score at discharge (P=.002) and significantly higher mRS score (irrespective of severity of OSA) at all points of evaluation. Ischemic stroke patients with OSA tend to have poor neurological and functional recovery, across all segments of stroke and OSA severity. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Inhibition of CXCL12 signaling attenuates the postischemic immune response and improves functional recovery after stroke

    DEFF Research Database (Denmark)

    Ruscher, Karsten; Kuric, Enida; Liu, Yawei

    2013-01-01

    ,4,8,11-tetrazacyclo-tetradecan (AMD3100) showed improved recovery compared with saline-treated rats after tMCAO, without a concomitant reduction in infarct size. This was accompanied by a reduction of infiltrating immune cells in the ischemic hemisphere, particularly cluster of differentiation 3-positive (CD3......(+)) and CD3(+)/CD4(+) T cells. Spleen atrophy and delayed death of splenocytes, induced by tMCAO, was prevented by AMD3100 treatment. We conclude that immoderate excessive activation of the CXCL12 pathway after stroke contributes to depression of neurologic function after stroke and that CXCR4 antagonism...

  16. Mechanisms for the recovery of aphasia following stroke. A positron emission tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Warburton, E

    1998-07-01

    Language disorders following stroke are common and are a major source of distress and disability. Most patients show some recovery with time implying the potential for neuronal plasticity within the brain for recovery of language. The mechanisms underlying recovery are poorly understood, making strategies for speech therapy and further investigation of potential therapeutic agents difficult. These studies were designed to explore the cortical re-organisation which underlies at least some language recovery using positron emission tomography (PET). With the rapid developments in PET technology and advances in image data processing it is now well established that language tasks can be studied in terms of responses within brain regions, and interactions between regions. The results can be interpreted with reference to neuropsychological theory and models. Many language activation studies have been performed in the normal brain. Thestudies reported here concentrated on one behavioural task - the verbal fluency task - the strategy being to compare patterns of activation in normal subjects with those in recovered aphasic patients performing the same fluency task. In the first part of this thesis, a detailed PET study of a verb retrieval task was made using different control tasks in normal volunteers. The results show that this task engages a widespread network of regions, predominantly in the left hemisphere i.e. the dorsolateral temporal cortex, the inferolateral temporal cortex and inferior parietal cortex, an extensive area of the dorsolateral prefrontal cortex (LDLPFC), the anterior cingulate and the supplementary motor area (SMA). The experiments using different control tasks suggest that the dorsolateral temporal cortex is involved with auditory and lexical processing of the stimulus nouns and it is demonstrated that observation of an activation in this region is dependent on the particular control task used with the retrieval task. This explains discrepancies

  17. Mechanisms for the recovery of aphasia following stroke. A positron emission tomography study

    International Nuclear Information System (INIS)

    Warburton, E.

    1998-01-01

    Language disorders following stroke are common and are a major source of distress and disability. Most patients show some recovery with time implying the potential for neuronal plasticity within the brain for recovery of language. The mechanisms underlying recovery are poorly understood, making strategies for speech therapy and further investigation of potential therapeutic agents difficult. These studies were designed to explore the cortical re-organisation which underlies at least some language recovery using positron emission tomography (PET). With the rapid developments in PET technology and advances in image data processing it is now well established that language tasks can be studied in terms of responses within brain regions, and interactions between regions. The results can be interpreted with reference to neuropsychological theory and models. Many language activation studies have been performed in the normal brain. The studies reported here concentrated on one behavioural task - the verbal fluency task - the strategy being to compare patterns of activation in normal subjects with those in recovered aphasic patients performing the same fluency task. In the first part of this thesis, a detailed PET study of a verb retrieval task was made using different control tasks in normal volunteers. The results show that this task engages a widespread network of regions, predominantly in the left hemisphere i.e. the dorsolateral temporal cortex, the inferolateral temporal cortex and inferior parietal cortex, an extensive area of the dorsolateral prefrontal cortex (LDLPFC), the anterior cingulate and the supplementary motor area (SMA). The experiments using different control tasks suggest that the dorsolateral temporal cortex is involved with auditory and lexical processing of the stimulus nouns and it is demonstrated that observation of an activation in this region is dependent on the particular control task used with the retrieval task. This explains discrepancies

  18. GDF10 Is a Signal for Axonal Sprouting and Functional Recovery after Stroke

    Science.gov (United States)

    Li, S; Nie, EH; Yin, Y; Benowitz, LI; Tung, S; Vinters, HV; Bahjat, FR; Stenzel-Poore, MP; Kawaguchi, R; Coppola, G; Carmichael, ST

    2016-01-01

    Stroke produces a limited process of neural repair. Axonal sprouting in cortex adjacent to the infarct is part of this recovery process, but the signal that initiates axonal sprouting is not known. Growth and Differentiation Factor 10 (GDF10) is induced in peri-infarct neurons in mouse, non-human primate and human. GDF10 promotes axonal outgrowth in vitro in mouse, rat and human neurons through TGFβRI/II signaling. Using pharmacogenetic gain and loss of function studies, GDF10 produces axonal sprouting and enhanced functional recovery after stroke; knocking down GDF10 blocks axonal sprouting and reduces recovery. RNA-seq from peri-infarct cortical neurons indicates that GDF10 downregulates PTEN and upregulates PI3 kinase signaling and induces specific axonal guidance molecules. Unsupervised genome-wide association analysis of the GDF10 transcriptome shows that it is not related to neurodevelopment but may partially overlap with other CNS injury patterns. GDF10 is a stroke-induced signal for axonal sprouting and functional recovery. PMID:26502261

  19. Vagus Nerve Stimulation Enhances Stable Plasticity and Generalization of Stroke Recovery.

    Science.gov (United States)

    Meyers, Eric C; Solorzano, Bleyda R; James, Justin; Ganzer, Patrick D; Lai, Elaine S; Rennaker, Robert L; Kilgard, Michael P; Hays, Seth A

    2018-03-01

    Chronic impairment of the arm and hand is a common consequence of stroke. Animal and human studies indicate that brief bursts of vagus nerve stimulation (VNS) in conjunction with rehabilitative training improve recovery of motor function after stroke. In this study, we tested whether VNS could promote generalization, long-lasting recovery, and structural plasticity in motor networks. Rats were trained on a fully automated, quantitative task that measures forelimb supination. On task proficiency, unilateral cortical and subcortical ischemic lesions were administered. One week after ischemic lesion, rats were randomly assigned to receive 6 weeks of rehabilitative training on the supination task with or without VNS. Rats then underwent 4 weeks of testing on a task assessing forelimb strength to test generalization of recovery. Finally, the durability of VNS benefits was tested on the supination task 2 months after the cessation of VNS. After the conclusion of behavioral testing, viral tracing was performed to assess synaptic connectivity in motor networks. VNS enhances plasticity in corticospinal motor networks to increase synaptic connectivity to musculature of the rehabilitated forelimb. Adding VNS more than doubled the benefit of rehabilitative training, and the improvements lasted months after the end of VNS. Pairing VNS with supination training also significantly improved performance on a similar, but untrained task that emphasized volitional forelimb strength, suggesting generalization of forelimb recovery. This study provides the first evidence that VNS paired with rehabilitative training after stroke (1) doubles long-lasting recovery on a complex task involving forelimb supination, (2) doubles recovery on a simple motor task that was not paired with VNS, and (3) enhances structural plasticity in motor networks. © 2018 American Heart Association, Inc.

  20. Therapeutic effect of Chinese herbal medicines for post stroke recovery: A traditional and network meta-analysis.

    Science.gov (United States)

    Han, Shi-You; Hong, Zhi-You; Xie, Yu-Hua; Zhao, Yong; Xu, Xiao

    2017-12-01

    Stroke is a condition with high morbidity and mortality, and 75% of stroke survivors lose their ability to work. Stroke is a burden to the family and society. The purpose of this study was to evaluate the effectiveness of Chinese herbal patent medicines in the treatment of patients after the acute phase of a stroke. We searched the following databases through August 2016: PubMed, Embase, Cochrane library, China Knowledge Resource Integrated Database (CNKI), China Science Periodical Database (CSPD), and China Biology Medicine disc (CBMdisc) for studies that evaluated Chinese herbal patent medicines for post stroke recovery. A random-effect model was used to pool therapeutic effects of Chinese herbal patent medicines on stroke recovery. Network meta-analysis was used to rank the treatment for each Chinese herbal patent medicine. In our meta-analysis, we evaluated 28 trials that included 2780 patients. Chinese herbal patent medicines were effective in promoting recovery after stroke (OR, 3.03; 95% CI: 2.53-3.64; P herbal patent medicines significantly improved neurological function defect scores when compared with the controls (standard mean difference [SMD], -0.89; 95% CI, -1.44 to -0.35; P = .001). Chinese herbal patent medicines significantly improved the Barthel index (SMD, 0.73; 95% CI, 0.53-0.94; P herbal medicines most likely to improve stroke recovery when combined with acupuncture. Our research suggests that the Chinese herbal patent medicines were effective for stroke recovery. The most effective treatments for stroke recovery were MLC601, Shuxuetong, and BuchangNaoxintong. However, to clarify the specific effective ingredients of Chinese herbal medicines, a well-designed study is warranted.

  1. Robotics, Stem Cells and Brain Computer Interfaces in Rehabilitation and Recovery from Stroke; Updates and Advances

    Science.gov (United States)

    Boninger, Michael L; Wechsler, Lawrence R.; Stein, Joel

    2014-01-01

    Objective To describe the current state and latest advances in robotics, stem cells, and brain computer interfaces in rehabilitation and recovery for stroke. Design The authors of this summary recently reviewed this work as part of a national presentation. The paper represents the information included in each area. Results Each area has seen great advances and challenges as products move to market and experiments are ongoing. Conclusion Robotics, stem cells, and brain computer interfaces all have tremendous potential to reduce disability and lead to better outcomes for patients with stroke. Continued research and investment will be needed as the field moves forward. With this investment, the potential for recovery of function is likely substantial PMID:25313662

  2. Lesion mapping in acute stroke aphasia and its implications for recovery.

    Science.gov (United States)

    Forkel, Stephanie J; Catani, Marco

    2018-03-29

    Patients with stroke lesions offer a unique window into understanding human brain function. Studying stroke lesions poses several challenges due to the complexity of the lesion anatomy and the mechanisms causing local and remote disruptions on brain networks. In this prospective longitudinal study, we compare standard and advanced approaches to white matter lesion mapping applied to acute stroke patients with aphasia. Eighteen patients with acute left hemisphere stroke were recruited and scanned within two weeks from symptom onset. Aphasia assessment was performed at baseline and six-month follow-up. Structural and diffusion MRI contrasts indicated an area of maximum overlap in the anterior external/extreme capsule with diffusion images showing a larger overlap extending into posterior perisylvian regions. Predictors of recovery included damage to ipsilesional tracts (as shown by both structural and diffusion images) and contralesional tracts (as shown by diffusion images only). These findings indicate converging results from structural and diffusion lesions mapping analysis but clear differences between the two approaches in their ability to identify predictors of recovery. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Electrical stimulation and iterative learning control for functional recovery in the upper limb post-stroke.

    Science.gov (United States)

    Meadmore, Katie; Exell, Timothy; Freeman, Christopher; Kutlu, Mustafa; Rogers, Eric; Hughes, Ann-Marie; Hallewell, Emma; Burridge, Jane

    2013-06-01

    Therapies using functional electrical stimulation (FES) in conjunction with practice of everyday tasks have proven effective in facilitating recovery of upper limb function following stroke. The aim of the current study is to develop a multi-channel electrical stimulation system that precisely controls the assistance provided in goal-orientated tasks through use of advanced model-based 'iterative learning control' (ILC) algorithms to facilitate functional motor recovery of the upper limb post-stroke. FES was applied to three muscle groups in the upper limb (the anterior deltoid, triceps and wrist extensors) to assist hemiparetic, chronic stroke participants to perform a series of functional tasks with real objects, including closing a drawer, turning on a light switch and repositioning an object. Position data from the participants' impaired upper limb was collected using a Microsoft Kinect® and was compared to an ideal reference. ILC used data from previous attempts at the task to moderate the FES signals applied to each muscle group on a trial by trial basis to reduce performance error whilst supporting voluntary effort by the participant. The clinical trial is on-going. Preliminary results show improvements in performance accuracy for each muscle group, as well as improvements in clinical outcome measures pre and post 18 training sessions. Thus, the feasibility of applying precisely controlled FES to three muscle groups in the upper limb to facilitate functional reach and grasp movements post stroke has been demonstrated.

  4. Human neural stem cells over-expressing VEGF provide neuroprotection, angiogenesis and functional recovery in mouse stroke model.

    Directory of Open Access Journals (Sweden)

    Hong J Lee

    Full Text Available BACKGROUND: Intracerebral hemorrhage (ICH is a lethal stroke type. As mortality approaches 50%, and current medical therapy against ICH shows only limited effectiveness, an alternative approach is required, such as stem cell-based cell therapy. Previously we have shown that intravenously transplanted human neural stem cells (NSCs selectively migrate to the brain and induce behavioral recovery in rat ICH model, and that combined administration of NSCs and vascular endothelial growth factor (VEGF results in improved structural and functional outcome from cerebral ischemia. METHODS AND FINDINGS: We postulated that human NSCs overexpressing VEGF transplanted into cerebral cortex overlying ICH lesion could provide improved survival of grafted NSCs, increased angiogenesis and behavioral recovery in mouse ICH model. ICH was induced in adult mice by unilateral injection of bacterial collagenase into striatum. HB1.F3.VEGF human NSC line produced an amount of VEGF four times higher than parental F3 cell line in vitro, and induced behavioral improvement and 2-3 fold increase in cell survival at two weeks and eight weeks post-transplantation. CONCLUSIONS: Brain transplantation of F3 human NSCs over-expressing VEGF near ICH lesion sites provided differentiation and survival of grafted human NSCs and renewed angiogenesis of host brain and functional recovery of ICH animals. These results suggest a possible application of the human neural stem cell line, which is genetically modified to over-express VEGF, as a therapeutic agent for ICH-stroke.

  5. Recovery-related indicators of motor network plasticity according to impairment severity after stroke.

    Science.gov (United States)

    Lee, J; Park, E; Lee, A; Chang, W H; Kim, D-S; Kim, Y-H

    2017-10-01

    Brain connectivity analysis has been widely used to investigate brain plasticity and recovery-related indicators of patients with stroke. However, results remain controversial because of interindividual variability of initial impairment and subsequent recovery of function. In this study, we aimed to investigate the differences in network plasticity and motor recovery-related indicators according to initial severity. We divided participants (16 males and 14 females, aged 54.2 ± 12.0 years) into groups of different severity by Fugl-Mayer Assessment score, i.e. moderate (50-84), severe (20-49) and extremely severe (impairment groups. Longitudinal resting-state functional magnetic resonance imaging data were acquired at 2 weeks and 3 months after onset. The differences in network plasticity and recovery-related indicators between groups were investigated using network distance and graph measurements. As the level of impairment increased, the network balance was more disrupted. Network balance, interhemispheric connectivity and network efficiency were recovered at 3 months only in the moderate impairment group. However, this was not the case in the extremely severe impairment group. A single connection strength between the ipsilesional primary motor cortex and ventral premotor cortex was implicated in the recovery of motor function for the extremely severe impairment group. The connections of the ipsilesional primary motor cortex-ventral premotor cortex were positively associated with motor recovery as the patients were more severely impaired. Differences in plasticity and recovery-related indicators of motor networks were noted according to impairment severity. Our results may suggest meaningful implications for recovery prediction and treatment strategies in future stroke research. © 2017 EAN.

  6. 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.

  7. The impact of falls on motor and cognitive recovery after discharge from in-patient stroke rehabilitation

    Science.gov (United States)

    Wong, Jennifer S.; Brooks, Dina; Inness, Elizabeth L.; Mansfield, Avril

    2016-01-01

    Background Falls are common among community-dwelling stroke survivors. The aim of this study was to (1) compare motor and cognitive outcomes between individuals who fell in the six months post-discharge from in-patient stroke rehabilitation and those who did not fall, and (2) explore potential mechanisms underlying the relationship between falls and recovery of motor and cognitive function. Methods Secondary analysis of a prospective cohort study of individuals discharged home from in-patient rehabilitation was conducted. Participants were recruited at discharge and completed a six-month falls monitoring period using postcards with follow-up. Non-fallers and fallers were compared at the six-month follow-up assessment on the Berg Balance Scale (BBS), Chedoke-McMaster Stroke Assessment (CMSA), gait speed, and Montreal Cognitive Assessment (MoCA). Measures of balance confidence and physical activity were also assessed. Results 23 fallers were matched to 23 non-fallers on age and functional balance scores at discharge. A total of 43 falls were reported during the study period (8 participants fell more than once). At follow-up, BBS scores (p=0.0066) and CMSA foot scores (p=0.0033) were significantly lower for fallers than non-fallers. The two groups did not differ on CMSA leg scores (p=0.049), gait speed (p=0.47) or MoCA (p=0.23). There was no significant association between change in balance confidence scores and change in physical activity levels among all participants from the first and third questionnaire (r=0.27, p=0.08). Conclusions Performance in balance and motor recovery of the foot were compromised in fallers when compared to non-fallers at six months post-discharge from in-patient stroke rehabilitation. PMID:27062418

  8. Magnetic inductive phase shift: a new method to differentiate hemorrhagic stroke from ischemic stroke on rabbit.

    Science.gov (United States)

    Yan, Qingguang; Jin, Gui; Ma, Ke; Qin, Mingxin; Zhuang, Wei; Sun, Jian

    2017-05-30

    The major therapy for ischemic stroke is thrombolytic treatment, but severe consequences occur when this method is used to treat hemorrhagic stroke. Currently, computed tomography and magnetic resonance imaging are used to differentiate between two types of stroke, but these two methods are ineffective for pre-hospital care. We developed a new brain diagnostic device for rabbits based on electromagnetic induction to non-invasively differentiate two types of stroke. The device includes two coils and a phase difference measurement system that detects the magnetic inductive phase shift (MIPS) value to reflect the tissue's condition. The hemorrhage model was established through the injection of autologous blood into the internal capsule of a rabbit's brain. Ischemia was induced in the brain of a rabbit by bilateral carotid artery occlusion. Two types of animal models were measured with our device. The MIPS value gradually decreased with increasing injected blood and increased with ischemia time. The MIPS changes induced by the two types of strokes were exact opposites, and the absolute values of MIPS variation in the hemorrhagic and the ischemic groups were significantly larger than those of the normal control group (P stroke from hemorrhagic stroke on rabbit brain in a non-invasive, continuous, and bulk monitoring manner by using a simple and inexpensive apparatus.

  9. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial.

    Science.gov (United States)

    Chollet, François; Tardy, Jean; Albucher, Jean-François; Thalamas, Claire; Berard, Emilie; Lamy, Catherine; Bejot, Yannick; Deltour, Sandrine; Jaillard, Assia; Niclot, Philippe; Guillon, Benoit; Moulin, Thierry; Marque, Philippe; Pariente, Jérémie; Arnaud, Catherine; Loubinoux, Isabelle

    2011-02-01

    Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that fluoxetine enhances motor recovery but its clinical efficacy is unknown. We therefore aimed to investigate whether fluoxetine would enhance motor recovery if given soon after an ischaemic stroke to patients who have motor deficits. In this double-blind, placebo-controlled trial, patients from nine stroke centres in France who had ischaemic stroke and hemiplegia or hemiparesis, had Fugl-Meyer motor scale (FMMS) scores of 55 or less, and were aged between 18 years and 85 years were eligible for inclusion. Patients were randomly assigned, using a computer random-number generator, in a 1:1 ratio to fluoxetine (20 mg once per day, orally) or placebo for 3 months starting 5-10 days after the onset of stroke. All patients had physiotherapy. The primary outcome measure was the change on the FMMS between day 0 and day 90 after the start of the study drug. Participants, carers, and physicians assessing the outcome were masked to group assignment. Analysis was of all patients for whom data were available (full analysis set). This trial is registered with ClinicalTrials.gov, number NCT00657163. 118 patients were randomly assigned to fluoxetine (n=59) or placebo (n=59), and 113 were included in the analysis (57 in the fluoxetine group and 56 in the placebo group). Two patients died before day 90 and three withdrew from the study. FMMS improvement at day 90 was significantly greater in the fluoxetine group (adjusted mean 34·0 points [95% CI 29·7-38·4]) than in the placebo group (24·3 points [19·9-28·7]; p=0·003). The main adverse events in the fluoxetine and placebo groups were hyponatraemia (two [4%] vs two [4%]), transient digestive disorders including nausea, diarrhoea, and abdominal pain (14 [25%] vs six [11%]), hepatic enzyme disorders (five [9%] vs ten [18%]), psychiatric disorders (three [5%] vs four [7%]), insomnia (19 [33%] vs 20 [36%]), and partial

  10. A thalamic-fronto-parietal structural covariance network emerging in the course of recovery from hand paresis after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Eugenio eAbela

    2015-10-01

    Full Text Available Aim: To describe structural covariance networks of grey matter volume (GMV change in 28 patients with first-ever stroke to the primary sensorimotor cortices, and to investigate their relationship to hand function recovery and local GMV change.Methods: Tensor based morphometry maps derived from high resolution structural images were subject to principal component analyses to identify the networks. We calculated correlations between network expression and local GMV change, sensorimotor hand function and lesion volume. To verify which of the structural covariance networks of GMV change have a significant relationship to hand function we performed an additional multivariate regression approach.Results: Expression of the second network, explaining 9.1% of variance, correlated with GMV increase in the medio-dorsal (md thalamus and hand motor skill. Patients with positive expression coefficients were distinguished by significantly higher GMV-increase of this structure during stroke recovery. Significant nodes of this network were located in md thalamus, dorsolateral prefrontal cortex and higher order sensorimotor cortices. Parameter of hand function had a unique relationship to the network and depended on an interaction between network expression and lesion volume. Inversely network expression is limited in patients with large lesion volumes.Conclusions: Chronic phase of sensorimotor cortical stroke has been characterized by a large scale covarying structural network in the ipsilesional hemisphere associated specifically with sensorimotor hand skill. Its expression is related to GMV-increase of md thalamus, one constituent of the network, and correlated with the cortico-striato-thalamic loop involved in control of motor execution and higher order sensorimotor cortices. A close relation between expression of this network with degree of recovery might indicate reduced compensatory resources in the impaired subgroup.

  11. BRAIN NATRIURETIC PEPTIDE (BNP: BIOMARKER FOR RISK STRATIFICATION AND FUNCTIONAL RECOVERY PREDICTION IN ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    STANESCU Ioana

    2015-02-01

    Full Text Available Functional outcome after cardiovascular and cerebrovascular events is traditionally predicted using demographic and clinical variables like age, gender, blood pressure, cholesterol levels, diabetes status, smoking habits or pre-existing morbidity. Identification of new variables will improve the risk stratification of specific categories of patients. Numerous blood-based biomarkers associated with increased cardiovascular risk have been identified; some of them even predict cardiovascular events. Investigators have tried to produce prediction models by incorporating traditional risk factors and biomarkers. (1. Widely-available, rapidly processed and less expensive biomarkers could be used in the future to guide management of complex cerebrovascular patients in order to maximize their recovery (2 Recently, studies have demonstrated that biomarkers can predict not only the risk for a specific clinical event, but also the risk of death of vascular cause and the functional outcome after cardiovascular or cerebrovascular events. Early prediction of fatal outcome after stroke may improve therapeutic strategies (such as the use of more aggressive treatments or inclusion of patients in clinical trials and guide decision-making processes in order to maximize patient’s chances for survival and recovery. (3 Long term functional outcome after stroke is one of the most difficult variables to predict. Elevated serum levels of brain natriuretic peptide (BNP are powerful predictor of outcomes in patients with cardiovascular disease (heart failure, atrial fibrillation. Potential role of BNP in predicting atrial fibrillation occurrence, cardio-embolic stroke and post-stroke mortality have been proved in many studies. However, data concerning the potential role of BNP in predicting short term and long term functional outcomes after stroke remain controversial.

  12. Statins Promote Long-Term Recovery after Ischemic Stroke by Reconnecting Noradrenergic Neuronal Circuitry

    Directory of Open Access Journals (Sweden)

    Kyoung Joo Cho

    2015-01-01

    Full Text Available Inhibitors of HMG-CoA reductase (statins, widely used to lower cholesterol in coronary heart and vascular disease, are effective drugs in reducing the risk of stroke and improving its outcome in the long term. After ischemic stroke, cardiac autonomic dysfunction and psychological problems are common complications related to deficits in the noradrenergic (NA system. This study investigated the effects of statins on the recovery of NA neuron circuitry and its function after transient focal cerebral ischemia (tFCI. Using the wheat germ agglutinin (WGA transgene technique combined with the recombinant adenoviral vector system, NA-specific neuronal pathways were labeled, and were identified in the locus coeruleus (LC, where NA neurons originate. NA circuitry in the atorvastatin-treated group recovered faster than in the vehicle-treated group. The damaged NA circuitry was partly reorganized with the gradual recovery of autonomic dysfunction and neurobehavioral deficit. Newly proliferated cells might contribute to reorganizing NA neurons and lead anatomic and functional recovery of NA neurons. Statins may be implicated to play facilitating roles in the recovery of the NA neuron and its function.

  13. Vagus nerve stimulation delivered during motor rehabilitation improves recovery in a rat model of stroke.

    Science.gov (United States)

    Khodaparast, Navid; Hays, Seth A; Sloan, Andrew M; Fayyaz, Tabbassum; Hulsey, Daniel R; Rennaker, Robert L; Kilgard, Michael P

    2014-09-01

    Neural plasticity is widely believed to support functional recovery following brain damage. Vagus nerve stimulation paired with different forelimb movements causes long-lasting map plasticity in rat primary motor cortex that is specific to the paired movement. We tested the hypothesis that repeatedly pairing vagus nerve stimulation with upper forelimb movements would improve recovery of motor function in a rat model of stroke. Rats were separated into 3 groups: vagus nerve stimulation during rehabilitation (rehab), vagus nerve stimulation after rehab, and rehab alone. Animals underwent 4 training stages: shaping (motor skill learning), prelesion training, postlesion training, and therapeutic training. Rats were given a unilateral ischemic lesion within motor cortex and implanted with a left vagus nerve cuff. Animals were allowed 1 week of recovery before postlesion baseline training. During the therapeutic training stage, rats received vagus nerve stimulation paired with each successful trial. All 17 trained rats demonstrated significant contralateral forelimb impairment when performing a bradykinesia assessment task. Forelimb function was recovered completely to prelesion levels when vagus nerve stimulation was delivered during rehab training. Alternatively, intensive rehab training alone (without stimulation) failed to restore function to prelesion levels. Delivering the same amount of stimulation after rehab training did not yield improvements compared with rehab alone. These results demonstrate that vagus nerve stimulation repeatedly paired with successful forelimb movements can improve recovery after motor cortex ischemia and may be a viable option for stroke rehabilitation. © The Author(s) 2014.

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

    Science.gov (United States)

    Bertolucci, Federica; Chisari, Carmelo; Fregni, Felipe

    2018-01-01

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

  15. Contralesional Cortical Structural Reorganization Contributes to Motor Recovery after Sub-Cortical Stroke: A Longitudinal Voxel-Based Morphometry Study.

    Science.gov (United States)

    Cai, Jianxin; Ji, Qiling; Xin, Ruiqiang; Zhang, Dianping; Na, Xu; Peng, Ruchen; Li, Kuncheng

    2016-01-01

    Although changes in brain gray matter after stroke have been identified in some neuroimaging studies, lesion heterogeneity and individual variability make the detection of potential neuronal reorganization difficult. This study attempted to investigate the potential structural cortical reorganization after sub-cortical stroke using a longitudinal voxel-based gray matter volume (GMV) analysis. Eleven right-handed patients with first-onset, subcortical, ischemic infarctions involving the basal ganglia regions underwent structural magnetic resonance imaging in addition to National Institutes of Health Stroke Scale (NIHSS) and Motricity Index (MI) assessments in the acute (reorganization of the CL "cognitive" cortices might contribute to motor recovery after sub-cortical stroke.

  16. Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward.

    Science.gov (United States)

    Ikenaga, Yasunori; Nakayama, Sayaka; Taniguchi, Hiroki; Ohori, Isao; Komatsu, Nahoko; Nishimura, Hitoshi; Katsuki, Yasuo

    2017-05-01

    Percutaneous endoscopic gastrostomy may be performed in dysphagic stroke patients. However, some patients regain complete oral intake without gastrostomy. This study aimed to investigate the predictive factors of intake, thereby determining gastrostomy indications. Stroke survivors admitted to our convalescent rehabilitation ward who underwent gastrostomy or nasogastric tube placement from 2009 to 2015 were divided into 2 groups based on intake status at discharge. Demographic data and Functional Independence Measure (FIM), Dysphagia Severity Scale (DSS), National Institutes of Health Stroke Scale, and Glasgow Coma Scale (GCS) scores on admission were compared between groups. We evaluated the factors predicting intake using a stepwise logistic regression analysis. Thirty-four patients recovered intake, whereas 38 achieved incomplete intake. Mean age was lower, mean body mass index (BMI) was higher, and mean time from stroke onset to admission was shorter in the complete intake group. The complete intake group had less impairment in terms of GCS, FIM, and DSS scores. In the stepwise logistic regression analysis, BMI, FIM-cognitive score, and DSS score were significant independent factors predicting intake. The formula of BMI × .26 + FIM cognitive score × .19 + DSS score × 1.60 predicted recovery of complete intake with a sensitivity of 88.2% and a specificity of 84.2%. Stroke survivors with dysphagia with a high BMI and FIM-cognitive and DSS scores tended to recover oral intake. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Method for the recovery of a material

    International Nuclear Information System (INIS)

    Spence, A.P.

    1978-01-01

    The present invention relates to an improved method for the solution mining of a mineral from a subterranean formation. More specifically, the invention relates to an improved method which enhances significantly the recovery of the mineral from a subterranean formation via solution mining. The improvement comprises switching a well which initially functions as a producer to an injector and vice versa after oxidant breakthrough has occurred at a production well

  18. 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.

  19. Moderate Recovery Unnecessary to Sustain High Stroke Volume during Interval Training. A Brief Report

    Directory of Open Access Journals (Sweden)

    Jamie Stanley

    2014-06-01

    Full Text Available It has been suggested that the time spent at a high stroke volume (SV is important for improving maximal cardiac function. The aim of this study was to examine the effect of recovery intensity on cardiovascular parameters during a typical high-intensity interval training (HIIT session in fourteen well-trained cyclists. Oxygen consumption (VO2, heart rate (HR, SV, cardiac output (Qc, and oxygenation of vastus lateralis (TSI were measured during a HIIT (3×3-min work period, 2 min of recovery session on two occasions. VO2, HR and Qc were largely higher during moderate-intensity (60% compared with low-intensity (30% (VO2, effect size; ES = +2.6; HR, ES = +2.8; Qc, ES = +2.2 and passive (HR, ES = +2.2; Qc, ES = +1.7 recovery. By contrast, there was no clear difference in SV between the three recovery conditions, with the SV during the two active recovery periods not being substantially different than during exercise (60%, ES = −0.1; 30%, ES = −0.2. To conclude, moderate-intensity recovery may not be required to maintain a high SV during HIIT.

  20. [Imaging techniques for studying functional recovery following a stroke: I. Methodological aspects].

    Science.gov (United States)

    Ramos-Cabrer, P; Agulla, J; Argibay, B; Brea, D; Campos, F; Castillo, J

    2011-03-16

    Many patients that survive stroke have to face serious functional disabilities for the rest of their lives, which is a personal drama for themselves and their relatives, and an elevated charge for society. Thus functional recovery following stroke should be a key objective for the development of new therapeutic approaches. In this series of two works we review the strategies and tools available nowadays for the evaluation of multiple aspects related to brain function (both in humans and research animals), and how they are helping neuroscientist to better understand the processes of restoration and reorganization of brain function that are triggered following stroke. We have mainly focused on magnetic resonance applications, probably the most versatile neuroimaging technique available nowadays, and that everyday surprises us with new and exciting applications. But we tackle other alternative and complementary techniques, since a multidisciplinary approach allows a wider perspective over the underlying mechanisms behind tissue repair, plastic reorganization of the brain and compensatory mechanisms that are triggered after stroke. The first of the works of this series is focused on methodological aspects that will help us to understand how it is possible to assess brain function based on different physical and physiological principles. In the second work we will focus on different practical issues related to the application of the techniques here discussed.

  1. [Imaging techniques for studying functional recovery following a stroke: II. Complementary techniques].

    Science.gov (United States)

    Ramos-Cabrer, Pedro; Agulla, Jesús; Rodríguez-González, Raquel; Sobrino, Tomás; Castillo, José

    2011-04-01

    Many patients that survive stroke have to face serious functional disabilities for the rest of their lives, which is a personal drama for themselves and their relatives, and an elevated charge for society. Thus, functional recovery after stroke must be a key aspect of the development of new therapeutic approaches. This is the second of a series of two works on which we review the strategies and tools available nowadays for the assessment of multiple aspects related to brain function (both in humans and research animals) and that are helping neuroscientist to better understand the processes of functional restoration and reorganization of the brain, that are triggered following stroke. We have assumed that a multidisciplinary approach is able to provide us with a wider perspective of the underlying mechanisms behind tissue repair, plastic reorganization of the brain and compensatory mechanisms, that can be triggered after stroke. In the second of the works of this series we are focusing in a series of techniques, complementary to the already discussed in the first work, and that are based on MR. These techniques are discussed separately from those ones, because they tackle with aspects not directly related to brain function, although they somehow do in indirect ways, or because they are based on physicochemical or physiological principles different from those discussed on the first work of this series.

  2. The effects of repeated rehabilitation “Tune-Ups” on functional recovery after stroke

    DEFF Research Database (Denmark)

    Clarke, Jared; Mala, Hana; Windle, Victoria

    2008-01-01

    Objectives: For the vast majority of stroke survivors, rehabilitation (i.e. physiotherapy and occupational therapy) is the only treatment option available. Following an initial phase of rehabilitation, many patients are sent home and return periodically for brief periods of therapy … often lasting...... recovery have been modeled in experimental stroke using a combination of enriched environment and rehabilitation (Biernaskie & Corbett, 2001), it remains uncertain if a secondary therapeutic intervention, such as a return to enrichment/rehabilitation ("Tune-Up"), can produce beneficial changes in brain...... and rehabilitative reaching (i.e. “enriched/rehab”). Following 9 weeks of treatment, all animals were placed in standard housing for 5 weeks, after which they received 2 weeks of intensive therapy consisting of enhanced enriched environments and structured sensorimotor/cognitive rehabilitative activities (i.e. “Tune...

  3. Investigating the Efficacy of Novel TrkB Agonists to Augment Stroke Recovery

    Science.gov (United States)

    Warraich, Zuha

    Stroke remains the leading cause of adult disability in developed countries. Most survivors live with residual motor impairments that severely diminish independence and quality of life. After stroke, the only accepted treatment for these patients is motor rehabilitation. However, the amount and kind of rehabilitation required to induce clinically significant improvements in motor function is rarely given due to the constraints of our current health care system. Research reported in this dissertation contributes towards developing adjuvant therapies that may augment the impact of motor rehabilitation and improve functional outcome. These studies have demonstrated reorganization of maps within motor cortex as a function of experience in both healthy and brain-injured animals by using intracortical microstimulation technique. Furthermore, synaptic plasticity has been identified as a key neural mechanism in directing motor map plasticity, evidenced by restoration of movement representations within the spared cortical tissue accompanied by increase in synapse number translating into motor improvement after stroke. There is increasing evidence that brain-derived neurotrophic factor (BDNF) modulates synaptic and morphological plasticity in the developing and mature nervous system. Unfortunately, BDNF itself is a poor candidate because of its short half-life, low penetration through the blood brain barrier, and activating multiple receptor units, p75 and TrkB on the neuronal membrane. In order to circumvent this problem efficacy of two recently developed novel TrkB agonists, LM22A-4 and 7,8-dihydroxyflavone, that actively penetrate the blood brain barrier and enhance functional recovery. Findings from these dissertation studies indicate that administration of these pharmacological compounds, accompanied by motor rehabilitation provide a powerful therapeutic tool for stroke recovery.

  4. Aminosilicone solvent recovery methods and systems

    Energy Technology Data Exchange (ETDEWEB)

    Spiry, Irina Pavlovna; Perry, Robert James; Wood, Benjamin Rue; Singh, Surinder Prabhjot; Farnum, Rachel Lizabeth; Genovese, Sarah Elizabeth

    2018-02-13

    The present invention is directed to aminosilicone solvent recovery methods and systems. The methods and systems disclosed herein may be used to recover aminosilicone solvent from a carbon dioxide containing vapor stream, for example, a vapor stream that leaves an aminosilicone solvent desorber apparatus. The methods and systems of the invention utilize a first condensation process at a temperature from about 80.degree. C. to about 150.degree. C. and a second condensation process at a temperature from about 5.degree. C. to about 75.degree. C. The first condensation process yields recovered aminosilicone solvent. The second condensation process yields water.

  5. Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system.

    Science.gov (United States)

    da Silva Cameirão, Mónica; Bermúdez I Badia, Sergi; Duarte, Esther; Verschure, Paul F M J

    2011-01-01

    Given the incidence of stroke, the need has arisen to consider more self-managed rehabilitation approaches. A promising technology is Virtual Reality (VR). Thus far, however, it is not clear what the benefits of VR systems are when compared to conventional methods. Here we investigated the clinical impact of one such system, the Rehabilitation Gaming System (RGS), on the recovery time course of acute stroke. RGS combines concepts of action execution and observation with an automatic individualization of training. METHODS. Acute stroke patients (n = 8) used the RGS during 12 weeks in addition to conventional therapy. A control group (n = 8) performed a time matched alternative treatment, which consisted of intense occupational therapy or non-specific interactive games. RESULTS. At the end of the treatment, between-group comparisons showed that the RGS group displayed significantly improved performance in paretic arm speed that was matched by better performance in the arm subpart of the Fugl-Meyer Assessment Test and the Chedoke Arm and Hand Activity Inventory. In addition, the RGS group presented a significantly faster improvement over time for all the clinical scales during the treatment period. CONCLUSIONS. Our results suggest that rehabilitation with the RGS facilitates the functional recovery of the upper extremities and that this system is therefore a promising tool for stroke neurorehabilitation.

  6. Multisensory stimulation improves functional recovery and resting-state functional connectivity in the mouse brain after stroke

    Directory of Open Access Journals (Sweden)

    Jakob Hakon

    2018-01-01

    Full Text Available Stroke causes direct structural damage to local brain networks and indirect functional damage to distant brain regions. Neuroplasticity after stroke involves molecular changes within perilesional tissue that can be influenced by regions functionally connected to the site of injury. Spontaneous functional recovery can be enhanced by rehabilitative strategies, which provides experience-driven cell signaling in the brain that enhances plasticity. Functional neuroimaging in humans and rodents has shown that spontaneous recovery of sensorimotor function after stroke is associated with changes in resting-state functional connectivity (RS-FC within and across brain networks. At the molecular level, GABAergic inhibitory interneurons can modulate brain plasticity in peri-infarct and remote brain regions. Among this cell-type, a decrease in parvalbumin (PV-immunoreactivity has been associated with improved behavioral outcome. Subjecting rodents to multisensory stimulation through exposure to an enriched environment (EE enhances brain plasticity and recovery of function after stroke. Yet, how multisensory stimulation relates to RS-FC has not been determined. In this study, we investigated the effect of EE on recovery of RS-FC and behavior in mice after stroke, and if EE-related changes in RS-FC were associated with levels of PV-expressing neurons. Photothrombotic stroke was induced in the sensorimotor cortex. Beginning 2 days after stroke, mice were housed in either standard environment (STD or EE for 12 days. Housing in EE significantly improved lost tactile-proprioceptive function compared to mice housed in STD environment. RS-FC in the mouse was measured by optical intrinsic signal imaging 14 days after stroke or sham surgery. Stroke induced a marked reduction in RS-FC within several perilesional and remote brain regions. EE partially restored interhemispheric homotopic RS-FC between spared motor regions, particularly posterior secondary motor

  7. The Role of Endogenous Neurogenesis in Functional Recovery and Motor Map Reorganization Induced by Rehabilitative Therapy after Stroke in Rats.

    Science.gov (United States)

    Shiromoto, Takashi; Okabe, Naohiko; Lu, Feng; Maruyama-Nakamura, Emi; Himi, Naoyuki; Narita, Kazuhiko; Yagita, Yoshiki; Kimura, Kazumi; Miyamoto, Osamu

    2017-02-01

    Endogenous neurogenesis is associated with functional recovery after stroke, but the roles it plays in such recovery processes are unknown. This study aims to clarify the roles of endogenous neurogenesis in functional recovery and motor map reorganization induced by rehabilitative therapy after stroke by using a rat model of cerebral ischemia (CI). Ischemia was induced via photothrombosis in the caudal forelimb area of the rat cortex. First, we examined the effect of rehabilitative therapy on functional recovery and motor map reorganization, using the skilled forelimb reaching test and intracortical microstimulation. Next, using the same approaches, we examined how motor map reorganization changed when endogenous neurogenesis after stroke was inhibited by cytosine-β-d-arabinofuranoside (Ara-C). Rehabilitative therapy for 4 weeks after the induction of stroke significantly improved functional recovery and expanded the rostral forelimb area (RFA). Intraventricular Ara-C administration for 4-10 days after stroke significantly suppressed endogenous neurogenesis compared to vehicle, but did not appear to influence non-neural cells (e.g., microglia, astrocytes, and vascular endothelial cells). Suppressing endogenous neurogenesis via Ara-C administration significantly inhibited (~50% less than vehicle) functional recovery and RFA expansion (~33% of vehicle) induced by rehabilitative therapy after CI. After CI, inhibition of endogenous neurogenesis suppressed both the functional and anatomical markers of rehabilitative therapy. These results suggest that endogenous neurogenesis contributes to functional recovery after CI related to rehabilitative therapy, possibly through its promotion of motor map reorganization, although other additional roles cannot be ruled out. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. Synergistic effect of moxibustion and rehabilitation training in functional recovery of post-stroke spastic hemiplegia.

    Science.gov (United States)

    Wei, Yan-Xia; Zhao, Xia; Zhang, Bao-Chao

    2016-06-01

    To evaluate the therapeutic benefit of combining moxibustion and rehabilitation training for functional recovery in post-stroke spastic hemiplegic patients. We randomly divided 84 cases subjecting to inclusion criteria into moxibustion plus rehabilitation training group (MRT group, n=44) and rehabilitation training group (RT group, n=40). Evaluation of therapeutic effect was observed before treatment, 2 weeks during treatment and 6 months after treatment. Spasticity was evaluated using modified Ashworth scale (MAS) and Clinical Spasticity Index (CSI), recovery of motor function was assessed by Brunnstrom recovery stages and Simplified Fugl-Meyer Motor Scale, and performance of activities of daily living (ADL) was measured, and the quality of life was assessed by Patient Reported Outcomes (PRO). Evaluation of upper limbs, hands and lower limbs based on CSI and MAS revealed significant improvements in patients treated with MRT, compared to RT alone, both during and after therapy. CSI and MAS also showed significant improvement in patients at each time point in the MRT group, compared to RT group. Marked improvement in Fugl-Meyer Motor Scale was also observed in MRT group at each time point. Based on Brunnstrom grades of upper limbs, hands and lower limbs, significant differences between the two groups were recorded at all time points during and after therapy. Barthel index (BI) and PRO also confirmed the dramatic differences between the two therapy groups. Our results demonstrate that combination therapy with moxibustion and rehabilitation training offers greater clinical benefits in relieving spasticity, promoting function recovery of motion, improving the performance of ADL, and increasing quality of life in post-stroke spastic hemiplegic patients, compared to RT alone. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Inertial Sensing Based Assessment Methods to Quantify the Effectiveness of Post-Stroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Hsin-Ta Li

    2015-07-01

    Full Text Available In clinical settings, traditional stroke rehabilitation evaluation methods are subjectively scored by occupational therapists, and the assessment results vary individually. To address this issue, this study aims to develop a stroke rehabilitation assessment system by using inertial measurement units. The inertial signals from the upper extremities were acquired, from which three quantitative indicators were extracted to reflect rehabilitation performance during stroke patients’ movement examination, i.e., shoulder flexion. Both healthy adults and stroke patients were recruited to correlate the proposed quantitative evaluation indices and traditional rehab assessment scales. Especially, as a unique feature of the study the weight for each of three evaluation indicators was estimated by the least squares method. The quantitative results demonstrate the proposed method accurately reflects patients’ recovery from pre-rehabilitation, and confirm the feasibility of applying inertial signals to evaluate rehab performance through feature extraction. The implemented assessment scheme appears to have the potential to overcome some shortcomings of traditional assessment methods and indicates rehab performance correctly.

  10. Robotic measurement of arm movements after stroke establishes biomarkers of motor recovery.

    Science.gov (United States)

    Krebs, Hermano I; Krams, Michael; Agrafiotis, Dimitris K; DiBernardo, Allitia; Chavez, Juan C; Littman, Gary S; Yang, Eric; Byttebier, Geert; Dipietro, Laura; Rykman, Avrielle; McArthur, Kate; Hajjar, Karim; Lees, Kennedy R; Volpe, Bruce T

    2014-01-01

    Because robotic devices record the kinematics and kinetics of human movements with high resolution, we hypothesized that robotic measures collected longitudinally in patients after stroke would bear a significant relationship to standard clinical outcome measures and, therefore, might provide superior biomarkers. In patients with moderate-to-severe acute ischemic stroke, we used clinical scales and robotic devices to measure arm movement 7, 14, 21, 30, and 90 days after the event at 2 clinical sites. The robots are interactive devices that measure speed, position, and force so that calculated kinematic and kinetic parameters could be compared with clinical assessments. Among 208 patients, robotic measures predicted well the clinical measures (cross-validated R(2) of modified Rankin scale=0.60; National Institutes of Health Stroke Scale=0.63; Fugl-Meyer=0.73; Motor Power=0.75). When suitably scaled and combined by an artificial neural network, the robotic measures demonstrated greater sensitivity in measuring the recovery of patients from day 7 to day 90 (increased standardized effect=1.47). These results demonstrate that robotic measures of motor performance will more than adequately capture outcome, and the altered effect size will reduce the required sample size. Reducing sample size will likely improve study efficiency.

  11. Dynein-deficient flagella respond to increased viscosity with contrasting changes in power and recovery strokes.

    Science.gov (United States)

    Wilson, Kate S; Gonzalez, Olivia; Dutcher, Susan K; Bayly, Philip V

    2015-09-01

    Changes in the flagellar waveform in response to increased viscosity were investigated in uniflagellate mutants of Chlamydomonas reinhardtii. We hypothesized that the waveforms of mutants lacking different dynein arms would change in different ways as viscosity was increased, and that these variations would illuminate the feedback pathways from force to dynein activity. Previous studies have investigated the effects of viscosity on cell body motion, propulsive force, and power in different mutants, but the effect on waveform has not yet been fully characterized. Beat frequency decreases with viscosity in wild-type uniflagellate (uni1) cells, and outer dynein arm deficient (oda2) mutants. In contrast, the inner dynein arm mutant ida1 (lacking I1/f) maintains beat frequency at high viscosity but alters its flagellar waveform more than either wild-type or oda2. The ida1 waveform is narrower than wild-type, primarily due to an abbreviated recovery stroke; this difference is amplified at high viscosity. The oda2 mutant in contrast, maintains a consistent waveform at high and low viscosity with a slightly longer power stroke than wild-type. Analysis of the delays and shear displacements between bends suggest that direct force feedback in the outer dynein arm system may initiate switching of dynein activity. In contrast, I1/f dynein appears to delay switching, most markedly at the initiation of the power stroke, possibly by controlling inter-doublet separation. © 2015 Wiley Periodicals, Inc.

  12. Community-Based Rehabilitation to Improve Stroke Survivors' Rehabilitation Participation and Functional Recovery.

    Science.gov (United States)

    Ru, Xiaojuan; Dai, Hong; Jiang, Bin; Li, Ninghua; Zhao, Xingquan; Hong, Zhen; He, Li; Wang, Wenzhi

    2017-07-01

    The aim of this study was to evaluate the effectiveness of a community-based rehabilitation appropriate technique (CRAT) intervention program in increasing rehabilitation participation and improving functional recovery of stroke survivors. This study followed a quasi-experimental design. In each of 5 centers servicing approximately 50,000 individuals, 2 communities were designated as either the intervention or control community. A CRAT intervention program, including 2-year rehabilitation education and 3-month CRAT treatment, was regularly implemented in the intervention communities, whereas there was no special intervention in the control community. Two sampling surveys, at baseline and after intervention, were administered to evaluate the rehabilitation activity undertaken. In intervention communities, stroke survivor's motor function, daily activity, and social activity were evaluated pretreatment and posttreatment, using the Fugl-Meyer Motor Function Assessment, Barthel index, and Social Functional Activities Questionnaire. The proportion of individuals participating in rehabilitation-related activity was increased significantly (P rehabilitation (P 0.05). Community-based rehabilitation appropriate technique increases rehabilitation participation rates and enhances motor function, daily activity, and social activity of stroke survivors.

  13. Effects of hippotherapy on recovery of gait and balance ability in patients with stroke.

    Science.gov (United States)

    Lee, Chae-Woo; Kim, Seong Gil; Yong, Min Sik

    2014-02-01

    [Purpose] The aim of this study was to examine the the effects of hippotherapy on gait and balance ability in patients with stroke. [Subjects and Methods] Thirty stroke patients were randomly divided into a hippotherapy group and a treadmill group and they conducted exercise for eight weeks. [Results] Berg Balance Scale score, gait velocity, and step length asymmetry ratio were significantly improved in the group receiving hippotherapy training. However, in the group receiving treadmill training, only step length asymmetry ratio was significantly improved. In the comparison between the hippotherapy group and treadmill group, there was no significant difference in Berg Balance Scale score, but a significant difference was found in gait velocity and step length asymmetry ratio. [Conclusion] The results of this study indicated that hippotherapy is a helpful treatment for stroke patients.

  14. The Cognitive Neuroplasticity of Reading Recovery following Chronic Stroke: A Representational Similarity Analysis Approach.

    Science.gov (United States)

    Fischer-Baum, Simon; Jang, Ava; Kajander, David

    2017-01-01

    Damage to certain left hemisphere regions leads to reading impairments, at least acutely, though some individuals eventually recover reading. Previous neuroimaging studies have shown a relationship between reading recovery and increases in contralesional and perilesional activation during word reading tasks, relative to controls. Questions remain about how to interpret these changes in activation. Do these changes reflect functional take-over, a reorganization of functions in the damaged brain? Or do they reveal compensatory masquerade or the use of alternative neural pathways to reading that are available in both patients and controls? We address these questions by studying a single individual, CH, who has made a partial recovery of reading familiar words following stroke. We use an fMRI analysis technique, representational similarity analysis (RSA), which allows us to decode cognitive function from distributed patterns of neural activity. Relative to controls, we find that CH shows a shift from visual to orthographic processing in contralesional regions, with a marginally significant result in perilesional regions as well. This pattern supports a contralesional reorganization of orthographic processing following stroke. More generally, these analyses demonstrate how powerful RSA can be for mapping the neural plasticity of language function.

  15. [Effects of jingjin acupuncture on fine activity of hemiplegic hand in recovery period of stroke].

    Science.gov (United States)

    Zhao, Yan-Ling; Li, Wen-Chun; Huang, Juan; Fu, Zai-Li; Tan, Ling-Qiong; Tang, Zhao-An; He, Jun-Feng

    2014-02-01

    To observe improved effects of Jingjin acupuncture on fine activity of hemiplegic hand in recovery period of stroke. Fifty cases were randomly divided into an observation group and a control group, 25 cases in each one. Regular western medicine treatment, rehabilitation training and regular acupuncture (in which Shuigou (GV 26), Baihui (GV 20), Neiguan (PC 6), etc. were selected) were applied in both groups. Additionally, muscles in palm side of affected hand, dorsal metacarpophalangeal joints and proximal interphalangeal joints were treated with acupuncture in the observation group, once every other day and electroacupuncture was applied when arrival of qi was acquired. Baxie (EX-UE 9) in the affected hand were needled in the control group, and electroacupuncture was added when arrival of qi was acquired. Ten days of treatment was considered a treatment course, and after two courses Lindmark score, Brunnstrom movement function grade, joint range of hand and Barthel index (BI) were observed in two groups. Compared before the treatment, the Lindmark score in two groups were both improved after the treatment (both P vs 6.84 +/- 2.43, 3.52 +/- 2.33 vs 2.16 +/- 2.12, 11.76 +/- 3.55 vs 9.00 +/- 3.62, all P vs (18.65 +/- 7.86) degrees, p acupuncture could effectively improve fine activity of hemiplegic hand in recovery period of stroke prove daily life ability.

  16. The functional connectivity of semantic task changes in the recovery from stroke aphasia

    Science.gov (United States)

    Lu, Jie; Wu, Xia; Yao, Li; Li, Kun-Cheng; Shu, Hua; Dong, Qi

    2007-03-01

    Little is known about the difference of functional connectivity of semantic task between the recovery aphasic patients and normal subject. In this paper, an fMRI experiment was performed in a patient with aphasia following a left-sided ischemic lesion and normal subject. Picture naming was used as semantic activation task in this study. We compared the preliminary functional connectivity results of the recovery aphasic patient with the normal subject. The fMRI data were separated by independent component analysis (ICA) into 90 components. According to our experience and other papers, we chose a region of interest (ROI) of semantic (x=-57, y=15, z=8, r=11mm). From the 90 components, we chose one component as the functional connectivity of the semantic ROI according to one criterion. The criterion is the mean value of the voxels in the ROI. So the component of the highest mean value of the ROI is the functional connectivity of the ROI. The voxel with its value higher than 2.4 was thought as activated (pgyrus and inferior/middle temporal gyrus are larger than the ones of normal. The activated area of the right inferior frontal gyrus is smaller than the ones of normal. The functional connectivity of stroke aphasic patient under semantic condition is different with the normal one. The focus of the stroke aphasic patient can affect the functional connectivity.

  17. Lesion location associated with balance recovery and gait velocity change after rehabilitation in stroke patients.

    Science.gov (United States)

    Moon, Hyun Im; Lee, Hyo Jeong; Yoon, Seo Yeon

    2017-06-01

    Impaired gait function after stroke contributes strongly to overall patient disability. However, the response to rehabilitation varies between individuals. The aims of this study were to identify predictors of gait velocity change and to elucidate lesion location associated with change of balance and gait function. We reviewed 102 stroke patients. The patients were divided into two groups according to gait ability post-rehabilitation, and we analyzed differences in their characteristics, such as demographic information, lesion factors, and initial balance function. Multivariate regression analyses were performed to examine the predictors of rehabilitation response. Lesion location and volume were measured on brain magnetic resonance images. We generated statistical maps of the lesions related to functional gains in gait and balance using voxel-based lesion symptom mapping (VLSM). The group of patients who regained independent ambulation function showed a smaller lesion size, a shorter duration from stroke onset, and higher initial balance function. In the regression model, gait velocity changes were predicted with the initial Berg balance scale (BBS) and duration post-onset. Absolute BBS changes were also correlated with the duration post-onset and initial BBS, and relative BBS changes were predicted by the baseline BBS. Using VLSM, lesion locations associated with gait velocity changes and balance adjusting for other factors were the insula, internal capsule, and adjacent white matter. Initial balance function as well as the interval between stroke onset and the initiation of therapy might influence balance recovery and gait velocity changes. Damage to the insula and internal capsule also affected gait velocity change after rehabilitation.

  18. The Effect of Electromagnetic Field Treatment on Recovery from Ischemic Stroke in a Rat Stroke Model: Clinical, Imaging, and Pathological Findings

    Directory of Open Access Journals (Sweden)

    Y. Segal

    2016-01-01

    Full Text Available Stroke is a leading cause of death and disability. Effects of stroke include significant deficits in sensory-motor skills and cognitive abilities. At present, there are limited effective interventions for postacute stroke patients. In this preliminary research we studied a new noninvasive, very low intensity, low frequency, electromagnetic field treatment (VLIFE, targeting a neural network, on an in vivo stroke rat model. Eighteen rats were divided into three groups: sham (M1 and two treatment groups which were exposed to VLIFE treatment for 4 weeks, one using theta waves (M2 and another using beta waves (M3; all groups were followed up for an additional month. Results indicate that the M2 and M3 treated groups showed recovery of sensorimotor functional deficits, as demonstrated by Modified Neurological Severity Score and forelimb placement tests. Brain MRI imaging results show a decrease in perilesional edema and lateral ventricle widening in the treated groups. Fiber tracts’ imaging, following VLIFE treatment, showed a higher white matter integrity compared to control. Histological findings support neural regeneration processes. Our data suggest that VLIFE treatment, targeting a specific functional neural network by frequency rather than location, promotes neuronal plasticity after stroke and, as a result, improves clinical recovery. Further studies will investigate the full potential of the treatment.

  19. 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.

  20. Effects of low-frequency repetitive transcranial magnetic stimulation on upper extremity motor recovery and functional outcomes in chronic stroke patients: A randomized controlled trial.

    Science.gov (United States)

    Aşkın, Ayhan; Tosun, Aliye; Demirdal, Ümit Seçil

    2017-06-01

    Repetitive transcranial magnetic stimulation (rTMS) was suggested as a preconditioning method that would increase brain plasticity and that it would be optimal to combine rTMS with intensive rehabilitation. To assess the efficacy of inhibitory rTMS on upper extremity motor recovery and functional outcomes in chronic ischemic stroke patients. In this randomized controlled trial, experimental group received low-frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT), and control group received PT. No statistically significant difference was found in baseline demographical and clinical characteristics of the subjects including stroke severity or severity of paralysis prior to intervention. There were statistically significant improvements in all clinical outcome measures except for the Brunnstrom Recovery Stages. Fugl-Meyer Assessment, Box and Block test, motor and total scores of Functional Independence Measurement (FIM), and Functional Ambulation Scale (FAS) scores were significantly increased in both groups, however, these changes were significantly greater in the rTMS group except for FAS score. FIM cognitive scores and standardized mini-mental test scores were significantly increased and distal and hand Modified Ashworth Scale scores were significantly decreased only in the rTMS group (p functional, and cognitive deficits in chronic stroke. Further studies with a larger number of patients with longer follow-up periods are needed to establish its effectiveness in stroke rehabilitation.

  1. Adapting the Home After a Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  2. Motor recovery by improvement of limb-kinetic apraxia in a chronic stroke patient.

    Science.gov (United States)

    Jang, Sung Ho

    2013-01-01

    We report on a chronic stroke patient who showed motor recovery by improvement of limb-kinetic apraxia (LKA) after undergoing intensive rehabilitation for a period of one month, which was demonstrated by diffusion tensor tractography (DTT) and transcranial magnetic stimulation (TMS). A 50-year-old male patient presented with severe paralysis of the left extremities at the onset of thalamic hemorrhage. At thirty months after onset, the patient exhibited moderate weakness of his left upper and lower extremities. In addition, he exhibited a slow, clumsy, and mutilated movement pattern during grasp-release movements of his left hand. During a one-month period of intensive rehabilitation, which was started at thrity months after onset, the patient showed 22% motor recovery of the left extremities. The slow, clumsy, and mutilated movement pattern of the left hand almost disappeared. DTTs of the corticospinal tract (CST) in both hemispheres originated from the cerebral cortex, including the primary motor cortex, and passed along the known CST pathway. The DTT of the right CST was located anterior to the old hemorrhagic lesion. TMS study performed at thirty and thirty-one months after onset showed normal and similar findings for motor evoked potential in terms of latency and amplitude of the left hand muscle. We think that the motor weakness of the left extremities in this patient was mainly ascribed to LKA and that most of the motor recovery during a one-month period of rehabilitation was attributed to improvement of LKA.

  3. Functional neural changes associated with acquired amusia across different stages of recovery after stroke.

    Science.gov (United States)

    Sihvonen, Aleksi J; Särkämö, Teppo; Ripollés, Pablo; Leo, Vera; Saunavaara, Jani; Parkkola, Riitta; Rodríguez-Fornells, Antoni; Soinila, Seppo

    2017-09-12

    Brain damage causing acquired amusia disrupts the functional music processing system, creating a unique opportunity to investigate the critical neural architectures of musical processing in the brain. In this longitudinal fMRI study of stroke patients (N = 41) with a 6-month follow-up, we used natural vocal music (sung with lyrics) and instrumental music stimuli to uncover brain activation and functional network connectivity changes associated with acquired amusia and its recovery. In the acute stage, amusic patients exhibited decreased activation in right superior temporal areas compared to non-amusic patients during instrumental music listening. During the follow-up, the activation deficits expanded to comprise a wide-spread bilateral frontal, temporal, and parietal network. The amusics showed less activation deficits to vocal music, suggesting preserved processing of singing in the amusic brain. Compared to non-recovered amusics, recovered amusics showed increased activation to instrumental music in bilateral frontoparietal areas at 3 months and in right middle and inferior frontal areas at 6 months. Amusia recovery was also associated with increased functional connectivity in right and left frontoparietal attention networks to instrumental music. Overall, our findings reveal the dynamic nature of deficient activation and connectivity patterns in acquired amusia and highlight the role of dorsal networks in amusia recovery.

  4. Electromyographic bridge for promoting the recovery of hand movements in subacute stroke patients: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Yu-Xuan Zhou

    2017-08-01

    Full Text Available Objective: The electromyographic bridge (EMGB detects surface electromyographic signals from a non-paretic limb. It then generates electric pulse trains according to the electromyographic time domain features, which can be used to stimulate a paralysed or paretic limb in real time. This strategy can be used for the contralateral control of neuromuscular electrical stimulation (NMES to improve motor function after stroke. The aim of this study was to compare the treat-ment effects of EMGB vs cyclic NMES on wrist and finger impairments in subacute stroke patients. Methods: A total of 42 hemiplegic patients within 6 months of their cerebrovascular accidents were randomly assigned to 4-week treatments with EMGB or cyclic NMES. Each group underwent a standard rehabilitation programme and 10 sessions per week of hand training with EMGB or cyclic NMES. Outcome measures were: Brunnstrom stage, upper extremity components of the Fugl-Meyer Assessment, Motor Status Scale, voluntary surface electromyographic ratio and active range of motion of the wrist and finger joints. Results: The EMGB group showed significantly greater improvements than the cyclic NMES group on the following measures: Brunnstrom stages for the hand, upper extremity – Fugl-Meyer Assessment, Motor Status Scale, and the voluntary surface electromyographic ratio of wrist and finger extensors. Eleven and 4 participants of the EMGB group who had no active wrist and finger movements, respectively, at the start of the treatment could perform measurable wrist and finger extensions after EMGB training. The corresponding numbers in the cyclic NMES group were only 4 and 1. Conclusion: In the present group of subacute stroke patients, the results favour EMGB over cyclic NMES for augmenting the recovery of volitional wrist and finger motion.

  5. 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.

  6. Clinical characteristics of unknown symptom onset stroke patients with and without diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch.

    Science.gov (United States)

    Thomalla, Götz; Boutitie, Florent; Fiebach, Jochen B; Simonsen, Claus Z; Pedraza, Salvador; Lemmens, Robin; Nighoghossian, Norbert; Roy, Pascal; Muir, Keith W; Ebinger, Martin; Ford, Ian; Cheng, Bastian; Galinovic, Ivana; Cho, Tae-Hee; Puig, Josep; Thijs, Vincent; Endres, Matthias; Fiehler, Jens; Gerloff, Christian

    2018-01-01

    Background Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch was suggested to identify stroke patients with unknown time of symptom onset likely to be within the time window for thrombolysis. Aims We aimed to study clinical characteristics associated with DWI-FLAIR mismatch in patients with unknown onset stroke. Methods We analyzed baseline MRI and clinical data from patients with acute ischemic stroke proven by DWI from WAKE-UP, an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset. Clinical characteristics were compared between patients with and without DWI-FLAIR mismatch. Results Of 699 patients included, 418 (59.8%) presented with DWI-FLAIR mismatch. A shorter delay between last seen well and symptom recognition (p = 0.0063), a shorter delay between symptom recognition and arrival at hospital (p = 0.0025), and history of atrial fibrillation (p = 0.19) were predictors of DWI-FLAIR mismatch in multivariate analysis. All other characteristics were comparable between groups. Conclusions There are only minor differences in measured clinical characteristics between unknown symptom onset stroke patients with and without DWI-FLAIR mismatch. DWI-FLAIR mismatch as an indicator of stroke onset within 4.5 h shows no relevant association with commonly collected clinical characteristics of stroke patients. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT01525290; URL: https://www.clinicaltrialsregister.eu . Unique identifier: 2011-005906-32.

  7. Use of virtual reality in gait recovery among post stroke patients--a systematic literature review.

    Science.gov (United States)

    Moreira, Marcela Cavalcanti; de Amorim Lima, Anne Michelle; Ferraz, Karla Monica; Benedetti Rodrigues, Marco Aurélio

    2013-09-01

    To conduct a systematic literature review focusing on the use of virtual reality (VR) for the improvement of gait in post-stroke patients. We performed a search of Randomized-controlled trials published from 1966 to 2011 in the databases: Medline, Lilacs, CINAHL, Cochrane and SciELO. Keywords used in the selection were: Virtual reality in combination with (AND) "Nervous System Diseases", (OR) "Motor Skill Disorders" (OR) "neurologic impairments" (OR) "motor function" (OR) function* (OR) locomotion (OR) ambulation (OR) gait (OR) "motor activity" (OR) Stroke. Selected articles were evaluated using the individual's components of methodological quality assessment and analysis of outcomes of each study was based on the domains of the International Classification of Functioning, Disability and Health (ICF). A total of 6520 references were found, however, based on the inclusion and exclusion criteria only four studies were considered and analyzed. These articles demonstrated that the use of VR promotes changes in gait parameters, despite the diversity of protocols, participants' characteristics, as well as the number of participants included in each study. The research studies analyses suggest that VR is a promising method to improve the gait of patients with stroke. Nevertheless, some questions still need to be answered. Some aspects should be investigated to confirm the true benefits and application of VR in this population. Stroke is the second cause of death and the leading cause of disability worldwide. The loss or impairment of ambulation is one of the most devasting sequelae of stroke. Restoration of gait can be considered the main goal of rehabilitation after stroke. Conventional interventions tend to be tedious, providing few opportunities to increase the difficulty level of the proposed tasks and do not encourage adaptive postural reactions. There is evidence to support the use of virtual reality for the promotion of walking in people with sequelae of stroke

  8. Inhibition of Glycogen Synthase Kinase-3ß Enhances Cognitive Recovery after Stroke: The Role of TAK1

    Science.gov (United States)

    Venna, Venugopal Reddy; Benashski, Sharon E.; Chauhan, Anjali; McCullough, Louise D.

    2015-01-01

    Memory deficits are common among stroke survivors. Identifying neuroprotective agents that can prevent memory impairment or improve memory recovery is a vital area of research. Glycogen synthase kinase-3ß (GSK-3ß) is involved in several essential intracellular signaling pathways. Unlike many other kinases, GSK-3ß is active only when…

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

    Science.gov (United States)

    Mikołajewska, Emilia

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Hill Keith

    2011-06-01

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

  11. Characterizing relationships of DTI, fMRI, and motor recovery in stroke rehabilitation utilizing brain-computer interface technology.

    Science.gov (United States)

    Song, Jie; Young, Brittany M; Nigogosyan, Zack; Walton, Leo M; Nair, Veena A; Grogan, Scott W; Tyler, Mitchell E; Farrar-Edwards, Dorothy; Caldera, Kristin E; Sattin, Justin A; Williams, Justin C; Prabhakaran, Vivek

    2014-01-01

    The relationship of the structural integrity of white matter tracts and cortical activity to motor functional outcomes in stroke patients is of particular interest in understanding mechanisms of brain structural and functional changes while recovering from stroke. This study aims to probe these underlying mechanisms using diffusion tensor imaging (DTI) and fMRI measures. We examined the structural integrity of the posterior limb of the internal capsule (PLIC) using DTI and corticomotor activity using motor-task fMRI in stroke patients who completed up to 15 sessions of rehabilitation therapy using Brain-Computer Interface (BCI) technology. We hypothesized that (1) the structural integrity of PLIC and corticomotor activity are affected by stroke; (2) changes in structural integrity and corticomotor activity following BCI intervention are related to motor recovery; (3) there is a potential relationship between structural integrity and corticomotor activity. We found that (1) the ipsilesional PLIC showed significantly decreased fractional anisotropy (FA) values when compared to the contralesional PLIC; (2) lower ipsilesional PLIC-FA values were significantly associated with worse motor outcomes (i.e., ipsilesional PLIC-FA and motor outcomes were positively correlated.); (3) lower ipsilesional PLIC-FA values were significantly associated with greater ipsilesional corticomotor activity during impaired-finger-tapping-task fMRI (i.e., ipsilesional PLIC-FA and ipsilesional corticomotor activity were negatively correlated), with an overall bilateral pattern of corticomotor activity observed; and (4) baseline FA values predicted motor recovery assessed after BCI intervention. These findings suggest that (1) greater vs. lesser microstructural integrity of the ipsilesional PLIC may contribute toward better vs. poor motor recovery respectively in the stroke-affected limb and demand lesser vs. greater cortical activity respectively from the ipsilesional motor cortex; and that (2

  12. Robot training for hand motor recovery in subacute stroke patients: A randomized controlled trial.

    Science.gov (United States)

    Orihuela-Espina, Felipe; Roldán, Giovana Femat; Sánchez-Villavicencio, Israel; Palafox, Lorena; Leder, Ronald; Sucar, Luis Enrique; Hernández-Franco, Jorge

    2016-01-01

    Evidence of superiority of robot training for the hand over classical therapies in stroke patients remains controversial. During the subacute stage, hand training is likely to be the most useful. To establish whether robot active assisted therapies provides any additional motor recovery for the hand when administered during the subacute stage (robot based therapies for hand recovery will show significant differences at subacute stages. A randomized clinical trial. A between subjects randomized controlled trial was carried out on subacute stroke patients (n = 17) comparing robot active assisted therapy (RT) with a classical occupational therapy (OT). Both groups received 40 sessions ensuring at least 300 repetitions per session. Treatment duration was (mean ± std) 2.18 ± 1.25 months for the control group and 2.44 ± 0.88 months for the study group. The primary outcome was motor dexterity changes assessed with the Fugl-Meyer (FMA) and the Motricity Index (MI). Both groups (OT: n = 8; RT: n = 9) exhibited significant improvements over time (Non-parametric Cliff's delta-within effect sizes: dwOT-FMA = 0.5, dwOT-MI = 0.5, dwRT-FMA = 1, dwRT-MI = 1). Regarding differences between the therapies; the Fugl-Meyer score indicated a significant advantage for the hand training with the robot (FMA hand: WRS: W = 8, p hand prehension for RT with respect to OT but failed to reach significance (MI prehension: W = 17.5, p = 0.080). No harm occurred. Robotic therapies may be useful during the subacute stages of stroke - both endpoints (FM hand and MI prehension) showed the expected trend with bigger effect size for the robotic intervention. Additional benefit of the robotic therapy over the control therapy was only significant when the difference was measured with FM, demanding further investigation with larger samples. Implications of this study are important for decision making during therapy administration and resource allocation. Copyright © 2016 Hanley

  13. Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study.

    Science.gov (United States)

    de Haart, Mirjam; Geurts, Alexander C; Huidekoper, Steven C; Fasotti, Luciano; van Limbeek, Jacques

    2004-06-01

    To identify and interrelate static and dynamic characteristics of the restoration of quiet standing balance in a representative sample of stroke survivors in the Netherlands during their inpatient rehabilitation. Exploratory study using an inception cohort with findings related to reference values from healthy elderly persons. Rehabilitation center. Thirty-seven inpatients (mean age, 61.6y; mean time poststroke, 10.0wk) with a first hemispheric intracerebral infarction or hematoma who were admitted to retrain standing balance and walking. Individualized therapy. Center of pressure fluctuations were registered under each foot and in the sagittal and frontal planes separately by using a dual-plate force platform. The first balance measurements took place as soon as patients were able to stand unassisted for at least 30 seconds as well as 2, 4, 8, and, 12 weeks later. Quiet standing was assessed under 4 conditions: with and without a visual midline reference, with the eyes closed, and while performing a concurrent arithmetic task. The stroke patients showed excessive postural sway and instability, particularly in the frontal plane, compared with reference values. Frontal plane balance was, however, also most responsive to the effects of balance training and recovery (Psensibility or ankle clonus, diminished considerably during the first 4 weeks of the follow-up period (P<.02). Yet, a substantial degree of weight-bearing asymmetry persisted during the 8 weeks thereafter, and it continued to be aggravated by attentional distraction (P<.001). During the same period, static asymmetry (ie, the degree of pes equinovarus loading at the paretic side) and dynamic asymmetry (ie, the extent to which compensatory ankle moments are applied at the nonparetic side) did not show normalization at all, although motor selectivity of the paretic leg improved by 1 stage on the 6-stage Brunnstrom scale (P<.001) and the independency level of balance and walking skills improved by 2 points

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

    Science.gov (United States)

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

    2011-06-18

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

  15. Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study

    Science.gov (United States)

    Fluet, Gerard G.; Patel, Jigna; Qiu, Qinyin; Yarossi, Matthew; Massood, Supriya; Adamovich, Sergei V.; Tunik, Eugene; Merians, Alma S.

    2016-01-01

    Purpose The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated. Methods This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl–Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation. Results Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. Conclusion This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. PMID:27669997

  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

    DEUCC vs UCC: −0.14; 95% CI, −0.32 to 0.05; P = .15). Secondary outcomes for the ASAP group were WMFT change score, −8.8 seconds, and improved SIS, 73%; DEUCC group, WMFT, −8.1 seconds, and SIS, 72%; and UCC group, WMFT, −7.2 seconds, and SIS, 69%, with no significant pairwise between-group differences (ASAP vs DEUCC: WMFT, 1.8 seconds; 95% CI, −0.8 to 4.5 seconds; P = .18; improved SIS, 1%; 95% CI, −12% to 13%; P = .54; ASAP vs UCC: WMFT, −0.6 seconds, 95% CI, −3.8 to 2.6 seconds; P = .72; improved SIS, 4%; 95% CI, −9% to 16%; P = .48; and DEUCC vs UCC: WMFT, −2.1 seconds; 95% CI, −4.5 to 0.3 seconds; P = .08; improved SIS, 3%; 95% CI, −9% to 15%; P = .22). A total of 168 serious adverse events occurred in 109 participants, resulting in 8 patients withdrawing from the study. CONCLUSIONS AND RELEVANCE Among patients with motor stroke and primarily moderate upper extremity impairment, use of a structured, task-oriented rehabilitation program did not significantly improve motor function or recovery beyond either an equivalent or a lower dose of UCC upper extremity rehabilitation. These findings do not support superiority of this program among patients with motor stroke and primarily moderate upper extremity impairment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00871715 PMID:26864411

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2014-11-01

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

  19. Balneotherapy in Treatment of Spastic Upper Limb after Stroke

    OpenAIRE

    Erceg-Rukavina, Tatjana; Stefanovski, Mihajlo

    2015-01-01

    Introduction: After stroke, spasticity is often the main problem that prevents functional recovery. Pain occurs in up to 70% of patients during the first year post-stroke. Materials and methods: A total of 70 patients (30 female and 45 male) mean age (65.67) participated in prospective, controlled study. Inclusion criteria: ischaemic stroke, developed spasticity of upper limb, post-stroke interval

  20. A highly efficient six-stroke internal combustion engine cycle with water injection for in-cylinder exhaust heat recovery

    International Nuclear Information System (INIS)

    Conklin, James C.; Szybist, James P.

    2010-01-01

    A concept adding two strokes to the Otto or Diesel engine cycle to increase fuel efficiency is presented here. It can be thought of as a four-stroke Otto or Diesel cycle followed by a two-stroke heat recovery steam cycle. A partial exhaust event coupled with water injection adds an additional power stroke. Waste heat from two sources is effectively converted into usable work: engine coolant and exhaust gas. An ideal thermodynamics model of the exhaust gas compression, water injection and expansion was used to investigate this modification. By changing the exhaust valve closing timing during the exhaust stroke, the optimum amount of exhaust can be recompressed, maximizing the net mean effective pressure of the steam expansion stroke (MEP steam ). The valve closing timing for maximum MEP steam is limited by either 1 bar or the dew point temperature of the expansion gas/moisture mixture when the exhaust valve opens. The range of MEP steam calculated for the geometry of a conventional gasoline engine and is from 0.75 to 2.5 bars. Typical combustion mean effective pressures (MEP combustion ) of naturally aspirated gasoline engines are up to 10 bar, thus this concept has the potential to significantly increase the engine efficiency and fuel economy.

  1. Correlation between risk factors, functional recovery, and the health-related quality of life of stroke survivors

    Directory of Open Access Journals (Sweden)

    Mandić Milan

    2017-01-01

    Full Text Available Introduction/Objective It has been estimated that 50% of strokes are preventable through the control of modifiable risk factors. The objective of the paper was to determine the correlation between the risk factors, functional status, and the health-related quality of life (HRQOL of stroke survivors. Method The prospective cohort study was used. The study included 136 patients 30–79 years old. Functional recovery was assessed using the Barthel index (BI and the Modified Rankin Scale (mRS. The HRQOL was evaluated by the generic Short Form 36 (SF-36 questionnaire. BI and mRS were determined at admission at the rehabilitation, one, three and six months after the stroke. The SF-36 was filled out at the same time. The analysis of the repeated measure variance (Repeated Measures ANOVA was applied, as well as the correlation analysis and Spearman’s coefficient of rank correlation. Results A total number of 136 patients [66 (48.5% male and 70 (51.5% female] completed the questionnaire. The average age of stroke survivors was 63.72 ± 8.73. At admission, mRS was 4.75 ± 0.55, and six months after the stroke onset it decreased to 2.60 ± 1.08. The average value of BI at admission was 25 ± 24.66, and within six months it increased to 83.75 ± 18.59 (p = 0.001. The ANOVA showed that the values of mRS significantly decreased (p < 0.001 and the values of BI significantly increased (ANOVA: p < 0.001. All domains of the SF-36 questionnaire, except for the pain domain, significantly increased (p < 0.001. The physical function (r = 0.238; p < 0. 01, physical role (r = 0.199; p < 0.05, and emotional role (r = 0.237; p < 0.01 were significantly lower among alcohol addicts (r = 0.199; p < 0.05. Mental health (r = 0.244; p < 0.01 and social relationships domains were significantly lower among smokers (r = 0.272; p < 0.01. The general health (r = -0.290; p < 001 and health condition change domains were significantly lower among smokers (r = 0.225; p < 0

  2. 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 ...

  3. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Simple Techniques Can Help Memory after a Stroke Self-Esteem after Stroke Cognitive Challenges After Stroke Depression Trumps ... spasticity), fatigue and more. Let's Talk About Stroke Fact Sheets Our stroke fact sheets cover treatments, recovery, ...

  4. Recovery of post stroke proximal arm function, driven by complex neuroplastic bilateral brain activation patterns and predicted by baseline motor dysfunction severity

    Directory of Open Access Journals (Sweden)

    Svetlana ePundik

    2015-07-01

    Full Text Available Objectives: Neuroplastic changes that drive recovery of shoulder/elbow function after stoke have been poorly understood. The purpose of this study was to determine the relationship between neuroplastic brain changes related to shoulder/elbow movement control in response to treatment and recovery of arm motor function in chronic stroke survivors. Methods: Twenty-three chronic stroke survivors were treated with 12 weeks of arm rehabilitation. Outcome measures included functional Magnetic Resonance Imaging (fMRI for the shoulder/elbow components of reach and a skilled motor function test (Arm Motor Abilities Test (AMAT, collected before and after treatment.Results: We observed two patterns of neuroplastic changes that were associated with gains in motor function: decreased or increased task-related brain activation. Those with significantly better motor function at baseline exhibited a decrease in brain activation in response to treatment, evident in the ipsilesional primary motor and contralesional supplementary motor regions; in contrast, those with greater baseline motor impairment, exhibited increased brain activation in response to treatment. There was an linear relationship between greater functional gain (AMAT and increased activation in bilateral primary motor, contralesional primary and secondary sensory regions, and contralesional lateral premotor area, after adjusting for baseline AMAT, age, and time since stroke. Conclusions: Recovery of functional reach involves recruitment of several contralesional and bilateral primary motor regions. In response to intensive therapy, the direction of functional brain change (i.e. increase or decrease in task-related brain recruitment for shoulder/elbow reach components depends on baseline level of motor function and may represent either different phases or different strategies of neuroplasticity that drive functional recovery.

  5. Upper-Limb Recovery After Stroke: A Randomized Controlled Trial Comparing EMG-Triggered, Cyclic, and Sensory Electrical Stimulation.

    Science.gov (United States)

    Wilson, Richard D; Page, Stephen J; Delahanty, Michael; Knutson, Jayme S; Gunzler, Douglas D; Sheffler, Lynne R; Chae, John

    2016-11-01

    This study compared the effect of cyclic neuromuscular electrical stimulation (NMES), electromyographically (EMG)-triggered NMES, and sensory stimulation on motor impairment and activity limitations in patients with upper-limb hemiplegia. This was a multicenter, single-blind, multiarm parallel-group study of nonhospitalized hemiplegic stroke survivors within 6 months of stroke. A total of 122 individuals were randomized to receive either cyclic NMES, EMG-triggered NMES, or sensory stimulation twice every weekday in 40-minute sessions, over an 8 week-period. Patients were followed for 6 months after treatment concluded. There were significant increases in the Fugl-Meyer Assessment [F(1, 111) = 92.6, P stimulation therapy applied within 6 months of stroke. Improvements were likely a result of spontaneous recovery. There was no difference based on the type of electrical stimulation that was administered. © The Author(s) 2016.

  6. Combined rTMS and virtual reality brain-computer interface training for motor recovery after stroke

    Science.gov (United States)

    Johnson, N. N.; Carey, J.; Edelman, B. J.; Doud, A.; Grande, A.; Lakshminarayan, K.; He, B.

    2018-02-01

    Objective. Combining repetitive transcranial magnetic stimulation (rTMS) with brain-computer interface (BCI) training can address motor impairment after stroke by down-regulating exaggerated inhibition from the contralesional hemisphere and encouraging ipsilesional activation. The objective was to evaluate the efficacy of combined rTMS  +  BCI, compared to sham rTMS  +  BCI, on motor recovery after stroke in subjects with lasting motor paresis. Approach. Three stroke subjects approximately one year post-stroke participated in three weeks of combined rTMS (real or sham) and BCI, followed by three weeks of BCI alone. Behavioral and electrophysiological differences were evaluated at baseline, after three weeks, and after six weeks of treatment. Main results. Motor improvements were observed in both real rTMS  +  BCI and sham groups, but only the former showed significant alterations in inter-hemispheric inhibition in the desired direction and increased relative ipsilesional cortical activation from fMRI. In addition, significant improvements in BCI performance over time and adequate control of the virtual reality BCI paradigm were observed only in the former group. Significance. When combined, the results highlight the feasibility and efficacy of combined rTMS  +  BCI for motor recovery, demonstrated by increased ipsilesional motor activity and improvements in behavioral function for the real rTMS  +  BCI condition in particular. Our findings also demonstrate the utility of BCI training alone, as shown by behavioral improvements for the sham rTMS  +  BCI condition. This study is the first to evaluate combined rTMS and BCI training for motor rehabilitation and provides a foundation for continued work to evaluate the potential of both rTMS and virtual reality BCI training for motor recovery after stroke.

  7. Contribution of the resting-state functional connectivity of the contralesional primary sensorimotor cortex to motor recovery after subcortical stroke.

    Directory of Open Access Journals (Sweden)

    Huijuan Xu

    Full Text Available It remains uncertain if the contralesional primary sensorimotor cortex (CL_PSMC contributes to motor recovery after stroke. Here we investigated longitudinal changes in the resting-state functional connectivity (rsFC of the CL_PSMC and their association with motor recovery. Thirteen patients who had experienced subcortical stroke underwent a series of resting-state fMRI and clinical assessments over a period of 1 year at 5 time points, i.e., within the first week, at 2 weeks, 1 month, 3 months, and 1 year after stroke onset. Thirteen age- and gender-matched healthy subjects were recruited as controls. The CL_PSMC was defined as a region centered at the voxel that had greatest activation during hand motion task. The dynamic changes in the rsFCs of the CL_PSMC within the whole brain were evaluated and correlated with the Motricity Index (MI scores. Compared with healthy controls, the rsFCs of the CL_PSMC with the bilateral PSMC were initially decreased, then gradually increased, and finally restored to the normal level 1 year later. Moreover, the dynamic change in the inter-hemispheric rsFC between the bilateral PSMC in these patients was positively correlated with the MI scores. However, the intra-hemispheric rsFC of the CL_PSMC was not correlated with the MI scores. This study shows dynamic changes in the rsFCs of the CL_PSMC after stroke and suggests that the increased inter-hemispheric rsFC between the bilateral PSMC may facilitate motor recovery in stroke patients. However, generalization of our findings is limited by the small sample size of our study and needs to be confirmed.

  8. Combined rTMS and virtual reality brain-computer interface training for motor recovery after stroke.

    Science.gov (United States)

    Johnson, N N; Carey, J; Edelman, B J; Doud, A; Grande, A; Lakshminarayan, K; He, B

    2018-02-01

    Combining repetitive transcranial magnetic stimulation (rTMS) with brain-computer interface (BCI) training can address motor impairment after stroke by down-regulating exaggerated inhibition from the contralesional hemisphere and encouraging ipsilesional activation. The objective was to evaluate the efficacy of combined rTMS  +  BCI, compared to sham rTMS  +  BCI, on motor recovery after stroke in subjects with lasting motor paresis. Three stroke subjects approximately one year post-stroke participated in three weeks of combined rTMS (real or sham) and BCI, followed by three weeks of BCI alone. Behavioral and electrophysiological differences were evaluated at baseline, after three weeks, and after six weeks of treatment. Motor improvements were observed in both real rTMS  +  BCI and sham groups, but only the former showed significant alterations in inter-hemispheric inhibition in the desired direction and increased relative ipsilesional cortical activation from fMRI. In addition, significant improvements in BCI performance over time and adequate control of the virtual reality BCI paradigm were observed only in the former group. When combined, the results highlight the feasibility and efficacy of combined rTMS  +  BCI for motor recovery, demonstrated by increased ipsilesional motor activity and improvements in behavioral function for the real rTMS  +  BCI condition in particular. Our findings also demonstrate the utility of BCI training alone, as shown by behavioral improvements for the sham rTMS  +  BCI condition. This study is the first to evaluate combined rTMS and BCI training for motor rehabilitation and provides a foundation for continued work to evaluate the potential of both rTMS and virtual reality BCI training for motor recovery after stroke.

  9. Relationship between the modified Rankin Scale and the Barthel Index in the process of functional recovery after stroke.

    Science.gov (United States)

    Cioncoloni, D; Piu, P; Tassi, R; Acampa, M; Guideri, F; Taddei, S; Bielli, S; Martini, G; Mazzocchio, R

    2012-01-01

    The modified Rankin Scale (mRS) and the Barthel Index (BI) are the most common clinimetrical instruments for measuring disability after stroke. This study investigated the relationship between the BI and the mRS at multiple time points after stroke. The BI, which is a widely used instrument for longitudinal follow-up post-stroke, was used as reference to determine the effect of time on the sensitivity of the mRS in differentiating functional recovery. Ninety-two patients with first stroke and hemispheric brain lesion were evaluated using the BI and mRS at 10 days, 3 and 6 months. The Kruskal-Wallis test was applied to examine median differences in BI among the mRS levels at 10 days, 3 and 6 months with Dunn's correction for multigroup comparison. The Mann and Whitney test was used to compare median differences in BI scores between two aggregations of mRS grades (mRS=0-2, mRS=3-5) at the same time periods after stroke. BI score distribution amongst mRS grades overlapped at 10 days, differentiating only between extreme grades (no disability vs severe disability). At 3 months, independent patients with slight disability could be distinguished from dependent patients with marked disability. At 6 months, grade 2 and 3 overlapped no more, differentiating independence (class 0-2) from dependence (class 3-5). The largest transition to an independent functional status occurred from grade 4, at 3 months. Maximum sensitivity of mRS in differentiating functional recovery is reached at six months post-stroke.

  10. An assistive control approach for a lower-limb exoskeleton to facilitate recovery of walking following stroke.

    Science.gov (United States)

    Murray, Spencer A; Ha, Kevin H; Hartigan, Clare; Goldfarb, Michael

    2015-05-01

    This paper presents a control approach for a lower-limb exoskeleton intended to facilitate recovery of walking in individuals with lower-extremity hemiparesis after stroke. The authors hypothesize that such recovery is facilitated by allowing the patient rather than the exoskeleton to provide movement coordination. As such, an assistive controller that provides walking assistance without dictating the spatiotemporal nature of joint movement is described here. Following a description of the control laws and finite state structure of the controller, the authors present the results of an experimental implementation and preliminary validation of the control approach, in which the control architecture was implemented on a lower limb exoskeleton, and the exoskeleton implemented in an experimental protocol on three subjects with hemiparesis following stroke. In a series of sessions in which each patient used the exoskeleton, all patients showed substantial single-session improvements in all measured gait outcomes, presumably as a result of using the assistive controller and exoskeleton.

  11. Robotics, stem cells, and brain-computer interfaces in rehabilitation and recovery from stroke: updates and advances.

    Science.gov (United States)

    Boninger, Michael L; Wechsler, Lawrence R; Stein, Joel

    2014-11-01

    The aim of this study was to describe the current state and latest advances in robotics, stem cells, and brain-computer interfaces in rehabilitation and recovery for stroke. The authors of this summary recently reviewed this work as part of a national presentation. The article represents the information included in each area. Each area has seen great advances and challenges as products move to market and experiments are ongoing. Robotics, stem cells, and brain-computer interfaces all have tremendous potential to reduce disability and lead to better outcomes for patients with stroke. Continued research and investment will be needed as the field moves forward. With this investment, the potential for recovery of function is likely substantial.

  12. Recovery in stroke rehabilitation through the rotation of preferred directions induced by bimanual movements: a computational study.

    Directory of Open Access Journals (Sweden)

    Ken Takiyama

    Full Text Available Stroke patients recover more effectively when they are rehabilitated with bimanual movement rather than with unimanual movement; however, it remains unclear why bimanual movement is more effective for stroke recovery. Using a computational model of stroke recovery, this study suggests that bimanual movement facilitates the reorganization of a damaged motor cortex because this movement induces rotations in the preferred directions (PDs of motor cortex neurons. Although the tuning curves of these neurons differ during unimanual and bimanual movement, changes in PD, but not changes in modulation depth, facilitate such reorganization. In addition, this reorganization was facilitated only when encoding PDs are rotated, but decoding PDs are not rotated. Bimanual movement facilitates reorganization because this movement changes neural activities through inter-hemispheric inhibition without changing cortical-spinal-muscle connections. Furthermore, stronger inter-hemispheric inhibition between motor cortices results in more effective reorganization. Thus, this study suggests that bimanual movement is effective for stroke rehabilitation because this movement rotates the encoding PDs of motor cortex neurons.

  13. 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.

  14. Determinants of Neurological Functional Recovery Potential after Stroke in Young Adults

    Directory of Open Access Journals (Sweden)

    Daniel Haselbach

    2014-04-01

    Full Text Available Background/Objectives: Despite recent progress in stroke prevention and acute treatment, neurorehabilitation remains one of the main methods of treatment in the management of stroke patients. The aim of this study is to point out some important predicting factors of in-hospital neurorehabilitation outcomes. Methods: A rehabilitation registry including all patients who had undergone a standardized program of neurorehabilitation at the neurorehabilitation unit of the Lausanne University Hospital, Lausanne, Switzerland, was created. Patients aged Results: Age >55 years, gender, aphasia, hemilateral spatial neglect, spasticity, complications, length of stay >70 days, entry FIM >100 and relative possible FIM gain/week of >10% were considered to be significant and independent predicting factors of the neurorehabilitation outcome. Discussion/Conclusion: Some factors of the in-hospital rehabilitation period have been identified before (spasticity, complications, length of stay, relative possible FIM gain/week and should be considered for a better management of the neurorehabilitation therapy. In addition, a personalized rehabilitation strategy based on the patient's individual needs should be aimed at. The question of resource allocation can also be addressed with regard to the present findings.

  15. Evaluation of a sequential global test of improved recovery following stroke as applied to the ICTUS trial of citicoline.

    Science.gov (United States)

    Bolland, Kim; Whitehead, John; Cobo, Erik; Secades, Julio J

    2009-01-01

    The International Citicoline Trial in acUte Stroke is a sequential phase III study of the use of the drug citicoline in the treatment of acute ischaemic stroke, which was initiated in 2006 in 56 treatment centres. The primary objective of the trial is to demonstrate improved recovery of patients randomized to citicoline relative to those randomized to placebo after 12 weeks of follow-up. The primary analysis will take the form of a global test combining the dichotomized results of assessments on three well-established scales: the Barthel Index, the modified Rankin scale and the National Institutes of Health Stroke Scale. This approach was previously used in the analysis of the influential National Institute of Neurological Disorders and Stroke trial of recombinant tissue plasminogen activator in stroke.The purpose of this paper is to describe how this trial was designed, and in particular how the simultaneous objectives of taking into account three assessment scales, performing a series of interim analyses and conducting treatment allocation and adjusting the analyses to account for prognostic factors, including more than 50 treatment centres, were addressed. Copyright 2008 John Wiley & Sons, Ltd.

  16. Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke.

    Science.gov (United States)

    Bao, Xiao; Mao, Yurong; Lin, Qiang; Qiu, Yunhai; Chen, Shaozhen; Li, Le; Cates, Ryan S; Zhou, Shufeng; Huang, Dongfeng

    2013-11-05

    The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game controller, and provides rehabilitation training for stroke patients with lower limb dysfunctions. However, the underlying mechanism remains unclear. In this study, 18 healthy subjects and five patients after subacute stroke were included. The five patients were scanned using functional MRI prior to training, 3 weeks after training and at a 12-week follow-up, and then compared with healthy subjects. The Fugl-Meyer Assessment and Wolf Motor Function Test scores of the hemiplegic upper limbs of stroke patients were significantly increased 3 weeks after training and at the 12-week follow-up. Functional MRI results showed that contralateral primary sensorimotor cortex was activated after Kinect-based virtual reality training in the stroke patients compared with the healthy subjects. Contralateral primary sensorimotor cortex, the bilateral supplementary motor area and the ipsilateral cerebellum were also activated during hand-clenching in all 18 healthy subjects. Our findings indicate that Kinect-based virtual reality training could promote the recovery of upper limb motor function in subacute stroke patients, and brain reorganization by Kinect-based virtual reality training may be linked to the contralateral sensorimotor cortex.

  17. Hand function recovery in chronic stroke with HEXORR robotic training: A case series.

    Science.gov (United States)

    Godfrey, Sasha Blue; Schabowsky, Christopher N; Holley, Rahsaan J; Lum, Peter S

    2010-01-01

    After a stroke, many survivors have impaired motor function. Robotic rehabilitation techniques have emerged to provide a repetitive, activity-based therapy at potentially lower cost than conventional methods. Many patients exhibit intrinsic resistance to hand extension in the form of spasticity and/or hypertonia. We have developed a therapy program using the Hand Exoskeleton Rehabilitation Robot (HEXORR) that is capable of compensating for tone to assist patients in opening the paretic hand. The system can move the user's hand, assist movement, allow free movement, or restrict movement to allow static force production. These options combine with an interactive virtual reality game to enhance user motivation. Four chronic stroke subjects received 18 sessions of robot therapy as well as pre and post evaluation sessions. All subjects showed at least modest gains in active finger range of motion (ROM) measured in the robot, and all but one subject had gains in active thumb ROM. Most of these gains carried over to ROM gains outside of the robot. The clinical measures (Fugl-Meyer, Box-and-Blocks) showed clear improvements in two subjects and mixed results in two subjects. Overall, the robot therapy was well received by subjects and shows promising results. We conclude HEXORR therapy is best suited for patients with mild-moderate tone and at least minimal extension.

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

    Science.gov (United States)

    Kahn, Leonard E; Zygman, Michele L; Rymer, W Zev; Reinkensmeyer, David J

    2006-06-21

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

  19. The Impact of Falls on Motor and Cognitive Recovery after Discharge from In-Patient Stroke Rehabilitation.

    Science.gov (United States)

    Wong, Jennifer S; Brooks, Dina; Inness, Elizabeth L; Mansfield, Avril

    2016-07-01

    Falls are common among community-dwelling stroke survivors. The aims of this study were (1) to compare motor and cognitive outcomes between individuals who fell in the 6 months' postdischarge from in-patient stroke rehabilitation and those who did not fall, and (2) to explore potential mechanisms underlying the relationship between falls and recovery of motor and cognitive function. Secondary analysis of a prospective cohort study of individuals discharged home from in-patient rehabilitation was conducted. Participants were recruited at discharge and completed a 6-month falls monitoring period using postcards with follow-up. Nonfallers and fallers were compared at the 6-month follow-up assessment on the Berg Balance Scale (BBS), the Chedoke-McMaster Stroke Assessment (CMSA), gait speed, and the Montreal Cognitive Assessment (MoCA). Measures of balance confidence and physical activity were also assessed. Twenty-three fallers were matched to 23 nonfallers on age and functional balance scores at discharge. A total of 43 falls were reported during the study period (8 participants fell more than once). At follow-up, BBS scores (P = .0066) and CMSA foot scores (P = .0033) were significantly lower for fallers than for nonfallers. The 2 groups did not differ on CMSA leg scores (P = .049), gait speed (P = .47), or MoCA score (P = .23). There was no significant association between change in balance confidence scores and change in physical activity levels among all participants from the first and third questionnaire (r = .27, P = .08). Performance in balance and motor recovery of the foot were compromised in fallers when compared to nonfallers at 6 months post discharge from in-patient stroke rehabilitation. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. The effects of increased dose of exercise-based therapies to enhance motor recovery after stroke: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Tallis Raymond C

    2010-10-01

    Full Text Available Abstract Background Exercise-based therapy is known to enhance motor recovery after stroke but the most appropriate amount, i.e. the dose, of therapy is unknown. To determine the strength of current evidence for provision of a higher dose of the same types of exercise-based therapy to enhance motor recovery after stroke. Methods An electronic search of: MEDLINE, EMBASE, CINHAL, AMED, and CENTRAL was undertaken. Two independent reviewers selected studies using predetermined inclusion criteria: randomised or quasi randomised controlled trials with or without blinding of assessors; adults, 18+ years, with a clinical diagnosis of stroke; experimental and control group interventions identical except for dose; exercise-based interventions investigated; and outcome measures of motor impairment, movement control or functional activity. Two reviewers independently extracted outcome and follow-up data. Effect sizes and 95% confidence intervals were interpreted with reference to risk of bias in included studies. Results 9 papers reporting 7 studies were included. Only 3 of the 7 included studies had all design elements assessed as low risk of bias. Intensity of the control intervention ranged from a mean of 9 to 28 hours over a maximum of 20 weeks. Experimental groups received between 14 and 92 hours of therapy over a maximum of 20 weeks. The included studies were heterogeneous with respect to types of therapy, outcome measures and time-points for outcome and follow-up. Consequently, most effect sizes relate to one study only. Single study effect sizes suggest a trend for better recovery with increased dose at the end of therapy but this trend was less evident at follow-up Meta-analysis was possible at outcome for: hand-grip strength, -10.1 [-19.1,-1.2] (2 studies, 97 participants; Action Research Arm Test (ARAT, 0.1 [-5.7,6.0] (3 studies, 126 participants; and comfortable walking speed, 0.3 [0.1,0.5] (2 studies, 58 participants. At follow-up, between 12

  1. The role of sleep in recovery following ischemic stroke: A review of human and animal data

    OpenAIRE

    Duss, Simone B.; Seiler, Andrea; Schmidt, Markus H.; Pace, Marta; Adamantidis, Antoine; Müri, René M.; Bassetti, Claudio L.

    2016-01-01

    Despite advancements in understanding the pathophysiology of stroke and the state of the art in acute management of afflicted patients as well as in subsequent neurorehabilitation training, stroke remains the most common neurological cause of long-term disability in adulthood. To enhance stroke patients’ independence and well-being it is necessary, therefore, to consider and develop new therapeutic strategies and approaches. We postulate that sleep might play a pivotal role in neurorehabilita...

  2. Effect of action observation therapy on daily activities and motor recovery in stroke patients

    Directory of Open Access Journals (Sweden)

    Mei-Hong Zhu

    2015-09-01

    Conclusion: Action observation therapy significantly improves upper extremity motor function and performance of activities of daily living, and alleviates upper limb spasticity in patients with stroke.

  3. Transcranial magnetic stimulation as an investigative tool for motor dysfunction and recovery in stroke: an overview for neurorehabilitation clinicians.

    Science.gov (United States)

    Cortes, Mar; Black-Schaffer, Randie M; Edwards, Dylan J

    2012-07-01

    An improved understanding of motor dysfunction and recovery after stroke has important clinical implications that may lead to the design of more effective rehabilitation strategies for patients with hemiparesis. Transcranial magnetic stimulation (TMS) is a safe and painless tool that has been used in conjunction with other existing diagnostic tools to investigate motor pathophysiology in stroke patients. Since TMS emerged more than two decades ago, its application in clinical and basic neuroscience has expanded worldwide. TMS can quantify the corticomotor excitability properties of clinically affected and unaffected muscles and can probe local cortical networks as well as remote but functionally related areas. This provides novel insight into the physiology of neural circuits underlying motor dysfunction and brain reorganization during the motor recovery process. This important tool needs to be used with caution by clinical investigators, its limitations need to be understood, and the results should to be interpreted along with clinical evaluation in this patient population. In this review, we provide an overview of the rationale, implementation, and limitations of TMS to study stroke motor physiology. This knowledge may be useful to guide future rehabilitation treatments by assessing and promoting functional plasticity. © 2012 International Neuromodulation Society.

  4. Transcranial magnetic stimulation as an investigative tool for motor dysfunction and recovery in stroke: an overview for neurorehabilitation clinicians

    Science.gov (United States)

    Cortes, Mar; Black-Schaffer, Randie M; Edwards, Dylan J

    2012-01-01

    Rationale An improved understanding of motor dysfunction and recovery after stroke has important clinical implications that may lead to the design of more effective rehabilitation strategies for patients with hemiparesis. Scope Transcranial magnetic stimulation (TMS) is a safe and painless tool that has been used in conjunction with other existing diagnostic tools to investigate motor pathophysiology in stroke patients. Since TMS emerged over two decades ago, its application in clinical and basic neuroscience has expanded worldwide. TMS can quantify the corticomotor excitability properties of clinically affected and unaffected muscles, and probe local cortical networks, as well as remote but functionally related areas. This provides novel insight into the physiology of neural circuits underlying motor dysfunction, and brain reorganization during the motor recovery process. This important tool needs to be used with caution by clinical investigators, its limitations need to be understood and the results should be interpreted along with clinical evaluation in this patient population. Summary In this review, we provide an overview of the rationale, implementation and limitations of TMS to study stroke motor physiology. This knowledge may be useful to guide future rehabilitation treatments by assessing and promoting functional plasticity. PMID:22624621

  5. Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke.

    Science.gov (United States)

    Aşkın, Ayhan; Atar, Emel; Koçyiğit, Hikmet; Tosun, Aliye

    2018-03-13

    Therapeutic benefits of Kinect-based virtual reality (VR) game training in rehabilitation encourage its use to improve motor function. To assess the effects of Kinect-based VR training on motor recovery of the upper extremity and functional outcomes in patients with chronic stroke. In this randomized controlled trial, group A received 20 sessions of physical therapy (PT) + 20 sessions of Kinect-based VR training and group B received only 20 sessions of PT. Clinical outcome measures were assessed at baseline and at the end of the treatments. Primary outcome measures that assess stroke patients' motor function included upper extremity (UE) Fugl-Meyer Assessment (FMA). Secondary outcome measures were Brunnstrom Recovery Stages (BRS), Modified Ashworth Scale (MAS), Box and Block test (BBT), Motricity index (MI), and active range of motion (AROM) measurement. Statistically significant improvements in game scores (p VR training may contribute to the improvement of UE motor function and AROM in chronic stroke patients. Further studies with a larger number of subjects with longer follow-up periods are needed to establish its effectiveness in neurorehabilitation.

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

    Directory of Open Access Journals (Sweden)

    Chao-jin-zi Li

    2016-01-01

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

  7. Methods of tritium recovery from molten lithium

    International Nuclear Information System (INIS)

    Farookhi, R.; Rogers, J.E.

    1968-01-01

    It is important to keep the tritium inventory in a blanket of a thermonuclear reactor at a low level both to eliminate possible hydriding of structural components and to reduce inventory cost. Removing the tritium from a lithium blanket by fractional distillation, flash vaporization, and fractional crystallization was investigated. No definitive data are available either on the vapor-liquid equilibrium between lithium and tritium at low T 2 concentrations, or on the rate of formation and decomposition of lithium tritide. The final distinction between the recovery systems discussed in this report will depend on such data, but presently distillation appears to be the best alternate to the diffusion scheme proposed by A.P. Fraas. The capital cost of equipment necessary to remove tritium by distillation appears to be greater than 10 million dollars for a 5000 MW system, whereas the capital cost associated with the diffusion process has been estimated to be 4 million dollars

  8. Time-varying Markov regression random-effect model with Bayesian estimation procedures: Application to dynamics of functional recovery in patients with stroke.

    Science.gov (United States)

    Pan, Shin-Liang; Chen, Hsiu-Hsi

    2010-09-01

    The rates of functional recovery after stroke tend to decrease with time. Time-varying Markov processes (TVMP) may be more biologically plausible than time-invariant Markov process for modeling such data. However, analysis of such stochastic processes, particularly tackling reversible transitions and the incorporation of random effects into models, can be analytically intractable. We make use of ordinary differential equations to solve continuous-time TVMP with reversible transitions. The proportional hazard form was used to assess the effects of an individual's covariates on multi-state transitions with the incorporation of random effects that capture the residual variation after being explained by measured covariates under the concept of generalized linear model. We further built up Bayesian directed acyclic graphic model to obtain full joint posterior distribution. Markov chain Monte Carlo (MCMC) with Gibbs sampling was applied to estimate parameters based on posterior marginal distributions with multiple integrands. The proposed method was illustrated with empirical data from a study on the functional recovery after stroke. Copyright 2010 Elsevier Inc. All rights reserved.

  9. A Randomized Controlled Pilot Study of the Triple Stimulation Technique in the Assessment of Electroacupuncture for Motor Function Recovery in Patients with Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Feng Tan

    2013-01-01

    Full Text Available The objective of this pilot study was to objectively assess electroacupuncture for motor function recovery in patients with acute ischemic stroke using the triple-stimulation technique (TST. The patients received either electroacupuncture plus western conventional medication (WCM (n=32 or single WCM (n=31 for 14 days. The total clinical effective rate was statistically significantly superior in electroacupuncture group to that in WCM group (P0.05. In conclusion, electroacupuncture was beneficial for the motor function recovery of patients with acute ischemic stroke and was generally safe. TST can be used for quantitative evaluation of electroacupuncture for motor function recovery in patients with acute ischemic stroke because it can objectively analyze the injury and recovery of corticospinal tract impairments.

  10. Effect of biofeedback cycling training on functional recovery and walking ability of lower extremity in patients with stroke.

    Science.gov (United States)

    Yang, Huei-Ching; Lee, Chia-Ling; Lin, Roxane; Hsu, Miao-Ju; Chen, Chia-Hsin; Lin, Jau-Hong; Lo, Sing Kai

    2014-01-01

    This study aimed to investigate the effectiveness of biofeedback cycling training on lower limb functional recovery, walking endurance, and walking speed for patients with chronic stroke. Thirty-one patients with stroke (stroke onset >3 months) were randomly assigned into two groups using a crossover design. One group (N = 16; mean: 53.6 ± 10.3 years) underwent conventional rehabilitation and cycling training (30 minutes/time, 5 times per week for 4 weeks), followed by only conventional rehabilitation for another 4 weeks. The other group (N = 15; mean: 54.5 ± 8.0 years) underwent the same training in reverse order. The bike used in this biofeedback cycling training was the MOTOmed viva2 Movement Trainer. Outcome measures included the lower extremity subscale of Fugl-Meyer assessment (LE-FMA), the 6-minute walk test (6MWT), the 10-meter walk test (10MWT), and the modified Ashworth scale (MAS). All participants were assessed at the beginning of the study, at the end of the 4(th) week, and at the end of the 8(th) week. Thirty participants completed the study, including the cycling training interventions and all assessments. The results showed that improvements in the period with cycling training were significantly better than the noncycling period in the LE-FMA (p cycling period and the noncycling period after adjusting for potential confounding factors in the multivariate analysis of variance (p cycling training could lead to improved LE functional recovery, walking endurance, and speed for patients with chronic stroke. Copyright © 2013. Published by Elsevier B.V.

  11. Efficacy of a Virtual Reality Commercial Gaming Device in Upper Limb Recovery after Stroke: A Randomized, Controlled Study.

    Science.gov (United States)

    Kong, Keng-He; Loh, Yong-Joo; Thia, Ernest; Chai, Audrey; Ng, Chwee-Yin; Soh, Yan-Ming; Toh, Shirlene; Tjan, Soon-Yin

    2016-10-01

    To compare the efficacy of a virtual reality commercial gaming device, Nintendo wii (NW) with conventional therapy and customary care in facilitating upper limb recovery after stroke. Randomized, controlled, single-blinded study. Tertiary rehabilitation center. 105 subjects admitted to in inpatient rehabilitation program within 6 weeks of stroke onset. Subjects were randomly assigned to one of three groups of upper limb exercises: (1) NW gaming; (2) conventional therapy; (3) control. NW gaming and conventional therapy were provided fourtimes a week for 3 weeks. The main outcome measure was Fugl-Meyer assessment (FMA) of upper limb function. Secondary outcome measures included Action Research Arm Test, Functional Independence Measure, and Stroke Impact Scale. These measures were assessed at baseline, completion of intervention (week 3) and at 4 weeks and 8 weeks after completion of intervention. The primary outcome measure was the change in FMA scores at completion of intervention. The mean age was 57.5±9.8 years, and subjects were enrolled at a mean of 13.7±8.9 days after stroke. The mean baseline FMA score was 16.4±14.2. There was no difference in FMA scores between all 3 groups at the end of intervention, and at 4 and 8 weeks after completion of intervention. Similar findings were also noted for the secondary outcome measures. Twelve sessions of augmented upper limb exercises via NW gaming or conventional therapy over a 3-week period was not effective in enhancing upper limb motor recovery compared to control.

  12. Temporal evolution of event-related desynchronization in acute stroke: A pilot study

    NARCIS (Netherlands)

    Tangwiriyasakul, Chayanin; Verhagen, Rens; Rutten, Wim; van Putten, Michel Johannes Antonius Maria

    2014-01-01

    Objective Assessment of event-related desynchronization (ERD) may assist in predicting recovery from stroke and rehabilitation, for instance in BCI applications. Here, we explore the temporal evolution of ERD during stroke recovery. Methods Ten stroke patients and eleven healthy controls were

  13. Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: A randomized sham-controlled pilot trial

    Directory of Open Access Journals (Sweden)

    Uthra Mohan

    2013-01-01

    Full Text Available Objective: To evaluate the effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke. Design: A randomized, sham-controlled, assessor blinded, pilot trial. Setting: Inpatient stroke rehabilitation unit. Subjects: First time onset of stroke with mean post-stroke duration of 6.41 days, able to respond to verbal instructions, and Brunnstrom recovery stage 2 and above were enrolled. Intervention: Mirror therapy group performed 30 minutes of functional synergy movements of non-paretic lower extremity, whereas control group underwent sham therapy with similar duration. In addition, both groups were administered with conventional stroke rehabilitation regime. Altogether 90 minutes therapy session per day, six days a week, for two weeks duration was administered to both groups. Outcome Measures: Lower extremity motor subscale of Fugl Meyer Assessment (FMA, Brunnel Balance Assessment (BBA and Functional Ambulation Categories (FAC. Results: Amongst the 22 patients included, equal number of patients participated in mirror group (N = 11 and control group (N = 11. Baseline variables were similar in both groups, except for Brunnstrom recovery stage. There was no statistical difference between groups, except for FAC. (FMA: P = 0.894; BBA: P = 0.358; FAC: P = 0.02. Significance was set at P < 0.05. Conclusion: Administration of mirror therapy early after stroke is not superior to conventional treatment in improving lower limb motor recovery and balance, except for improvement in mobility.

  14. Factors Associated With Upper Extremity Functional Recovery Following Low-Frequency Repetitive Transcranial Magnetic Stimulation in Stroke Patients.

    Science.gov (United States)

    Kim, Seo Young; Shin, Sung Bong; Lee, Seong Jae; Kim, Tae Uk; Hyun, Jung Keun

    2016-06-01

    To investigate the factors related to upper extremity functional improvement following inhibitory repetitive transcranial magnetic stimulation (rTMS) in stroke patients. Forty-one stroke patients received low-frequency rTMS over the contralesional hemisphere according to a standard protocol, in addition to conventional physical and occupational therapy. The rTMS-treated patients were divided into two groups according to their responsiveness to rTMS measured by the self-care score of the Korean version of Modified Barthel Index (K-MBI): responded group (n=19) and non-responded group (n=22). Forty-one age-matched stroke patients who had not received rTMS served as controls. Neurological, cognitive and functional assessments were performed before rTMS and 4 weeks after rTMS treatment. Among the rTMS-treated patients, the responded group was significantly younger than the non-responded group (51.6±10.5 years and 65.5±13.7 years, respectively; p=0.001). Four weeks after rTMS, the National Institutes of Health Stroke Scale, the Brunnstrom recovery stage and upper extremity muscle power scores were significantly more improved in the responded group than in the control group. Besides the self-care score, the mobility score of the K-MBI was also more improved in the responded group than in the non-responded group or controls. Age is the most obvious factor determining upper extremity functional responsiveness to low-frequency rTMS in stroke patients.

  15. Bobath Concept versus constraint-induced movement therapy to improve arm functional recovery in stroke patients: a randomized controlled trial.

    Science.gov (United States)

    Huseyinsinoglu, Burcu Ersoz; Ozdincler, Arzu Razak; Krespi, Yakup

    2012-08-01

    To compare the effects of the Bobath Concept and constraint-induced movement therapy on arm functional recovery among stroke patients with a high level of function on the affected side. A single-blinded, randomized controlled trial. Outpatient physiotherapy department of a stroke unit. A total of 24 patients were randomized to constraint-induced movement therapy or Bobath Concept group. The Bobath Concept group was treated for 1 hour whereas the constraint-induced movement therapy group received training for 3 hours per day during 10 consecutive weekdays. Main measures were the Motor Activity Log-28, the Wolf Motor Function Test, the Motor Evaluation Scale for Arm in Stroke Patients and the Functional Independence Measure. The two groups were found to be homogeneous based on demographic variables and baseline measurements. Significant improvements were seen after treatment only in the 'Amount of use' and 'Quality of movement' subscales of the Motor Activity Log-28 in the constraint-induced movement therapy group over the the Bobath Concept group (P = 0.003; P = 0.01 respectively). There were no significant differences in Wolf Motor Function Test 'Functional ability' (P = 0.137) and 'Performance time' (P = 0.922), Motor Evaluation Scale for Arm in Stroke Patients (P = 0.947) and Functional Independence Measure scores (P = 0.259) between the two intervention groups. Constraint-induced movement therapy and the Bobath Concept have similar efficiencies in improving functional ability, speed and quality of movement in the paretic arm among stroke patients with a high level of function. Constraint-induced movement therapy seems to be slightly more efficient than the Bobath Concept in improving the amount and quality of affected arm use.

  16. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Winstein, Carolee J; Stein, Joel; Arena, Ross; Bates, Barbara; Cherney, Leora R; Cramer, Steven C; Deruyter, Frank; Eng, Janice J; Fisher, Beth; Harvey, Richard L; Lang, Catherine E; MacKay-Lyons, Marilyn; Ottenbacher, Kenneth J; Pugh, Sue; Reeves, Mathew J; Richards, Lorie G; Stiers, William; Zorowitz, Richard D

    2016-06-01

    The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from

  17. The axon-glia unit in white matter stroke: mechanisms of damage and recovery.

    Science.gov (United States)

    Rosenzweig, Shira; Carmichael, S Thomas

    2015-10-14

    Approximately one quarter of all strokes in humans occur in white matter, and the progressive nature of white matter lesions often results in severe physical and mental disability. Unlike cortical grey matter stroke, the pathology of white matter stroke revolves around disrupted connectivity and injured axons and glial cells, rather than neuronal cell bodies. Consequently, the mechanisms behind ischemic damage to white matter elements, the regenerative responses of glial cells and their signaling pathways, all differ significantly from those in grey matter. Development of effective therapies for white matter stroke would require an enhanced understanding of the complex cellular and molecular interactions within the white matter, leading to the identification of new therapeutic targets. This review will address the unique properties of the axon-glia unit during white matter stroke, describe the challenging process of promoting effective white matter repair, and discuss recently-identified signaling pathways which may hold potential targets for repair in this disease. This article is part of a Special Issue entitled SI: Cell Interactions In Stroke. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Enriched housing enhances recovery of limb placement ability and reduces aggrecan-containing perineuronal nets in the rat somatosensory cortex after experimental stroke.

    Directory of Open Access Journals (Sweden)

    Alexandre Madinier

    Full Text Available Stroke causes life long disabilities where few therapeutic options are available. Using electrical and magnetic stimulation of the brain and physical rehabilitation, recovery of brain function can be enhanced even late after stroke. Animal models support this notion, and housing rodents in an enriched environment (EE several days after experimental stroke stimulates lost brain function by multisensory mechanisms. We studied the dynamics of functional recovery of rats with a lesion to the fore and hind limb motor areas induced by photothrombosis (PT, and with subsequent housing in either standard (STD or EE. In this model, skilled motor function is not significantly enhanced by enriched housing, while the speed of recovery of sensori-motor function substantially improves over the 9-week study period. In particular, this stroke lesion completely obliterates the fore and hind limb placing ability when visual and whisker guidance is prevented, a deficit that persists for up to 9 weeks of recovery, but that is markedly restored within 2 weeks by enriched housing. Enriched housing after stroke also leads to a significant loss of perineuronal net (PNN immunoreactivity; detection of aggrecan protein backbone with AB1031 antibody was decreased by 13-22%, and labelling of a glycan moiety of aggrecan with Cat-315 antibody was reduced by 25-30% in the peri-infarct area and in the somatosensory cortex, respectively. The majority of these cells are parvalbumin/GABA inhibitory interneurons that are important in sensori-information processing. We conclude that damage to the fore and hind limb motor areas provides a model of loss of limb placing response without visual guidance, a deficit also seen in more than 50% of stroke patients. This loss is amenable to recovery induced by multiple sensory stimulation and correlates with a decrease in aggrecan-containing PNNs around inhibitory interneurons. Modulating the PNN structure after ischemic damage may provide new

  19. Integrating Lesion-Symptom Mapping with Other Methods to Investigate Language Networks and Aphasia Recovery

    Directory of Open Access Journals (Sweden)

    Peter E Turkeltaub

    2015-04-01

    Full Text Available Voxel-based lesion-symptom mapping (VLSM has provided valuable insights into the neural underpinnings of various language functions. Integrating lesion mapping methods with other neuroscience techniques may provide new opportunities to investigate questions related both to the neurobiology of language and to plasticity after brain injury. For example, recent diffusion tensor imaging studies have explored relationships between aphasia symptomology and damage in specific white matter tracts (Forkel et al., 2014 or disruption of the white matter connectome (Bonilha, Rorden, & Fridriksson, 2014. VLSM has also recently been used to assess correlations between lesion location and response to transcranial direct current stimulation aphasia treatment (Campana, Caltagirone, & Marangolo, 2015. We have recently undertaken studies integrating VLSM with other techniques, including voxel-based morphometry (VBM and functional MRI, in order to investigate how parts of the brain spared by stroke contribute to recovery. VLSM can be used in this context to map lesions associated with particular patterns of plasticity in brain structure, function, or connectivity. We have also used VLSM to estimate the variance in behavior due to the stroke itself so that this lesion-symptom relationship can be controlled for when examining the contributions of the rest of the brain. Using this approach in combination with VBM, we have identified areas of the right temporoparietal cortex that appear to undergo hypertrophy after stroke and compensate for speech production deficits. In this talk, I will review recent advances in integrating lesion-symptom mapping with other imaging and brain stimulation techniques in order to better understand the brain basis of language and of aphasia recovery.

  20. Can kinesio tape be used as an ankle training method in the rehabilitation of the stroke patients?

    Science.gov (United States)

    Koseoglu, Belma Fusun; Dogan, Asuman; Tatli, Hilmi Umut; Sezgin Ozcan, Didem; Polat, Cemile Sevgi

    2017-05-01

    To investigate the effects of the kinesio tape application to the tibialis anterior on rehabilitation outcomes of the stroke patients. Twenty patients with stroke were allocated into two groups: the first group of ten patients was assigned to receive kinesio tape in addition to the conventional rehabilitation program while a second group of 10 patients was assigned to receive a conventional rehabilitation program only. The clinical variables and health-related quality of life (HRQoL) were evaluated at baseline and at the end of the forth week. The present study showed that kinesio tape application to the tibialis anterior has significant effects on motor recovery of the lower extremity, spasticity, ambulation capacity, HRQoL and gait compared to the control group and baseline. The results of this study suggest that kinesio tape can be used as an ankle training method. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. [Observation on clinical therapeutic effect of "mother-son" reinforcing-reducing method on stroke at restoration stage].

    Science.gov (United States)

    Wang, Li; Yan, De-Ying

    2005-05-01

    To probe into the role of "mother-son" reinforcing-reducing method of five Shu points in clinical treatment of stroke at restoration stage. Sixty-six cases of stroke were randomly divided into a treatment group (n = 34) and a control group (n = 32). The treatment group were treated by acupuncture at acupoints of The Hand-Yangming and The Foot-Yangming Channels, and "mother-son" reinforcing-reducing method of the five Shu for reinforcing deficiency and reducing excess according to deficiency and excess of channels differentiated by Cunkou Renying diagnosis; the control group were treated only by acupuncture at acupoints of The Hand-Yangming and Foot-Yangming Channels with uniform reinforcing-reducing method. Blood flow velocity in Cunkou and Renying Vessels before and after treatment were determined with transcranial Doppler ultrasono-blood flow meter and their clinical therapeutic effects were compared. There was a very significant difference before and after treatment in blood flow velocity in Cunkou and Renying vessels in the treatment group; the clinically basic recovery and markedly improving rate after treatment in the treatment group was significantly superior to that in the control group (P mother-son" reinforcing-reducing method of five Shu points based on differentiation of yin, yang and deficiency and excess of channels by Cunkou and Renying Vessel methods can increase clinical therapeutic effect on stroke at restoration stage.

  2. Method for silicon nitride precursor solids recovery

    Science.gov (United States)

    Crosbie, Gary M.; Predmesky, Ronald L.; Nicholson, John M.

    1992-12-15

    Method and apparatus are provided for collecting reaction product solids entrained in a gaseous outflow from a reaction situs, wherein the gaseous outflow includes a condensable vapor. A condensate is formed of the condensable vapor on static mixer surfaces within a static mixer heat exchanger. The entrained reaction product solids are captured in the condensate which can be collected for further processing, such as return to the reaction situs. In production of silicon imide, optionally integrated into a production process for making silicon nitride caramic, wherein reactant feed gas comprising silicon halide and substantially inert carrier gas is reacted with liquid ammonia in a reaction vessel, silicon imide reaction product solids entrained in a gaseous outflow comprising residual carrier gas and vaporized ammonia can be captured by forming a condensate of the ammonia vapor on static mixer surfaces of a static mixer heat exchanger.

  3. Effectiveness of commercial gaming-based virtual reality movement therapy on functional recovery of upper extremity in subacute stroke patients.

    Science.gov (United States)

    Choi, Jun Hwan; Han, Eun Young; Kim, Bo Ryun; Kim, Sun Mi; Im, Sang Hee; Lee, So Young; Hyun, Chul Woong

    2014-08-01

    To investigate the effectiveness of commercial gaming-based virtual reality (VR) therapy on the recovery of paretic upper extremity in subacute stroke patients. Twenty patients with the first-onset subacute stroke were enrolled and randomly assigned to the case group (n=10) and the control group (n=10). Primary outcome was measured by the upper limb score through the Fugl-Meyer Assessment (FMA-UL) for the motor function of both upper extremities. Secondary outcomes were assessed for motor function of both upper extremities including manual function test (MFT), box and block test (BBT), grip strength, evaluated for activities of daily living (Korean version of Modified Barthel Index [K-MBI]), and cognitive functions (Korean version of the Mini-Mental State Examination [K-MMSE] and continuous performance test [CPT]). The case group received commercial gaming-based VR therapy using Wii (Nintendo, Tokyo, Japan), and the control group received conventional occupational therapy (OT) for 30 minutes a day during the period of 4 weeks. All patients were evaluated before and after the 4-week intervention. There were no significant differences in the baseline between the two groups. After 4 weeks, both groups showed significant improvement in the FMA-UL, MFT, BBT, K-MBI, K-MMSE, and correct detection of auditory CPT. However, grip strength was improved significantly only in the case group. There were no significant intergroup differences before and after the treatment. These findings suggested that the commercial gaming-based VR therapy was as effective as conventional OT on the recovery of upper extremity motor and daily living function in subacute stroke patients.

  4. Effects of virtual reality-based training with BTs-Nirvana on functional recovery in stroke patients: preliminary considerations.

    Science.gov (United States)

    De Luca, Rosaria; Russo, Margherita; Naro, Antonino; Tomasello, Provvidenza; Leonardi, Simona; Santamaria, Floriana; Desireè, Latella; Bramanti, Alessia; Silvestri, Giuseppe; Bramanti, Placido; Calabrò, Rocco Salvatore

    2018-02-02

    Cognitive impairment occurs frequently in post-stroke patients. This study aimed to determine the effects of a virtual reality training (VRT) with BTs-Nirvana (BTsN) on the recovery of cognitive functions in stroke patients, using the Interactive-Semi-Immersive Program (I-SIP). We enrolled 12 subjects (randomly divided into two groups: experimental group (EG); and control group (CG)), who attended the Laboratory of Robotic and Cognitive Rehabilitation of IRCCS Neurolesi of Messina from January to June 2016. The EG underwent a VRT with BTsN, whereas CG received a standard cognitive treatment. Both the groups underwent the same conventional physiotherapy program. Each treatment session lasted 45 minutes and was repeated three times a week for 8 weeks. All the patients were evaluated by a specific clinical-psychometric battery before (T0), immediately (T1), and one month (T2) after the end of the training. At T1, the EG presented a greater improvement in the trunk control test (p = 0.03), the Montreal Cognitive Assessment (p = 0.01), the selective attention assessment scores (p = 0.01), the verbal memory (p = 0.03), and the visuospatial and constructive abilities (p = 0.01), as compared to CG. Moreover, such amelioration persisted at T2 only in the EG. According to these preliminary data, VRT with I-SIP can be considered a useful complementary treatment to potentiate functional recovery, with regard to attention, visual-spatial deficits, and motor function in patients affected by stroke.

  5. Cerebrolysin for functional recovery in patients with acute ischemic stroke: a meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Wang ZF

    2017-04-01

    Full Text Available Zefeng Wang,1,* Ligen Shi,1,* Shenbin Xu,1 Jianmin Zhang1–3 1Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, 2Brain Research Institute, 3Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, People’s Republic of China *These authors contributed equally to this work Abstract: Cerebrolysin has been shown to have an inconsistent efficacy on functional recovery in patients with acute ischemic stroke (AIS. The present meta-analysis aims to evaluate the value of cerebrolysin and to explore the potential influencing factors. The main electronic databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched. The primary outcome was functional recovery at Day 90. The secondary outcomes included mortality and adverse events. A total of 1,649 patients with AIS were pooled from six randomized controlled trials (RCTs. Cerebrolysin had no significant effect on functional recovery at Day 90 compared with the effect of placebo as shown by the modified Rankin Scale response (relative risk [RR] 1.33, 95% confidence interval [CI] 0.79–2.24, P=0.28, National Institutes of Health Stroke Scale response (RR 1.03, 95% CI 0.83–1.28, P=0.77, and Barthel Index response (RR 0.95, 95% CI 0.84–1.08, P=0.44. In safety analysis, cerebrolysin did not increase the risk of adverse events (RR 0.98, 95% CI 0.88–1.09, P=0.67, risk of serious adverse events (RR 1.20, 95% CI 0.86–1.66, P=0.29, or the mortality rate (RR 0.86, 95% CI 0.57–1.31, P=0.49. In conclusion, routine administration of cerebrolysin to patients with AIS cannot be supported by the available evidence from RCTs. Keywords: acute ischemic stroke, cerebrolysin, functional recovery, meta-analysis, randomized controlled trials

  6. 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)

  7. Optimal Scoring Methods of Hand-Strength Tests in Patients with Stroke

    Science.gov (United States)

    Huang, Sheau-Ling; Hsieh, Ching-Lin; Lin, Jau-Hong; Chen, Hui-Mei

    2011-01-01

    The purpose of this study was to determine the optimal scoring methods for measuring strength of the more-affected hand in patients with stroke by examining the effect of reducing measurement errors. Three hand-strength tests of grip, palmar pinch, and lateral pinch were administered at two sessions in 56 patients with stroke. Five scoring methods…

  8. Adherence to postacute rehabilitation guidelines is associated with functional recovery in stroke.

    Science.gov (United States)

    Duncan, Pamela W; Horner, Ronnie D; Reker, Dean M; Samsa, Gregory P; Hoenig, Helen; Hamilton, Byron; LaClair, Barbara J; Dudley, Tara K

    2002-01-01

    The purpose of this study was to determine if compliance with poststroke rehabilitation guidelines was associated with better functional outcomes. An inception cohort of 288 stroke patients in 11 Department of Veteran Affairs Medical Centers hospitalized between January 1998 and March 1999 were followed prospectively for 6 months. Data were abstracted from medical records and telephone interviews. The primary study outcome was the Functional Independence Motor Score (FIM). Secondary outcomes included Instrumental Activities of Daily Living (IADL), SF-36 physical functioning, and the Stroke Impact Scale (SIS). Acute and postacute rehabilitation guideline compliance scores (range 0 to 100) were derived from an algorithm. All outcomes were adjusted for case-mix. Average compliance scores in acute and postacute care settings were 68.2% (SD 14) and 69.5% (SD 14.4), respectively. After case-mix adjustment, level of compliance with postacute rehabilitation guidelines was significantly associated with FIM motor, IADL, and the SIS physical domain scores. SF-36 physical function was not associated with guideline compliance. Level of compliance with rehabilitation guidelines in acute settings was unrelated to any of the outcome measures. Greater levels of adherence to postacute stroke rehabilitation guidelines were associated with improved patient outcomes. Compliance with guidelines may be viewed as a quality-of-care indicator with which to evaluate new organizational and funding changes involving postacute stroke rehabilitation.

  9. [Polymorphism of brain derived neurotrophic factor and recovery of functions after ischemic stroke].

    Science.gov (United States)

    Liepert, J; Heller, A; Behnisch, G; Schoenfeld, A

    2015-10-01

    After ischemic stroke, many factors influence the restitution of functions. In particular they include the patient age, the initial stroke severity and the presence of cognitive and neuropsychological deficits. In this study we investigated whether a polymorphism in the gene encoding for brain derived neurotrophic factor (BDNF) influences improvements of motor functions and everyday activities. Patients with subacute ischemic stroke (n = 67) were examined at the beginning of an inpatient neurological rehabilitation, after 4 weeks of treatment and after 6 months. The Barthel index (BI) and the Rivermead motor assessment (RMA) were used to measure motor functions and everyday activities. Patients were allocated to three groups (valine [Val]/valine, val/methionine [Met] and Met/Met) depending on the BDNF polymorphism at codon 66. The 3 groups (Val/Val, n = 34 patients, Val/Met, n = 26 and Met/Met, n = 7) showed significant improvements in BI and RMA after 4 weeks and after 6 months as compared to the preceding measurements. The BI and RMA were positively correlated. The three groups did not differ with respect to the extent of improvement. After ischemic stroke, motor functions and everyday activities improved continuously over a period of at least 6 months. The BDNF polymorphism did not influence this development.

  10. Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study

    NARCIS (Netherlands)

    de Haart, Mirjam; Geurts, Alexander C.; Huidekoper, Steven C.; Fasotti, Luciano; van Limbeek, Jacques

    2004-01-01

    OBJECTIVE: To identify and interrelate static and dynamic characteristics of the restoration of quiet standing balance in a representative sample of stroke survivors in the Netherlands during their inpatient rehabilitation. DESIGN: Exploratory study using an inception cohort with findings related to

  11. Self-efficacy and its influence on recovery of patients with stroke : a systematic review

    NARCIS (Netherlands)

    Korpershoek, Corrie; van der Bijl, Jaap; Hafsteinsdottir, Thora B.

    Aims. To provide an overview of the literature focusing on the influence of self-efficacy and self-efficacy enhancing interventions on mobility, activities of daily living, depression and quality of life of patients with stroke. Background. There is growing evidence for the importance of

  12. Effect of biofeedback cycling training on functional recovery and walking ability of lower extremity in patients with stroke

    Directory of Open Access Journals (Sweden)

    Huei-Ching Yang

    2014-01-01

    Full Text Available This study aimed to investigate the effectiveness of biofeedback cycling training on lower limb functional recovery, walking endurance, and walking speed for patients with chronic stroke. Thirty-one patients with stroke (stroke onset >3 months were randomly assigned into two groups using a crossover design. One group (N = 16; mean: 53.6 ± 10.3 years underwent conventional rehabilitation and cycling training (30 minutes/time, 5 times per week for 4 weeks, followed by only conventional rehabilitation for another 4 weeks. The other group (N = 15; mean: 54.5 ± 8.0 years underwent the same training in reverse order. The bike used in this biofeedback cycling training was the MOTOmed viva2 Movement Trainer. Outcome measures included the lower extremity subscale of Fugl-Meyer assessment (LE-FMA, the 6-minute walk test (6MWT, the 10-meter walk test (10MWT, and the modified Ashworth scale (MAS. All participants were assessed at the beginning of the study, at the end of the 4th week, and at the end of the 8th week. Thirty participants completed the study, including the cycling training interventions and all assessments. The results showed that improvements in the period with cycling training were significantly better than the noncycling period in the LE-FMA (p < 0.05, 6MWT (p < 0.001, 10MWT (p < 0.001, and MAS (p < 0.001 scores. No significant carryover effects were observed. The improvements on outcome measures were significantly different between the cycling period and the noncycling period after adjusting for potential confounding factors in the multivariate analysis of variance (p < 0.001. The study result indicates that the additional 4-week biofeedback cycling training could lead to improved LE functional recovery, walking endurance, and speed for patients with chronic stroke.

  13. Discuss on the Data Recovery Method of Embedded DVR

    Directory of Open Access Journals (Sweden)

    Li Rongrong

    2015-01-01

    Full Text Available On condition that the manufacturer keeps the file system and storage mechanism as the secret, this article makes an analysis and comparison of large amount of underlying data, and realize the research of digital video data recovery by researching the head, tail of frame data, passage number, data storage and other methods.

  14. Methods to maximise recovery of environmental DNA from water samples.

    Directory of Open Access Journals (Sweden)

    Rheyda Hinlo

    Full Text Available The environmental DNA (eDNA method is a detection technique that is rapidly gaining credibility as a sensitive tool useful in the surveillance and monitoring of invasive and threatened species. Because eDNA analysis often deals with small quantities of short and degraded DNA fragments, methods that maximize eDNA recovery are required to increase detectability. In this study, we performed experiments at different stages of the eDNA analysis to show which combinations of methods give the best recovery rate for eDNA. Using Oriental weatherloach (Misgurnus anguillicaudatus as a study species, we show that various combinations of DNA capture, preservation and extraction methods can significantly affect DNA yield. Filtration using cellulose nitrate filter paper preserved in ethanol or stored in a -20°C freezer and extracted with the Qiagen DNeasy kit outperformed other combinations in terms of cost and efficiency of DNA recovery. Our results support the recommendation to filter water samples within 24hours but if this is not possible, our results suggest that refrigeration may be a better option than freezing for short-term storage (i.e., 3-5 days. This information is useful in designing eDNA detection of low-density invasive or threatened species, where small variations in DNA recovery can signify the difference between detection success or failure.

  15. Analytic Method for Pressure Recovery in Truncated Diffusers ...

    African Journals Online (AJOL)

    A prediction method is presented for the static pressure recovery in subsonic axisymmetric truncated conical diffusers. In the analysis, a turbulent boundary layer is assumed at the diffuser inlet and a potential core exists throughout the flow. When flow separation occurs, this approach cannot be used to predict the maximum ...

  16. Does Inhibitory Repetitive Transcranial Magnetic Stimulation Augment Functional Task Practice to Improve Arm Recovery in Chronic Stroke?

    Directory of Open Access Journals (Sweden)

    Dorian K. Rose

    2014-01-01

    Full Text Available Introduction. Restoration of upper extremity (UE functional use remains a challenge for individuals following stroke. Repetitive transcranial magnetic stimulation (rTMS is a noninvasive modality that modulates cortical excitability and is being explored as a means to potentially ameliorate these deficits. The purpose of this study was to evaluate, in the presence of chronic stroke, the effects of low-frequency rTMS to the contralesional hemisphere as an adjuvant to functional task practice (FTP, to improve UE functional ability. Methods. Twenty-two individuals with chronic stroke and subsequent moderate UE deficits were randomized to receive 16 sessions (4 times/week for 4 weeks of either real-rTMS or sham-rTMS followed by 1-hour of paretic UE FTP. Results. No differences in UE outcomes were revealed between the real-rTMS and sham-rTMS intervention groups. After adjusting for baseline differences, no differences were revealed in contralesional cortical excitability postintervention. In a secondary analysis, data pooled across both groups revealed small, but statistically significant, improvements in UE behavioral measures. Conclusions. rTMS did not augment changes in UE motor ability in this population of individuals with chronic stroke. The chronicity of our participant cohort and their degree of UE motor impairment may have contributed to inability to produce marked effects using rTMS.

  17. Action research in rehabilitation with chronic stroke recovery: A case report with a focus on neural plasticity.

    Science.gov (United States)

    Pedersen, Malene; Bundgaard, Tina H; Zeeman, Peter; Jørgensen, Jørgen R; Sørensen, Peter M B; Berro, Hamza M; Larsson, Bodil W

    2016-06-27

    Chronic stroke patients are primarily referred to general rehabilitation, rather than to specific neurorehabilitation. Currently, there are no Danish clinical guidelines for chronic stroke, but recent research in neuroplasticity has contributed to possible rehabilitation interventions for these patients. The purpose of this project is to describe the use of a specialized neuroplastic approach in combination with an already existing training program. The project is designed as an action research project concerning four participants with chronic stroke. Through ten intervention, a neuroplastic focus has been added to their group training program including daily home training. Participants were tested before and after the intervention with MAS, DGI, 6MWT, SSQLS. All four participants improved their functional levels and their quality of life following the intervention. This report indicates that a specific neuroplastic focus in combination with action research has an impact on the participants with chronic stroke. However, there is still no clarity regarding what type of rehabilitation methods can be considered the most efficacious in promoting neuroplasticity. This case report serves as a pilot project for further studies of how to implement neuroplasticity in physical therapy.

  18. Effect of the presence of brain-derived neurotrophic factor val(66)met polymorphism on the recovery in patients with acute subcortical stroke.

    Science.gov (United States)

    Kim, Won-Seok; Lim, Jong Youb; Shin, Joon Ho; Park, Hye Kyung; Tan, Samuel Arnado; Park, Kyoung Un; Paik, Nam-Jong

    2013-06-01

    To investigate the effect of brain-derived neurotrophic factor (BDNF) Val(66)Met polymorphism on the recovery after subcortical stroke, using the modified Rankin Scale (mRS). Subcortical stroke patients with copies of BDNF Val(66)Met polymorphism (n=7) were compared to their controls (n=7) without a copy of BDNF Val(66)Met polymorphism after matching for initial severity, location and type of stroke. The mRS scores at 1 and 3 months after discharge from the neurorehabilitation unit were compared between the groups. A repeated measures ANOVA for mRS revealed significant interaction between time and group (F(2, 24) =37.2, pfactor for recovery and responses to rehabilitation therapies after stroke in Korean patients. There is a need for developing different rehabilitation strategies for the population with BDNF Val(66)Met polymorphism. Further studies assessing different outcomes for various functional domains of stroke recovery are needed to clarify the role of BDNF Val(66)Met polymorphism.

  19. The Tracer Gas Method of Determining the Charging Efficiency of Two-stroke-cycle Diesel Engines

    Science.gov (United States)

    Schweitzer, P H; Deluca, Frank, Jr

    1942-01-01

    A convenient method has been developed for determining the scavenging efficiency or the charging efficiency of two-stroke-cycle engines. The method consists of introducing a suitable tracer gas into the inlet air of the running engine and measuring chemically its concentration both in the inlet and exhaust gas. Monomethylamine CH(sub 3)NH(sub 2) was found suitable for the purpose as it burns almost completely during combustion, whereas the "short-circuited" portion does not burn at all and can be determined quantitatively in the exhaust. The method was tested both on four-stroke and on two-stroke engines and is considered accurate within 1 percent.

  20. Recovery process of elite athletes: A review of contemporary methods

    Directory of Open Access Journals (Sweden)

    Veljović Draško

    2012-01-01

    Full Text Available A numerous training stimulus and competition as well can reduce level of abilities among athletes. This decline of performance can be a temporary phenomenon, with duration of several minutes or several hours after a workout, or take much longer, even a several days. The lack of adequate recovery process can influence on athletes not being able to train at the desired intensity or do not fully meet the tasks at the next training session. Chronic fatigue can lead to injuries, and therefore, full recovery is necessary for achieving optimal level of abilities that will ensure a better athletic performance. For this reasons, athletes often carry out a variety of techniques and methods aimed to recover after training or match. They have become a part of the training process and their purpose is reduction of stress and fatigue incurred as a result of daily exposure to intense training stimulus. There are numerous methods and techniques today that can accelerate the recovery process of athletes. For this reason it is necessary to know the efficiency of an adequate method which will be applied in the training process. The aim of this review article is to point to those currently used and their effects on the process of recovery after physical activity in elite sport.

  1. Industrial development of a simulation method for ore recovery evaluation

    International Nuclear Information System (INIS)

    Deraisme; De Fouquet; Fraisse

    1983-01-01

    The purpose of downstream geostatistics is to provide to engineers, responsible for mining project studies, with a method for predicting the ore reserve recovery coming from different mining methods and for choosing the best one according to economic criteria. In the case of the BEN LOMOND uranium deposit, the metal recovery at the production stage depends on the geometry of mineralized lenses. For the first step of this study the usual technique for constructing a numerical model of deposit has been used. But this does not reproduce the geological structures very precisely. The recovered reserves have been computed for three more or less selective mining methods. This has been done inputing the outlines of stopes on a digitalizer. In the case of a cut and fill method an automatic algorithm for the optimization under constraints has been developed [fr

  2. Comparison of increased venous contrast in ischemic stroke using phase-sensitive MR imaging with perfusion changes on flow-sensitive alternating inversion recovery at 3 Tesla

    International Nuclear Information System (INIS)

    Yamashita, Eijiro; Kanasaki, Yoshiko; Fujii, Shinya; Ogawa, Toshihide; Tanaka, Takuro; Hirata, Yoshiharu

    2011-01-01

    Background Increased venous contrast in ischemic stroke using susceptibility-weighted imaging has been widely reported, although few reports have compared increased venous contrast areas with perfusion change areas. Purpose To compare venous contrast on phase-sensitive MR images (PSI) with perfusion change on flow-sensitive alternating inversion recovery (FAIR) images, and to discuss the clinical use of PSI in ischemic stroke. Material and Methods Thirty patients with clinically suspected acute infarction of the middle cerebral artery (MCA) territory within 7 days of onset were evaluated. Phase-sensitive imaging (PSI), flow-sensitive alternating inversion recovery (FAIR), diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) were obtained using 3 Tesla scanner. Two neuroradiologists independently reviewed the MR images, as well as the PSI, DWI, and FAIR images. They were blinded to the clinical data and to each other's findings. The abnormal area of each image was ultimately identified after both neuroradiologists reached consensus. We analyzed areas of increased venous contrast on PSI, perfusion changes on FAIR images and signal changes on DWI for each case. Results Venous contrast increased on PSI and hypoperfusion was evident on FAIR images from 22 of the 30 patients (73%). The distribution of the increased venous contrast was the same as that of the hypoperfused areas on FAIR images in 16 of these 22. The extent of these lesions was larger than that of lesions visualized by on DWI in 18 of the 22 patients. Hypointense signals reflecting hemorrhage and no increased venous contrast on PSI and hyperperfusion on FAIR images were found in six of the remaining eight patients (20%). Findings on PSI were normal and hypoperfusion areas were absent on FAIR images of two patients (7%). Conclusion Increased venous contrast on PSI might serve as an index of misery perfusion and provide useful information

  3. Spasticity and contractures at the wrist after stroke: time course of development and their association with functional recovery of the upper limb

    NARCIS (Netherlands)

    Malhotra, S.; Malhotra, S.; Pandyan, A.D.; Rosewilliam, S.; Roffe, C.; Hermens, Hermanus J.

    Objective: To investigate the time course of development of spasticity and contractures at the wrist after stroke and to explore if these are associated with upper limb functional recovery. - Design: Longitudinal observational study using secondary data from the control group of a randomized

  4. How salient is the silent period? The role of the silent period in the prognosis of upper extremity motor recovery after severe stroke.

    NARCIS (Netherlands)

    Kuijk, A. van; Pasman, J.W.; Geurts, A.C.H.; Hendricks, H.T.

    2005-01-01

    Transcranial magnetic stimulation (TMS) has been successful in the prediction of motor recovery in acute stroke patients with initially severe paresis or paralysis of the upper extremity. Motor evoked potentials (MEP) appear to have a high specificity but a rather low sensitivity with regard to

  5. Lower limb SSEP changes in stroke-predictive values regarding functional recovery.

    Science.gov (United States)

    Tzvetanov, Pl; Rousseff, R T; Milanov, Iv

    2003-04-01

    To assess the predictive value of lower limbs somatosensory evoked potentials (SSEPs) in the acute phase of stroke. 94 stroke patients (mean age: 61.2; S.D.: 11.8; 43 women) were included. Computed tomography confirmed diagnosis was cortical middle cerebral artery (MCA) infarction in 35, subcortical MCA in 11, and mixed in 25. By size, infarctions were large (29), limited (33), and lacunar (9). Thalamic haemorrhage was found in eight patients, putaminal in seven, small capsular in two, massive in two and lobar in four patients. All patients presented with hemiparesis (54) or hemiplegia (40), pure in five and combined with hemihypesthesia in 89. Tibial nerve SSEPs were recorded early in the course of the disease (up to third day). SSEP parameters (presence/absence of SSEP, absolute P40 latency, amplitude and amplitude ratio-affected/healthy side of P40-N50) were evaluated and compared with motor ability using the Medical Research Council (MRC) scale, and daily living activities using Barthel index (ADLB) followed for 3 months after stroke. Disability was assessed after the Rankin scale. The absolute amplitude of P40 has moderately strong correlation with Barthel index (r=0.63) and nearly moderate (r=-0.46) with Rankin scale at 3 months. P40 ratio exhibits weaker correlations with clinical outcome parameters. The combination of SSEP abnormalities and MRC has stronger predictive value than MRC alone (Pvs Pstroke, independently or combined with muscle power assessment, significantly increases prognostic capability.

  6. Right-hemispheric processing of non-linguistic word features: implications for mapping language recovery after stroke.

    Science.gov (United States)

    Baumgaertner, Annette; Hartwigsen, Gesa; Roman Siebner, Hartwig

    2013-06-01

    Verbal stimuli often induce right-hemispheric activation in patients with aphasia after left-hemispheric stroke. This right-hemispheric activation is commonly attributed to functional reorganization within the language system. Yet previous evidence suggests that functional activation in right-hemispheric homologues of classic left-hemispheric language areas may partly be due to processing nonlinguistic perceptual features of verbal stimuli. We used functional MRI (fMRI) to clarify the role of the right hemisphere in the perception of nonlinguistic word features in healthy individuals. Participants made perceptual, semantic, or phonological decisions on the same set of auditorily and visually presented word stimuli. Perceptual decisions required judgements about stimulus-inherent changes in font size (visual modality) or fundamental frequency contour (auditory modality). The semantic judgement required subjects to decide whether a stimulus is natural or man-made; the phonologic decision required a decision on whether a stimulus contains two or three syllables. Compared to phonologic or semantic decision, nonlinguistic perceptual decisions resulted in a stronger right-hemispheric activation. Specifically, the right inferior frontal gyrus (IFG), an area previously suggested to support language recovery after left-hemispheric stroke, displayed modality-independent activation during perceptual processing of word stimuli. Our findings indicate that activation of the right hemisphere during language tasks may, in some instances, be driven by a "nonlinguistic perceptual processing" mode that focuses on nonlinguistic word features. This raises the possibility that stronger activation of right inferior frontal areas during language tasks in aphasic patients with left-hemispheric stroke may at least partially reflect increased attentional focus on nonlinguistic perceptual aspects of language. Copyright © 2012 Wiley Periodicals, Inc.

  7. Electromyographic bridge for promoting the recovery of hand movements in subacute stroke patients: A randomized controlled trial.

    Science.gov (United States)

    Zhou, Yu-Xuan; Xia, Yang; Huang, Jia; Wang, Hai-Peng; Bao, Xue-Liang; Bi, Zheng-Yang; Chen, Xiao-Bing; Gao, Yu-Jie; Lü, Xiao-Ying; Wang, Zhi-Gong

    2017-08-31

    The electromyographic bridge (EMGB) detects surface electromyographic signals from a non-paretic limb. It then generates electric pulse trains according to the electromyographic time domain features, which can be used to stimulate a paralysed or paretic limb in real time. This strategy can be used for the contralateral control of neuromuscular electrical stimulation (NMES) to improve motor function after stroke. The aim of this study was to compare the treat-ment effects of EMGB vs cyclic NMES on wrist and finger impairments in subacute stroke patients. A total of 42 hemiplegic patients within 6 months of their cerebrovascular accidents were randomly assigned to 4-week treatments with EMGB or cyclic NMES. Each group underwent a standard rehabilitation programme and 10 sessions per week of hand training with EMGB or cyclic NMES. Outcome measures were: Brunnstrom stage, upper extremity components of the Fugl-Meyer Assessment, Motor Status Scale, voluntary surface electromyographic ratio and active range of motion of the wrist and finger joints. The EMGB group showed significantly greater improvements than the cyclic NMES group on the following measures: Brunnstrom stages for the hand, upper extremity - Fugl-Meyer Assessment, Motor Status Scale, and the voluntary surface electromyographic ratio of wrist and finger extensors. Eleven and 4 participants of the EMGB group who had no active wrist and finger movements, respectively, at the start of the treatment could perform measurable wrist and finger extensions after EMGB training. The corresponding numbers in the cyclic NMES group were only 4 and 1. In the present group of subacute stroke patients, the results favour EMGB over cyclic NMES for augmenting the recovery of volitional wrist and finger motion.

  8. Transient Sensory Recovery in Stroke Patients After Pulsed Radiofrequency Electrical Stimulation on Dorsal Root Ganglia: A Case Series.

    Science.gov (United States)

    Apiliogullari, Seza; Gezer, Ilknur A; Levendoglu, Funda

    2017-01-01

    The integrity of the somatosensory system is important for motor recovery and neuroplasticity after strokes. Peripheral stimulation or central stimulation in patients with central nervous system lesions can be an effective modality in improving function and in facilitating neuroplasticity. We present 2 hemiplegic cases with sensory motor deficit and the result of the pulsed radiofrequency (PRF) electrical stimulation to the dorsal root ganglia. After PRF electrical stimulation, significant improvement was achieved in the examination of patients with superficial and deep sensation. However, during the follow-up visits were observed that the effect of PRF electrical stimulation disappeared. We believe that these preliminary results could be used in the development of future prospective cohort studies and randomized controlled trials that focus on the effect of PRF electrical stimulation on dorsal root ganglia to treat sensory deficits in poststroke patients.

  9. The impact of cognitive impairment on upper body dressing difficulties after stroke: a video analysis of patterns of recovery.

    Science.gov (United States)

    Walker, C M; Sunderland, A; Sharma, J; Walker, M F

    2004-01-01

    to study the underlying cognitive deficits influencing a stroke patient's ability to relearn to dress. The aim was to investigate how recovery had occurred and whether the nature of cognitive impairment was the reason for persistent dressing problems. the dressing performance of 30 stroke patients was compared at the sub-acute stage and three months later. Standardised cognitive and physical tests were carried out, together with a video analysis of patients putting on a polo shirt. thirteen patients with preserved power in the upper limb used both arms to put on the shirt. Despite visuospatial impairment or apraxia in some cases, all were successful given sufficient time. Out of 17 patients with arm paresis, 12 were dependent putting on the shirt. Amongst the five who were independent, significantly fewer cases of cognitive impairment were seen on tests for apraxia (papraxia. Three patients who failed shirt dressing showed neglect or apraxia at follow up and had persistent arm paresis. Test failures also occurred amongst those who were independent. cognitive impairment affected patients attempting to relearn to dress with one hand, but did not affect patients who used both hands. The three patients who remained impaired on cognitive tests at follow up were unable to adapt or learn any compensatory strategies. The influence of cognition on a person's ability to learn compensatory strategies has implications for the design of rehabilitation therapies.

  10. The combined impact of virtual reality neurorehabilitation and its interfaces on upper extremity functional recovery in patients with chronic stroke.

    Science.gov (United States)

    Cameirão, Mónica S; Badia, Sergi Bermúdez i; Duarte, Esther; Frisoli, Antonio; Verschure, Paul F M J

    2012-10-01

    Although there is strong evidence on the beneficial effects of virtual reality (VR)-based rehabilitation, it is not yet well understood how the different aspects of these systems affect recovery. Consequently, we do not exactly know what features of VR neurorehabilitation systems are decisive in conveying their beneficial effects. To specifically address this issue, we developed 3 different configurations of the same VR-based rehabilitation system, the Rehabilitation Gaming System, using 3 different interface technologies: vision-based tracking, haptics, and a passive exoskeleton. Forty-four patients with chronic stroke were randomly allocated to one of the configurations and used the system for 35 minutes a day for 5 days a week during 4 weeks. Our results revealed significant within-subject improvements at most of the standard clinical evaluation scales for all groups. Specifically we observe that the beneficial effects of VR-based training are modulated by the use/nonuse of compensatory movement strategies and the specific sensorimotor contingencies presented to the user, that is, visual feedback versus combined visual haptic feedback. Our findings suggest that the beneficial effects of VR-based neurorehabilitation systems such as the Rehabilitation Gaming System for the treatment of chronic stroke depend on the specific interface systems used. These results have strong implications for the design of future VR rehabilitation strategies that aim at maximizing functional outcomes and their retention. Clinical Trial Registration- This trial was not registered because it is a small clinical study that evaluates the feasibility of prototype devices.

  11. Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study.

    Science.gov (United States)

    Wang, Ray-Yau; Chen, Hsiu-I; Chen, Chen-Yin; Yang, Yea-Ru

    2005-03-01

    To investigate the effectiveness of Bobath on stroke patients at different motor stages by comparing their treatment with orthopaedic treatment. A single-blind study, with random assignment to Bobath or orthopaedic group. Physical therapy department of a medical centre. Twenty-one patients with stroke with spasticity and 23 patients with stroke at relative recovery stages participated. Twenty sessions of Bobath programme or orthopaedic treatment programme given in four weeks. Stroke Impairment Assessment Set (SIAS), Motor Assessment Scale (MAS), Berg Balance Scale (BBS) and Stroke Impact Scale (SIS) for impairment and functional limitation level. Participants with spasticity showed greater improvement in tone control (change score: 1.20 +/- 1.03 versus 0.08 +/- 0.67, p = 0.006), MAS (change score: 7.64 +/- 4.03 versus 4.00 +/- 1.95, p = 0.011), and SIS (change score: 7.30 +/- 6.24 versus 1.25 +/- 5.33, p = 0.023) after 20 sessions of Bobath treatment than with orthopaedic treatment. Participants with relative recovery receiving Bobath treatment showed greater improvement in MAS (change score: 6.14 +/- 5.55 versus 2.77 +/- 9.89, p = 0.007), BBS (change score: 19.18 +/- 15.94 versus 6.85 +/- 5.23, p = 0.015), and SIS scores (change score: 8.50 +/- 3.41 versus 3.62 +/- 4.07, p = 0.006) than those with orthopaedic treatment. Bobath or orthopaedic treatment paired with spontaneous recovery resulted in improvements in impairment and functional levels for patient with stroke. Patients benefit more from the Bobath treatment in MAS and SIS scores than from the orthopaedic treatment programme regardless of their motor recovery stages.

  12. Brain mapping for long-term recovery of gait after supratentorial stroke: A retrospective cross-sectional study.

    Science.gov (United States)

    Kim, Dae Hyun; Kyeong, Sunghyon; Do, Kyung Hee; Lim, Seong Kyu; Cho, Hyong Keun; Jung, Suk; Kim, Hye Won

    2018-04-01

    The recovery of independent gait after stroke is a main goal of patients and understanding the relationship between brain lesions and the recovery of gait can help physicians set viable rehabilitation plans. Our study investigated the association between variables of gait parameters and brain lesions.Fifty poststroke patients with a mean age of 67.5 ± 1.3 years and an average duration after onset of 62.2 ± 7.9 months were included. Three-dimensional gait analysis and magnetic resonance imaging were conducted for all patients. Twelve quantified gait parameters of temporal-spatial, kinematic, and kinetic data were used. To correlate gait parameters with specific brain lesions, we used a voxel-based lesion symptom mapping analysis. Statistical significance was set to an uncorrected P value 10 voxels.Based on the location of a brain lesion, the following results were obtained: The posterior limb of the internal capsule was significantly associated with gait speed and increased knee extension in the stance phase. The hippocampus and frontal lobe were significantly associated with cadence. The proximal corona radiata was significantly associated with stride length and affected the hip maximal extension angle in the stance phase. The paracentral lobule was significantly associated with the affected knee maximal flexion angle in the swing phase and with the affected ankle maximal dorsiflexion angle in the stance phase. The frontal lobe, thalamus, and the lentiform nucleus were associated with kinetic gait parameters.Cortical, proximal white matter, and learning-related and motor-related areas are mainly associated with one's walking ability after stroke.

  13. Neurodevelopmental outcome after neonatal perforator stroke

    NARCIS (Netherlands)

    Ecury-Goossen, Ginette M; van der Haer, Marit; Smit, Liesbeth S; Feijen-Roon, Monique; Lequin, Maarten; de Jonge, Rogier C J; Govaert, Paul; Dudink, Jeroen

    AIM: To assess outcome after neonatal perforator stroke in the largest cohort to date. METHOD: Survivors from a cohort of children diagnosed with neonatal perforator stroke using cranial ultrasound or magnetic resonance imaging were eligible for inclusion. Recovery and Recurrence Questionnaire

  14. Electroencephalography as a post-stroke assessment method: An updated review.

    Science.gov (United States)

    Monge-Pereira, E; Molina-Rueda, F; Rivas-Montero, F M; Ibáñez, J; Serrano, J I; Alguacil-Diego, I M; Miangolarra-Page, J C

    Given that stroke is currently a serious problem in the population, employing more reliable and objective techniques for determining diagnosis and prognosis is necessary in order to enable effective clinical decision-making. EEG is a simple, low-cost, non-invasive tool that can provide information about the changes occurring in the cerebral cortex during the recovery process after stroke. EEG provides data on the evolution of cortical activation patterns which can be used to establish a prognosis geared toward harnessing each patient's full potential. This strategy can be used to prevent compensation and maladaptive plasticity, redirect treatments, and develop new interventions that will let stroke patients reach their new maximum motor levels. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Effects of Robot-assisted Gait Training Combined with Functional Electrical Stimulation on Recovery of Locomotor Mobility in Chronic Stroke Patients: A Randomized Controlled Trial.

    Science.gov (United States)

    Bae, Young-Hyeon; Ko, Young Jun; Chang, Won Hyuk; Lee, Ju Hyeok; Lee, Kyeong Bong; Park, Yoo Jung; Ha, Hyun Geun; Kim, Yun-Hee

    2014-12-01

    [Purpose] The purpose of the present study was to investigate the effects of robot-assisted gait training combined with functional electrical stimulation on locomotor recovery in patients with chronic stroke. [Subjects] The 20 subjects were randomly assigned into either an experimental group (n = 10) that received a combination of robot-assisted gait training and functional electrical stimulation on the ankle dorsiflexor of the affected side or a control group (n = 10) that received robot-assisted gait training only. [Methods] Both groups received the respective therapies for 30 min/day, 3 days/week for 5 weeks. The outcome was measured using the Modified Motor Assessment Scale (MMAS), Timed Up-and-Go Test (TUG), Berg Balance Scale (BBS), and gait parameters through gait analysis (Vicon 370 motion analysis system, Oxford Metrics Ltd., Oxford, UK). All the variables were measured before and after training. [Results] Step length and maximal knee extension were significantly greater than those before training in the experimental group only. Maximal Knee flexion showed a significant difference between the experimental and control groups. The MMAS, BBS, and TUG scores improved significantly after training compared with before training in both groups. [Conclusion] We suggest that the combination of robot-assisted gait training and functional electrical stimulation encourages patients to actively participate in training because it facilitates locomotor recovery without the risk of adverse effects.

  16. Comparison of surface sampling methods for virus recovery from fomites.

    Science.gov (United States)

    Julian, Timothy R; Tamayo, Francisco J; Leckie, James O; Boehm, Alexandria B

    2011-10-01

    The role of fomites in infectious disease transmission relative to other exposure routes is difficult to discern due, in part, to the lack of information on the level and distribution of virus contamination on surfaces. Comparisons of studies intending to fill this gap are difficult because multiple different sampling methods are employed and authors rarely report their method's lower limit of detection. In the present study, we compare a subset of sampling methods identified from a literature review to demonstrate that sampling method significantly influences study outcomes. We then compare a subset of methods identified from the review to determine the most efficient methods for recovering virus from surfaces in a laboratory trial using MS2 bacteriophage as a model virus. Recoveries of infective MS2 and MS2 RNA are determined using both a plaque assay and quantitative reverse transcription-PCR, respectively. We conclude that the method that most effectively recovers virus from nonporous fomites uses polyester-tipped swabs prewetted in either one-quarter-strength Ringer's solution or saline solution. This method recovers a median fraction for infective MS2 of 0.40 and for MS2 RNA of 0.07. Use of the proposed method for virus recovery in future fomite sampling studies would provide opportunities to compare findings across multiple studies.

  17. Dynamics of the recovery of autonomic nervous system in patients after surgical treatment of hemorrhagic stroke.

    Directory of Open Access Journals (Sweden)

    Kuftan Mohammed Nazmi Kuftan

    2012-04-01

    Full Text Available We talking about the impact of tools and techniques of physical rehabilitation on the performance of the autonomic nervous system (parasympathetic activity and sympathetic tone and heart rate of patients after surgical treatment of hemorrhagic stroke. The experiment had involved 53 patients aged from 37 to 72 years. The survey was conducted on patients' clinical stage of rehabilitation in the second, third and sixth week after surgery. The analysis is based on the measurement of heart rate variability. A positive effect of the use of tools and techniques of physical rehabilitation program on the state of autonomic regulation.

  18. Geothermal Energy Production With Innovative Methods Of Geothermal Heat Recovery

    Energy Technology Data Exchange (ETDEWEB)

    Swenson, Allen [GeoTek Energy, LLC, Frisco, TX (United States); Darlow, Rick [GeoTek Energy, LLC, Frisco, TX (United States); Sanchez, Angel [GeoTek Energy, LLC, Frisco, TX (United States); Pierce, Michael [GeoTek Energy, LLC, Frisco, TX (United States); Sellers, Blake [GeoTek Energy, LLC, Frisco, TX (United States)

    2014-12-19

    The ThermalDrive™ Power System (“TDPS”) offers one of the most exciting technological advances in the geothermal power generation industry in the last 30 years. Using innovations in subsurface heat recovery methods, revolutionary advances in downhole pumping technology and a distributed approach to surface power production, GeoTek Energy, LLC’s TDPS offers an opportunity to change the geothermal power industry dynamics.

  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. Monitoring Neuro-Motor Recovery From Stroke With High-Resolution EEG, Robotics and Virtual Reality: A Proof of Concept.

    Science.gov (United States)

    Comani, Silvia; Velluto, Lucia; Schinaia, Lorenzo; Cerroni, Gianluigi; Serio, Antonio; Buzzelli, Sandro; Sorbi, Sandro; Guarnieri, Biancamaria

    2015-11-01

    A novel system for the neuro-motor rehabilitation of upper limbs was validated in three sub-acute post-stroke patients. The system permits synchronized cortical and kinematic measures by integrating high-resolution EEG, passive robotic device and Virtual Reality. The brain functional re-organization was monitored in association with motor patterns replicating activities of daily living (ADL). Patients underwent 13 rehabilitation sessions. At sessions 1, 7 and 13, clinical tests were administered to assess the level of motor impairment, and EEG was recorded during rehabilitation task execution. For each session and rehabilitation task, four kinematic indices of motor performance were calculated and compared with the outcome of clinical tests. Functional source maps were obtained from EEG data and projected on the real patients' anatomy (MRI data). Laterality indices were calculated for hemispheric dominance assessment. All patients showed increased participation in the rehabilitation process. Cortical activation changes during recovery were detected in relation to different motor patterns, hence verifying the system's suitability to add quantitative measures of motor performance and neural recovery to classical tests. We conclude that this system seems a promising tool for novel robot-based rehabilitation paradigms tailored to individual needs and neuro-motor responses of the patients.

  1. Effects of repetitive transcranial magnetic stimulation on motor recovery and motor cortex excitability in patients with stroke: a randomized controlled trial.

    Science.gov (United States)

    Du, J; Tian, L; Liu, W; Hu, J; Xu, G; Ma, M; Fan, X; Ye, R; Jiang, Y; Yin, Q; Zhu, W; Xiong, Y; Yang, F; Liu, X

    2016-11-01

    Repetitive transcranial magnetic stimulation (rTMS) changes the excitability of the motor cortex and thereby has the potential to enhance motor recovery after stroke. This randomized, sham-controlled, double-blind study was to compare the effects of high-frequency versus low-frequency rTMS on motor recovery during the early phase of stroke and to identify the neurophysiological correlates of motor improvements. A total of 69 first-ever ischemic stroke patients with motor deficits were randomly allocated to receive five daily sessions of 3-Hz ipsilesional rTMS, 1-Hz contralesional rTMS or sham rTMS in addition to standard physical therapy. Outcome measures included motor deficits, neurological scores and cortical excitability, which were assessed at baseline, after the intervention and at 3-month follow-up. The rTMS groups manifested greater motor improvements than the control group, which were sustained for at least 3 months after the end of the treatment sessions. 1-Hz rTMS over the unaffected hemisphere produced more profound effects than 3-Hz rTMS in facilitating upper limb motor performance. There was a significant correlation between motor function improvement and motor cortex excitability change in the affected hemisphere. Repetitive transcranial magnetic stimulation is a beneficial neurorehabilitative strategy for enhancing motor recovery in the acute and subacute phase after stroke. © 2016 EAN.

  2. Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients.

    Science.gov (United States)

    Wang, Zun-Rong; Wang, Ping; Xing, Liang; Mei, Li-Ping; Zhao, Jun; Zhang, Tong

    2017-11-01

    Virtual reality is nowadays used to facilitate motor recovery in stroke patients. Most virtual reality studies have involved chronic stroke patients; however, brain plasticity remains good in acute and subacute patients. Most virtual reality systems are only applicable to the proximal upper limbs (arms) because of the limitations of their capture systems. Nevertheless, the functional recovery of an affected hand is most difficult in the case of hemiparesis rehabilitation after a stroke. The recently developed Leap Motion controller can track the fine movements of both hands and fingers. Therefore, the present study explored the effects of a Leap Motion-based virtual reality system on subacute stroke. Twenty-six subacute stroke patients were assigned to an experimental group that received virtual reality training along with conventional occupational rehabilitation, and a control group that only received conventional rehabilitation. The Wolf motor function test (WMFT) was used to assess the motor function of the affected upper limb; functional magnetic resonance imaging was used to measure the cortical activation. After four weeks of treatment, the motor functions of the affected upper limbs were significantly improved in all the patients, with the improvement in the experimental group being significantly better than in the control group. The action performance time in the WMFT significantly decreased in the experimental group. Furthermore, the activation intensity and the laterality index of the contralateral primary sensorimotor cortex increased in both the experimental and control groups. These results confirmed that Leap Motion-based virtual reality training was a promising and feasible supplementary rehabilitation intervention, could facilitate the recovery of motor functions in subacute stroke patients. The study has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-OCH-12002238).

  3. Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients

    Directory of Open Access Journals (Sweden)

    Zun-rong Wang

    2017-01-01

    Full Text Available Virtual reality is nowadays used to facilitate motor recovery in stroke patients. Most virtual reality studies have involved chronic stroke patients; however, brain plasticity remains good in acute and subacute patients. Most virtual reality systems are only applicable to the proximal upper limbs (arms because of the limitations of their capture systems. Nevertheless, the functional recovery of an affected hand is most difficult in the case of hemiparesis rehabilitation after a stroke. The recently developed Leap Motion controller can track the fine movements of both hands and fingers. Therefore, the present study explored the effects of a Leap Motion-based virtual reality system on subacute stroke. Twenty-six subacute stroke patients were assigned to an experimental group that received virtual reality training along with conventional occupational rehabilitation, and a control group that only received conventional rehabilitation. The Wolf motor function test (WMFT was used to assess the motor function of the affected upper limb; functional magnetic resonance imaging was used to measure the cortical activation. After four weeks of treatment, the motor functions of the affected upper limbs were significantly improved in all the patients, with the improvement in the experimental group being significantly better than in the control group. The action performance time in the WMFT significantly decreased in the experimental group. Furthermore, the activation intensity and the laterality index of the contralateral primary sensorimotor cortex increased in both the experimental and control groups. These results confirmed that Leap Motion-based virtual reality training was a promising and feasible supplementary rehabilitation intervention, could facilitate the recovery of motor functions in subacute stroke patients. The study has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-OCH-12002238.

  4. The effect of obstructive sleep apnea and treatment with continuous positive airway pressure on stroke rehabilitation: rationale, design and methods of the TOROS study

    NARCIS (Netherlands)

    Aaronson, Justine A.; van Bennekom, Coen A. M.; Hofman, Winni F.; van Bezeij, Tijs; van den Aardweg, Joost G.; Groet, Erny; Kylstra, Wytske A.; Schmand, Ben A.

    2014-01-01

    Obstructive sleep apnea is a common sleep disorder in stroke patients. Obstructive sleep apnea is associated with stroke severity and poor functional outcome. Continuous positive airway pressure seems to improve functional recovery in stroke rehabilitation. To date, the effect of continuous positive

  5. The effect of obstructive sleep apnea and treatment with continuous positive airway pressure on stroke rehabilitation: rationale, design and methods of the TOROS study

    NARCIS (Netherlands)

    Aaronson, J.A.; van Bennekom, C.A.M.; Hofman, W.F.; van Bezeij, T.; van den Aardweg, J.G.; Groet, E.; Kylstra, W.A.; Schmand, B.A.

    2014-01-01

    BACKGROUND: Obstructive sleep apnea is a common sleep disorder in stroke patients. Obstructive sleep apnea is associated with stroke severity and poor functional outcome. Continuous positive airway pressure seems to improve functional recovery in stroke rehabilitation. To date, the effect of

  6. Methods of silver recovery from radiographs - comparative study

    Science.gov (United States)

    Canda, L. R.; Ardelean, E.; Hepuţ, T.

    2018-01-01

    Management and recovery of waste are activities with multiple impacts: technologically (by using waste on current production flows, thus replacing poor raw materials), economically (can substantially reduce manufacturing costs by recycling waste), social (by creating new jobs where it is necessary to process the waste in a form more suited to technological flows) and ecologically (by removing waste that is currently produced or already stored - but poses a threat to the health of the population and / or to the environment). This is also the case for medical waste, for example radiographs, which are currently produced in large quantities, for which replacement solutions are sought, but are currently stored by archiving in hospital units. The paper presents two methods used for this kind of waste management, the result being the recovery of silver, material with applications and with increasing price, but also the proper disposal of the polymeric support. This analysis aims at developing a more efficient recycling technology for medical radiographs.

  7. Method for the removal and recovery of mercury

    Science.gov (United States)

    Easterly, Clay E.; Vass, Arpad A.; Tyndall, Richard L.

    1997-01-01

    The present invention is an enhanced method for the removal and recovery of mercury from mercury-contaminated matrices. The method involves contacting a mercury-contaminated matrix with an aqueous dispersant solution derived from specific intra-amoebic isolates to release the mercury from the mercury-contaminated matrix and emulsify the mercury; then, contacting the matrix with an amalgamating metal from a metal source to amalgamate the mercury to the amalgamating metal; removing the metallic source from the mercury-contaminated matrix; and heating the metallic source to vaporize the mercury in a closed system to capture the mercury vapors.

  8. Critical analysis of active methods of ozone layer recovery

    Science.gov (United States)

    Bekker, S. Z.; Doronin, A. P.; Kozlov, S. I.

    2017-09-01

    A critical analysis is given for various methods for recovery of the ozone layer of the Earth: the emission of alkane gases, the destruction of freons by laser IR radiation and with microwave discharge, exposure to laser UV radiation and electric discharge in the atmosphere, the use of solar radiation, laser infrared radiation, and gamma rays, and the creation of an artificial formation at high altitudes that shields the solar radiation dissociating ozone. The optimal methods are discussed in terms of their effectiveness, economic costs, and environmental consequences. These include the use of gamma rays sources, electric discharge in the atmosphere, and microwave breakdown.

  9. Outcomes of the Bobath concept on upper limb recovery following stroke.

    Science.gov (United States)

    Luke, Carolyn; Dodd, Karen J; Brock, Kim

    2004-12-01

    To determine the effectiveness of the Bobath concept at reducing upper limb impairments, activity limitations and participation restrictions after stroke. Electronic databases were searched to identify relevant trials published between 1966 and 2003. Two reviewers independently assessed articles for the following inclusion criteria: population of adults with upper limb disability after stroke; stated use of the Bobath concept aimed at improving upper limb disability in isolation from other approaches; outcomes reflecting changes in upper limb impairment, activity limitation or participation restriction. Of the 688 articles initially identified, eight met the inclusion criteria. Five were randomized controlled trials, one used a single-group crossover design and two were single-case design studies. Five studies measured impairments including shoulder pain, tone, muscle strength and motor control. The Bobath concept was found to reduce shoulder pain better than cryotherapy, and to reduce tone compared to no intervention and compared to proprioceptive neuromuscular facilitation (PNF). However, no difference was detected for changes in tone between the Bobath concept and a functional approach. Differences did not reach significance for measures of muscle strength and motor control. Six studies measured activity limitations, none of these found the Bobath concept was superior to other therapy approaches. Two studies measured changes in participation restriction and both found equivocal results. Comparisons of the Bobath concept with other approaches do not demonstrate superiority of one approach over the other at improving upper limb impairment, activity or participation. However, study limitations relating to methodological quality, the outcome measures used and contextual factors investigated limit the ability to draw conclusions. Future research should use sensitive upper limb measures, trained Bobath therapists and homogeneous samples to identify the influence of

  10. A nearly full-recovery from AVM hemorrhagic stroke 17 years after insult using a new integrated neurodevelopmental approach: A case report.

    Science.gov (United States)

    Friedmann, Alberto J

    2017-09-01

    With the prevalence of stroke increasing in the USA and the world along with increased survival and longevity due to medical advancements, it has become increasingly necessary to look at the chronic phase of stroke recovery. Previous paradigms of stroke treatment have proven ineffective when looking at 10, 15, or 20 years of survival post insult. The patient, being a young man just out of high school, was concerned with his overall morbidity. He was highly concerned with the quality of life he could expect as a stroke survivor with a life expectancy of 60 years or more. C was diagnosed with a hemorrhagic AVM stroke that impacted several regions of the brain, particularly the right occipital and temporal lobes as well as bilateral motor control. C experienced severe hpertonicity of the musculature and significant vertigo. This study investigated a novel approach to chronic-phase stroke rehabilitation using traditional child motor-learning techniques, play, and proprioceptive-building activities in addition to current stroke rehabilitation techniques. During an initial six-month period, followed by a three-year period, the participant used motor-developmental learning activities as well as traditional strength, gait, and balance training. During the initial phase of treatment, clinically-significant improvements were recorded along with self-reported lifestyle enhancements. These gains continued throughout the three-and-a-half year process. C regained the ability to free-walk in small bouts and went from the use of a walker to canes. He regained use of his hands and removed a large partion of his vertigo. Of specific interest was the participant's ability to progress from using a walker to driving, returning to school, and starting a family. This study lays the groundwork for future studies into this type of therapeutic approach as well as highlighting the ability of chronic-phase stroke patients to recover well into the second decade post stroke. After the initial

  11. Effectiveness of Faradic and Russian currents on plantar flexor muscle spasticity, ankle motor recovery, and functional gait in stroke patients.

    Science.gov (United States)

    Ganesh, G Shankar; Kumari, Ranjita; Pattnaik, Monalisa; Mohanty, Patitapaban; Mishra, Chittaranjan; Kaur, Parminder; Dakshinamoorthy, Anandhi

    2018-04-01

    Spasticity is a major disabling symptom in patients post stroke. Though studies have demonstrated that electrical stimulation (ES) can reduce spasticity and improve passive ankle range of motion (ROM), not many studies have evaluated the effectiveness of ES on active ankle ROM. The purpose of this study was to determine the effectiveness of Faradic and Russian currents in the reduction of ankle plantar-flexor spasticity and improving motor recovery in patients post stroke. Eighty-three patients (29 females and 54 males; mean age of 57.12 years) were randomly assigned to Group 1 (task-oriented exercises), Group 2 (Faradic current for 10 min and task-oriented exercises), and Group 3 (Russian current for 10 min and task-oriented exercises) for a period of 5 sessions per week for 6 weeks. All patients were assessed for soleus and gastrocnemius muscles spasticity measured by modified modified Ashworth scale; active and passive range ROM measured by goniometer; and functional ambulation measured by modified Emory Functional Ambulation Profile at the time of recruitment to study and after 6 weeks. Both the types of stimulation and exercises were not associated with improvements in modified Emory Functional Ambulation Profile (p > 0.05). The results showed that all the groups are effective in improving passive ankle ROM (p spasticity (p treatment CONCLUSION: Adding ES to exercises are associated with low to medium effect sizes (spasticity and improving ankle ROM. Copyright © 2018 John Wiley & Sons, Ltd.

  12. Cannabidiol reduces brain damage and improves functional recovery in a neonatal rat model of arterial ischemic stroke.

    Science.gov (United States)

    Ceprián, Maria; Jiménez-Sánchez, Laura; Vargas, Carlos; Barata, Lorena; Hind, Will; Martínez-Orgado, Jose

    2017-04-01

    and purpose: Currently there is no effective treatment for neonatal arterial ischemic stroke (AIS). Cannabidiol (CBD) is neuroprotective in models of newborn hypoxic-ischemic brain damage and adult stroke. The purpose of this work was to study the protective effect of CBD in a neonatal rat model of AIS. Middle Cerebral Artery Occlusion (MCAO) was achieved in neonatal Wistar rats by introducing a nylon filament to the left MCA for 3 h; 15 min after removing the occluder vehicle (MCAO-V) or CBD single dose 5 mg/kg (MCAO-C) were administered i. p. Similarly manipulated but non-occluded rats served as controls (SHM). A set of behavioral tests was then conducted one week (P15) or one month (P38) after MCAO. Brain damage was then assessed by magnetic resonance imaging (MRI), proton magnetic resonance spectroscopy (H + -MRS) and histologic (TUNEL for cell death, immunohistochemistry for neuron, astrocyte and microglia identification) studies. CBD administration improved neurobehavioral function regarding strength, hemiparesis, coordination and sensorimotor performance as assessed at P15 and P38. MRI indicated that CBD did not reduce the volume of infarct but reduced the volume of perilesional gliosis. H + -MRS indicated that CBD reduced metabolic derangement and excitotoxicty, and protected astrocyte function. Histologic studies indicated that CBD reduced neuronal loss and apoptosis, and modulated astrogliosis and microglial proliferation and activation. CBD administration after MCAO led to long-term functional recovery, reducing neuronal loss and astrogliosis, and modulating apoptosis, metabolic derangement, excitotoxicity and neuro-inflammation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Effects of scapulohumeral rehabilitation protocol on trunk control recovery in patients with subacute stroke: A pilot randomized controlled trial.

    Science.gov (United States)

    Dell'Uomo, Daniela; Morone, Giovanni; Centrella, Antonio; Paolucci, Stefano; Caltagirone, Carlo; Grasso, Maria Grazia; Traballesi, Marco; Iosa, Marco

    2017-01-01

    Despite upper limb rehabilitation is widely investigated in patients with stroke, the effects of scapulohumeral rehabilitation on trunk stabillization are mainly unknown. To test the effects of scapulohumeral rehabilitation protocol on trunk control recovery in patients with subacute stroke. A pilot randomized controlled trial with two groups of 14 patients each one performing 20 minutes per day, 5 days a week, for 6 weeks in add on to standard therapy. Experimental group performed a specific scapulohumeral rehabilitation protocol aiming to improve trunk competencies whereas control group performed conventional arm rehabilitation. Clinical scale tests and accelerometric evaluations were performed pre- and post-treatment. Experimental groups showed better scores at discharge at Trunk impairment Scale (p post-stroke.

  14. Nursing application of Bobath principles in stroke care.

    Science.gov (United States)

    Passarella, P M; Lewis, N

    1987-04-01

    The nursing approach in the care of stroke patients has a direct impact on functional outcome. Nursing application of Bobath principles in stroke care offers a nursing focus on involvement of the affected side; facilitation of normal tone, posture, and movement; and development of more normal function. A research study evaluating the functional gains of stroke patients demonstrated a significant level of functional improvement in those treated with Bobath principles over stroke patients treated with the traditional nursing approach. Practical methods for applying Bobath principles in patient care activities are described. These therapeutic methods provide nurses with the means to maximize stroke patients' potential and further influence their functional recovery.

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

    Science.gov (United States)

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

    2015-10-01

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

  16. Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study.

    Science.gov (United States)

    Fluet, Gerard G; Patel, Jigna; Qiu, Qinyin; Yarossi, Matthew; Massood, Supriya; Adamovich, Sergei V; Tunik, Eugene; Merians, Alma S

    2017-07-01

    The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated. This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation. Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document

  17. Effect of low-frequency repetitive transcranial magnetic stimulation combining task-oriented training on upper limb motor function recovery after stroke

    Directory of Open Access Journals (Sweden)

    Hong-bin WANG

    2017-07-01

    Full Text Available Objective To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS combined with task-oriented training on the recovery of upper limb motor function of stroke patients. Methods A total of 42 patients with hemiplegia after stroke were randomly divided into control group (N = 20 and treatment group (N = 22. Control group received routine rehabilitation training and task-oriented training, and treatment group received low-frequency (1 Hz rTMS over the contralesional cortex addition to routine rehabilitation and task-oriented training. Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE and Wolf Motor Function Test (WMFT were used to evaluate upper limb motor function of all patients before treatment, after 4-week treatment and 3 months after treatment. The latency and central motor conduction time (CMCT of motor-evoked potential (MEP in the contralesional cortex were recorded and analyzed. Results Compared with control group, FMA-UE score (P = 0.006 and WMFT score (P = 0.024 were significantly increased in treatment group. There was significant difference in FMA-AUE score (P = 0.000 and WMFT score (P = 0.000 at different time points. Compared with before treatment, FMA-UE score (P = 0.000, for all and WMFT score (P = 0.000, for all of patients in both groups were all significantly increased after 4-week treatment and 3 months after treatment. Besides, FMA-UE score (P = 0.000, for all and WMFT score (P = 0.000, for all 3 months after treatment were higher than those after 4-week treatment. There was no statistically significant difference between 2 groups on the latency (P = 0.979 and CMCT (P = 0.807 of MEP before and after treatment, and so was the difference on the latency (P = 0.085 and CMCT (P = 0.507 of MEP in the contralesional cortex at different time points (before treatment, after 4-week treatment and 3 months after treatment. Conclusions Low-frequency rTMS over the contralesional cortex combined

  18. Single well tracer method to evaluate enhanced recovery

    Science.gov (United States)

    Sheely, Jr., Clyde Q.; Baldwin, Jr., David E.

    1978-01-01

    Data useful to evaluate the effectiveness of or to design an enhanced recovery process (the recovery process involving mobilizing and moving hydrocarbons through a hydrocarbon-bearing subterranean formation from an injection well to a production well by injecting a mobilizing fluid into the injection well) are obtained by a process which comprises sequentially: determining hydrocarbon saturation in the formation in a volume in the formation near a well bore penetrating the formation, injecting sufficient of the mobilizing fluid to mobilize and move hydrocarbons from a volume in the formation near the well bore penetrating the formation, and determining by the single well tracer method a hydrocarbon saturation profile in a volume from which hydrocarbons are moved. The single well tracer method employed is disclosed by U.S. Pat. No. 3,623,842. The process is useful to evaluate surfactant floods, water floods, polymer floods, CO.sub.2 floods, caustic floods, micellar floods, and the like in the reservoir in much less time at greatly reduced costs, compared to conventional multi-well pilot test.

  19. 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.

  20. 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

  1. The combined perceptions of people with stroke and their carers regarding rehabilitation needs 1 year after stroke: a mixed methods study

    Science.gov (United States)

    Ekstam, Lisa; Johansson, Ulla; Guidetti, Susanne; Eriksson, Gunilla; Ytterberg, Charlotte

    2015-01-01

    Objectives The aim of the study was to explore the associations between the dyad’s (person with stroke and informal caregiver) perception of the person with stroke’s rehabilitation needs and stroke severity, personal factors (gender, age, sense of coherence), the use of rehabilitation services, amount of informal care and caregiver burden. Further, the aim was to explore the personal experience of everyday life changes among persons with stroke and their caregivers and their strategies for handling these 1 year after stroke. Design A mixed methods design was used combining quantitative and qualitative data and analyses. Setting Data were mainly collected in the participants’ homes. Outcome measures Data were collected through established instruments and open-ended interviews. The dyad's perceptions of the person with stroke’s rehabilitation needs were assessed by the persons with stroke and their informal caregivers using a questionnaire based on Ware’s taxonomy. The results were combined and classified into three groups: met, discordant (ie, not in agreement) and unmet rehabilitation needs. To assess sense of coherence (SOC) in persons with stroke, the SOC-scale was used. Caregiver burden was assessed using the Caregiver Burden Scale. Data on the use of rehabilitation services were obtained from the computerised register at the Stockholm County Council. Participants 86 persons with stroke (mean age 73 years, 38% women) and their caregivers (mean age 65 years, 40% women). Results Fifty-two per cent of the dyads perceived that the person with stroke’s need for rehabilitation was met 12 months after stroke. Met rehabilitation needs were associated with less severe stroke, more coping strategies for solving problems in everyday activities and less caregiver burden. Conclusions Rehabilitation interventions need to focus on supporting the dyads’ process of psychological and social adaptation after stroke. Future studies need to explore and evaluate

  2. Nutritional Status of Hospitalized Stroke Patients: Assessment by Body Mass Index and Subjective Global Assessment Method

    Directory of Open Access Journals (Sweden)

    Gloria Kartika

    2017-06-01

    Full Text Available Background: Stroke is a disease with a high mortality rate and common cause of disability. Nutritional factors are strongly associated with this disease. Malnutrition in hospitalized patients increases the incidence of complications, prolonged the length of stay and also the cost of hospitalization. Furthermore, nutritional status of stroke patients can deteriorate during hospitalization. The prevalence of malnutrition in hospitalized stroke patients is about 6% to 62%. The objective of this study was to identify  the nutritional status of hospitalized stroke patient. Methods: This was a descriptive cross-sectional study. Population of the study was hospitalized stroke patients at Neurology Ward, Kemuning Building Dr. Hasan Sadikin General Hospital Bandung, Indonesia from August until October 2014 who meet the inclusion criteria. Nutritional status was measured objectively using Body Mass Index (BMI and subjectively using Subjective Global Assessment (SGA method. The collected data were processed using  frequency tabulation and percentage. Results: Twenty six hospitalized stroke patients were included in this study. The hospitalized patients with normal BMI were about 12 people (46.15%, 8 people were overweight (30.77%, 4 people were undernourished (15.39% and 2 people (7.69% were obese. According to SGA measurement, approximately 18 people (69.22% were moderately malnourished, and as much as 4 people (15.39% were in good nutrition, whereas 4 people (15.39% were severely malnourished. Conclusions: Majority of the hospitalized stroke patients has normal BMI and moderately malnourished based on SGA.   DOI: 10.15850/amj.v4n2.1090

  3. Durability of the beneficial effect of MLC601 (NeuroAiD™) on functional recovery among stroke patients from the Philippines in the CHIMES and CHIMES-E studies.

    Science.gov (United States)

    Navarro, Jose C; Chen, Christopher Lh; Lee, Chun F; Gan, Herminigildo H; Lao, Annabelle Y; Baroque, Alejandro C; Hiyadan, John Harold B; Chua, Carlos L; San Jose, Ma Cristina; Advincula, Joel M; Venketasubramanian, Narayanaswamy

    2017-04-01

    Background and Aim A pre-specified country analysis of subjects from the Philippines in the CHInese Medicine NeuroAiD Efficacy on Stroke recovery (CHIMES) Study showed significantly improved functional and neurological outcomes on MLC601 at month (M) 3. We aimed to assess these effects on long-term functional recovery in the Filipino cohort. Methods The CHIMES-E (extension) Study evaluated subjects who completed three months of randomized placebo-controlled treatment in CHIMES up to two years. Blinding of treatment allocation was maintained and all subjects received standard stroke care and rehabilitation. Modified Rankin Score (mRS) and Barthel Index (BI) were assessed in-person at M3 and by telephone at M6, M12, M18, M24. Odds ratios (OR) with corresponding 95% confidence intervals (CI) for functional recovery using ordinal analysis of mRS and for achieving functional independence (mRS 0-1 or BI ≥ 95) at each time point were calculated, adjusting for age, sex, baseline National Institute of Health Stroke Scale (NIHSS), onset-to-treatment time (OTT) and pre-stroke mRS. Results The 378 subjects (MLC601 192, placebo 186) included in CHIMES-E from the Philippines (mean age 60.2 ± 11.1) had more women ( p < 0.001), worse baseline NIHSS ( p < 0.001) and longer onset to treatment time ( p = 0.002) compared to other countries. Baseline characteristics were similar between treatment groups. The treatment effect of MLC601 seen at M3 peaked at M6 with OR for mRS shift of 1.53 (95% CI 1.05-2.22), mRS dichotomy 0-1 of 1.77 (95% CI 1.10-2.83), and BI ≥ 95 of 1.87 (95% CI 1.16-3.02). The beneficial effect persisted up to M24. Conclusion The beneficial effect of MLC601 seen at M3 in the Filipino cohort is durable up to two years after stroke.

  4. Granulocyte Colony Stimulating Factor and Physiotherapy after Stroke: Results of a Feasibility Randomised Controlled Trial: Stem Cell Trial of Recovery EnhanceMent after Stroke-3 (STEMS-3 ISRCTN16714730).

    Science.gov (United States)

    Sprigg, Nikola; O'Connor, Rebecca; Woodhouse, Lisa; Krishnan, Kailash; England, Timothy J; Connell, Louise A; Walker, Marion F; Bath, Philip M

    2016-01-01

    Granulocyte-colony stimulating factor (G-CSF) mobilises endogenous haematopoietic stem cells and enhances recovery in experimental stroke. Recovery may also be dependent on an enriched environment and physical activity. G-CSF may have the potential to enhance recovery when used in combination with physiotherapy, in patients with disability late after stroke. A pilot 2 x 2 factorial randomised (1:1) placebo-controlled trial of G-CSF (double-blind), and/or a 6 week course of physiotherapy, in 60 participants with disability (mRS >1), at least 3 months after stroke. Primary outcome was feasibility, acceptability and tolerability. Secondary outcomes included death, dependency, motor function and quality of life measured 90 and 365 days after enrolment. Recruitment to the trial was feasible and acceptable; of 118 screened patients, 92 were eligible and 32 declined to participate. 60 patients were recruited between November 2011 and July 2013. All participants received some allocated treatment. Although 29 out of 30 participants received all 5 G-CSF/placebo injections, only 7 of 30 participants received all 18 therapy sessions. G-CSF was well tolerated but associated with a tendency to more adverse events than placebo (16 vs 10 patients, p = 0.12) and serious adverse events (SAE) (9 vs 3, p = 0.10). On average, patients received 14 (out of 18 planned) therapy sessions, interquartile range [12, 17]. Only a minority (23%) of participants completed all physiotherapy sessions, a large proportion of sessions (114 of 540, 21%) were cancelled due to patient (94, 17%) and therapist factors (20, 4%). No significant differences in functional outcomes were detected in either the G-CSF or physiotherapy group at day 90 or 365. Delivery of G-CSF is feasible in chronic stroke. However, the study failed to demonstrate feasibility for delivering additional physiotherapy sessions late after stroke therefore a definitive study using this trial design is not supported. Future work should

  5. Screening methods for post-stroke visual impairment: a systematic review.

    Science.gov (United States)

    Hanna, Kerry Louise; Hepworth, Lauren Rachel; Rowe, Fiona

    2017-12-01

    assess all potential post-stroke visual impairments. The current tools screen for only a number of potential stroke-related impairments, which means many visual defects may be missed. The sensitivity of those which screen for all impairments is significantly lowered when patients are unable to report their visual symptoms. Future research is required to develop a tool capable of assessing stroke patients which encompasses all potential visual deficits and can also be easily performed by both the patients and administered by health care professionals in order to ensure all stroke survivors with visual impairment are accurately identified and managed. Implications for Rehabilitation Over 65% of stroke survivors will suffer from a visual impairment, whereas 45% of stroke units do not assess vision. Visual impairment significantly reduces the quality of life, such as being unable to return to work, driving and depression. This review outlines the available screening methods to accurately identify stroke survivors with visual impairments. Identifying visual impairment after stroke can aid general rehabilitation and thus, improve the quality of life for these patients.

  6. Fibroblast Growth Factor Type 1 (FGF1)-Overexpressed Adipose-Derived Mesenchaymal Stem Cells (AD-MSCFGF1) Induce Neuroprotection and Functional Recovery in a Rat Stroke Model.

    Science.gov (United States)

    Ghazavi, Hamed; Hoseini, Seyed Javad; Ebrahimzadeh-Bideskan, Alireza; Mashkani, Baratali; Mehri, Soghra; Ghorbani, Ahmad; Sadri, Kayvan; Mahdipour, Elahe; Ghasemi, Faezeh; Forouzanfar, Fatemeh; Hoseini, Azar; Pasdar, Ali Reza; Sadeghnia, Hamid Reza; Ghayour-Mobarhan, Majid

    2017-10-01

    Stroke, as the second most common cause of death, imposes a great financial burden on both the individual and society. Mesenchymal stem cells from rodents have demonstrated efficacy in experimental animal models of stroke due to enhanced neurological recovery. Since FGF1 (fibroblast growth factor 1) displays neuroprotective properties, for the first time, we investigated the effect of acute intravenous administration of FGF1 gene transfected adipose-derived mesenchymal stem cell (AD-MSC FGF1 ) on transient experimental ischemic stroke in rats. Stroke induction was made by transient middle cerebral artery occlusion (tMCAO). 2 × 10 6  AD-MSC FGF1 was administrated intravenously 30 min after carotid reperfusion. The ability of technetium 99m -hexamethyl propylene amine oxime ( 99m Tc-HMPAO)-labeled AD-MSC FGF1 to enter into ischemic brain was evaluated 2 h post injection. 24 h post operation, the neurological recovery (rotarod and Roger's tests), the infarct volume (2, 3, 5-triphenyltetrazolium chloride, TTC assay), apoptosis rate (TUNEL assay), and the expression of FGF1 protein (western blotting) in the ischemic hemisphere were assessed. The 99m Tc-HMPAO-labeled AD-MSC FGF1 could enter into the ischemic brain. Ischemic hemisphere activity was significantly higher than that observed in the contralateral hemisphere (p = 0.002). The administration of AD-MSC FGF1 resulted in significant improvement of neurological function tests and increased density of FGF1 protein in the peri-infarct area, while the infarct volume and the apoptotic index were significantly decreased, in comparison to the other treated groups. In conclusion, acute intravenous administration of AD-MSC FGF1 can be a novel and promising candidate approach for the treatment of ischemic stroke.

  7. Cognitive performance after ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Maria Gabriela R. Ferreira

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

  8. An optimized dosing regimen of cimaglermin (neuregulin 1β3, glial growth factor 2) enhances molecular markers of neuroplasticity and functional recovery after permanent ischemic stroke in rats.

    Science.gov (United States)

    Iaci, Jennifer F; Parry, Tom J; Huang, Zhihong; Pavlopoulos, Elias; Finklestein, Seth P; Ren, Jingmei; Caggiano, Anthony

    2016-03-01

    Cimaglermin (neuregulin 1β3, glial growth factor 2) is a neuregulin growth factor family member in clinical development for chronic heart failure. Previously, in a permanent middle cerebral artery occlusion (pMCAO) rat stroke model, systemic cimaglermin treatment initiated up to 7 days after ischemia onset promoted recovery without reduced lesion volume. Presented here to extend the evidence are two studies that use a rat stroke model to evaluate the effects of cimaglermin dose level and dose frequency initiated 24 hr after pMCAO. Forelimb- and hindlimb-placing scores (proprioceptive behavioral tests), body-swing symmetry, and infarct volume were compared between treatment groups (n = 12/group). Possible mechanisms underlying cimaglermin-mediated neurologic recovery were examined through axonal growth and synapse formation histological markers. Cimaglermin was evaluated over a wider dose range (0.02, 0.1, or 1.0 mg/kg) than doses previously shown to be effective but used the same dosing regimen (2 weeks of daily intravenous administration, then 1 week without treatment). The dose-frequency study used the dose-ranging study's most effective dose (1.0 mg/kg) to compare daily, once per week, and twice per week dosing for 3 weeks (then 1 week without treatment). Dose- and frequency-dependent functional improvements were observed with cimaglermin without reduced lesion volume. Cimaglermin treatment significantly increased growth-associated protein 43 expression in both hemispheres (particularly somatosensory and motor cortices) and also increased synaptophysin expression. These data indicate that cimaglermin enhances recovery after stroke. Immunohistochemical changes were consistent with axonal sprouting and synapse formation but not acute neuroprotection. Cimaglermin represents a potential clinical development candidate for ischemic stroke treatment. © 2015 The Authors. Journal of Neuroscience Research Published by Wiley Periodicals, Inc.

  9. Stroke Education in an Emergency Department Waiting Room: a Comparison of Methods

    Directory of Open Access Journals (Sweden)

    Yu-Feng Yvonne Chan1

    2015-03-01

    Full Text Available Background: Since the emergency department (ED waiting room hosts a large, captive audience of patients and visitors, it may be an ideal location for conduct-ing focused stroke education. The aim of this study was to assess the effective-ness of various stroke education methods.Methods: Patients and visitors of an urban ED waiting room were randomized into one of the following groups: video, brochure, one-to-one teaching, combi-nation of these three methods, or control group. We administered a 13-question multiple-choice test to assess stroke knowledge prior to, immediately after, and at 1 month post-education to patients and visitors in the ED waiting room.Results: Of 4 groups receiving education, all significantly improved their test scores immediately post intervention (test scores 9.4±2.5-10.3±2.0, P<0.01. At 1 month, the combination group retained the most knowledge (9.4±2.4 exceed-ing pre-intervention and control scores (both 6.7±2.6, P<0.01.Conclusion: Among the various stroke education methods delivered in the ED waiting room, the combination method resulted in the highest knowledge reten-tion at 1-month post intervention.

  10. Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study.

    Science.gov (United States)

    Bjartmarz, Ingibjörg; Jónsdóttir, Helga; Hafsteinsdóttir, Thóra B

    2017-01-01

    Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses' and auxiliary nurses' view of the implementation. A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation. Improved nursing documentation was found for 23 items ( N  = 37), which was significant for nine items focusing mobility ( p  = 0.002, p  = 0.024, p  = 0.012), pain ( p  = 0.012), patient teaching ( p  = 0.001, p  = 0.000) and discharge planning ( p  = 0.000, p  = 0.002, p  = 0.004). Improved guideline use was found for 20 QIT-items ( N  = 30), with significant improvement on six items focusing on mobility ( p  = 0.023), depression ( p  = 0.033, p  = 0.025, p  = 0.046, p  = 0.046), discharge planning ( p  = 0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation ( p  = 0.019) and Context ( p  = 0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful

  11. Shorter length of stay in the stroke unit

    DEFF Research Database (Denmark)

    Tistad, Malin; Ytterberg, Charlotte; Sjöstrand, Christina

    2012-01-01

    was seen at 6 or 12 months post stroke. CONCLUSION: It seems possible to reduce the number of days spent in the stroke unit after mild to moderate stroke and instead spend days in a rehabilitation unit, and yet achieve similar patient satisfaction and faster recovery in ADL....... the first year post stroke in 2 groups of patients with mild to moderate stroke who received care in the same stroke unit. METHOD: The patients (1993/96, n=40; 2006/07, n=43) in this study received care in the stroke unit at Karolinska University Hospital, Huddinge, Sweden. Data on LOS and on the use...... unit was shorter in the 2006-2007 group (median 8 days) compared to the 1993-1996 group (13 days) (P post stroke in the 2006-2007 group, but no difference...

  12. A novel classification method for aid decision of traditional Chinese patent medicines for stroke treatment.

    Science.gov (United States)

    Zhao, Yufeng; Liu, Bo; He, Liyun; Bai, Wenjing; Yu, Xueyun; Cao, Xinyu; Luo, Lin; Rong, Peijing; Zhao, Yuxue; Li, Guozheng; Liu, Baoyan

    2017-09-01

    Traditional Chinese patent medicines are widely used to treat stroke because it has good efficacy in the clinical environment. However, because of the lack of knowledge on traditional Chinese patent medicines, many Western physicians, who are accountable for the majority of clinical prescriptions for such medicine, are confused with the use of traditional Chinese patent medicines. Therefore, the aid-decision method is critical and necessary to help Western physicians rationally use traditional Chinese patent medicines. In this paper, Manifold Ranking is employed to develop the aid-decision model of traditional Chinese patent medicines for stroke treatment. First, 115 stroke patients from three hospitals are recruited in the cross-sectional survey. Simultaneously, traditional Chinese physicians determine the traditional Chinese patent medicines appropriate for each patient. Second, particular indicators are explored to characterize the population feature of traditional Chinese patent medicines for stroke treatment. Moreover, these particular indicators can be easily obtained byWestern physicians and are feasible for widespread clinical application in the future. Third, the aid-decision model of traditional Chinese patent medicines for stroke treatment is constructed based on Manifold Ranking. Experimental results reveal that traditional Chinese patent medicines can be differentiated. Moreover, the proposed model can obtain high accuracy of aid decision.

  13. 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.

  14. Effects of microplasmin on recovery in a rat embolic stroke model

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Overgaard, K.; Pakola, S.

    2008-01-01

    OBJECTIVES: The purpose of the present study was to examine the effects of microplasmin on behavioral performance and infarct volume after middle cerebral artery occlusion (MCAO) in rats. Some experiments support that microplasmin may have neuroprotective and thrombolytic properties. METHODS...... bodyweight (pimproved both behavioral rehabilitation and bodyweight compared to 10 mg/kg microplasmin treatment, while saline...

  15. The older person has a stroke: Learning to adapt using the Feldenkrais® Method.

    Science.gov (United States)

    Jackson-Wyatt, O

    1995-01-01

    The older person with a stroke requires adapted therapeutic interventions to take into account normal age-related changes. The Feldenkrais® Method presents a model for learning to promote adaptability that addresses key functional changes seen with normal aging. Clinical examples related to specific functional tasks are discussed to highlight major treatment modifications and neuromuscular, psychological, emotional, and sensory considerations.

  16. Effects of low-frequency repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation on upper extremity motor recovery in the early period after stroke: a preliminary study.

    Science.gov (United States)

    Tosun, Aliye; Türe, Sabiha; Askin, Ayhan; Yardimci, Engin Ugur; Demirdal, Secil Umit; Kurt Incesu, Tülay; Tosun, Ozgur; Kocyigit, Hikmet; Akhan, Galip; Gelal, Fazıl Mustafa

    2017-07-01

    To assess the efficacy of inhibitory repetitive transcranial magnetic stimulation (rTMS) and neuromuscular electrical stimulation (NMES) on upper extremity motor function in patients with acute/subacute ischemic stroke. Twenty-five ischemic acute/subacute stroke subjects were enrolled in this randomized controlled trial. Experimental group 1 received low frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT) including activities to improve strength, flexibility, transfers, posture, balance, coordination, and activities of daily living, mainly focusing on upper limb movements; experimental group 2 received the same protocol combined with NMES to hand extensor muscles; and the control group received only PT. Functional magnetic resonance imaging (fMRI) scan was used to evaluate the activation or inhibition of the affected and unaffected primary motor cortex. No adverse effect was reported. Most of the clinical outcome scores improved significantly in all groups, however no statistically significant difference was found between groups due to the small sample sizes. The highest percent improvement scores were observed in TMS + NMES group (varying between 48 and 99.3%) and the lowest scores in control group (varying between 13.1 and 28.1%). Hand motor recovery was significant in both experimental groups while it did not change in control group. Some motor cortex excitability changes were also observed in fMRI. LF-rTMS with or without NMES seems to facilitate the motor recovery in the paretic hand of patients with acute/subacute ischemic stroke. TMS or the combination of TMS + NMES may be a promising additional therapy in upper limb motor training. Further studies with larger numbers of patients are needed to establish their effectiveness in upper limb motor rehabilitation of stroke.

  17. Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia.

    Science.gov (United States)

    Pérez, Laura Mónica; Inzitari, Marco; Roqué, Marta; Duarte, Esther; Vallés, Elisabeth; Rodó, Montserrat; Gallofré, Miquel

    2015-10-01

    Recovery after a stroke is determined by a broad range of neurological, functional and psychosocial factors. Evidence regarding these factors is not well established, in particular influence of cognition changes during rehabilitation. We aimed to investigate whether selective characteristics, including cognitive performance and its change over time, modulate functional recovery with home discharge in stroke survivors admitted to post-acute rehabilitation units. We undertook a multicenter cohort study, including all patients discharged from acute wards to any geriatric rehabilitation unit in Catalonia-Spain during 2008. Patients were assessed for demographics, clinical and functional variables using Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris (CMBD-RSS), which adapts the Minimum Data Set tool used in America's nursing homes. Baseline-to-discharge change in cognition was calculated on repeated assessments using the Cognitive Performance Scale (CPS, range 0-6, best-worst cognition). The multivariable effect of these factors was analyzed in relation to the outcome. 879 post-stroke patients were included (mean age 77.48 ± 10.18 years, 52.6% women). A worse initial CPS [OR (95% CI) = 0.851 (0.774-0.935)] and prevalent fecal incontinence [OR (95% CI) = 0.560 (0.454-0.691)] reduced the likelihood of returning home with functional improvement; whereas improvement of CPS, baseline to discharge, [OR (95% CI) = 1.348 (1.144-1.588)], more rehabilitation days within the first 2 weeks [OR (95% CI) = 1.011 (1.006-1.015)] and a longer hospital stay [OR (95% CI) = 1.011 (1.006-1.015)] were associated with the outcome. In our sample, different clinical characteristics, including cognitive function and its improvement over time, are associated with functional improvement in stroke patients undergoing rehabilitation. Our results might provide information to further studies aimed at exploring the influence of cognition changes during rehabilitation.

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

    Science.gov (United States)

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

    2016-12-01

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

  19. Stroke: Working toward a Prioritized World Agenda

    Science.gov (United States)

    Hachinski, Vladimir; Donnan, Geoffrey A.; Gorelick, Philip B.; Hacke, Werner; Cramer, Steven C.; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M.; Lo, Eng H.; Skolnick, Brett E.; Furie, Karen L.; Hankey, Graeme J.; Kivipelto, Miia; Morris, John; Rothwell, Peter M.; Sacco, Ralph L.; Smith, Jr., Sidney C.; Wang, Yulun; Bryer, Alan; Ford, Gary A.; Iadecola, Costantino; Martins, Sheila C.O.; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M.; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A.; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P.; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H.; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K.; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M.; Davis, Stephen M.; Goldstein, Larry B.; Leys, Didier; Tuomilehto, Jaakko

    2010-01-01

    Background and Purpose The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent ‘silo’ mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (e.g., social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build

  20. Thermally-enhanced oil recovery method and apparatus

    Science.gov (United States)

    Stahl, Charles R.; Gibson, Michael A.; Knudsen, Christian W.

    1987-01-01

    A thermally-enhanced oil recovery method and apparatus for exploiting deep well reservoirs utilizes electric downhole steam generators to provide supplemental heat to generate high quality steam from hot pressurized water which is heated at the surface. A downhole electric heater placed within a well bore for local heating of the pressurized liquid water into steam is powered by electricity from the above-ground gas turbine-driven electric generators fueled by any clean fuel such as natural gas, distillate or some crude oils, or may come from the field being stimulated. Heat recovered from the turbine exhaust is used to provide the hot pressurized water. Electrical power may be cogenerated and sold to an electric utility to provide immediate cash flow and improved economics. During the cogeneration period (no electrical power to some or all of the downhole units), the oil field can continue to be stimulated by injecting hot pressurized water, which will flash into lower quality steam at reservoir conditions. The heater includes electrical heating elements supplied with three-phase alternating current or direct current. The injection fluid flows through the heater elements to generate high quality steam to exit at the bottom of the heater assembly into the reservoir. The injection tube is closed at the bottom and has radial orifices for expanding the injection fluid to reservoir pressure.

  1. The SOS pilot study: a RCT of routine oxygen supplementation early after acute stroke--effect on recovery of neurological function at one week.

    Directory of Open Access Journals (Sweden)

    Christine Roffe

    Full Text Available Mild hypoxia is common after stroke and associated with poor long-term outcome. Oxygen supplementation could prevent hypoxia and improve recovery. A previous study of routine oxygen supplementation showed no significant benefit at 7 and 12 months. This pilot study reports the effects of routine oxygen supplementation for 72 hours on oxygen saturation and neurological outcomes at 1 week after a stroke.Patients with a clinical diagnosis of acute stroke were recruited within 24 h of hospital admission between October 2004 and April 2008. Participants were randomized to oxygen via nasal cannulae (72 h or control (room air, oxygen given only if clinically indicated. Clinical outcomes were assessed by research team members at 1 week. Baseline data for oxygen (n = 148 and control (n = 141 did not differ between groups.The median (interquartile range National Institutes of Health Stroke Scale (NIHSS score for the groups at baseline was 6 (7 and 5 (7 respectively. The median Nocturnal Oxygen Saturation during treatment was 1.4% (0.3 higher in the oxygen than in the control group (p<0.001 during the intervention. At 1 week, the median NIHSS score had reduced by 2 (3 in the oxygen and by 1 (2 in the control group. 31% of participants in the oxygen group and 14% in the control group had an improvement of ≥4 NIHSS points at 1 week doubling the odds of improvement in the oxygen group (OR: 2.9.Our data show that routine oxygen supplementation started within 24 hours of hospital admission with acute stroke led to a small, but statistically significant, improvement in neurological recovery at 1 week. However, the difference in NIHSS improvement may be due to baseline imbalance in stroke severity between the two groups and needs to be confirmed in a larger study and linked to longer-term clinical outcome.Controlled-Trials.com ISRCTN12362720; European Clinical Trials Database 2004-001866-41.

  2. Malnutrition risk predicts recovery of full oral intake among older adult stroke patients undergoing enteral nutrition: Secondary analysis of a multicentre survey (the APPLE study).

    Science.gov (United States)

    Nishioka, Shinta; Okamoto, Takatsugu; Takayama, Masako; Urushihara, Maki; Watanabe, Misuzu; Kiriya, Yumiko; Shintani, Keiko; Nakagomi, Hiromi; Kageyama, Noriko

    2017-08-01

    Whether malnutrition risk correlates with recovery of swallowing function of convalescent stroke patients is unknown. This study was conducted to clarify whether malnutrition risks predict achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition. We conducted a secondary analysis of 466 convalescent stroke patients, aged 65 years or over, who were undergoing enteral nutrition. Patients were extracted from the "Algorithm for Post-stroke Patients to improve oral intake Level; APPLE" study database compiled at the Kaifukuki (convalescent) rehabilitation wards. Malnutrition risk was determined by the Geriatric Nutritional Risk Index as follows: severe (malnutrition risks (≥98). Swallowing function was assessed by Fujishima's swallowing grade (FSG) on admission and discharge. The primary outcome was achievement of full oral intake, indicated by FSG ≥ 7. Binary logistic regression analysis was performed to identify predictive factors, including malnutrition risk, for achieving full oral intake. Estimated hazard risk was computed by Cox's hazard model. Of the 466 individuals, 264 were ultimately included in this study. Participants with severe malnutrition risk showed a significantly lower proportion of achievement of full oral intake than lower severity groups (P = 0.001). After adjusting for potential confounders, binary logistic regression analysis showed that patients with severe malnutrition risk were less likely to achieve full oral intake (adjusted odds ratio: 0.232, 95% confidence interval [95% CI]: 0.047-1.141). Cox's proportional hazard model revealed that severe malnutrition risk was an independent predictor of full oral intake (adjusted hazard ratio: 0.374, 95% CI: 0.166-0.842). Compared to patients who did not achieve full oral intake, patients who achieved full oral intake had significantly higher energy intake, but there was no difference in protein intake and weight change. Severe malnutrition risk independently

  3. Comparison of different cryotherapy recovery methods in elite junior cyclists.

    Science.gov (United States)

    Chan, Yue-Yan; Yim, Yik-Man; Bercades, Dave; Cheng, To Toby; Ngo, Kwan-Lung; Lo, Ka-Kay

    2016-07-01

    Cold water immersion (CWI) and active recovery treatment (ACT) are commonly used recovery treatments for athletes between exercise bouts, but they are sometimes limited by space and availability of equipment in training and competition venues. Therefore, the purpose of this study was to determine whether cold compression therapy (CCT) would provide the same effect as CWI and ACT as an alternative option in a hot environment. Eight elite male junior cyclists (age, 15.5 ± 1.2 years; height, 167.7 ± 3.3 cm; body mass, 57.3 ± 3.5 kg; peak oxygen uptake, 64.7 ± 4.3 mL/kg/min) completed a maximal cycling test to determine their peak power output (PPO) and oxygen uptake. Then they completed three tests using randomised recovery protocol of CWI, CCT and ACT for 15 minutes. Each test consisted of two 35-minute exercise bouts, with 5 minutes of warm-up, 15 minutes of cycling at 75% PPO and 15 minutes maximal trial. The two exercise bouts were separated by 60 minutes (5 minutes cool-down, 10 minutes preparation for recovery treatment, 15 minutes recovery treatment, and 30 minutes passive recovery). There was no significant difference between average power output, blood lactate, rating of perceived exertion, and heart rate for two time-trial bouts for all recovery treatments. A significant decrease in core temperature was noted prior to the start of the second exercise bout for CWI. CCT, CWI and ACT are all useful recovery treatments between exercise bouts.

  4. A mixed methods study of multiple health behaviors among individuals with stroke

    Directory of Open Access Journals (Sweden)

    Matthew Plow

    2017-05-01

    Full Text Available Background Individuals with stroke often have multiple cardiovascular risk factors that necessitate promoting engagement in multiple health behaviors. However, observational studies of individuals with stroke have typically focused on promoting a single health behavior. Thus, there is a poor understanding of linkages between healthy behaviors and the circumstances in which factors, such as stroke impairments, may influence a single or multiple health behaviors. Methods We conducted a mixed methods convergent parallel study of 25 individuals with stroke to examine the relationships between stroke impairments and physical activity, sleep, and nutrition. Our goal was to gain further insight into possible strategies to promote multiple health behaviors among individuals with stroke. This study focused on physical activity, sleep, and nutrition because of their importance in achieving energy balance, maintaining a healthy weight, and reducing cardiovascular risks. Qualitative and quantitative data were collected concurrently, with the former being prioritized over the latter. Qualitative data was prioritized in order to develop a conceptual model of engagement in multiple health behaviors among individuals with stroke. Qualitative and quantitative data were analyzed independently and then were integrated during the inference stage to develop meta-inferences. The 25 individuals with stroke completed closed-ended questionnaires on healthy behaviors and physical function. They also participated in face-to-face focus groups and one-to-one phone interviews. Results We found statistically significant and moderate correlations between hand function and healthy eating habits (r = 0.45, sleep disturbances and limitations in activities of daily living (r =  − 0.55, BMI and limitations in activities of daily living (r =  − 0.49, physical activity and limitations in activities of daily living (r = 0.41, mobility impairments and BMI (r

  5. Know your tools - concordance of different methods for measuring brain volume change after ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Yassi, Nawaf; Campbell, Bruce C.V.; Davis, Stephen M.; Bivard, Andrew [The University of Melbourne, Departments of Medicine and Neurology, Melbourne Brain Centre rate at The Royal Melbourne Hospital, Parkville, Victoria (Australia); Moffat, Bradford A.; Steward, Christopher; Desmond, Patricia M. [The University of Melbourne, Department of Radiology, The Royal Melbourne Hospital, Parkville (Australia); Churilov, Leonid [The University of Melbourne, The Florey Institute of Neurosciences and Mental Health, Parkville (Australia); Parsons, Mark W. [University of Newcastle and Hunter Medical Research Institute, Priority Research Centre for Translational Neuroscience and Mental Health, Newcastle (Australia)

    2015-07-15

    Longitudinal brain volume changes have been investigated in a number of cerebral disorders as a surrogate marker of clinical outcome. In stroke, unique methodological challenges are posed by dynamic structural changes occurring after onset, particularly those relating to the infarct lesion. We aimed to evaluate agreement between different analysis methods for the measurement of post-stroke brain volume change, and to explore technical challenges inherent to these methods. Fifteen patients with anterior circulation stroke underwent magnetic resonance imaging within 1 week of onset and at 1 and 3 months. Whole-brain as well as grey- and white-matter volume were estimated separately using both an intensity-based and a surface watershed-based algorithm. In the case of the intensity-based algorithm, the analysis was also performed with and without exclusion of the infarct lesion. Due to the effects of peri-infarct edema at the baseline scan, longitudinal volume change was measured as percentage change between the 1 and 3-month scans. Intra-class and concordance correlation coefficients were used to assess agreement between the different analysis methods. Reduced major axis regression was used to inspect the nature of bias between measurements. Overall agreement between methods was modest with strong disagreement between some techniques. Measurements were variably impacted by procedures performed to account for infarct lesions. Improvements in volumetric methods and consensus between methodologies employed in different studies are necessary in order to increase the validity of conclusions derived from post-stroke cerebral volumetric studies. Readers should be aware of the potential impact of different methods on study conclusions. (orig.)

  6. Stroke: working toward a prioritized world agenda.

    Science.gov (United States)

    Hachinski, Vladimir; Donnan, Geoffrey A; Gorelick, Philip B; Hacke, Werner; Cramer, Steven C; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M; Lo, Eng H; Skolnick, Brett E; Furie, Karen L; Hankey, Graeme J; Kivipelto, Miia; Morris, John; Rothwell, Peter M; Sacco, Ralph L; Smith, Sidney C; Wang, Yulun; Bryer, Alan; Ford, Gary A; Iadecola, Costantino; Martins, Sheila C O; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M; Davis, Stephen M; Goldstein, Larry B; Leys, Didier; Tuomilehto, Jaakko

    2010-08-01

    The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Preliminary work was performed by seven working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent 'silo' mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and

  7. Validation of the efficiency of a robotic rehabilitation training system for recovery of severe plegie hand motor function after a stroke.

    Science.gov (United States)

    Tanabe, Hirofumi; Ikuta, Munehiro; Morita, Yoshifumi

    2017-07-01

    We have developed a rehabilitation training system called the Useful and Ultimate Rehabilitation System PARKO (UR System PARKO) to promote the recovery of motor function of the severe chronic plegic hand of stroke patients. This system was equipped with two functions to realize two conditions: (1) fixing of all fingers to a hyperextended position and (2) extending the elbow joint while applying resistance load to the fingertips. A clinical test was conducted with two patients to determine the therapeutic effect of the UR System PARKO for severe plegic hand. In both patients, the active ranges of motion of finger extension improved after training with the UR System PARKO. Moreover, the Modified Ashworth scale scores of finger extension increased. Thus, training reduced the spastic paralysis. These results suggest the effectiveness of training with the UR System PARKO for recovery of motor function as reflected in the finger extension of the severe plegic hand.

  8. Guide to Choosing Stroke Rehabilitation Services

    Science.gov (United States)

    National Stroke Association’s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you:  Re-learn basic skills such ...

  9. 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

  10. 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

  11. Interactive Bio-feedback Therapy Using Hybrid Assistive Limbs for Motor Recovery after Stroke: Current Practice and Future Perspectives.

    Science.gov (United States)

    Morishita, Takashi; Inoue, Tooru

    2016-10-15

    Interactive bio-feedback (iBF) was initially developed for the rehabilitation of motor function in patients with neurological disorders, and subsequently yielded the development of the hybrid assistive limb (HAL). Here, we provide a review of the theory underlying HAL treatment as well as our clinical experience and recommendations for future clinical studies using HAL in acute stroke patients. We performed a PubMed-based literature search, a retrospective data review of our acute stroke case series, and included a sample case report of our findings. Given past animal studies and functional imaging results, iBF therapy using the HAL in the acute phase of stroke seems an appropriate approach for preventing learned non-use and interhemispheric excitation imbalances. iBF therapy may furthermore promote appropriate neuronal network reorganization. Based on experiences in our stroke center, HAL rehabilitation is a safe and effective treatment modality for recovering motor impairments after acute stroke, and allows the design of tailored rehabilitation programs for individual patients. iBF therapy through the HAL system seems to be an effective and promising approach to stroke rehabilitation; however, the superiority of this treatment to conventional rehabilitation remains unclear. Further clinical studies are warranted. Additionally, the formation of a patient registry will permit a meta-analysis of HAL cases and address the problems associated with a controlled trial (e.g., the heterogeneity of an acute stroke cohort). The development of robotic engineering will improve the efficacy of HAL rehabilitation and has the potential to standardize patient rehabilitation practice.

  12. 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

  13. [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.

  14. Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study.

    Science.gov (United States)

    Xu, Qun; Guo, Feng; Salem, Hassan M Abo; Chen, Hong; Huang, Xiaolin

    2017-12-01

    To investigate the effectiveness of mirror therapy combined with neuromuscular electrical stimulation in promoting motor recovery of the lower limbs and walking ability in patients suffering from foot drop after stroke. Randomized controlled study. Inpatient rehabilitation center of a teaching hospital. Sixty-nine patients with foot drop. Patients were randomly divided into three groups: control, mirror therapy, and mirror therapy + neuromuscular electrical stimulation. All groups received interventions for 0.5 hours/day and five days/week for four weeks. 10-Meter walk test, Brunnstrom stage of motor recovery of the lower limbs, Modified Ashworth Scale score of plantar flexor spasticity, and passive ankle joint dorsiflexion range of motion were assessed before and after the four-week period. After four weeks of intervention, Brunnstrom stage ( P = 0.04), 10-meter walk test ( P electrical stimulation group showed better results than those in the mirror therapy group in the 10-meter walk test ( P electrical stimulation group showed a significant decrease in spasticity ( P electrical stimulation may help improve walking ability and reduce spasticity in stroke patients with foot drop.

  15. The Neuroprotective Effects of Flaxseed Oil Supplementation on Functional Motor Recovery in a Model of Ischemic Brain Stroke: Upregulation of BDNF and GDNF.

    Science.gov (United States)

    Bagheri, Abolqasem; Talei, Sahand; Hassanzadeh, Negar; Mokhtari, Tahmineh; Akbari, Mohammad; Malek, Fatemeh; Jameie, Seyed Behnamedin; Sadeghi, Yousef; Hassanzadeh, Gholamreza

    2017-12-01

    Cerebral ischemic stroke is a common leading cause of disability. Flaxseed is a richest plant-based source of antioxidants. In this study, the effects of flaxseed oil (FSO) pretreatment on functional motor recovery and gene expression and protein content of neurotrophic factors in motor cortex area in rat model of brain ischemia/reperfusion (I/R) were assessed. Transient middle cerebral artery occlusion (tMCAo) in rats was used as model brain I/R. Rats (6 in each group) were randomly divided into four groups of Control (Co+normal saline [NS]), Sham (Sh+NS), tMCAo+NS and tMCAo+FSO. After three weeks of pretreatment with vehicle or FSO (0.2 ml~800 mg/kg body weight), the rats were operated in sham and ischemic groups. Ischemia was induced for 1 h and then reperfused. After 24 h of reperfusion, neurological examination was performed, and animals were sacrificed, and their brains were used for molecular and histopathological studies. FSO significantly improved the functional motor recovery compared with tMCAo+NS group (Pmotor cortex area following cerebral ischemic stroke by increasing the neurotrophic factors (BDNF, GDNF).

  16. Conductive Education as a Method of Stroke Rehabilitation: A Single Blinded Randomised Controlled Feasibility Study

    Directory of Open Access Journals (Sweden)

    Judith Bek

    2016-01-01

    Full Text Available Background. Conductive Education for stroke survivors has shown promise but randomised evidence is unavailable. This study assessed the feasibility of a definitive randomised controlled trial to evaluate efficacy. Methods. Adult stroke survivors were recruited through local community notices. Those completing the baseline assessment were randomised using an online program and group allocation was independent. Intervention group participants received 10 weekly 1.5-hour sessions of Conductive Education at the National Institute of Conductive Education in Birmingham, UK. The control group participants attended two group meetings. The study evaluated the feasibility of recruitment procedures, delivery of the intervention, retention of participants, and appropriateness of outcome measures and data collection methods. Independent assessments included the Barthel Index, the Stroke Impact Scale, the Timed Up and Go test, and the Hospital Anxiety and Depression Scale. Results. Eighty-two patients were enrolled; 77 completed the baseline assessment (46 men, mean age 62.1 yrs. and were randomised. 70 commenced the intervention (n=37 or an equivalent waiting period (n=33. 32/37 completed the 10-week training and 32/33 the waiting period. There were no missing items from completed questionnaires and no adverse events. Discussion. Recruitment, intervention, and assessment methods worked well. Transport issues for intervention and assessment appointments require review. Conclusion. A definitive trial is feasible. This trial is registered with ISRCTN84064492.

  17. The use of recovery methods post-exercise.

    Science.gov (United States)

    Reilly, Thomas; Ekblom, Bjorn

    2005-06-01

    Competitive soccer engages many of the body's systems to a major extent. The musculoskeletal, nervous, immune and metabolic systems are stressed to a point where recovery strategies post-exercise become influential in preparing for the next match. Intense activity at a 7-day training camp causes participants to experience lowered concentrations of non-killer cells and T-helper cells. Two consecutive games in 24 h produce disturbances in the testosterone-cortisol ratio. When competitive schedules are congested, the recovery process should be optimized for performance capabilities to be restored to normal as soon as possible. There is evidence that glycogen stores are reduced near to depletion at the end of a soccer game and that a diet high in carbohydrates can aid recovery. Water alone is not the best means of restoring body fluids, since carbohydrate-electrolyte drinks display better intestinal absorption and reduce urine output. Some relief from muscle soreness may be achieved by means of a warm-down. Deep-water running regimens can replace conventional physical training in the days after competition. Massage, cryotherapy and alternative therapies have not been shown to be consistently effective. It is concluded that optimizing recovery post-exercise depends on a combination of factors that incorporate a consideration of individual differences and lifestyle factors. The procedures to facilitate recovery processes should start immediately the game or training finishes. Match administrators and tournament planners should consider the stressful consequences for players in periods of congested fixtures and alleviate the physiological strain as far as possible by allowing 72 h between competitive games. This frequency of competition is unlikely to be sustainable in the long term.

  18. Recovery of mineral oil from waste emulsion using electrocoagulation method

    Directory of Open Access Journals (Sweden)

    Razali Mohd Najib

    2016-01-01

    Full Text Available This paper presents a research to recover mineral oil from industrial waste emulsion. This research also evaluates the standard of water produced after the oil recovery. The ecosystem could be polluted if this waste is not treated prior to discharge. The equipment needed for this experiment is power supply (generator, connecting wire and metal plate for providing the coagulant. The chosen plates were aluminium and iron plate. The power supply will be connected to the plate producing anode (positive terminal and cathode (negative terminal. Both plates are immersed into a beaker containing waste emulsion. The charge supplied by the current will cause the aluminium or ferum to dissisipate and became ions. These ions will attract the oil to flock together and float at the surface. The water will then filter by using filter paper. Electrocoagulation was done without addition of chemical thus can prevent the hazard from the chemicals. The samples was sent for oil and grease test. The optimum time needed for recovery of oil was 3 hours. The percentage recovery reach constant trend of 95% afterwards. When the power consumption increases, the percentage recovery also increases. However, the current should be lower than 0.5 ampere as it is the limit that human body can withstand. Thus, power consumption of 27.5 Watt was chosen as optimum value. The oil recovery of at power consumption at 27.5W is 96%. The best plate in the process was the aluminium pair which can recover more than ferum plate. The present work concludes the promising future for waste water treatment by usage of electrocoagulation technique.

  19. How to improve walking, balance and social participation following stroke: a comparison of the long term effects of two walking aids--canes and an orthosis TheraTogs--on the recovery of gait following acute stroke. A study protocol for a multi-centre, single blind, randomised control trial

    Directory of Open Access Journals (Sweden)

    Maguire Clare

    2012-03-01

    Full Text Available Abstract Background Annually, some 9000 people in Switzerland suffer a first time stroke. Of these 60% are left with moderate to severe walking disability. Evidence shows that rehabilitation techniques which emphasise activity of the hemiplegic side increase ipsilesional cortical plasticity and improve functional outcomes. Canes are commonly used in gait rehabilitation although they significantly reduce hemiplegic muscle activity. We have shown that an orthosis "TheraTogs" (a corset with elasticated strapping significantly increases hemiplegic muscle activity during gait. The aim of the present study is to investigate the long term effects on the recovery of gait, balance and social participation of gait rehabilitation with TheraTogs compared to gait rehabilitation with a cane following first time acute stroke. Methods/Design Multi-centre, single blind, randomised trial with 120 patients after first stroke. When subjects have reached Functional Ambulation Category 3 they will be randomly allocated into TheraTogs or cane group. TheraTogs will be applied to support hip extensor and abductor musculature according to a standardised procedure. Cane walking held at the level of the radial styloid of the sound wrist. Subjects will walk throughout the day with only the assigned walking aid. Standard therapy treatments and usual care will remain unchanged and documented. The intervention will continue for five weeks or until patients have reached Functional Ambulation category 5. Outcome measures will be assessed the day before begin of intervention, the day after completion, 3 months, 6 months and 2 years. Primary outcome: Timed "up and go" test, secondary outcomes: peak surface EMG of gluteus maximus and gluteus medius, activation patterns of hemiplegic leg musculature, temporo-spatial gait parameters, hemiplegic hip kinematics in the frontal and sagittal planes, dynamic balance, daily activity measured by accelerometry, Stroke Impact Scale

  20. Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke.

    Science.gov (United States)

    Ballester, Belén Rubio; Nirme, Jens; Camacho, Irene; Duarte, Esther; Rodríguez, Susana; Cuxart, Ampar; Duff, Armin; Verschure, Paul F M J

    2017-08-07

    Most stroke survivors continue to experience motor impairments even after hospital discharge. Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments. Here we assess the impact of at-home VR-based motor training on functional motor recovery, corticospinal excitability and cortical reorganization. The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on (1) cortical reorganization, (2) corticospinal tract, and (3) functional recovery after stroke in comparison to home-based occupational therapy. We conducted a parallel-group, controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities. A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment. A group of subjects was trained using a VR-based system for motor rehabilitation, while the control group followed a conventional therapy. Motor function was evaluated at baseline, after the intervention, and at 12-weeks follow-up. In a subgroup of subjects, we used Navigated Brain Stimulation (NBS) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization. Results from the system's recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group (1.53, SD 2.4 in Chedoke Arm and Hand Activity Inventory). However, functional improvements did not reach clinical significance. After the therapy, physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere, that is, abductor pollicis brevis. We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere, which strongly correlated with improvements in clinical scales. These

  1. [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

  2. Beneficial falls in stroke patients: evaluation using a mixed method design.

    Science.gov (United States)

    Watabe, Takayuki; Suzuki, Hisayoshi; Konuki, Yusuke; Aoki, Keiichiro; Nagashima, Jun; Sako, Rikitaro

    2018-03-01

    Purpose To use a mixed method design to evaluate how clinicians judge falls in stroke patients as a beneficial event, and to identify patient-specific characteristics associated with beneficial falls. Methods The definition of beneficial falls was based on interviews with six experienced clinicians in stroke rehabilitation. Interview data were analyzed using the grounded theory approach, with outcomes used to develop a checklist to judge falls as beneficial. We subsequently used the checklist to identify falls sustained by patients in our rehabilitation unit as beneficial events. The characteristics of beneficial fallers were investigated in this retrospective study. Results According to experienced clinicians, beneficial falls result from patient-specific factors and level of independence. Beneficial falls are not associated with after-effects or a diagnosis of cognitive impairment, do not result in physical injury and post-fall syndrome, and do not alter the course of rehabilitation. These falls are considered to enhance patients' self-awareness of their physical status and abilities. Among the 123 stroke patients who experienced a fall in our study group, 23 patients (18.7%) were identified as beneficial fallers according to our checklist. The majority had a left hemiplegia and perceptual impairments, and were at low risk of recurrent falls and made functional gains during rehabilitation. Conclusions Based on our results, we created a 10-item checklist to differentiate beneficial from adverse falls. This differentiation is important to target fall prevention programs to adverse fallers in rehabilitation units.

  3. Multimodal pressure-flow method to assess dynamics of cerebral autoregulation in stroke and hypertension

    Directory of Open Access Journals (Sweden)

    Lipsitz Lewis A

    2004-10-01

    Full Text Available Abstract Background This study evaluated the effects of stroke on regulation of cerebral blood flow in response to fluctuations in systemic blood pressure (BP. The autoregulatory dynamics are difficult to assess because of the nonstationarity and nonlinearity of the component signals. Methods We studied 15 normotensive, 20 hypertensive and 15 minor stroke subjects (48.0 ± 1.3 years. BP and blood flow velocities (BFV from middle cerebral arteries (MCA were measured during the Valsalva maneuver (VM using transcranial Doppler ultrasound. Results A new technique, multimodal pressure-flow analysis (MMPF, was implemented to analyze these short, nonstationary signals. MMPF analysis decomposes complex BP and BFV signals into multiple empirical modes, representing their instantaneous frequency-amplitude modulation. The empirical mode corresponding to the VM BP profile was used to construct the continuous phase diagram and to identify the minimum and maximum values from the residual BP (BPR and BFV (BFVR signals. The BP-BFV phase shift was calculated as the difference between the phase corresponding to the BPR and BFVR minimum (maximum values. BP-BFV phase shifts were significantly different between groups. In the normotensive group, the BFVR minimum and maximum preceded the BPR minimum and maximum, respectively, leading to large positive values of BP-BFV shifts. Conclusion In the stroke and hypertensive groups, the resulting BP-BFV phase shift was significantly smaller compared to the normotensive group. A standard autoregulation index did not differentiate the groups. The MMPF method enables evaluation of autoregulatory dynamics based on instantaneous BP-BFV phase analysis. Regulation of BP-BFV dynamics is altered with hypertension and after stroke, rendering blood flow dependent on blood pressure.

  4. Experimental Evaluation of a Method for Turbocharging Four-Stroke, Single Cylinder, Internal Combustion Engines

    Science.gov (United States)

    Buchman, Michael; Winter, Amos

    2015-11-01

    Turbocharging an engine increases specific power, improves fuel economy, reduces emissions, and lowers cost compared to a naturally aspirated engine of the same power output. These advantages make turbocharging commonplace for multi-cylinder engines. Single cylinder engineers are not commonly turbocharged due to the phase lag between the exhaust stroke, which powers the turbocharger, and the intake stroke, when air is pumped into the engine. Our proposed method of turbocharging single cylinder engines is to add an ``air capacitor'' to the intake manifold, an additional volume that acts as a buffer to store compressed air between the exhaust and intake strokes, and smooth out the pressure pulses from the turbocharger. This talk presents experimental results from a single cylinder, turbocharged diesel engine fit with various sized air capacitors. Power output from the engine was measured using a dynamometer made from a generator, with the electrical power dissipated with resistive heating elements. We found that intake air density increases with capacitor size as theoretically predicted, ranging from 40 to 60 percent depending on heat transfer. Our experiment was able to produce 29 percent more power compared to using natural aspiration. These results validated that an air capacitor and turbocharger may be a simple, cost effective means of increasing the power density of single cylinder engines.

  5. Pediatric Stroke and transcranial Direct Current Stimulation: Methods for Rational Individualized Dose Optimization

    Directory of Open Access Journals (Sweden)

    Bernadette T Gillick

    2014-09-01

    Full Text Available Background- Transcranial direct current stimulation (tDCS has been investigated mainly in adults and doses may not be appropriate in pediatric applications. In perinatal stroke where potential applications are promising, rational adaptation of dosage for children remains under investigation.Objective - Construct child-specific tDCS dosing parameters through case study within a perinatal stroke tDCS safety and feasibility trial. Methods- 10-year-old subject with a diagnosis of presumed perinatal ischemic stroke and hemiparesis was identified. T1 MRI scans used to derive computerized model for current flow and electrode positions. Workflow using modeling results and consideration of dosage in previous clinical trials was incorporated. Prior Ad hoc adult montages versus de novo optimized montages provided distinct risk benefit analysis. Approximating adult dose required consideration of changes in both peak brain current flow and distribution which further tradeoff between maximizing efficacy and adding safety factors. Electrode size, position, current intensity, compliance voltage, and duration were controlled independently in this process.Results- Brain electric fields modeled and compared to values previously predicted models. Approximating conservative brain current flow patterns and intensities used in previous adult trials for comparable indications, the optimal current intensity established was 0.7 mA for 10 minutes with a tDCS C3/C4 montage. Specifically 0.7 mA produced comparable peak brain current intensity of an average adult receiving 1.0 mA. Electrode size of 5x7 cm2 with 1.0 mA and low-voltage tDCS was employed to maximize tolerability. Safety and feasibility confirmed with subject tolerating the session well and no serious adverse events.Conclusion- Rational approaches to dose customization, with steps informed by computational modeling, may improve guidance for pediatric stroke tDCS trials.

  6. Methods guiding stakeholder engagement in planning a pragmatic study on changing stroke systems of care.

    Science.gov (United States)

    Gesell, Sabina B; Klein, Karen Potvin; Halladay, Jacqueline; Bettger, Janet Prvu; Freburger, Janet; Cummings, Doyle M; Lutz, Barbara J; Coleman, Sylvia; Bushnell, Cheryl; Rosamond, Wayne; Duncan, Pamela W

    2017-04-01

    The Comprehensive Post-Acute Stroke Services (COMPASS) Study is one of the first large pragmatic randomized-controlled clinical trials using comparative effectiveness research methods, funded by the Patient-Centered Outcomes Research Institute. In the COMPASS Study, we compare the effectiveness of a patient-centered, transitional care intervention versus usual care for stroke patients discharged home from acute care. Outcomes include stroke patient post-discharge functional status and caregiver strain 90 days after discharge, and hospital readmissions. A central tenet of Patient-Centered Outcomes Research Institute-funded research is stakeholder engagement throughout the research process. However, evidence on how to successfully implement a pragmatic trial that changes systems of care in combination with robust stakeholder engagement is limited. This combination is not without challenges. We present our approach for broad-based stakeholder engagement in the context of a pragmatic trial with the participation of patients, caregivers, community stakeholders, including the North Carolina Stroke Care Collaborative hospital network, and policy makers. To maximize stakeholder engagement throughout the COMPASS Study, we employed a conceptual model with the following components: (1) Patient and Other Stakeholder Identification and Selection; (2) Patient and Other Stakeholder Involvement Across the Spectrum of Research Activities; (3) Dedicated Resources for Patient and Other Stakeholder Involvement; (4) Support for Patient and Other Stakeholder Engagement Through Organizational Processes; (5) Communication with Patients and Other Stakeholders; (6) Transparent Involvement Processes; (7) Tracking of Engagement; and (8) Evaluation of Engagement. In this paper, we describe how each component of the model is being implemented and how this approach addresses existing gaps in the literature on strategies for engaging stakeholders in meaningful and useful ways when conducting

  7. Method for the recovery of Cr and Co species from effluents using ...

    African Journals Online (AJOL)

    Microbial chromium and cobalt reduction was investigated for application in their recovery from industrial wastewater using flame atomic absorption technique. This paper presents the development of a routine method for the recovery of Cr and Co species in microbial-treated industrial wastewater using agricultural ...

  8. Recovery of DNA from agarose gel by trap method | Xia | African ...

    African Journals Online (AJOL)

    Recovery of DNA from agarose gel electrophoresis is a basic operation during molecular cloning. Circular or linear DNA fragments which vary from 1.5 to 6.5 kb and correspond to 1 kb marker can be recovered from 0.8 to 1.0% agarose gel smoothly with a simple and rapid trap method. The recovery efficiency could be ...

  9. A new prognostic scale for the early prediction of ischemic stroke recovery mainly based on traditional Chinese medicine symptoms and NIHSS score: a retrospective cohort study.

    Science.gov (United States)

    Cao, Ke-Gang; Fu, Cai-Hong; Li, Huan-Qin; Xin, Xi-Yan; Gao, Ying

    2015-11-16

    Ischemic stroke (IS) is a common disease, often resulting in death or disability. Previous studies on prognosis of stroke mainly focused on the baseline condition or modern expensive tests. However, the change of clinical symptoms during acute stage is considerably neglected. In our study, we aim to develop a new prognostic scale to predict the 90-day outcome of IS patients. In this retrospective cohort study, a secondary data analysis was performed on 489 patients extracted from 1046 patients of 4 hospitals. A new prognostic scale was constructed to predict the recovery of IS mainly based on the National Institutes of Health Stroke Scale (NIHSS) score, traditional Chinese Medicine (TCM) symptoms & signs and the changes during the first 3 days of patients in the 3 TCM hospitals. Receiver Operating Characteristic (ROC) curve was used to determine the cutoff point for prediction. In the end, the scale was used to test the outcome of IS patients in Xuanwu hospital. The new prognostic scale was composed of 8 items including age degree (OR = 3.32; 95 % CI: 1.72-6.42), history of diabetes mellitus (DM) (OR = 2.20; 95 % CI: 1.19-4.08), NIHSS score (OR = 3.08; 95 % CI: 2.16-4.40), anxiety (OR = 3.17; 95 % CI: 1.90-5.29) and irritability (OR = 4.61; 95 % CI: 1.36-15.63) on the 1st day of illness onset, change in NIHSS score (OR = 2.49; 95 % CI: 1.31-4.73), and circumrotating (OR = 7.80; 95 % CI: 1.98-30.64) and tinnitus (OR = 13.25; 95 % CI: 1.55-113.34) during the first 3 days of stroke onset. The total score of the scale was 16.5 and the cutoff point was 9.5, which means patients would have poor outcome at 90 days of stroke onset if the score was higher than 9.5. The new scale was validated on the data of Xuanwu hospital, and the value of its sensitivity, specificity and overall accuracy were 69.6 %, 83.3 % and 75.0 % respectively. The 8-item scale, mainly based on TCM symptoms, NIHSS score and their changes during the first 3 days, can predict the 90-day outcome for IS

  10. Transcranial Direct Current Stimulation combined with treadmill training in the subacute phase following stroke: case series

    DEFF Research Database (Denmark)

    Figlewski, Krystian; Nielsen, Jørgen Feldbæk; Blicher, Jakob

    anodal tDCS. Aims: to evaluate the feasibility of anodal tDCS with body weight support treadmill training (BWSTT) in the subacute stroke patients. Methods Four subjects (Table 1.) participated in BWSTT coupled with anodal tDCS thrice per week for 4 weeks. Subjects were included within 14 days from stroke......Background Stroke is a common cause of gait impairment and regaining a normal gait is a major target in stroke rehabilitation. To facilitate motor recovery after stroke, a variety of experimental approaches have been tested. Recent developments include non-invasive brain stimulation techniques...

  11. Motor Imagery-Based Rehabilitation: Potential Neural Correlates and Clinical Application for Functional Recovery of Motor Deficits after Stroke.

    Science.gov (United States)

    Tong, Yanna; Pendy, John T; Li, William A; Du, Huishan; Zhang, Tong; Geng, Xiaokun; Ding, Yuchuan

    2017-05-01

    Motor imagery (MI), defined as the mental implementation of an action in the absence of movement or muscle activation, is a rehabilitation technique that offers a means to replace or restore lost motor function in stroke patients when used in conjunction with conventional physiotherapy procedures. This article briefly reviews the concepts and neural correlates of MI in order to promote improved understanding, as well as to enhance the clinical utility of MI-based rehabilitation regimens. We specifically highlight the role of the cerebellum and basal ganglia, premotor, supplementary motor, and prefrontal areas, primary motor cortex, and parietal cortex. Additionally, we examine the recent literature related to MI and its potential as a therapeutic technique in both upper and lower limb stroke rehabilitation.

  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. Prediction of upper limb recovery, general disability, and rehabilitation status by activity measurements assessed by accelerometers or the Fugl-Meyer score in acute stroke.

    Science.gov (United States)

    Gebruers, Nick; Truijen, Steven; Engelborghs, Sebastiaan; De Deyn, Peter P

    2014-03-01

    This study investigated the clinical predictive value of the Fugl-Meyer Assessment (FMA) arm score and the upper limb activity assessed by accelerometers in patients with hemiparesis after acute stroke. The prospective cohort (n = 129) was recruited from a general hospital; activity variables and FMA score at intake were related to the FMA, the modified Rankin Scale, and rehabilitation status after 3 mos of follow-up. The prediction model was based on binary logistic regression. Although the FMA score at intake has the best overall predictive value for all three outcome measures (FMA3, 87.6%; modified Rankin Scale, 85.3%; RS, 73.6%), the activity of the impaired arm as assessed by the accelerometer has the best predictive value to determine patients who are at risk for continued disability (modified Rankin Scale score 1, 95.1%). The most difficult outcome measure for prediction is the rehabilitation status; specifically, the patients who went home are predicted imprecisely. The ratio variable is the least accurate predictor of all tested variables. The FMA arm score at intake is the best predictor for arm recovery and general disability. The activity of the impaired arm is an excellent predictor for prolonged disability and is an alternative to the FMA score when it is impossible to score the FMA in the acute phase of stroke.

  14. Classification of enhanced oil recovery methods by lithology ...

    African Journals Online (AJOL)

    In this article classified EOR methods base on lithology of the reservoirs and investigated the frequent EOR method (gas injection) in the carbonate reservoir that is the most reservoir lithology in Iran, gas has low viscosity and due to this property we need some complementary methods like foam flooding to overcome this ...

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

    Directory of Open Access Journals (Sweden)

    Rania E. Mohamed

    2014-12-01

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

  16. Personality as significant predictor of post-stroke anxiety.

    Science.gov (United States)

    Solgajová, Andrea; Sollár, Tomáš; Vörösová, Gabriela; Zrubcová, Dana

    2017-08-01

    Anxiety in stroke patients is very frequent. It negatively influences the whole recovery process. The study objective is to study personality traits, age, gender, and type of stroke as predictors of anxiety in stroke patients. Research presents a prospective cross-sectional descriptive study. The sample consisted of 74 hospitalized stroke patients. The data collection methods were the HADS for anxiety measurement and the Mini IPIP for evaluation of five personality factors. Hierarchical multiple regression analysis was used to study the relationship between anxiety and personality variables, gender, age, and type of stroke. We found three statistically significant predictors of anxiety in stroke patients. Neuroticism and low Agreeableness explain 50% of the variability of anxiety. Another statistically significant predictor was age; higher-level anxiety relates to lower age. Other personality traits (Extraversion, Openness to experience, and Conscientiousness), gender, and type of stroke do not appear as significant predictors of post-stroke anxiety. Anxiety in stroke patients is predicted mostly by the personality traits and young age of patients. Knowing these predictors can result in early detection and management of emotional consequences of disease, and thus influence the whole recovery process.

  17. Place attachment in stroke rehabilitation: A transdisciplinary encounter between cultural geography, environmental psychology and rehabilitation medicine

    OpenAIRE

    Nanninga, Christa S.; Meijering, Louise; Schonherr, Marleen C.; Postema, Klaas; Lettinga, Ant T.

    2015-01-01

    Purpose: To increase understanding of stroke survivor's needs to successfully re-establish attachment to meaningful places at home and in the community. Methods: Qualitative research methodology including in-depth interviews with stroke survivors in the clinical, post-discharge and reintegration phases of the rehabilitation process. Results: Participants longed for recovery and domestic places in the clinical phase, for pre-stroke activities and roles in the post-discharge phase, and for reco...

  18. a transport layer protocol using adaptive loss recovery method for ...

    Indian Academy of Sciences (India)

    Ayhan Kİraz

    intermediate nodes are responsible for recovering missing segments. When LRMs were compared, hop-by-hop method performs achieves results in unreliable connections. End-to-end method provides faster segment transmission and low end-to-end latency values in low error rates. Sev- eral simulations were performed ...

  19. Method for energy recovery of spent ERL beams

    Energy Technology Data Exchange (ETDEWEB)

    Marhauser, Frank; Hannon, Fay; Rimmer, Robert; Whitney, R. Roy

    2018-01-16

    A method for recovering energy from spent energy recovered linac (ERL) beams. The method includes adding a plurality of passive decelerating cavities at the beam dump of the ERL, adding one or more coupling waveguides between the passive decelerating cavities, setting an adequate external Q (Qext) to adjust to the beam loading situation, and extracting the RF energy through the coupling waveguides.

  20. Recovery Rate of intestinal parasites using conventional methods in ...

    African Journals Online (AJOL)

    None of the methods could detect all the cases observed in the study alone, thus no single technique was satisfactory as none was equally applicable for trophozoites and cysts of protozoa, eggs or larvae of helminths. Brine flotation technique should be added to the routine diagnostic method (wet preparation), since it ...

  1. Cortical stimulation for upper limb recovery following ischemic stroke: a small phase II pilot study of a fully implanted stimulator.

    Science.gov (United States)

    Huang, Mark; Harvey, Richard L; Stoykov, Mary Ellen; Ruland, Sean; Weinand, Martin; Lowry, David; Levy, Robert

    2008-01-01

    To evaluate the feasibility of a fully implanted cortical stimulator for improving hand and arm function in patients following ischemic stroke. Twenty-four chronic stroke patients with hemiplegia were randomized to targeted implanted cortical electrical stimulation of the motor cortex with upper limb rehabilitation therapy or rehabilitation therapy alone. Using repeated measures regression models, we estimated and compared treatment effects between groups over the study follow-up period. The investigational group had significantly greater mean improvements in Upper Extremity Fugl-Meyer (UEFM) scores during the 6-month follow-up period (weeks 1-24 following therapy), as compared to the control group (difference in estimated means = 3.8, p = .042). Box and Block (B & B) test improvement from baseline scores were also significantly better in the investigational group across the 6-month follow-up assessments (difference in estimated means = 3.8, p = .046). There was one report of seizure after device implant but prior to cortical stimulation and rehabilitation therapy, but no reports of neurologic decline. There were no improvements seen in the other measures assessed. Evidence suggests that cortical stimulation with rehabilitation therapy produces a lasting treatment effect in upper extremity motor control and is not associated with serious neurological complications. A larger multicenter study is underway.

  2. Chinese Herb Astragalus membranaceus Enhances Recovery of Hemorrhagic Stroke: Double-Blind, Placebo-Controlled, Randomized Study

    Directory of Open Access Journals (Sweden)

    Chun-Chung Chen

    2012-01-01

    Full Text Available We tested the effect of Astragalus membranaceus (AM on acute hemorrhagic stroke. Seventy-eight patients were randomly assigned to Group A (3 g of AM three times/day for 14 days; or Group B (3 g of placebo herb. A total of 68 patients (Group A 36, Group B 32 completed the trial. The increase of functional independence measure scale score between baseline and week 4 was 24.53 ± 23.40, and between baseline and week 12 was 34.69 ± 28.89, in the Group A was greater than 11.97 ± 11.48 and 23.94 ± 14.8 in the Group B (both P≦0.05. The increase of Glasgow outcome scale score between baseline and week 12 was 0.75 ± 0.77 in the Group A was greater than 0.41 ± 0.50 in the Group B (P<0.05. The results are preliminary and need a larger study to assess the efficacy of AM after stroke.

  3. Cerebral Ischemia versus MS in Young Adults Clinical Imaging Diagnosis Difficulties and Recovery Methods

    OpenAIRE

    Any DOCU-AXELERAD; Dan DOCU-AXELERAD

    2012-01-01

    Ischemia in young adults is often the result of non-atherosclerotic vasculopathies, cardiac embolism or clotting disorders. One third of young adults ischemic stroke etiology remains undetermined. Materials and methods: We present the case of a patient aged 42, diagnosed with probable MS without cardiovascular or metabolic risk factors, presented to our clinic for decrease of force at right limbs and recent dysarthria. Results and discussion: The history revealed recurrent episodes of right h...

  4. Robotic therapy provides a stimulus for upper limb motor recovery after stroke that is complementary to and distinct from conventional therapy.

    Science.gov (United States)

    Brokaw, Elizabeth B; Nichols, Diane; Holley, Rahsaan J; Lum, Peter S

    2014-05-01

    Individuals with chronic stroke often have long-lasting upper extremity impairments that impede function during activities of daily living. Rehabilitation robotics have shown promise in improving arm function, but current systems do not allow realistic training of activities of daily living. We have incorporated the ARMin III and HandSOME device into a novel robotic therapy modality that provides functional training of reach and grasp tasks. To compare the effects of equal doses of robotic and conventional therapy in individuals with chronic stroke. Subjects were randomized to 12 hours of robotic or conventional therapy and then crossed over to the other therapy type after a 1-month washout period. Twelve moderate to severely impaired individuals with chronic stroke were enrolled, and 10 completed the study. Across the 3-month study period, subjects showed significant improvements in the Fugl-Meyer (P = .013) and Box and Blocks tests (P = .028). The robotic intervention produced significantly greater improvements in the Action Research Arm Test than conventional therapy (P = .033). Gains in the Box and Blocks test from conventional therapy were larger than from robotic therapy in subjects who received conventional therapy after robotic therapy (P = .044). Data suggest that robotic therapy can elicit improvements in arm function that are distinct from conventional therapy and supplements conventional methods to improve outcomes. Results from this pilot study should be confirmed in a larger study.

  5. Effects of Arm Weight Support Training to Promote Recovery of Upper Limb Function for Subacute Patients after Stroke with Different Levels of Arm Impairments

    Directory of Open Access Journals (Sweden)

    Irene H. L. Chan

    2016-01-01

    Full Text Available Purpose. The goal of this study was to investigate the effects of arm weight support training using the ArmeoSpring for subacute patients after stroke with different levels of hemiplegic arm impairments. Methods. 48 inpatients with subacute stroke, stratified into 3 groups from mild to severe upper extremity impairment, were engaged in ArmeoSpring training for 45 minutes daily, 5 days per week for 3 weeks, in addition to conventional rehabilitation. Evaluations were conducted at three measurement occasions: immediately before training (T1; immediately after training (T2; and at a 3-week follow-up (T3 by a blind rater. Results. Shoulder flexion active range of motion, Upper Extremity Scores in the Fugl-Meyer Assessment (FMA, and Vertical Catch had the greatest differences in gain scores for patients between severe and moderate impairments, whereas FMA Hand Scores had significant differences in gain scores between moderate and mild impairments. There was no significant change in muscle tone or hand-path ratios between T1, T2, and T3 within the groups. Conclusion. Arm weight support training is beneficial for subacute stroke patients with moderate to severe arm impairments, especially to improve vertical control such as shoulder flexion, and there were no adverse effects in muscle tone.

  6. Silver recovery from the waste materials by the method of flotation process

    Directory of Open Access Journals (Sweden)

    B. Oleksiak

    2018-01-01

    Full Text Available During the leaching process of zinc concentrates, the waste materials rich in various metals such as eg. silver are produced. So far no attempts of silver recovery from the mentioned waste materials have been made due to the lack of any method which would be both effective and beneficial. The paper presents some possibilities of application of flotation process in silver recovery form waste materials generated during zinc production.

  7. A quantitative and standardized robotic method for the evaluation of arm proprioception after stroke.

    Science.gov (United States)

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

    2011-01-01

    Stroke often results in both motor and sensory deficits, which may interact in the manifested functional impairment. Proprioception is known to play important roles in the planning and control of limb posture and movement; however, the impact of proprioceptive deficits on motor function has been difficult to elucidate due in part to the qualitative nature of available clinical tests. We present a quantitative and standardized method for evaluating proprioception in tasks directly relevant to those used to assess motor function. Using a robotic manipulandum that exerted controlled displacements of the hand, stroke participants were evaluated, and compared with a control group, in their ability to detect such displacements in a 2-alternative, forced-choice paradigm. A psychometric function parameterized the decision process underlying the detection of the hand displacements. The shape of this function was determined by a signal detection threshold and by the variability of the response about this threshold. Our automatic procedure differentiates between participants with and without proprioceptive deficits and quantifies functional proprioceptive sensation on a magnitude scale that is meaningful for ongoing studies of degraded motor function in comparable horizontal movements.

  8. Simulation method for cardiac stroke volume estimation by intracardiac electrical impedance measurement.

    Science.gov (United States)

    Barak, C; Leviatan, Y; Inbar, G F; Hoekstein, K N

    1992-09-01

    Using the electrical impedance measurement technique to investigate stroke volume estimation, three models of the ventricle were simulated. A four-electrode impedance catheter was used; two electrodes to set up an electric field in the model and the other two to measure the potential difference. A new approach, itself an application of the quasi-static case of a method used to solve electromagnetic field problems, was used to solve the electric field in the model. The behaviour of the estimation is examined with respect to the electrode configuration on the catheter and to catheter location with respect to the ventricle walls. Cardiac stroke volume estimation was found to be robust to catheter location generating a 10 per cent error for an offset of 40 per cent of the catheter from the chamber axis and rotation of 20 degrees with respect to the axis. The electrode configuration has a dominant effect on the sensitivity and accuracy of the estimation. Certain configurations gave high accuracy, whereas in others high sensitivity was found with lower accuracy. This led to the conclusion that the electrode configuration should be carefully chosen according to the desired criteria.

  9. Methods for treating hydrocarbon recovery operations and industrial waters

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, N.E.S.; Asperger, R.G.

    1989-05-02

    This patent describes a method for consisting adding to the emulsion an effective demulsifying amount of a composition comprising a compound containing: an alkane triyl group of 1 to 30 carbon atoms; an alkylene group of 1 to 30 carbon atoms; and an alkali or alkaline earth metal group or an ammonium group.

  10. Method for recovery of uranium from phosphoric acid

    International Nuclear Information System (INIS)

    Duarte Neto, J.

    1984-01-01

    The results of a method for recuperation of uranium from phosphoric acid by humid way are presented. The extracting mixture used was di-ethylhexylphosphoric acid (D 2 EHPA) and trioctylphosphine oxide (TOPO). An installation in micro-pilot scale was made to get and visualize data for continuous process. (M.A.C.) [pt

  11. Post-stroke depression: an update.

    Science.gov (United States)

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

    2015-01-01

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

  12. Method for measuring recovery of catalytic elements from fuel cells

    Science.gov (United States)

    Shore, Lawrence [Edison, NJ; Matlin, Ramail [Berkeley, NJ

    2011-03-08

    A method is provided for measuring the concentration of a catalytic clement in a fuel cell powder. The method includes depositing on a porous substrate at least one layer of a powder mixture comprising the fuel cell powder and an internal standard material, ablating a sample of the powder mixture using a laser, and vaporizing the sample using an inductively coupled plasma. A normalized concentration of catalytic element in the sample is determined by quantifying the intensity of a first signal correlated to the amount of catalytic element in the sample, quantifying the intensity of a second signal correlated to the amount of internal standard material in the sample, and using a ratio of the first signal intensity to the second signal intensity to cancel out the effects of sample size.

  13. Analytical methods associated with the recovery of uranium

    International Nuclear Information System (INIS)

    Dixon, K.

    1983-01-01

    This report summarizes various approaches made to the analysis of materials arising from the processing of Karoo deposits for uranium. These materials include head and residue samples, aqueous solutions and organic solvents and, finally, the precipitated cakes of the elements recovered, i.e. uranium, molybdenum, and arsenic. Analysis was required for these elements and also vanadium, carbon, sulphur, and carbonate in the head and residue samples. The concentration of uranium, molybdenum, and arsenic, other than in the precipitated cakes, ranges from 1 to 2000μg/g, and that of carbon, sulphur, and carbonate from 0,1 to 5 per cent. The analysis of cakes necessitates the determination of silver, arsenic, iron, copper, calcium, magnesium, manganese, molybdenum, lead, tin, titanium, and vanadium within the range 1 to 1000μg/g, and of sodium and silica within the range 10 to 20 000μg/g. The methods used include combustion methods for carbon, sulphur, and carbonate, and atomic-absorption, X-ray-fluorescence, and emission methods for the other analytes. The accuracy of the analysis is within 10 per cent

  14. An optimized rapid bisulfite conversion method with high recovery of cell-free DNA.

    Science.gov (United States)

    Yi, Shaohua; Long, Fei; Cheng, Juanbo; Huang, Daixin

    2017-12-19

    Methylation analysis of cell-free DNA is a encouraging tool for tumor diagnosis, monitoring and prognosis. Sensitivity of methylation analysis is a very important matter due to the tiny amounts of cell-free DNA available in plasma. Most current methods of DNA methylation analysis are based on the difference of bisulfite-mediated deamination of cytosine between cytosine and 5-methylcytosine. However, the recovery of bisulfite-converted DNA based on current methods is very poor for the methylation analysis of cell-free DNA. We optimized a rapid method for the crucial steps of bisulfite conversion with high recovery of cell-free DNA. A rapid deamination step and alkaline desulfonation was combined with the purification of DNA on a silica column. The conversion efficiency and recovery of bisulfite-treated DNA was investigated by the droplet digital PCR. The optimization of the reaction results in complete cytosine conversion in 30 min at 70 °C and about 65% of recovery of bisulfite-treated cell-free DNA, which is higher than current methods. The method allows high recovery from low levels of bisulfite-treated cell-free DNA, enhancing the analysis sensitivity of methylation detection from cell-free DNA.

  15. Analytical recovery of protozoan enumeration methods: have drinking water QMRA models corrected or created bias?

    Science.gov (United States)

    Schmidt, P J; Emelko, M B; Thompson, M E

    2013-05-01

    Quantitative microbial risk assessment (QMRA) is a tool to evaluate the potential implications of pathogens in a water supply or other media and is of increasing interest to regulators. In the case of potentially pathogenic protozoa (e.g. Cryptosporidium oocysts and Giardia cysts), it is well known that the methods used to enumerate (oo)cysts in samples of water and other media can have low and highly variable analytical recovery. In these applications, QMRA has evolved from ignoring analytical recovery to addressing it in point-estimates of risk, and then to addressing variation of analytical recovery in Monte Carlo risk assessments. Often, variation of analytical recovery is addressed in exposure assessment by dividing concentration values that were obtained without consideration of analytical recovery by random beta-distributed recovery values. A simple mathematical proof is provided to demonstrate that this conventional approach to address non-constant analytical recovery in drinking water QMRA will lead to overestimation of mean pathogen concentrations. The bias, which can exceed an order of magnitude, is greatest when low analytical recovery values are common. A simulated dataset is analyzed using a diverse set of approaches to obtain distributions representing temporal variation in the oocyst concentration, and mean annual risk is then computed from each concentration distribution using a simple risk model. This illustrative example demonstrates that the bias associated with mishandling non-constant analytical recovery and non-detect samples can cause drinking water systems to be erroneously classified as surpassing risk thresholds. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Economic and environmental evaluation of nitrogen removal and recovery methods from wastewater.

    Science.gov (United States)

    Lin, Yanzi; Guo, Miao; Shah, Nilay; Stuckey, David C

    2016-09-01

    The driver for waste-based economic growth is long-term strategic design, and a paradigm-shift from waste treatment to resource recovery. This study aims to use an integrated modelling approach to evaluate the holistic economic and environmental profiles of three alternative nitrogen removal and recovery methods integrated into wastewater treatment systems, including conventional nitrification-denitrification, Anammox, and the anaerobic ion exchange route, to provide insights into N recovery system designs which are key elements in building a sustainable circular economy. Our results suggest that ion exchange is a promising technology showing high N removal-recovery efficiency from municipal wastewater and delivering competitive sustainability scores. In comparison with the well-developed conventional route, ion exchange and Anammox are undergoing significant research and development; as highlighted in sensitivity analyses, there is considerable room for process design and optimisation of ion exchange systems to achieve economically and environmentally optimal performance. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Acute Effect of Lower-Body Vibration as a Recovery Method After Fatiguing Exercise

    Directory of Open Access Journals (Sweden)

    Svetlana Nepocatych

    2015-09-01

    Full Text Available The purpose of this study was to compare three recovery methods: control (CON, lower-body vibration (LBV and LBV+ local muscle cooling (LBVC on lower-body performance, perceived recovery, and muscle soreness. Physically active male volunteers (n=8 in a repeated-measures, counterbalanced design, completed three sets of squats to fatigue, each recovery treatment, and two Wingate Anaerobic Tests. Rating of perceived exertion (RPE, and heart rate (HR were measured after fatiguing exercise, recovery treatment and Wingate Anaerobic tests. Peak and mean power, fatigue index, Delayed Onset Muscle Soreness (DOMS, and comfort levels were compared between each treatment. In Wingate 1, no significant differences (p=0.42 were found among CON, LBV, or LBVC regarding peak power (1119±239, 1097±225, and 1146±260 W, respectively, mean power (p=0.32, or fatigue index (p=0.47. In Wingate 2, no significant (p=0.17 differences were found among CON, LBV, or LBVC regarding peak power (1042±228, 1078±233, and 1110±268 W, respectively, mean power (p=0.38, or fatigue index (p=0.15. A significantly better (p=0.01 perceived recovery was observed after LBV (6±1 and LBVC (6±1 compared to CON (4±1. The study findings support psychological but not performance enhancing benefits after the use of LBV and LBVC as recovery methods.

  18. 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 ...

  19. The Comprehensive Post-Acute Stroke Services (COMPASS) study: design and methods for a cluster-randomized pragmatic trial.

    Science.gov (United States)

    Duncan, Pamela W; Bushnell, Cheryl D; Rosamond, Wayne D; Jones Berkeley, Sara B; Gesell, Sabina B; D'Agostino, Ralph B; Ambrosius, Walter T; Barton-Percival, Blair; Bettger, Janet Prvu; Coleman, Sylvia W; Cummings, Doyle M; Freburger, Janet K; Halladay, Jacqueline; Johnson, Anna M; Kucharska-Newton, Anna M; Lundy-Lamm, Gladys; Lutz, Barbara J; Mettam, Laurie H; Pastva, Amy M; Sissine, Mysha E; Vetter, Betsy

    2017-07-17

    study engages patients, caregivers, and other stakeholders (including policymakers, advocacy groups, payers, and local community coalitions) to advise and support the design, implementation, and sustainability of the COMPASS care model. Given the high societal and economic burden of stroke, identifying a care model to improve recovery, independence, and quality of life is critical for stroke survivors and their caregivers. The pragmatic trial design provides a real-world assessment of the COMPASS care model effectiveness and will facilitate rapid implementation into clinical practice if successful. Clinicaltrials.gov: NCT02588664 ; October 23, 2015.

  20. A review: Motor rehabilitation after stroke with control based on human intent.

    Science.gov (United States)

    Li, Min; Xu, Guanghua; Xie, Jun; Chen, Chaoyang

    2018-02-01

    Strokes are a leading cause of acquired disability worldwide, and there is a significant need for novel interventions and further research to facilitate functional motor recovery in stroke patients. This article reviews motor rehabilitation methods for stroke survivors with a focus on rehabilitation controlled by human motor intent. The review begins with the neurodevelopmental principles of motor rehabilitation that provide the neuroscientific basis for intuitively controlled rehabilitation, followed by a review of methods allowing human motor intent detection, biofeedback approaches, and quantitative motor rehabilitation assessment. Challenges for future advances in motor rehabilitation after stroke using intuitively controlled approaches are addressed.

  1. 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....

  2. Application of a precipitation method for uranium recovery from Abu-Zaabal phosphoric acid plant, egypt

    International Nuclear Information System (INIS)

    El-Hazek, N.M.T.; Hussein, E.M.

    1997-01-01

    Current industrial recovery of uranium from 30% phosphoric acid-produced by the dihydrate process-is based on solvent extraction method. Uranium recovery from concentrated phosphoric acid (45-52% P 2 O 5 ) produced by evaporation of the 30% acid or directly produced by the hemihydrate process, by solvent extraction is difficult to apply in practice. In addition to possible contamination of the acid by the organic solvents and/or their deterioration. This paper investigates the possibility of applying a precipitation method (Weterings and Janssen, 1985) for uranium recovery from both low (28% P 2 O 2 ) and high (48% P 2 O 5 ) concentration phosphoric acids produced by abu-Zaabal phosphoric acid plant (abu-Zaabal fertilizers and chemicals Co., Egypt). The 28% acid produced by H 2 SO 4 dihydrate method and the 48% acid produced by evaporation of the 28% acid

  3. Influence of killing method on Lepidoptera DNA barcode recovery.

    Science.gov (United States)

    Willows-Munro, Sandi; Schoeman, M Corrie

    2015-05-01

    The global DNA barcoding initiative has revolutionized the field of biodiversity research. Such large-scale sequencing projects require the collection of large numbers of specimens, which need to be killed and preserved in a way that is both DNA-friendly and which will keep voucher specimens in good condition for later study. Factors such as time since collection, correct storage (exposure to free water and heat) and DNA extraction protocol are known to play a role in the success of downstream molecular applications. Limited data are available on the most efficient, DNA-friendly protocol for killing. In this study, we evaluate the quality of DNA barcode (cytochrome oxidase I) sequences amplified from DNA extracted from specimens collected using three different killing methods (ethyl acetate, cyanide and freezing). Previous studies have suggested that chemicals, such as ethyl acetate and formaldehyde, degraded DNA and as such may not be appropriate for the collection of insects for DNA-based research. All Lepidoptera collected produced DNA barcodes of good quality, and our study found no clear difference in nucleotide signal strength, probability of incorrect base calling and phylogenetic utility among the three different treatment groups. Our findings suggest that ethyl acetate, cyanide and freezing can all be used to collect specimens for DNA analysis. © 2014 John Wiley & Sons Ltd.

  4. Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

    OpenAIRE

    Grace Vincent-Onabajo; Taritei Moses

    2016-01-01

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

  5. Stress recovery techniques for natural element method in 2-D solid mechanics

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jin Rae [Dept. of Naval Architecture and Ocean Engineering, Hongik University, Sejong (Korea, Republic of)

    2016-11-15

    This paper is concerned with the stress recovery for the natural element method in which the problem domain is discretized with Delaunay triangles and the structural behavior is approximated with Laplace interpolation functions. Basically, the global and local patch recovery techniques based on the L2-projection method are adopted. For the local patch recovery, the local element patches are defined by the supports of each Laplace interpolation function. For the comparison purpose, the local stress recovery is also performed using Lagrange-type basis functions that are used for 3- and 6-node triangular elements. The stresses that are recovered by the present global and local recovery techniques are compared each other and compared with the available analytic solution, in terms of their spatial distributions and the convergence rates. As well, the dependence of the recovered stress field on the type of test basis functions that are used forbnov-Galerkin (BG) and Petrov-Galerkin (PG) natural element methods is also investigated.

  6. An overview of heavy oil properties and its recovery and transportation methods

    Directory of Open Access Journals (Sweden)

    R. G. Santos

    2014-09-01

    Full Text Available Unconventional oils - mainly heavy oils, extra heavy oils and bitumens - represent a significant share of the total oil world reserves. Oil companies have expressed interest in unconventional oil as alternative resources for the energy supply. These resources are composed usually of viscous oils and, for this reason, their use requires additional efforts to guarantee the viability of the oil recovery from the reservoir and its subsequent transportation to production wells and to ports and refineries. This review describes the main properties of high-viscosity crude oils, as well as compares traditional and emergent methods for their recovery and transportation. The main characteristics of viscous oils are discussed to highlight the oil properties that affect their flowability in the processes of recovery and pipeline transportation. Chemical composition is the starting point for the oil characterization and it has major impact on other properties, including key properties for their dynamics, such as density and viscosity. Next, enhanced oil recovery (EOR methods are presented, followed by a discussion about pipeline and transportation methods. In addition, the main challenges to achieve viable recovery and transportation of unconventional oils are compared for the different alternatives proposed. The work is especially focused on the heavy oils, while other hydrocarbon solid sources, such as oil sands and shale oil, are outside of the scope of this review.

  7. Ischemic Stroke Detection System with a Computer-Aided Diagnostic Ability Using an Unsupervised Feature Perception Enhancement Method

    Directory of Open Access Journals (Sweden)

    Yeu-Sheng Tyan

    2014-01-01

    Full Text Available We propose an ischemic stroke detection system with a computer-aided diagnostic ability using a four-step unsupervised feature perception enhancement method. In the first step, known as preprocessing, we use a cubic curve contrast enhancement method to enhance image contrast. In the second step, we use a series of methods to extract the brain tissue image area identified during preprocessing. To detect abnormal regions in the brain images, we propose using an unsupervised region growing algorithm to segment the brain tissue area. The brain is centered on a horizontal line and the white matter of the brain’s inner ring is split into eight regions. In the third step, we use a coinciding regional location method to find the hybrid area of locations where a stroke may have occurred in each cerebral hemisphere. Finally, we make corrections and mark the stroke area with red color. In the experiment, we tested the system on 90 computed tomography (CT images from 26 patients, and, with the assistance of two radiologists, we proved that our proposed system has computer-aided diagnostic capabilities. Our results show an increased stroke diagnosis sensitivity of 83% in comparison to 31% when radiologists use conventional diagnostic images.

  8. Top 10 research priorities relating to stroke nursing: a rigorous approach to establish a national nurse-led research agenda.

    Science.gov (United States)

    Rowat, Anne; Pollock, Alex; St George, Bridget; Cowey, Eileen; Booth, Joanne; Lawrence, Maggie

    2016-11-01

    To determine the top 10 research priorities specific to stroke nursing. It is important that stroke nurses build their research capability and capacity. This project built on a previous James Lind Alliance prioritization project, which established the shared stroke research priorities of stroke survivors, carers and health professionals. Research priority setting project using James Lind Alliance methods; a survey for interim prioritization and a consensus meeting for final priority setting. Between September - November 2014, stroke nurses were invited to select their top 10 priorities from a previously established list of 226 unique unanswered questions. These data were used to generate a list of shared research priorities (interim priority setting stage). A purposefully selected group of stroke nurses attended a final consensus meeting (April 2015) to determine the top 10 research priorities. During the interim prioritization stage, 97 stroke nurses identified 28 shared priority treatment uncertainties. At the final consensus meeting, 27 stroke nurses reached agreement on the top 10 stroke nursing research priorities. Five of the top 10 questions relate to stroke-specific impairments and five relate to rehabilitation and long-term consequences of stroke. The research agenda for stroke nursing has now been clearly defined, facilitating nurses to undertake research, which is of importance to stroke survivors and carers and central to supporting optimal recovery and quality of life after stroke. © 2016 John Wiley & Sons Ltd.

  9. Methods to improve efficiency of four stroke, spark ignition engines at part load

    International Nuclear Information System (INIS)

    Kutlar, Osman Akin; Arslan, Hikmet; Calik, Alper Tolga

    2005-01-01

    The four stroke, spark ignition (SI) engine pressure-volume diagram (p-V) contains two main parts. They are the compression-combustion-expansion (high pressure loop) and the exhaust-intake (low pressure or gas exchange loop) parts. The main reason for efficiency decrease at part load conditions for these types of engines is the flow restriction at the cross sectional area of the intake system by partially closing the throttle valve, which leads to increased pumping losses and to increased low pressure loop area on the p-V diagram. Meanwhile, the poorer combustion quality, i.e. lower combustion speed and cycle to cycle variations, additionally influence these pressure loop areas. In this study, methods for increasing efficiency at part load conditions and their potential for practical use are investigated. The study also includes a review of the vast literature on the solution of this problem. This investigation shows that the potential for increasing the efficiency of SI engines at part load conditions is not yet exhausted. Each method has its own advantages and disadvantages. Among these, the most promising methods to decrease the fuel consumption at part load conditions are stratified charge and variable displacement engines. When used in combination, the other listed methods are more effective than their usage alone

  10. Multibody-based topology synthesis method for large stroke flexure hinges

    NARCIS (Netherlands)

    Naves, Mark; Brouwer, Dannis Michel; Aarts, Ronald G.K.M.

    2016-01-01

    Large stroke flexure mechanisms inherently lose stiffness in supporting directions when deflected due to load components in compliant bending and torsion directions. To maximize performance over the entire range of motion, a topology optimization suited for large stroke mechanisms is required. In

  11. Influence of recovery method and centrifugation on epididymal sperm from collared peccaries (Pecari tajacu Linnaeus, 1758).

    Science.gov (United States)

    Bezerra, José Artur Brilhante; da Silva, Andréia Maria; Peixoto, Gislayne Christianne Xavier; da Silva, Mariana de Araújo; Franco de Oliveira, Moacir; Silva, Alexandre Rodrigues

    2014-05-01

    In order to establish protocols for gamete recovery from accidentally killed wild animals, or to take advantage of those slaughtered by captive breeders, we assess the influence of two methods on the recovery of epididymal sperm from collared peccaries, and verify the effect of centrifugation on such gametes. Genitalia from nine animals were used. For each animal, one epididymis was processed by flotation and the other was processed by retrograde flushing, both using a buffered media based on Tris. Following recovery, sperm were evaluated for motility, vigor, viability, functional membrane integrity, and morphology. A 1-mL aliquot of each sample was centrifuged, the supernatant removed, and the pellet suspended and evaluated as fresh samples. The sperm characteristics did not differ between the samples collected by flotation or retrograde flushing (P methods was affected by centrifugation. In conclusion, epididymal sperm from collared peccaries can be efficiently collected through flotation or retrograde flushing, but not when either is followed by centrifugation.

  12. The Train Driver Recovery Problem - Solution Method and Decision Support System Framework

    DEFF Research Database (Denmark)

    Rezanova, Natalia Jurjevna

    2009-01-01

    -tog’s operations. Furthermore, we present comprehensive reviews of operations research applications within railway crew scheduling, rolling stock re-scheduling, railway crew re-scheduling, and airline crew recovery. In addition, the project has resulted in the three scientific publications listed below. 1...... and methods. Computers and Operations Research, in press, 2009. doi: 10.1016/j.cor.2009.03.027. 3. Rezanova NJ, Ryan DM. The train driver recovery problem–A set partitioning based model and solution method. IMM-Technical Report-2006-24. Informatics and Mathematical Modelling, Technical University of Denmark......In this thesis we consider the train driver recovery problem (TDRP). The problem occurs when the daily train driver schedule becomes infeasible due to irregular operations on the railway network. Unforeseen disruptions such as signalling problems or rolling stock failures prevent the train drivers...

  13. The Effect of Body Weight Support Treadmill Training on Gait Recovery, Proximal Lower Limb Motor Pattern, and Balance in Patients with Subacute Stroke

    Directory of Open Access Journals (Sweden)

    Yu-Rong Mao

    2015-01-01

    Full Text Available Objective. Gait performance is an indicator of mobility impairment after stroke. This study evaluated changes in balance, lower extremity motor function, and spatiotemporal gait parameters after receiving body weight supported treadmill training (BWSTT and conventional overground walking training (CT in patients with subacute stroke using 3D motion analysis. Setting. Inpatient department of rehabilitation medicine at a university-affiliated hospital. Participants. 24 subjects with unilateral hemiplegia in the subacute stage were randomized to the BWSTT (n=12 and CT (n=12 groups. Parameters were compared between the two groups. Data from twelve age matched healthy subjects were recorded as reference. Interventions. Patients received gait training with BWSTT or CT for an average of 30 minutes/day, 5 days/week, for 3 weeks. Main Outcome Measures. Balance was measured by the Brunel balance assessment. Lower extremity motor function was evaluated by the Fugl-Meyer assessment scale. Kinematic data were collected and analyzed using a gait capture system before and after the interventions. Results. Both groups improved on balance and lower extremity motor function measures (P<0.05, with no significant difference between the two groups after intervention. However, kinematic data were significantly improved (P<0.05 after BWSTT but not after CT. Maximum hip extension and flexion angles were significantly improved (P<0.05 for the BWSTT group during the stance and swing phases compared to baseline. Conclusion. In subacute patients with stroke, BWSTT can lead to improved gait quality when compared with conventional gait training. Both methods can improve balance and motor function.

  14. Religious faith and psychosocial adaptation among stroke patients in Kuwait: a mixed method study.

    Science.gov (United States)

    Omu, Onutobor; Al-Obaidi, Saud; Reynolds, Frances

    2014-04-01

    Religious faith is central to life for Muslim patients in Kuwait, so it may influence adaptation and rehabilitation. This study explored quantitative associations among religious faith, self-efficacy, and life satisfaction in 40 female stroke patients and explored the influence of religion within stroke rehabilitation through qualitative interviews with 12 health professionals. The quantitative measure of religious faith did not relate to life satisfaction or self-efficacy in stroke patients. However, the health professionals described religious coping as influencing adaptation post-stroke. Fatalistic beliefs were thought to have mixed influences on rehabilitation. Measuring religious faith among Muslims through a standardized scale is debated. The qualitative accounts suggest that religious beliefs need to be acknowledged in stroke rehabilitation in Kuwait.

  15. 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.

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

    Science.gov (United States)

    Sakharov, V Iu; Isanova, V A

    2014-01-01

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

  17. Physiological functions of the effects of the different bathing method on recovery from local muscle fatigue

    Directory of Open Access Journals (Sweden)

    Lee Soomin

    2012-09-01

    Full Text Available Abstract Background Recently, mist saunas have been used in the home as a new bathing style in Japan. However, there are still few reports on the effects of bathing methods on recovery from muscle fatigue. Furthermore, the effect of mist sauna bathing on human physiological function has not yet been revealed. Therefore, we measured the physiological effects of bathing methods including the mist sauna on recovery from muscle fatigue. Methods The bathing methods studied included four conditions: full immersion bath, shower, mist sauna, and no bathing as a control. Ten men participated in this study. The participants completed four consecutive sessions: a 30-min rest period, a 10-min all out elbow flexion task period, a 10-min bathing period, and a 10-min recovery period. We evaluated the mean power frequency (MNF of the electromyogram (EMG, rectal temperature (Tre, skin temperature (Tsk, skin blood flow (SBF, concentration of oxygenated hemoglobin (O2Hb, and subjective evaluation. Results We found that the MNF under the full immersion bath condition was significantly higher than those under the other conditions. Furthermore, Tre, SBF, and O2Hb under the full immersion bath condition were significantly higher than under the other conditions. Conclusions Following the results for the full immersion bath condition, the SBF and O2Hb of the mist sauna condition were significantly higher than those for the shower and no bathing conditions. These results suggest that full immersion bath and mist sauna are effective in facilitating recovery from muscle fatigue.

  18. Enhanced oil recovery using improved aqueous fluid-injection methods: an annotated bibliography. [328 citations

    Energy Technology Data Exchange (ETDEWEB)

    Meister, M.J.; Kettenbrink, G.K.; Collins, A.G.

    1976-10-01

    This annotated bibliography contains abstracts, prepared by the authors, of articles published between 1968 and early 1976 on tests of improved aqueous fluid injection methods (i.e., polymer and surfactant floods). The abstracts have been written and organized to facilitate studies of the oil recovery potential of polymer and surfactant floods under known reservoir conditions. 328 citations.

  19. Post-match recovery methods used by U19 and U21 provincial ...

    African Journals Online (AJOL)

    The aim of the study was to identify the most preferred post-match recovery methods utilized by U19 and U21 provincial rugby union players (n=97; Mean age: ± 20.2 years) in Gauteng Province of South Africa. Questionnaire-based data were collected from a purposive sample size of 97 rugby players. The findings ...

  20. A method for studying post-fledging survival rates using data from ringing recoveries

    NARCIS (Netherlands)

    Thomson, D.L.; Baillie, S.R.; Peach, W.J.

    1999-01-01

    We present a method for studying post-fledging survival rates from data on national ringing recoveries. The approach extends the classical two-age-class models of Brownie et al. (1985) to include a third age-class of birds ringed as nestlings. The models can incorporate age-class-specific and

  1. 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.

  2. The Effect of Body Weight Support Treadmill Training on Gait Recovery, Proximal Lower Limb Motor Pattern, and Balance in Patients with Subacute Stroke.

    Science.gov (United States)

    Mao, Yu-Rong; Lo, Wai Leung; Lin, Qiang; Li, Le; Xiao, Xiang; Raghavan, Preeti; Huang, Dong-Feng

    2015-01-01

    Gait performance is an indicator of mobility impairment after stroke. This study evaluated changes in balance, lower extremity motor function, and spatiotemporal gait parameters after receiving body weight supported treadmill training (BWSTT) and conventional overground walking training (CT) in patients with subacute stroke using 3D motion analysis. Inpatient department of rehabilitation medicine at a university-affiliated hospital. 24 subjects with unilateral hemiplegia in the subacute stage were randomized to the BWSTT (n = 12) and CT (n = 12) groups. Parameters were compared between the two groups. Data from twelve age matched healthy subjects were recorded as reference. Patients received gait training with BWSTT or CT for an average of 30 minutes/day, 5 days/week, for 3 weeks. Balance was measured by the Brunel balance assessment. Lower extremity motor function was evaluated by the Fugl-Meyer assessment scale. Kinematic data were collected and analyzed using a gait capture system before and after the interventions. Both groups improved on balance and lower extremity motor function measures (P training. Both methods can improve balance and motor function.

  3. Microfluidic and micro-core methods for enhanced oil recovery and carbon storage applications

    Science.gov (United States)

    Nguyen, Phong

    Injection of CO2 into the subsurface, for both storage and oil recovery, is an emerging strategy to mitigate atmospheric CO2 emissions and associated climate change. In this thesis microfluidic and micro-core methods were developed to inform combined CO2-storage and oil recovery operations and determine relevant fluid properties. Pore scale studies of nanoparticle stabilized CO2-in-water foam and its application in oil recovery to show significant improvement in oil recovery rate with different oils from around the world (light, medium, and heavy). The CO2 nanoparticle-stabilized CO2 foams generate a three-fold increase in oil recovery (an additional 15% of initial oil in place) as compared to an otherwise similar CO2 gas flood. Nanoparticle-stabilized CO2 foam flooding also results in significantly smaller oil-in-water emulsion sizes. All three oils show substantial additional oil recovery and a positive reservoir homogenization effect. A supporting microfluidic approach is developed to quantify the minimum miscibility pressure (MMP) -- a critical parameter for combined CO 2 storage and enhanced oil recovery. The method leverages the inherent fluorescence of crude oils, is faster than conventional technologies, and provides quantitative, operator-independent measurements. In terms of speed, a pressure scan for a single minimum miscibility pressure measurement required less than 30 min, in stark contrast to days or weeks with existing rising bubble and slimtube methods. In practice, subsurface geology also interacts with injected CO 2. Commonly carbonate dissolution results in pore structure, porosity, and permeability changes. These changes are measured by x-ray microtomography (micro-CT), liquid permeability measurements, and chemical analysis. Chemical composition of the produced liquid analyzed by inductively coupled plasma-atomic emission spectrometer (ICP-AES) shows concentrations of magnesium and calcium. This work leverages established advantages of

  4. Comparison of methods for determining the hydrologic recovery time after forest disturbance

    Science.gov (United States)

    Oda, T.; Green, M.; Ohte, N.; Urakawa, R.; Endo, I.; Scanlon, T. M.; Sebestyen, S. D.; McGuire, K. J.; Katsuyama, M.; Fukuzawa, K.; Tague, C.; Hiraoka, M.; Fukushima, K.; Giambelluca, T. W.

    2013-12-01

    Changes in forest hydrology changes after forest disturbance vary among catchments. Although studies have summarized the initial runoff changes following forest disturbance, the estimates of long-term recovery time are less frequently reported. To understand the mechanisms of long-term recovery processes and to predict the long-term changes in streamflow after forest disturbance, it is important to compare recovery times after disturbance. However, there is no clear consensus regarding the best methodology for such research, especially for watershed studies that were not designed as paired watersheds. We compared methods of determining the hydrologic recovery time to determine if there is a common method for sites in any hydroclimatic setting. We defined the hydrologic recovery time to be the time of disturbance to the time when hydrological factors first recovered to pre-disturbance levels. We acquired data on long-term rainfall and runoff at 16 sites in northeastern USA and Japan that had at least 10 years (and up to 50 years) of post disturbance data. The types of disturbance include harvesting, diseases and insect damages. We compared multiple indices of hydrological response including annual runoff, annual runoff ratio (annual runoff/annual rainfall), annual loss (annual rainfall-annual runoff), fiftieth-percentile annual flow, and seasonal water balance. The results showed that comparing annual runoff to a reference site was most robust at constraining the recovery time, followed by using pre-disturbance data as reference data and calculating the differences in annual runoff from pre-disturbance levels. However, in case of small disturbance at sites without reference data or long-term pre-disturbance data, the inter-annual variation of rainfall makes the effect of disturbance unclear. We found that annual loss had smaller inter-annual variation, and defining recovery time with annual loss was best in terms of matching the results from paired watersheds. The

  5. The Train Driver Recovery Problem - a Set Partitioning Based Model and Solution Method

    DEFF Research Database (Denmark)

    Rezanova, Natalia Jurjevna; Ryan, David

    2010-01-01

    The need to recover a train driver schedule occurs during major disruptions in the daily railway operations. Based on data from the Danish passenger railway operator DSB S-tog A/S, a solution method to the train driver recovery problem (TDRP) is developed. The TDRP is formulated as a set...... partitioning problem. We define a disruption neighbourhood by identifying a small set of drivers and train tasks directly affected by the disruption. Based on the disruption neighbourhood, the TDRP model is formed and solved. If the TDRP solution provides a feasible recovery for the drivers within...

  6. Recovery of somatosensory and motor functions of the paretic upper limb in patients after stroke: Comparison of two therapeutic approaches

    Directory of Open Access Journals (Sweden)

    Kateřina Macháčková

    2016-03-01

    Full Text Available Background: Frequent and extensive disturbances to the somatosensory and motor hand functions after stroke are common. This study explores a new therapeutic approach that may improve the effectiveness of rehabilitation for these upper limb impairments. Objective: To assess the effect of rehabilitation combining standard therapy and somatosensory stimulation on sensorimotor hand functions. To compare the effect of this method with the standard method of rehabilitation. Methods: Two groups of patients were used to compare the effect of standard therapy (group A, n = 15, age = 59.8 ± 9.4 years, and the effect of therapy with targeted somatosensory stimulation (group B, n = 15, age = 65.5 ± 8.2. The groups consisted of patients after an ischemic stroke in post-acute phase, with hemiparesis, aged from 45 to 75 years, both men and women. The methods used to assess patients comprised a neurological clinical examination, two batteries of tests of somatosensory function (Rivermead Assessment of Somatosensory Performance, Fabric Matching Test, two batteries of tests of motor function (Nine Hole Peg Test, Test of Manipulation Functions, and activities of daily living assessment. Results: The results show that before therapy a deficit of somatosensory function occurred on the paretic upper limb in more than 50% of patients in both groups. Motor functions were impaired more frequently than somatosensory functions. Somatosensory stimulation therapy had an enhanced improvement of somatosensory functions, especially tactile discrimination of the object surface. Conclusions: Major improvement, particularly of tactile discrimination sensation, occurred in group B, where therapy focused on somatosensory deficit was applied. We did not show that such considerable improvement in discrimination sensation in group B was associated with any change in motor function. Clinical improvement in the motor function of the paretic limb occurred in

  7. Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial.

    Science.gov (United States)

    Lloréns, Roberto; Noé, Enrique; Colomer, Carolina; Alcañiz, Mariano

    2015-03-01

    First, to evaluate the clinical effectiveness of a virtual reality (VR)-based telerehabilitation program in the balance recovery of individuals with hemiparesis after stroke in comparison with an in-clinic program; second, to compare the subjective experiences; and third, to contrast the costs of both programs. Single-blind, randomized, controlled trial. Neurorehabilitation unit. Chronic outpatients with stroke (N=30) with residual hemiparesis. Twenty 45-minute training sessions with the telerehabilitation system, conducted 3 times a week, in the clinic or in the home. First, Berg Balance Scale for balance assessment. The Performance-Oriented Mobility Assessment balance and gait subscales, and the Brunel Balance Assessment were secondary outcome measures. Clinical assessments were conducted at baseline, 8 weeks (posttreatment), and 12 weeks (follow-up). Second, the System Usability Scale and the Intrinsic Motivation Inventory for subjective experiences. Third, cost (in dollars). Significant improvement in both groups (in-clinic group [control] and a home-based telerehabilitation group) from the initial to the final assessment in the Berg Balance Scale (ηp(2)=.68; P=.001), in the balance (ηp(2)=.24; P=.006) and gait (ηp(2)=.57, P=.001) subscales of the Tinetti Performance-Oriented Mobility Assessment, and in the Brunel Balance Assessment (control: χ(2)=15.0; P=.002; experimental: χ(2)=21.9; P=.001). No significant differences were found between the groups in any balance scale or in the feedback questionnaires. With regard to subjective experiences, both groups considered the VR system similarly usable and motivating. The in-clinic intervention resulted in more expenses than did the telerehabilitation intervention ($654.72 per person). First, VR-based telerehabilitation interventions can promote the reacquisition of locomotor skills associated with balance in the same way as do in-clinic interventions, both complemented with a conventional therapy program

  8. A Concentrated Hydrochloric Acid-based Method for Complete Recovery of DNA from Bone.

    Science.gov (United States)

    Huynen, Leon; Lambert, David M

    2015-11-01

    The successful extraction of DNA from historical or ancient animal bone is important for the analysis of discriminating genetic markers. Methods used currently rely on the digestion of bone with EDTA and proteinase K, followed by purification with phenol/chloroform and silica bed binding. We have developed a simple concentrated hydrochloric acid-based method that precludes the use of phenol/chloroform purification and can lead to a several-fold increase in DNA yield when compared to other commonly used methods. Concentrated hydrochloric acid was shown to dissolve most of the undigested bone and allowed the efficient recovery of DNA fragments <100 bases in length. This method should prove useful for the recovery of DNAs from highly degraded animal bone, such as that found in historical or ancient samples. © 2015 American Academy of Forensic Sciences.

  9. Experimental studies for the development of a new method for stroke volume measuring using X-ray videodensitometry

    International Nuclear Information System (INIS)

    Odenthal, H.J.

    1982-01-01

    Quantitative videodensitometry was studied with a view to its possible application as a new, non-invasive method of measuring cardiac stroke volume. To begin with, the accuracy of roentgen volumetric measurements was determined. After this, blood volume variations were measured by densitometry in five animal experiments. The findings were compared with the volumes measured by a flowmeter in the pulmonary artery. The total stroke volume was found to be proportional to the difference between the maximum and mean densitometric volume. A comparison between videodensitometry and other non-invasive methods showed that, in a stable circulatory system, the results of videodensitometry are equally reliable as, or even more reliable than, those of the conventional methods. (orig./MG) [de

  10. Measuring disabilities in stroke patients with apraxia: a validation study of an observational method.

    OpenAIRE

    Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Dijk, A.J. van; Stehmann-Saris, F.C.; Kinebanian, A.

    2000-01-01

    The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a blouse or shirt. The study was carried out at occupational therapy departments in general hospitals, rehabilitation centres, and nursing homes. Patients diagnosed to have had a stroke in the left h...

  11. Delirium in the acute phase after stroke: comparison between methods of detection.

    Science.gov (United States)

    Infante, Maria Teresa; Pardini, Matteo; Balestrino, Maurizio; Finocchi, Cinzia; Malfatto, Laura; Bellelli, Giuseppe; Mancardi, Giovanni Luigi; Gandolfo, Carlo; Serrati, Carlo

    2017-06-01

    Delirium is an acute neuropsychiatric syndrome, very common in hospitalized people with medical and neurological conditions. The identification of delirium after stroke is not an easy task and validated psychometric instruments are needed to correctly identify it. We decided to verify if (1) formal training in DSM-V criteria is needed to correctly identify post-stroke delirium, (2) if the use of a brief psychometric instrument such as 4AT improves its identification, (3) the applicability of these scales in the stroke setting. In the first phase of this study we retrospectively studied 102 acute stroke patients in Stroke Units of San Martino Hospital (Genova, Italy) to evaluate delirium with clinical criteria, first by a neurologist without a formal training in DSM-V criteria and after training. Then, we enrolled 100 new acute stroke patients who underwent screening for delirium using 4AT scale and DSM-V criteria. In the first phase, DSM-V criteria training significantly increased the ability to capture delirium (5 vs. 15%). In the second phase, the 4AT was used for delirium screening revealing a 52% of cases of delirium, the same observed by the consensus diagnosis of two senior neurologists (that was 50%). In the second phase, the use of 4AT scale allowed to capture post-stroke delirium as well as the consensus diagnosis by two neurologists. The identification of post-stroke delirium is not an easy task and requires both formal training in DSM-V criteria as well as the application of brief scales, such as the 4AT.

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

    African Journals Online (AJOL)

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

  13. Heat Recovery from High Temperature Slags: A Review of Chemical Methods

    Directory of Open Access Journals (Sweden)

    Yongqi Sun

    2015-03-01

    Full Text Available Waste heat recovery from high temperature slags represents the latest potential way to remarkably reduce the energy consumption and CO2 emissions of the steel industry. The molten slags, in the temperature range of 1723–1923 K, carry large amounts of high quality energy. However, the heat recovery from slags faces several fundamental challenges, including their low thermal conductivity, inside crystallization, and discontinuous availability. During past decades, various chemical methods have been exploited and performed including methane reforming, coal and biomass gasification, and direct compositional modification and utilization of slags. These methods effectively meet the challenges mentioned before and help integrate the steel industry with other industrial sectors. During the heat recovery using chemical methods, slags can act as not only heat carriers but also as catalysts and reactants, which expands the field of utilization of slags. Fuel gas production using the waste heat accounts for the main R&D trend, through which the thermal heat in the slag could be transformed into high quality chemical energy in the fuel gas. Moreover, these chemical methods should be extended to an industrial scale to realize their commercial application, which is the only way by which the substantial energy in the slags could be extracted, i.e., amounting to 16 million tons of standard coal in China.

  14. Analytical Investigation for In Situ Stress Measurement with Rheological Stress Recovery Method and Its Application

    Directory of Open Access Journals (Sweden)

    Quansheng Liu

    2016-01-01

    Full Text Available In situ stress is one of the most important parameters in underground engineering. Due to the difficulty and weakness of current stress measurement methods in deep soft rock, a new one, rheological stress recovery (RSR method, to determine three-dimensional stress tensor is developed. It is supposed that rock stresses will recover gradually with time and can be measured by embedding transducers into the borehole. In order to explore the relationship between the measured recovery stress and the initial stress, analytical solutions are developed for the stress measurement process with RSR method in a viscoelastic surrounding rock. The results showed that the measured recovery stress would be more close to the initial stress if the rock mass has a better rheological property, and the property of grouting material should be close to that of rock mass. Then, the RSR method, as well as overcoring technique, was carried out to measure the in situ stresses in Pingdingshan Number 1 coal mines in Henan Province, China. The stress measurement results are basically in the same order, and the major principal stresses are approximately in the direction of NW-SE, which correlates well with the stress regime of Pingdingshan zone known from the tectonic movement history.

  15. Application of a precipitation method for uranium recovery from abu-zaabal phosphoric acid plant, Egypt

    International Nuclear Information System (INIS)

    El-hazek, N.M.T.; Hussein, E.M.

    1995-01-01

    Current industrial recovery of uranium from 30% phosphoric acid-produced by the dihydrate process-is based on solvent extraction method. Uranium recovery from concentrated phosphoric acid (45-52% p o5 ) produced by evaporation of the 30% acid or directly produced by the hemihydrate process, by solvent extraction is difficult to apply in practice. In addition to possible contamination of the acid by the organic solvents and/or their deterioration. This paper investigates the possibility of applying a precipitation method (Weterings and Janssen, 1985) for uranium recovery from both low (28% P 2 O 5 ) and high (48% P 2 O 5 ) concentration phosphoric acids produced by abu-zaabal phosphoric acid plant (Abuzaabal fertilizers and chemicals Co., Egypt). The 28% acid produced by H 2 SO 4 dihydrate method and the 48% acid produced by evaporation of the 28% acid The applied precipitation method depends on using NH 4 F as a uranium precipitant from both low and high concentration phosphoric acids in presence of acetone as a dispersing agent. All the relevant factors have been studied

  16. Comparison of Surface Sampling Methods for Virus Recovery from Fomites ▿ †

    Science.gov (United States)

    Julian, Timothy R.; Tamayo, Francisco J.; Leckie, James O.; Boehm, Alexandria B.

    2011-01-01

    The role of fomites in infectious disease transmission relative to other exposure routes is difficult to discern due, in part, to the lack of information on the level and distribution of virus contamination on surfaces. Comparisons of studies intending to fill this gap are difficult because multiple different sampling methods are employed and authors rarely report their method's lower limit of detection. In the present study, we compare a subset of sampling methods identified from a literature review to demonstrate that sampling method significantly influences study outcomes. We then compare a subset of methods identified from the review to determine the most efficient methods for recovering virus from surfaces in a laboratory trial using MS2 bacteriophage as a model virus. Recoveries of infective MS2 and MS2 RNA are determined using both a plaque assay and quantitative reverse transcription-PCR, respectively. We conclude that the method that most effectively recovers virus from nonporous fomites uses polyester-tipped swabs prewetted in either one-quarter-strength Ringer's solution or saline solution. This method recovers a median fraction for infective MS2 of 0.40 and for MS2 RNA of 0.07. Use of the proposed method for virus recovery in future fomite sampling studies would provide opportunities to compare findings across multiple studies. PMID:21821742

  17. Method selection for sustainability assessments: The case of recovery of resources from waste water.

    Science.gov (United States)

    Zijp, M C; Waaijers-van der Loop, S L; Heijungs, R; Broeren, M L M; Peeters, R; Van Nieuwenhuijzen, A; Shen, L; Heugens, E H W; Posthuma, L

    2017-07-15

    Sustainability assessments provide scientific support in decision procedures towards sustainable solutions. However, in order to contribute in identifying and choosing sustainable solutions, the sustainability assessment has to fit the decision context. Two complicating factors exist. First, different stakeholders tend to have different views on what a sustainability assessment should encompass. Second, a plethora of sustainability assessment methods exist, due to the multi-dimensional characteristic of the concept. Different methods provide other representations of sustainability. Based on a literature review, we present a protocol to facilitate method selection together with stakeholders. The protocol guides the exploration of i) the decision context, ii) the different views of stakeholders and iii) the selection of pertinent assessment methods. In addition, we present an online tool for method selection. This tool identifies assessment methods that meet the specifications obtained with the protocol, and currently contains characteristics of 30 sustainability assessment methods. The utility of the protocol and the tool are tested in a case study on the recovery of resources from domestic waste water. In several iterations, a combination of methods was selected, followed by execution of the selected sustainability assessment methods. The assessment results can be used in the first phase of the decision procedure that leads to a strategic choice for sustainable resource recovery from waste water in the Netherlands. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Effect of water immersion methods on post-exercise recovery from simulated team sport exercise.

    Science.gov (United States)

    Ingram, Jeremy; Dawson, Brian; Goodman, Carmel; Wallman, Karen; Beilby, John

    2009-05-01

    This study aimed to compare the efficacy of hot/cold contrast water immersion (CWI), cold-water immersion (COLD) and no recovery treatment (control) as post-exercise recovery methods following exhaustive simulated team sports exercise. Repeated sprint ability, strength, muscle soreness and inflammatory markers were measured across the 48-h post-exercise period. Eleven male team-sport athletes completed three 3-day testing trials, each separated by 2 weeks. On day 1, baseline measures of performance (10 m x 20 m sprints and isometric strength of quadriceps, hamstrings and hip flexors) were recorded. Participants then performed 80 min of simulated team sports exercise followed by a 20-m shuttle run test to exhaustion. Upon completion of the exercise, and 24h later, participants performed one of the post-exercise recovery procedures for 15 min. At 48 h post-exercise, the performance tests were repeated. Blood samples and muscle soreness ratings were taken before and immediately after post-exercise, and at 24h and 48 h post-exercise. In comparison to the control and CWI treatments, COLD resulted in significantly lower (pbenefit of CWI over control was a significant reduction in muscle soreness 24h post-exercise. This study demonstrated that COLD following exhaustive simulated team sports exercise offers greater recovery benefits than CWI or control treatments.

  19. Stroke rehabilitation: recent advances and future therapies.

    LENUS (Irish Health Repository)

    Brewer, L

    2012-09-27

    Despite advances in the acute management of stroke, a large proportion of stroke patients are left with significant impairments. Over the coming decades the prevalence of stroke-related disability is expected to increase worldwide and this will impact greatly on families, healthcare systems and economies. Effective neuro-rehabilitation is a key factor in reducing disability after stroke. In this review, we discuss the effects of stroke, principles of stroke rehabilitative care and predictors of recovery. We also discuss novel therapies in stroke rehabilitation, including non-invasive brain stimulation, robotics and pharmacological augmentation. Many trials are currently underway, which, in time, may impact on future rehabilitative practice.

  20. Neuroplastic changes in resting-state functional connectivity after stroke rehabilitation

    Directory of Open Access Journals (Sweden)

    Yang-teng eFan

    2015-10-01

    Full Text Available Most neuroimaging research in stroke rehabilitation mainly focuses on the neural mechanisms underlying the natural history of post-stroke recovery. However, connectivity mapping from resting-state fMRI is well suited for different neurological conditions and provides a promising method to explore plastic changes for treatment-induced recovery from stroke. We examined the changes in resting-state functional connectivity (RS-FC of the ipsilesional primary motor cortex (M1 in 10 post-acute stroke patients before and immediately after 4 weeks of robot-assisted bilateral arm therapy (RBAT. Motor performance, functional use of the affected arm, and daily function improved in all participants. Reduced interhemispheric RS-FC between the ipsilesional and contralesional M1 (M1-M1 and the contralesional-lateralized connections were noted before treatment. In contrast, greater M1-M1 functional connectivity and disturbed resting-state networks were observed after RBAT relative to pre-treatment. Increased changes in M1-M1 RS-FC after RBAT were coupled with better motor and functional improvements. Mediation analysis showed the pre-to-post difference in M1-M1 RS-FC was a significant mediator for the relationship between motor and functional recovery. These results show neuroplastic changes and functional recoveries induced by RBAT in post-acute stroke survivors and suggest that interhemispheric functional connectivity in the motor cortex may be a neurobiological marker for recovery after stroke rehabilitation.

  1. Lessons from comparative effectiveness research methods development projects funded under the Recovery Act.

    Science.gov (United States)

    Zurovac, Jelena; Esposito, Dominick

    2014-11-01

    The American Recovery and Reinvestment Act of 2009 (ARRA) directed nearly US$29.2 million to comparative effectiveness research (CER) methods development. To help inform future CER methods investments, we describe the ARRA CER methods projects, identify barriers to this research and discuss the alignment of topics with published methods development priorities. We used several existing resources and held discussions with ARRA CER methods investigators. Although funded projects explored many identified priority topics, investigators noted that much work remains. For example, given the considerable investments in CER data infrastructure, the methods development field can benefit from additional efforts to educate researchers about the availability of new data sources and about how best to apply methods to match their research questions and data.

  2. Post-stroke depression: mechanisms, translation and therapy

    OpenAIRE

    Loubinoux, Isabelle; Kronenberg, Golo; Endres, Matthias; Schumann-Bard, Pascale; Freret, Thomas; Filipkowski, Robert K; Kaczmarek, Leszek; Popa-Wagner, Aurel

    2012-01-01

    The interaction between depression and stroke is highly complex. Post-stroke depression (PSD) is among the most frequent neuropsychiatric consequences of stroke. Depression also negatively impacts stroke outcome with increased morbidity, mortality and poorer functional recovery. Antidepressants such as the commonly prescribed selective serotonin reuptake inhibitors improve stroke outcome, an effect that may extend far beyond depression, e.g., to motor recovery. The main biological theory of P...

  3. Disintegration-wave method of recovery of industrial waste iron and steel industry enterprises

    Directory of Open Access Journals (Sweden)

    M. A. Vasechkin

    2016-01-01

    Full Text Available Rational use of raw materials and waste is one of the most important factors determining the effectiveness of any processing enterprise. Industrial wastes of mining and metallurgical industries are a valuable source of many elements. However, little activity of the mineral and inconsistent chemical and phase composition of the waste reduce their attractiveness for use as a secondary raw material, and the presence of heavy metals and water-soluble compounds is a serious environmental threat. Fractional excretion of elements that make up the slag can be carried out with the help of their recovery by disintegration-wave method. The paper presents a machine-hardware circuits for the implementation of recovery process of slag and disintegrator design. In conducting research on the example of slag samples of the enterprises in Stavropol and Krasnoyarsk territories, it was found out that the observed enrichment of slags on the composition of iron takes place, its physical and chemical activity increases and persists for a long period of time. These facts were noted in the study of the microstructure and the results of spectral analysis of the initial slags and subjected to recovery by disintegration-wave method. The results analysis led to the conclusion about the possibility of waste recovery of mining and metallurgical industries with by disintegration-wave method. Resulting in the processing materials with enhanced activity of the mineral part and certain chemical and phase composition, can be used as raw material for the production of metallurgical, cement and other industries.

  4. Play-level distributions of estimates of recovery factors for a miscible carbon dioxide enhanced oil recovery method used in oil reservoirs in the conterminous United States

    Science.gov (United States)

    Attanasi, E.D.; Freeman, P.A.

    2016-03-02

    In a U.S. Geological Survey (USGS) study, recovery-factor estimates were calculated by using a publicly available reservoir simulator (CO2 Prophet) to estimate how much oil might be recovered with the application of a miscible carbon dioxide (CO2) enhanced oil recovery (EOR) method to technically screened oil reservoirs located in onshore and State offshore areas in the conterminous United States. A recovery factor represents the percentage of an oil reservoir’s original oil in place estimated to be recoverable by the application of a miscible CO2-EOR method. The USGS estimates were calculated for 2,018 clastic and 1,681 carbonate candidate reservoirs in the “Significant Oil and Gas Fields of the United States Database” prepared by Nehring Associates, Inc. (2012).

  5. A new electric method for non-invasive continuous monitoring of stroke volume and ventricular volume-time curves

    Directory of Open Access Journals (Sweden)

    Konings Maurits K

    2012-08-01

    Full Text Available Abstract Background In this paper a new non-invasive, operator-free, continuous ventricular stroke volume monitoring device (Hemodynamic Cardiac Profiler, HCP is presented, that measures the average stroke volume (SV for each period of 20 seconds, as well as ventricular volume-time curves for each cardiac cycle, using a new electric method (Ventricular Field Recognition with six independent electrode pairs distributed over the frontal thoracic skin. In contrast to existing non-invasive electric methods, our method does not use the algorithms of impedance or bioreactance cardiography. Instead, our method is based on specific 2D spatial patterns on the thoracic skin, representing the distribution, over the thorax, of changes in the applied current field caused by cardiac volume changes during the cardiac cycle. Since total heart volume variation during the cardiac cycle is a poor indicator for ventricular stroke volume, our HCP separates atrial filling effects from ventricular filling effects, and retrieves the volume changes of only the ventricles. Methods ex-vivo experiments on a post-mortem human heart have been performed to measure the effects of increasing the blood volume inside the ventricles in isolation, leaving the atrial volume invariant (which can not be done in-vivo. These effects have been measured as a specific 2D pattern of voltage changes on the thoracic skin. Furthermore, a working prototype of the HCP has been developed that uses these ex-vivo results in an algorithm to decompose voltage changes, that were measured in-vivo by the HCP on the thoracic skin of a human volunteer, into an atrial component and a ventricular component, in almost real-time (with a delay of maximally 39 seconds. The HCP prototype has been tested in-vivo on 7 human volunteers, using G-suit inflation and deflation to provoke stroke volume changes, and LVot Doppler as a reference technique. Results The ex-vivo measurements showed that ventricular filling

  6. [The peculiarities of the application of transcranial magnetic therapy and electrical stimulation for the treatment of the patients presenting with various types of stroke].

    Science.gov (United States)

    Melnikova, E A

    2015-01-01

    In this article, the results of the authors' research, including analysis of the clinical and instrumental data concerning 203 patients with, stroke are presented. It is shown that the clinical effectiveness of the transcranial methods incorporated in the combined rehabilitation programs depends on the type of stroke and localization of the lesions. Specifically, the patients presenting with ischemic stroke of hemispheric localization experienced a neurophysiologically confirmed significant clinical improvement that became apparent after the consistent application of transcranial magnetic therapy and micropolarization. In the patients with ischemic stroke of stem localization, the positive influence on psychomotor recovery was achieved with the application of transcranial magnetic therapy, but transcranial micropolarization did not have an appreciable effect on the recovery of such patients. The patients presenting with hemorrhagic stroke did not experience any significant improvement of psychomotor parameters from transcranial magnetic therapy and transcranial micropolarization. The likely mechanism underlying the recovery of psychomotor processes under effect of transcranial magnetic therapy in the patients with ischemic stroke is the normalization of the frequency of interaction between brain structures. In addition, in the patients with ischemic stroke of hemispheric localization and in the patients with hemorrhagic stroke electrical myostimulation has a marked impact on the psychomotor recovery only in case of functional treatment. In the patients suffering from ischemic stroke of stem localization non-functional electromyostimulation significantly improves motor functions and cognitive motor control.

  7. Dissolved air flotation and centrifugation as methods for oil recovery from ruptured microalgal cells.

    Science.gov (United States)

    Ghasemi Naghdi, Forough; Schenk, Peer M

    2016-10-01

    Solvent-free microalgal lipid recovery is highly desirable for safer, more sustainable and more economical microalgal oil production. Dispersed air flotation and centrifugation were evaluated for the ability to separate oil and debris from a slurry mixture of osmotically fractured Chaetoceros muelleri cells with and without utilizing collectors. Microalgal oil partially phase-separated as a top layer and partially formed an oil-in-water emulsion. Although collectors, such as sodium dodecyl sulphate enhanced selective flotation, by just adjusting the pH and cell concentration of the mixture, up to 78% of the lipids were recovered in the froth. Using centrifugation of fractured microalgal slurry resulted in removal of 60% cell debris and up to 68.5% of microalgal oil was present in the supernatant. Both methods, centrifugation and flotation provided options for separation of microalgal oil from C. muelleri slurry with similar fatty acid recoveries of 57% and 60%, respectively. Copyright © 2016. Published by Elsevier Ltd.

  8. A method for seedling recovery in Jatropha curcas after cryogenic exposure of the seeds.

    Science.gov (United States)

    Silva, Rafael de C; Camillo, Julcéia; Scherwinski-Pereira, Jonny E

    2012-03-01

    Actually, the germplasm of Jatropha spp. is conserved as whole plants in field collections. Under this storage method, the genetic resources are exposed to disease, pest and natural hazards such as human error, drought and weather damage. Besides, field genebanks are costly to maintain and with important requirements of trained personnel. Thus, the development of efficient techniques to ensure its safe conservation and regeneration is therefore of paramount importance. In this work we describe a method for Jatropha curcas seeds cryoexposure and seedling recovery after thawed. In a first experiment, an efficient protocol for in vitro plant recovery was carried out using zygotic embryo or seeds with or without coat. In a second experiment, desiccated seeds with or without coat were exposed to liquid nitrogen and evaluated after cryoexposure. Germination percentages were variable among treatments, and seeds demonstrated tolerance to liquid nitrogen exposure under certain conditions. Seeds of J. curcas presented up to 99.6% germination after seed coat removal. Seeds with coat cultured in vitro did not germinate, and were 60% contaminated. The germination of the zygotic embryos was significantly higher in the 1/2 MS medium (93.1%) than in WPM medium (76.2%), but from zygotic embryo, abnormal seedlings reached up to 99%. Seeds with coat exposed to liquid nitrogen showed 60% germination in culture after coat removal with good plant growth, and seeds cryopreserved without coat presented 82% germination, but seedlings showed a reduced vigor and a significant increase in abnormal plants. Seeds cultured in vitro with coat did not germinate, independently of cryoexposure or not. This study reports the first successful in vitro seedling recovery methodology for Jatropha curcas seeds, after a cryopreservation treatment, and is recommended as an efficient procedure for in vitro plant recovery, when seeds are conserved in germplasm banks by low or cryotemperatures.

  9. A method for seedling recovery in Jatropha curcas after cryogenic exposure of the seeds

    Directory of Open Access Journals (Sweden)

    Rafael de C. Silva

    2012-03-01

    Full Text Available Actually, the germplasm of Jatropha spp. is conserved as whole plants in field collections. Under this storage method, the genetic resources are exposed to disease, pest and natural hazards such as human error, drought and weather damage. Besides, field genebanks are costly to maintain and with important requirements of trained personnel. Thus, the development of efficient techniques to ensure its safe conservation and regeneration is therefore of paramount importance. In this work we describe a method for Jatropha curcas seeds cryoexposure and seedling recovery after thawed. In a first experiment, an efficient protocol for in vitro plant recovery was carried out using zygotic embryo or seeds with or without coat. In a second experiment, desiccated seeds with or without coat were exposed to liquid nitrogen and evaluated after cryoexposure. Germination percentages were variable among treatments, and seeds demonstrated tolerance to liquid nitrogen exposure under certain conditions. Seeds of J. curcas presented up to 99.6% germination after seed coat removal. Seeds with coat cultured in vitro did not germinate, and were 60% contaminated. The germination of the zygotic embryos was significantly higher in the ½ MS medium (93.1% than in WPM medium (76.2%, but from zygotic embryo, abnormal seedlings reached up to 99%. Seeds with coat exposed to liquid nitrogen showed 60% germination in culture after coat removal with good plant growth, and seeds cryopreserved without coat presented 82% germination, but seedlings showed a reduced vigor and a significant increase in abnormal plants. Seeds cultured in vitro with coat did not germinate, independently of cryoexposure or not. This study reports the first successful in vitro seedling recovery methodology for Jatropha curcas seeds, after a cryopreservation treatment, and is recommended as an efficient procedure for in vitro plant recovery, when seeds are conserved in germplasm banks by low or cryotemperatures.

  10. Measuring disabilities in stroke patients with apraxia : A validation study of an observational method

    NARCIS (Netherlands)

    van Heugten, CM; Dekker, J; Deelman, BG; van Dijk, AJ; Stehmann-Saris, FC; Kinebanian, A

    The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a

  11. Measuring disabilities in stroke patients with apraxia: a validation study of an observational method.

    NARCIS (Netherlands)

    Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Dijk, A.J. van; Stehmann-Saris, F.C.; Kinebanian, A.

    2000-01-01

    The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a

  12. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich

    2014-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  13. The Dotter method revisited: early experience with a novel method of rapid internal carotid artery revascularization in the setting of acute ischemic stroke.

    Science.gov (United States)

    Woodward, Keith; Wegryn, Scott; Staruk, Carla; Nyberg, Eric M

    2016-04-01

    Tandem occlusive disease in the setting of acute ischemic stroke involving cervical and cerebral arteries has been associated with poor neurological outcome and poses significant challenges to neurointerventionists. Previously described endovascular methods typically involve carotid revascularization with stent placement prior to or following intracranial thrombectomy. Stent-based approaches, however, require the use of antiplatelet therapy which may increase the risk of hemorrhagic transformation. We describe a novel modified Dotter technique which may be used for carotid revascularization in lieu of stenting. This technique can eliminate the need for antiplatelet therapy, reduce procedure times, and possibly reduce hemorrhagic conversion rates. Seven patients presenting between April 2013 and January 2014 were treated with this technique. All patients had carotid stenosis of 65-100% and tandem middle cerebral artery occlusions. National Institutes of Health (NIH) Stroke Scale scores as well as clinical and procedural times were recorded. Pre- and post-Dotter stenosis was measured using the NASCET criteria. Follow-up imaging and clinical data were reviewed. The mean age was 64 years and mean initial NIH Stroke Scale score was 11.7. Mean groin to recanalization time was 26 min. Thrombolysis In Cerebral Infarction grade 2b-3 was achieved in all patients. The mean stenosis was 88% preoperatively and 61% postoperatively. There were no intracranial hemorrhages. The modified Rankin Scale score was 0 in six patients (86%) and 6 in one patient (14%). The Dotter stroke technique is a feasible and safe alternative to carotid stenting in the setting of acute ischemic stroke and may reduce the risk of hemorrhagic conversion. No re-occlusion occurred during follow-up in patients with post-Dotter stenosis ≤65%. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Angiotensin receptor blockade in acute stroke. The Scandinavian Candesartan Acute Stroke Trial: rationale, methods and design of a multicentre, randomised- and placebo-controlled clinical trial (NCT00120003)

    DEFF Research Database (Denmark)

    Sandset, Else Charlotte; Murray, Gordon; Boysen, Gudrun Margrethe

    2010-01-01

    Elevated blood pressure following acute stroke is common, and yet early antihypertensive treatment is controversial. ACCESS suggested a beneficial effect of the angiotensin receptor blocker candesartan in the acute phase of stroke, but these findings need to be confirmed in new, large trials. AIMS......, Sweden, Denmark, Belgium, Germany, Poland, Lithuania, Estonia and Finland. STUDY OUTCOMES: There are two co-primary effect variables: • Functional status at 6-months, measured by the modified Rankin Scale, and • vascular death, myocardial infarction or stroke during the first 6-months. Secondary outcome...

  15. Mixed method versus full top-down microcosting for organ recovery cost assessment in a French hospital group

    OpenAIRE

    Hrifach, Abdelbaste; Brault, Coralie; Couray-Targe, Sandrine; Badet, Lionel; Guerre, Pascale; Ganne, Christell; Serrier, Hassan; Labeye, Vanessa; Farge, Pierre; Colin, Cyrille

    2016-01-01

    Background The costing method used can change the results of economic evaluations. Choosing the appropriate method to assess the cost of organ recovery is an issue of considerable interest to health economists, hospitals, financial managers and policy makers in most developed countries. Objectives The main objective of this study was to compare a mixed method, combining top-down microcosting and bottom-up microcosting versus full top-down microcosting to assess the cost of organ recovery in a...

  16. Mixed method versus full top-down microcosting for organ recovery cost assessment in a French hospital group

    OpenAIRE

    Hrifach, Abdelbaste; Brault, Coralie; Couray-Targe, Sandrine; Badet, Lionel; Guerre, Pascale; Ganne, Christell; Serrier, Hassan; Labeye, Vanessa; Farge, Pierre; Colin, Cyrille

    2016-01-01

    Background: The costing method used can change the results of economic evaluations. Choosing the appropriate method to assess the cost of organ recovery is an issue of considerable interest to health economists, hospitals, financial managers and policy makers in most developed countries. Objectives: The main objective of this study was to compare a mixed method, combining top-down microcosting and bottom-up microcosting versus full top-down microcosting to assess the cost of organ recovery in...

  17. Recovery After Stroke: Healthy Eating

    Science.gov (United States)

    ... Can Help  A dietician or nutritionist  Speech and language therapist – to find one in your area call the American Speech-Language- Hearing Association at (800) 638-8255.  Dentist  A ...

  18. A pianist's recovery from stroke.

    Science.gov (United States)

    Toole, James F; Flowers, D Lynn; Burdette, Jonathan H; Absher, John R

    2007-08-01

    To determine alternative neural pathways for restitution of piano playing after right hemispheric infarction causing left arm and hand paralysis. Case report testing coordinated bimanual skills using structured motor skills tests and neuroimaging. A professional pianist sustained a lacunar infarction in the posterior limb of his right internal capsule, which resulted in left hemiparesis with immobilized left-hand and -finger movements persisting for 13 weeks. After 6 months, he had recovered bimanual coordinated piano skills by "ignoring" his left hand while concentrating or discussing subjects other than music while playing. A 63-year-old, male professional pianist. Detailed neurological examination including computed cranial tomography, functional magnetic resonance imaging, and positron emission tomography. Functional magnetic resonance imaging activation patterns correlated with rapid movements of fingers in each hand separately and together demonstrating that subcortical and cerebellar pathways were activated during skilled motor function of his left hand. Contralateral cerebral and cerebellar activation occurred with both left- and right-hand movements. During tapping of the left fingers, there was bilateral cerebellar, parietal, and left premotor strip and left thalamic activation. Patterns of activation relate to task performance and they are not similar to subjects engaged in simpler tasks such as finger opposition.

  19. Acute ischemic stroke prognostication, comparison between ...

    African Journals Online (AJOL)

    Ossama Y. Mansour

    2014-11-20

    Nov 20, 2014 ... or predict all dimensions of recovery and disability after acute stroke. Several scales have proven reliability and validity in stroke trials. Objectives: The aim of the work was to evaluate the FOUR score predictability for outcome of patients with acute ischemic stroke in comparison with the NIHSS and the GCS ...

  20. Characteristic of wet method of phosphorus recovery from polish sewage sludge ash with nitric acid

    Directory of Open Access Journals (Sweden)

    Gorazda Katarzyna

    2016-01-01

    Full Text Available Sewage Sludge Ash (SSA is a concentrated source of phosphorus and can be successfully recycled via a number of different routes. This paper presents research results on phosphorus recovery from differently combusted sewage sludge with the use of nitric acid extraction. Different SSA forms from Polish thermal utilization stations were compared. It was revealed that sewage treatment technology as well as combustion technology influence many physical and chemical parameters of ashes that are crucial for further phosphorus recovery from such waste according to the proposed method. Presented research defines extraction efficiency, characterized extracts composition and verifies the possibility of using SSA as cheaper and alternative sources of phosphorus compounds. Gdynia, Kielce and Kraków SSA have the best properties for the proposed technology of phosphorus recovery with high extraction efficiency greater than 86%. Unsuitable results were obtained for Bydgoszcz, Szczecin Slag and Warszawa SSA. Extraction process for Łódź and Szczecin Dust SSA need to be improved for a higher phosphorus extraction efficiency greater than 80%.

  1. The usefulness of diffusion-weighted/fluid-attenuated inversion recovery imaging in the diagnostics and timing of lacunar and nonlacunar stroke

    Energy Technology Data Exchange (ETDEWEB)

    Witkowski, Grzegorz; Sienkiewicz-Jarosz, Halina [Institute of Psychiatry and Neurology, 1st Department of Neurology, Warsaw (Poland); Piliszek, Agnieszka; Ryglewicz, Danuta [Central Clinical Hospital of the Ministry of Interior, Department of Radiology, Warsaw (Poland); Skierczynska, Agnieszka; Poniatowska, Renata [Institute of Psychiatry and Neurology, Department of Radiology, Warsaw (Poland); Dorobek, Malgorzata; Filipek-Gliszczynska, Anna [Central Clinical Hospital of the Ministry of Interior, Department of Neurology, Warsaw (Poland); Walecki, Jerzy [Polish Academy of Science, Mossakowski Medical Research Centre, Warsaw (Poland)

    2014-10-15

    The DWI/FLAIR mismatch is a potential radiological marker for the timing of stroke onset. The aim of the study was to assess if the DWI/FLAIR mismatch can help to identify patients with both lacunar and nonlacunar acute ischemic stroke within 4.5 h of onset. A retrospective study was performed in which the authors analysed data from 86 ischemic lacunar and nonlacunar stroke patients with a known time of symptom onset, imaged within the first 24 h from stroke onset (36 patients <4.5 h, 14 patients 4.5-6 h, 15 patients 6-12 h, and 21 patients 12-24 h). Patients underwent the admission CT and MR scan. The presence of lesions was assessed in correlation with the duration of the stroke. The time from stroke onset to neuroimaging was significantly shorter in patients with an ischemic lesion visible only in the DWI (mean 2.78 h, n = 24) as compared to patients with signs of ischemia also in other modalities (mean 8.6 h, n = 62) (p = 0.0001, Kruskal-Wallis ANOVA). The DWI/FLAIR mismatch was characterised by a global sensitivity of 58 %, specificity 94 %, PPV 87.5 %, and NPV 76 % in identifying patients in the 4.5 h thrombolysis time window. For lacunar strokes (n = 20), these parameters were as follows: sensitivity 50 %, specificity 92.8 %, PPV 75 %, and NPV 81.2 %. The presence of acute ischemic lesions only in DWI can help to identify both lacunar and nonlacunar stroke patients who are in the 4.5 h time window for intravenous thrombolysis with high specificity. (orig.)

  2. Simulation Opportunity Index, A Simple and Effective Method to Boost the Hydrocarbon Recovery

    KAUST Repository

    Saputra, Wardana

    2016-09-08

    During periods of low oil prices, profitability of field developments drops drastically. To help with this difficulty, a cost-effective method has been proposed to boost the hydrocarbon recovery by optimizing well locations through the Simulated Opportunity Index (SOI). SOI is an intelligent method to identify zones with high potential for production which is empirically calculated from basic rock and fluid properties, and from reservoir pressure as its energy capacity. In order to obtain the best results, the original SOI formula (Molina et al., 2009) was extended to both oil and gas fields. Based on this modified SOI formula, a software program has been developed to locate the best well locations considering multilayer, existing wells, and fault existences. This paper describes how the SOI software helps as a simple, fast, and accurate way to obtain the higher hydrocarbon production than that of trial-error method and previous studies in two different fields located in offshore Indonesia. On one hand, the proposed method could save money by minimizing the required number of wells. On the other hand, it could maximize profit by maximizing recovery.

  3. Effect of Physical Methods of Lymphatic Drainage on Postexercise Recovery of Mixed Martial Arts Athletes.

    Science.gov (United States)

    Zebrowska, Aleksandra; Trybulski, Robert; Roczniok, Robert; Marcol, Wieslaw

    2017-08-16

    Physical methods are reported to be important for accelerating skeletal muscle regeneration, decreasing muscle soreness, and shortening of the recovery time. The aim of the study was to assess the effect of the physical methods of lymphatic drainage (PMLD) such as manual lymphatic drainage (MLD), the Bodyflow (BF) therapy, and lymphatic drainage by deep oscillation (DO) on postexercise regeneration of the forearm muscles of mixed martial arts (MMA) athletes. Eighty MMA athletes aged 27.5 ± 6.4 years were allocated to 4 groups: MLD, the BF device, DO therapy, and the control group. Blood flow velocity in the cephalic vein was measured with the ultrasound Doppler velocity meter. Maximal strength of the forearm muscles (Fmax), muscle tissue tension, pain threshold, blood lactate concentration (LA), and activity of creatine kinase were measured in all groups at rest, after the muscle fatigue test (post-ex) and then 20 minutes, 24, and 48 hours after the application of PMLD. The muscle fatigue test reduced Fmax in all subjects, but in the groups receiving MLD, DO, and BF significantly higher Fmax was observed at recovery compared with post-ex values. The application of MDL reduced the postexercise blood LA and postexercise muscle tension. The lymphatic drainage methods, whether manual or using electro-stimulation and DO, improve postexercise regeneration of the forearm muscles of MMA athletes. The methods can be an important element of therapeutic management focused on optimizing training effects and reducing the risk of injuries of the combat sports athletes.

  4. Residual nitrogen-15 recovery by corn as influenced by tillage and fertilization method

    International Nuclear Information System (INIS)

    Timmons, D.R.; Cruse, R.M.

    1991-01-01

    Tillage systems that create different surface residue conditions may also affect the recovery of residual fertilizer N during subsequent growing seasons. This study evaluated the recovery of residual labeled N fertilizer in the soil by corn (Zea mays L.) for two tillage systems and two fertilization methods. Five atom % 15 N-enriched 28% urea-ammonium nitrate solution (UAN) at 224 kg N ha -1 was either surface-applied in the fall before any primary tillage or banded (knifed in) just before planting in the spring. Continuous corn was grown with either fall moldboard-plow (MP) or ridge-till (RT) systems. After the initial growing season, the recovery of residual labeled N in the soil by corn was determined for three consecutive growing seasons, and the soil profile was sampled periodically to measure residual 15 N in the organic and inorganic pools. One year after labeled UAN application, from 16 to 27% of the initial 15 N applied was found in the organic N pool and only 1% as inorganic N[NH 4 +(NO 2 +NO 3 )-N]. After four seasons, residual 15 N in the organic N pool ranged from 13 to 24%. Less than 0.5% remained as inorganic N. Regression analyses indicated that about 5 kg 15 N ha -1 year -1 became available for both MP and RT systems with banded N, so the amounts were small. Total residual 15 N recovery by corn grain plus stover for three seasons ranged from 1.7 to 3.5%, and was greatest for spring-banded fertilizer. Because the amounts of residual 15 N utilized were too small to affect corn growth, this N source appears to be negligible when considering corn-N needs

  5. Improved methods for generation, sampling, and recovery of biological aerosols in filter challenge tests.

    Science.gov (United States)

    McCullough, N V; Brosseau, L M; Vesley, D; Vincent, J H

    1998-04-01

    In preparation for filter efficiency tests and sampler comparison studies, methods of biological aerosol generation, sampling, and filter recovery were modified from previous studies. Methods described include (1) techniques for generating aerosols that reduced nuisance particles to negligible levels and increased the cell culturability of Mycobacterium abscessus by 30%, (2) sampling techniques that lowered the detectable range of biological particle size from 0.65 to 0.45 micron and reduced the sampling flow from the chamber from 28.3 to 1.5 L/min, and (3) development of methods to remove culturable organisms from respirator filter media. These methods were developed for filter challenge tests with M. abscessus and were applied to two other bacteria. They may also have application to a wider variety of organisms and bioaerosol assessments.

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

    Directory of Open Access Journals (Sweden)

    Мaya P. Danovska

    2014-03-01

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

  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. Obstructive sleep apnea exaggerates cognitive dysfunction in stroke patients.

    Science.gov (United States)

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

    2017-05-01

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

  10. Recovery of Americium-241 from lightning rod by the method of chemical treatment

    International Nuclear Information System (INIS)

    Cruz, W.H.

    2013-01-01

    About 95% of the lightning rods installed in the Peruvian territory have set in their structures, pose small amounts of radioactive sources such as Americium-241 ( 241 Am), fewer and Radium 226 ( 226 Ra) these are alpha emitters and have a half life of 432 years and 1600 years respectively. In this paper describes the recovery of radioactive sources of 241 Am radioactive lightning rods using the conventional chemical treatment method using agents and acids to break down the slides. The 241 Am recovered was as excitation source and alpha particle generator for analysing samples by X Ray Fluorescence, for fixing the stainless steel 241 Am technique was used electrodeposition. (author)

  11. Recovery of Lithium From Geothermal Fluid at Lumpur Sidoarjo by Adsorption Method

    OpenAIRE

    Noerochim, Lukman; Satriawangsa, Gita Akbar; Widodo, Amien

    2016-01-01

    The recovery of lithium from geothermal fluid at Lumpur Sidoarjo, Indonesia was investigated employing an adsorption method with polymer membrane as container. The lithium concentration in geothermal fluid from Lumpur Sidoarjo used in the present study was about 5 mg/l. Lithium manganese oxide (LMO) was selected as a promising adsorbent material due to its non-toxic, topotactical behavior and low cost. In this study, LMO with single Li/Mn mole ratio was prepared, i.e. Li1.6Mn1.6O4. The adsorb...

  12. The Train Driver Recovery Problem - a Set Partitioning Based Model and Solution Method

    DEFF Research Database (Denmark)

    Rezanova, Natalia Jurjevna; Ryan, David

    The need to recover a train driver schedule occurs during major disruptions in the daily railway operations. Using data from the train driver schedule of the Danish passenger railway operator DSB S-tog A/S, a solution method to the Train Driver Recovery Problem (TDRP) is developed. The TDRP...... is formulated as a set partitioning problem. The LP relaxation of the set partitioning formulation of the TDRP possesses strong integer properties. The proposed model is therefore solved via the LP relaxation and Branch & Price. Starting with a small set of drivers and train tasks assigned to the drivers within...

  13. Potential contribution of fish restocking to the recovery of deteriorated coral reefs: an alternative restoration method?

    Directory of Open Access Journals (Sweden)

    Uri Obolski

    2016-02-01

    Full Text Available Counteracting the worldwide trend of coral reef degeneration is a major challenge for the scientific community. A crucial management approach to minimizing stress effects on healthy reefs and helping the recovery of disturbed reefs is reef protection. However, the current rapid decline of the world’s reefs suggests that protection might be insufficient as a viable stand-alone management approach for some reefs. We thus suggest that the ecological restoration of coral reefs (CRR should be considered as a valid component of coral reef management, in addition to protection, if the applied method is economically applicable and scalable. This theoretical study examines the potential applicability and outcomes of restocking grazers as a restoration tool for coral reef recovery—a tool that has not been applied so far in reef restoration projects. We studied the effect of restocking grazing fish as a restoration method using a mathematical model of degrading reefs, and analyzed the financial outcomes of the restocking intervention. The results suggest that applying this restoration method, in addition to protection, can facilitate reef recovery. Moreover, our analysis suggests that the restocking approach almost always becomes profitable within several years. Considering the relatively low cost of this restoration approach and the feasibility of mass production of herbivorous fish, we suggest that this approach should be considered and examined as an additional viable restoration tool for coral reefs.

  14. The spasticity in the motor and functional disability in adults with post-stroke hemiparetic

    OpenAIRE

    Cacho, Roberta de Oliveira; Cacho, Enio Walker Azevedo; Loureiro, Anderson Barbosa; Cirne, Gabriele Natane de Medeiros; Pereira, Silvana Alves; Freitas, Rodrigo Pegado de Abreu; Lima, Núbia Maria Freire Vieira; Borges, Guilherme

    2017-01-01

    Abstract Introduction: Spasticity acts as a limiting factor in motor and functional recovery after Stroke, impairing the performance of daily living activities. Objective: To analyze the influence of spasticity on main muscle groups and to associate it with motor impairment and functional level of chronic hemiparetic patients after stroke. Methods: Twenty-seven chronic hemiparetic patients of both sexes were selected at the Physical Therapy and Occupational Therapy Service of the Unicamp...

  15. A novel method for the quantification of key components of manual dexterity after stroke

    OpenAIRE

    T?r?metz, Maxime; Colle, Florence; Hamdoun, Sonia; Maier, Marc A.; Lindberg, P?vel G.

    2015-01-01

    Background A high degree of manual dexterity is a central feature of the human upper limb. A rich interplay of sensory and motor components in the hand and fingers allows for independent control of fingers in terms of timing, kinematics and force. Stroke often leads to impaired hand function and decreased manual dexterity, limiting activities of daily living and impacting quality of life. Clinically, there is a lack of quantitative multi-dimensional measures of manual dexterity. We therefore ...

  16. An innovative treatment method for an aqueous waste from the enhanced oil recovery process

    Energy Technology Data Exchange (ETDEWEB)

    Alimahmoodi, M.; Mulligan, C.N. [Concordia Univ., Montreal, Quebec (Canada)

    2009-07-01

    Anaerobic treatment was evaluated to determine its effectiveness in treating a waste stream from the process of Enhanced Oil Recovery (EOR) to remove solubilized CO{sub 2} (98%) and petroleum hydrocarbons (83%) using formate (2 g/L) and sucrose (2.5 g/L) as electron donors in two consecutive reactors. The method of evolutionary operation (EVOP) factorial design was applied to optimize the system and the net energy ratio (NER) of 3.7 was calculated for the system which showed a sustainable biogas production. This method is less complex than other competitive methods, and in addition to its low energy requirements, it can produce CH{sub 4} from CO{sub 2} as a clean source of energy. (author)

  17. Microbiological methods for the water recovery systems test, revision 1.1

    Science.gov (United States)

    Rhoads, Tim; Kilgore, M. V., Jr.; Mikell, A. T., Jr.

    1990-01-01

    Current microbiological parameters specified to verify microbiological quality of Space Station Freedom water quality include the enumeration of total bacteria, anaerobes, aerobes, yeasts and molds, enteric bacteria, gram positives, gram negatives, and E. coli. In addition, other parameters have been identified as necessary to support the Water Recovery Test activities to be conducted at the NASA/MSFC later this year. These other parameters include aerotolerant eutrophic mesophiles, legionellae, and an additional method for heterotrophic bacteria. If inter-laboratory data are to be compared to evaluate quality, analytical methods must be eliminated as a variable. Therefore, each participating laboratory must utilize the same analytical methods and procedures. Without this standardization, data can be neither compared nor validated between laboratories. Multiple laboratory participation represents a conservative approach to insure quality and completeness of data. Invariably, sample loss will occur in transport and analyses. Natural variance is a reality on any test of this magnitude and is further enhanced because biological entities, capable of growth and death, are specific parameters of interest. The large variation due to the participation of human test subjects has been noted with previous testing. The resultant data might be dismissed as 'out of control' unless intra-laboratory control is included as part of the method or if participating laboratories are not available for verification. The purpose of this document is to provide standardized laboratory procedures for the enumeration of certain microorganisms in water and wastewater specific to the water recovery systems test. The document consists of ten separate cultural methods and one direct count procedure. It is not intended nor is it implied to be a complete microbiological methods manual.

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

    Science.gov (United States)

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

    2015-07-01

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

  19. Life after Stroke in an Urban Minority Population: A Photovoice Project

    Directory of Open Access Journals (Sweden)

    Revathi Balakrishnan

    2017-03-01

    Full Text Available Stroke is a leading cause of disability in the United States and disproportionately affects minority populations. We sought to explore the quality of life in urban, minority stroke survivors through their own photos and narratives. Using the Photovoice method, seventeen stroke survivors were instructed to take pictures reflecting their experience living with and recovering from stroke. Key photographs were discussed in detail; participants brainstormed ways to improve their lives and presented their work in clinical and community sites. Group discussions were recorded, transcribed, and coded transcripts were reviewed with written narratives to identify themes. Participants conveyed recovery from stroke in three stages: learning to navigate the initial physical and emotional impact of the stroke; coping with newfound physical and emotional barriers; and long-term adaptation to physical impairment and/or chronic disease. Participants navigated this stage-based model to varying degrees of success and identified barriers and facilitators to this process. Barriers included limited access for disabled and limited healthy food choices unique to the urban setting; facilitators included presence of social support and community engagement. Using Photovoice, diverse stroke survivors were able to identify common challenges in adapting to life after stroke and important factors for recovery of quality of life.

  20. Modelling of Evaporator in Waste Heat Recovery System using Finite Volume Method and Fuzzy Technique

    Directory of Open Access Journals (Sweden)

    Jahedul Islam Chowdhury

    2015-12-01

    Full Text Available The evaporator is an important component in the Organic Rankine Cycle (ORC-based Waste Heat Recovery (WHR system since the effective heat transfer of this device reflects on the efficiency of the system. When the WHR system operates under supercritical conditions, the heat transfer mechanism in the evaporator is unpredictable due to the change of thermo-physical properties of the fluid with temperature. Although the conventional finite volume model can successfully capture those changes in the evaporator of the WHR process, the computation time for this method is high. To reduce the computation time, this paper develops a new fuzzy based evaporator model and compares its performance with the finite volume method. The results show that the fuzzy technique can be applied to predict the output of the supercritical evaporator in the waste heat recovery system and can significantly reduce the required computation time. The proposed model, therefore, has the potential to be used in real time control applications.

  1. Review of statistical methods used in enhanced-oil-recovery research and performance prediction. [131 references

    Energy Technology Data Exchange (ETDEWEB)

    Selvidge, J.E.

    1982-06-01

    Recent literature in the field of enhanced oil recovery (EOR) was surveyed to determine the extent to which researchers in EOR take advantage of statistical techniques in analyzing their data. In addition to determining the current level of reliance on statistical tools, another objective of this study is to promote by example the greater use of these tools. To serve this objective, the discussion of the techniques highlights the observed trend toward the use of increasingly more sophisticated methods and points out the strengths and pitfalls of different approaches. Several examples are also given of opportunities for extending EOR research findings by additional statistical manipulation. The search of the EOR literature, conducted mainly through computerized data bases, yielded nearly 200 articles containing mathematical analysis of the research. Of these, 21 were found to include examples of statistical approaches to data analysis and are discussed in detail in this review. The use of statistical techniques, as might be expected from their general purpose nature, extends across nearly all types of EOR research covering thermal methods of recovery, miscible processes, and micellar polymer floods. Data come from field tests, the laboratory, and computer simulation. The statistical methods range from simple comparisons of mean values to multiple non-linear regression equations and to probabilistic decision functions. The methods are applied to both engineering and economic data. The results of the survey are grouped by statistical technique and include brief descriptions of each of the 21 relevant papers. Complete abstracts of the papers are included in the bibliography. Brief bibliographic information (without abstracts) is also given for the articles identified in the initial search as containing mathematical analyses using other than statistical methods.

  2. Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II.

    Science.gov (United States)

    Bettger, Janet Prvu; Li, Zixiao; Xian, Ying; Liu, Liping; Zhao, Xingquan; Li, Hao; Wang, Chunxue; Wang, Chunjuan; Meng, Xia; Wang, Anxin; Pan, Yuesong; Peterson, Eric D; Wang, Yilong; Wang, Yongjun

    2017-04-01

    Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

  3. Taguchi optimization: Case study of gold recovery from amalgamation tailing by using froth flotation method

    Science.gov (United States)

    Sudibyo, Aji, B. B.; Sumardi, S.; Mufakir, F. R.; Junaidi, A.; Nurjaman, F.; Karna, Aziza, Aulia

    2017-01-01

    Gold amalgamation process was widely used to treat gold ore. This process produces the tailing or amalgamation solid waste, which still contains gold at 8-9 ppm. Froth flotation is one of the promising methods to beneficiate gold from this tailing. However, this process requires optimal conditions which depends on the type of raw material. In this study, Taguchi method was used to optimize the optimum conditions of the froth flotation process. The Taguchi optimization shows that the gold recovery was strongly influenced by the particle size which is the best particle size at 150 mesh followed by the Potassium amyl xanthate concentration, pH and pine oil concentration at 1133.98, 4535.92 and 68.04 gr/ton amalgamation tailing, respectively.

  4. Pre-stroke use of beta-blockers does not affect ischaemic stroke severity and outcome

    NARCIS (Netherlands)

    De Raedt, S.; Haentjens, P.; De Smedt, A.; Brouns, R.; Uyttenboogaart, Maarten; Luijckx, G. J.; De Keyser, J.

    Background and purpose: It is unclear whether pre-stroke beta-blockers use may influence stroke outcome. This study evaluates the independent effect of pre-stroke use of beta-blockers on ischaemic stroke severity and 3 months functional outcome. Methods: Pre-stroke use of beta-blockers was

  5. Cerebral Ischemia versus MS in Young Adults Clinical Imaging Diagnosis Difficulties and Recovery Methods

    Directory of Open Access Journals (Sweden)

    Any DOCU-AXELERAD

    2012-12-01

    Full Text Available Ischemia in young adults is often the result of non-atherosclerotic vasculopathies, cardiac embolism or clotting disorders. One third of young adults ischemic stroke etiology remains undetermined. Materials and methods: We present the case of a patient aged 42, diagnosed with probable MS without cardiovascular or metabolic risk factors, presented to our clinic for decrease of force at right limbs and recent dysarthria. Results and discussion: The history revealed recurrent episodes of right hemi-body numbness and vertigo labeled as relapse in MS. Patient is non smoker, does not take oral contraceptives and has no history of cerebrovascular disease in the family. Extensive imaging and laboratory investigations confirms the ischemic clinical picture, carotid Doppler ultrasound showing significant stenosis of the bulbo-left carotid. The patient is guided to the cardiovascular surgery clinic for specialized treatment. Two weeks postoperatively we apply a kinetic-therapy program. Conclusion: Uncertain imaging and lack of vascular and metabolic risk factors do not preclude ischemia in young adults.

  6. Effect of method of analysis on iron content of beef from advanced meat recovery systems.

    Science.gov (United States)

    Windham, W R; Field, R A

    2000-12-01

    A field survey was conducted by the USDA, Food Safety Inspection Service (FSIS) to provide analytical data on meat obtained from beef cervical vertebrae processed by advanced meat recovery (AMR) systems. As a result, an added iron performance standard was proposed to limit the amount of marrow in AMR products. The performance standard was based on iron content of hand boned lean compared to AMR lean. Iron content was determined by a hydrochloric wet ash digestion method. The same samples were then analyzed using dry ash digestion. The objectives of the study were to determine differences in iron content of the survey samples due to the digestion method and the impact of this difference on the added iron performance standard. Iron values by the dry ash method were approximately double those of the wet ash method. The difference was a result of incomplete volatilization of the organic matrix by hydrochloric acid in the wet ash procedure. The performance standards developed from the wet and dry ash methods were 1.8 and 3.2 mg added iron 100(-1) g, respectively. Added iron levels from the dry ash method greater than 3.2 mg 100(-1) g were present in 60% of the AMR lean indicating that some marrow was present or that factors other than amount of iron in hand boned lean should be considered before a performance standard is established.

  7. Team sport athletes' perceptions and use of recovery strategies: a mixed-methods survey study.

    Science.gov (United States)

    Crowther, Fiona; Sealey, Rebecca; Crowe, Melissa; Edwards, Andrew; Halson, Shona

    2017-01-01

    A variety of recovery strategies are used by athletes, although there is currently no research that investigates perceptions and usage of recovery by different competition levels of team sport athletes. The recovery techniques used by team sport athletes of different competition levels was investigated by survey. Specifically this study investigated if, when, why and how the following recovery strategies were used: active land-based recovery (ALB), active water-based recovery (AWB), stretching (STR), cold water immersion (CWI) and contrast water therapy (CWT). Three hundred and thirty-one athletes were surveyed. Fifty-seven percent were found to utilise one or more recovery strategies. Stretching was rated the most effective recovery strategy (4.4/5) with ALB considered the least effective by its users (3.6/5). The water immersion strategies were considered effective/ineffective mainly due to psychological reasons; in contrast STR and ALB were considered to be effective/ineffective mainly due to physical reasons. This study demonstrates that athletes may not be aware of the specific effects that a recovery strategy has upon their physical recovery and thus athlete and coach recovery education is encouraged. This study also provides new information on the prevalence of different recovery strategies and contextual information that may be useful to inform best practice among coaches and athletes.

  8. Penumbra pattern assessment in acute stroke patients: comparison of quantitative and non-quantitative methods in whole brain CT perfusion.

    Directory of Open Access Journals (Sweden)

    Kolja M Thierfelder

    Full Text Available BACKGROUND AND PURPOSE: While penumbra assessment has become an important part of the clinical decision making for acute stroke patients, there is a lack of studies measuring the reliability and reproducibility of defined assessment techniques in the clinical setting. Our aim was to determine reliability and reproducibility of different types of three-dimensional penumbra assessment methods in stroke patients who underwent whole brain CT perfusion imaging (WB-CTP. MATERIALS AND METHODS: We included 29 patients with a confirmed MCA infarction who underwent initial WB-CTP with a scan coverage of 100 mm in the z-axis. Two blinded and experienced readers assessed the flow-volume-mismatch twice and in two quantitative ways: Performing a volumetric mismatch analysis using OsiriX imaging software (MM(VOL and visual estimation of mismatch (MM(EST. Complementarily, the semiquantitative Alberta Stroke Programme Early CT Score for CT perfusion was used to define mismatch (MM(ASPECTS. A favorable penumbral pattern was defined by a mismatch of ≥ 30% in combination with a cerebral blood flow deficit of ≤ 90 ml and an MM(ASPECTS score of ≥ 1, respectively. Inter- and intrareader agreement was determined by Kappa-values and ICCs. RESULTS: Overall, MM(VOL showed considerably higher inter-/intrareader agreement (ICCs: 0.751/0.843 compared to MM(EST (0.292/0.749. In the subgroup of large (≥ 50 mL perfusion deficits, inter- and intrareader agreement of MM(VOL was excellent (ICCs: 0.961/0.942, while MM(EST interreader agreement was poor (0.415 and intrareader agreement was good (0.919. With respect to penumbra classification, MM(VOL showed the highest agreement (interreader agreement: 25 agreements/4 non-agreements/κ: 0.595; intrareader agreement 27/2/0.833, followed by MM(EST (22/7/0.471; 23/6/0.577, and MM(ASPECTS (18/11/0.133; 21/8/0.340. CONCLUSION: The evaluated approach of volumetric mismatch assessment is superior to pure visual and ASPECTS penumbra

  9. 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.

  10. Know Stroke: Know the Signs, Act in Time Video

    Medline Plus

    Full Text Available ... much better chance for a complete recovery. Effective treatment is available for strokes caused by a blood ... And the blood starts flowing again." Announcer: New treatments can limit the disability caused by a stroke, ...

  11. Modified Approach to Stroke Rehabilitation (MAStR): feasibility study of a method to apply procedural memory concepts to transfer training.

    Science.gov (United States)

    Pavol, Marykay A; Bassile, Clare C; Lehman, Jennifer R; Harmon, Emma; Ferreira, Nancy; Shinn, Brittany; St James, Nancy; Callender, Jacqueline; Stein, Joel

    2018-04-03

    Training and implementation for a multidisciplinary stroke rehabilitation method emphasizing procedural memory. Current practice in stroke rehabilitation relies on explicit memory, often compromised by stroke, failing to capitalize on better-preserved procedural memory skills. Recruitment of procedural memory requires consistency and practice, characteristics difficulty to promote on inpatient rehabilitation units. We designed a method Modified Approach to Stroke Rehabilitation (MAStR) to maximize consistency and practice for transfer training with stroke patients. Phase I, single-group study. MAStR has two innovations: (1) simplification of instructions to only three words, other direction provided non-verbally; (2) having all rehabilitation staff apply the same approach for transfers. Staff training in MAStR included review of written material describing the rationale for MAStR and demonstration of a transfer using MAStR. Enrolled patients completed each transfer with MAStR in addition to standard rehabilitation therapy. The MAStR method was taught to a large, multidisciplinary rehabilitation staff (n = 31). Training and certification required 15 min per staff member. Five stroke patients were enrolled. No transfers with MAStR resulted in injury, no negative feedback was received from staff or patients. Staff reported satisfaction with the brief MAStR training and reported transfers were easier to complete with the MAStR method. Feasibility was demonstrated for an innovative application of procedural memory concepts to stroke rehabilitation. All rehabilitation disciplines were successfully trained. MAStR was well-tolerated and liked by rehabilitation staff and patients. These results support pursuit of a Phase II pilot study.

  12. Acoustic Radiation Force-Induced Creep-Recovery (ARFICR): A Noninvasive Method to Characterize Tissue Viscoelasticity.

    Science.gov (United States)

    Amador Carrascal, Carolina; Chen, Shigao; Urban, Matthew W; Greenleaf, James F

    2018-01-01

    Ultrasound shear wave elastography is a promising noninvasive, low cost, and clinically viable tool for liver fibrosis staging. Current shear wave imaging technologies on clinical ultrasound scanners ignore shear wave dispersion and use a single group velocity measured over the shear wave bandwidth to estimate tissue elasticity. The center frequency and bandwidth of shear waves induced by acoustic radiation force depend on the ultrasound push beam (push duration, -number, etc.) and the viscoelasticity of the medium, and therefore are different across scanners from different vendors. As a result, scanners from different vendors may give different tissue elasticity measurements within the same patient. Various methods have been proposed to evaluate shear wave dispersion to better estimate tissue viscoelasticity. A rheological model such as the Kelvin-Voigt model is typically fitted to the shear wave dispersion to solve for the elasticity and viscosity of tissue. However, these rheological models impose strong assumptions about frequency dependence of elasticity and viscosity. Here, we propose a new method called Acoustic Radiation Force Induced Creep-Recovery (ARFICR) capable of quantifying rheological model-independent measurements of elasticity and viscosity for more robust tissue health assessment. In ARFICR, the creep-recovery time signal at the focus of the push beam is used to calculate the relative elasticity and viscosity (scaled by an unknown constant) over a wide frequency range. Shear waves generated during the ARFICR measurement are also detected and used to calculate the shear wave velocity at its center frequency, which is then used to calibrate the relative elasticity and viscosity to absolute elasticity and viscosity. In this paper, finite-element method simulations and experiments in tissue mimicking phantoms are used to validate and characterize the extent of viscoelastic quantification of ARFICR. The results suggest that ARFICR can measure tissue

  13. Prediction of Upper Limb Recovery, General Disability, and Rehabilitation Status by Activity Measurements Assessed by Accelerometers or the Fugl-Meyer Score in Acute Stroke

    NARCIS (Netherlands)

    Gebruers, Nick; Truijen, Steven; Engelborghs, Sebastiaan; De Deyn, Peter P.

    Objective This study investigated the clinical predictive value of the Fugl-Meyer Assessment (FMA) arm score and the upper limb activity assessed by accelerometers in patients with hemiparesis after acute stroke. Design The prospective cohort (n = 129) was recruited from a general hospital; activity

  14. Recovery of crown mass for energy with whole-tree skidding methods; Puupolttoaineen tuottaminen kokopuujuontomenetelmillae

    Energy Technology Data Exchange (ETDEWEB)

    Nousiainen, I. [Finntech Ltd Oy, Jyvaeskylae (Finland); Vesisenaho, T. [VTT Energy, Jyvaeskylae (Finland)

    1996-12-31

    The main aim of the project `Recovery of crown mass for energy with whole-tree skidding methods` was to develop the integrated harvesting method of wood raw material and wood fuel based on whole-tree skidding. The developed method gives also the possibility to deliver to sawmills raw material in the form of log section. In the harvesting chain under development whole-trees are felled and bunched with a normal one-grip harvester. The whole-trees are skidded to the roadside by a forwarder equipped with a clam bunk. At the roadside the trees are delimbed and cut with the one-grip harvester used for felling and bunching. According to the results of the field tests the harvesting costs of logging residues are in certain final cutting conditions even under 10 FIM/m{sup 3}, when the average stem size is over 0,500 m{sup 3}. In the developed method felling and bunching of whole trees with the one-grip harvester and skidding of whole-trees with the clam skidder succeeded well. The problems of the method concentrate on delimbing and bucking of whole-trees in landing site

  15. Towards Upright Pedalling to drive recovery in people who cannot walk in the first weeks after stroke: movement patterns and measurement.

    Science.gov (United States)

    Hancock, Nicola J; Shepstone, Lee; Rowe, Philip; Myint, Phyo K; Pomeroy, Valerie M

    2017-12-01

    To examine whether people who are within 31days of stroke onset are able to produce controlled lower limb movement, and phasic activity in antagonistic lower limb muscle groups, during Upright Pedalling (UP). Observational study. Acute stroke unit within a University Hospital. Eight adults between 3 and 30days from stroke onset, with unilateral lower limb paresis and unable to walk without assistance. Participants were considered fit to participate as assessed by a physician-led medical team and were able to take part in UP for one, one minute session. Participants took part in one session of instrumented UP at their comfortable cadence, as part of a feasibility study investigating UP early after stroke. Reciprocal activation of lower limb muscles derived from muscle activity recorded with surface EMG, quantified using Jaccards Coefficient (J); smoothness of pedalling determined from standard deviations of time spent in each of eight 45° wheel position bins ("S-Ped"). Motor behavioural measures: Motricity Index, Trunk Control Test, Functional Ambulatory Categories. Participants were all unable to walk (FAC 0) with severe to moderate lower limb paresis (Motricity Index score/100 median 48.5, IQR 32 to 65.5). Smooth pedalling was observed; some participants pedalling similarly smoothly to healthy older adults, with a variety of muscle activation patterns in the affected and unaffected legs. These observational data indicate that people with substantial paresis early after stroke and who cannot walk, can produce smooth movement during UP using a variety of muscle activation strategies. Copyright © 2016. Published by Elsevier Ltd.

  16. Fertilizer nitrogen prescription for cotton by 15N recovery method under integrated nutrient management using soil test crop response function

    International Nuclear Information System (INIS)

    Arulmozhiselvan, K.; Govindaswamy, M.; Chellamuthu, S.

    2007-01-01

    Fertilizer efficiency is a vital parameter in prescription functions to compute fertilizer requirements of crops for achieving a specific yield target. In Soil Test Crop Response (STCR) function, nitrogen fertilizer efficiency is calculated by Apparent N Recovery (ANR) method, which includes the effect of added N interaction (ANI) on soil N reserves. In order to exclude soil effect and refine STCR function, the real efficiency of fertilizer N was estimated by 15 N recovery method. By fitting 15 N recovery in the function, the fertilizer N required for a specific yield target of cotton was estimated. The estimated N requirement by 15 N recovery method was lesser than ANR method when available soil N relatively increased. The approach also fine-tuned the N contributing efficiency of soil, farmyard manure and Azospirillum under Integrated Nutrient Management (INM). For achieving 25 q of seed cotton yield in a soil having 220 kg of available N ha -1 , the predicted N requirement was 159 kg ha -1 under ANR method, whereas in 15 N recovery method fertilizer N to be applied was 138 kg ha -1 with urea alone and 79 kg ha -1 with urea + FYM + Azospirillum. (author)

  17. Stroke risk perception among participants of a stroke awareness campaign

    OpenAIRE

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

    2007-01-01

    Abstract Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. S...

  18. 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

  19. Actinides recovery from molten salt/liquid metal system by electrochemical methods

    Science.gov (United States)

    Iizuka, Masatoshi; Koyama, Tadafumi; Kondo, Naruhito; Fujita, Reiko; Tanaka, Hiroshi

    1997-08-01

    Electrochemical methods were examined for the recovery of actinides from the electrorefiner which is used in pyrometallurgical reprocessing of spent metal fuel for fast reactors. Uranium was successfully collected at the solid steel cathode from both liquid cadmium and molten salt solvents. In electrotransport from liquid cadmium, the behavior of uranium and rare earths was as expected by a computer simulation code based on the diffusion layer model at the interface between the electrolyte and the electrodes. In electroreduction from the molten salt electrolyte, a considerable amount of uranium was reduced at the CdLi anode by direct chemical reduction with lithium, especially at a lower anodic current density. The decrease in collection efficiency of uranium due to the direct chemical reduction would be avoided by maintaining the anode potential higher than the deposition potential of uranium.

  20. Miscible gas enhanced oil recovery method using oil-brine compatible pre-formed foam

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, S.

    1988-08-16

    A method is described of enhancing recovery of petroleum from an oil bearing formation during injection of a non-condensible gas having at least partial miscibility in the oil which comprises at least periodically injecting a preformed foam composition formed of alpha olefin sulfonate (AOS) and brine or water, into the oil bearing formation, the pre-formed foam being a mixture of the gas, brine or water and an effective foam forming amount of an AOS, the AOS having from 8 to 24 carbon atoms, the number of carbon atoms being selected in accordance with the salt content of brine in the formation so that at higher salt concentrations the AOS has on average less than about 12 carbon atoms and at lower salt concentrations the AOS has on average at least about 12 carbon atoms.

  1. Method for enhancing selectivity and recovery in the fractional flotation of particles in a flotation column

    Science.gov (United States)

    Klunder, Edgar B [Bethel Park, PA

    2011-08-09

    The method relates to particle separation from a feed stream. The feed stream is injected directly into the froth zone of a vertical flotation column in the presence of a counter-current reflux stream. A froth breaker generates a reflux stream and a concentrate stream, and the reflux stream is injected into the froth zone to mix with the interstitial liquid between bubbles in the froth zone. Counter-current flow between the plurality of bubbles and the interstitial liquid facilitates the attachment of higher hydrophobicity particles to bubble surfaces as lower hydrophobicity particles detach. The height of the feed stream injection and the reflux ratio may be varied in order to optimize the concentrate or tailing stream recoveries desired based on existing operating conditions.

  2. Recovery of Lithium from Geothermal Fluid at Lumpur Sidoarjo by Adsorption Method

    Directory of Open Access Journals (Sweden)

    Lukman Noerochim

    2016-05-01

    Full Text Available The recovery of lithium from geothermal fluid at Lumpur Sidoarjo, Indonesia was investigated employing an adsorption method with polymer membrane as container. The lithium concentration in geothermal fluid from Lumpur Sidoarjo used in the present study was about 5 mg/l. Lithium manganese oxide (LMO was selected as a promising adsorbent material due to its non-toxic, topotactical behavior and low cost. In this study, LMO with single Li/Mn mole ratio was prepared, i.e. Li1.6Mn1.6O4. The adsorbent was synthesized by solid state reaction at 500 °C for 5 hrs. A lithium uptake yield from the geothermal fluid of around 6.6 mg/g was obtained.

  3. Recovery of 238Pu from irradiated 237Np using anion exchange method

    International Nuclear Information System (INIS)

    Zhang Shaoqi; Hu Huaizhong; Zhang Qinfen; Xue Shijin; Tang Xuzhen; Qin Zhongxian; Zhu Shuzhong

    1986-04-01

    A process for recovering and purifying 238 Pu from irradiated NpO 2 target by anion exchange method is described in detail. Related results obtained in the technological experiment for the process are given. First, absorb and desorb behaviour of 237 Np- 239 Pu on the anion exchange columu using 237 Np and 239 Pu, various factors effecting 237 Np/ 239 Pu separation were investigated, then, we selected technical parameters for the four cycles process. Finally, a 'hot' experiment was conducted using an irradiated NpO 2 target. The cross-contamination of 237 Np and 238 Pu is less than 1%, the total recoveries of 237 Np and 238 Pu are respectively 99.6% and 98.1%. The total γ elimination coefficient of 237 Np- 238 Pu obtained in the first anion exchange cycle is 2.4 x 10 3

  4. A microdestructive capillary electrophoresis method for the analysis of blue-pen-ink strokes on office paper.

    Science.gov (United States)

    Calcerrada, Matías; González-Herráez, Miguel; Garcia-Ruiz, Carmen

    2015-06-26

    This manuscript describes the development of a capillary electrophoresis (CE) method for the detection of acid and basic dyes and its application to real samples, blue-pen-ink strokes on office paper. First, a capillary zone electrophoresis (CZE) method was developed for the separation of basic and acid dyes, by studying the separation medium (buffer nature, pH and relative amount of additive) and instrumental parameters (temperature, voltage and capillary dimensions). The method performance was evaluated in terms of selectivity, resolution (above 5 and 2 for acid dyes and basic dyes, respectively, except for two basic dye standards), LOD (lower than 0.4 mg/L) and precision as intraday and interday RSD values of peak migration times (lower than 0.6%). The developed method was then applied to 34 blue pens from different technologies (rollerball, ballpoint, markers) and with different ink composition (gel, water-based, oil-based). A microdestructive sample treatment using a scalpel to scratch 0.3mg of ink stroke was performed. The entire electropherogram profile allowed the visual discrimination between different types of ink and brands, being not necessary a statistical treatment. A 100% of discrimination was achieved between pen technologies, brands, and models, although non-reproducible zones in the electropherograms were found for blue gel pen samples. The two different batches of blue oil-based pens were also differentiated. Thus, this method provides a simple, microdestructive, and rapid analysis of different blue pen technologies which may complement the current analysis of questioned documents performed by forensic laboratories. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Comparison of three DNA extraction methods for recovery of soil protist DNA.

    Science.gov (United States)

    Santos, Susana S; Nielsen, Tue Kjærgaard; Hansen, Lars H; Winding, Anne

    2015-08-01

    The use of molecular methods to investigate protist communities in soil is in rapid development this decade. Molecular analysis of soil protist communities is usually dependant on direct genomic DNA extraction from soil and inefficient or differential DNA extraction of protist DNA can lead to bias in downstream community analysis. Three commonly used soil DNA extraction methods have been tested on soil samples from three European Long-Term Observatories (LTOs) with different land-use and three protist cultures belonging to different phylogenetic groups in different growth stages. The methods tested were: ISOm-11063 (a version of the ISO-11063 method modified to include a FastPrep ®-24 mechanical lysis step), GnS-GII (developed by the GenoSol platform to extract soil DNA in large-scale soil surveys) and a commercial DNA extraction kit - Power Lyzer™ PowerSoil® DNA Isolation Kit (MoBio). DNA yield and quality were evaluated along with DNA suitability for amplification of 18S rDNA fragments by PCR. On soil samples, ISOm-11063 yields significantly higher DNA for two of the three soil samples, however, MoBio extraction favors DNA quality. This method was also more effective to recover copies of 18S rDNA numbers from all soil types. In addition and despite the lower yields, higher DNA quality was observed with DNA extracted from protist cultures with the MoBio method. Likewise, a bead-beating step shows to be a good solution for DNA extraction of soil protists, since the recovery of DNA from protist cultures and from the different soil samples with the ISOm method proved to be efficient in recovering PCR-amplifiable DNA. This study showed that soil DNA extraction methods provide biased results towards the cyst stages of protist organism. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Novel sample preparation method for surfactant containing suppositories: effect of micelle formation on drug recovery.

    Science.gov (United States)

    Kalmár, Éva; Ueno, Konomi; Forgó, Péter; Szakonyi, Gerda; Dombi, György

    2013-09-01

    Rectal drug delivery is currently at the focus of attention. Surfactants promote drug release from the suppository bases and enhance the formulation properties. The aim of our work was to develop a sample preparation method for HPLC analysis for a suppository base containing 95% hard fat, 2.5% Tween 20 and 2.5% Tween 60. A conventional sample preparation method did not provide successful results as the recovery of the drug failed to fulfil the validation criterion 95-105%. This was caused by the non-ionic surfactants in the suppository base incorporating some of the drug, preventing its release. As guidance for the formulation from an analytical aspect, we suggest a well defined surfactant content based on the turbidimetric determination of the CMC (critical micelle formation concentration) in the applied methanol-water solvent. Our CMC data correlate well with the results of previous studies. As regards the sample preparation procedure, a study was performed of the effects of ionic strength and pH on the drug recovery with the avoidance of degradation of the drug during the procedure. Aminophenazone and paracetamol were used as model drugs. The optimum conditions for drug release from the molten suppository base were found to be 100 mM NaCl, 20-40 mM NaOH and a 30 min ultrasonic treatment of the final sample solution. As these conditions could cause the degradation of the drugs in the solution, this was followed by NMR spectroscopy, and the results indicated that degradation did not take place. The determined CMCs were 0.08 mM for Tween 20, 0.06 mM for Tween 60 and 0.04 mM for a combined Tween 20, Tween 60 system. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. LOWER COST METHODS FOR IMPROVED OIL RECOVERY (IOR) VIA SURFACTANT FLOODING

    Energy Technology Data Exchange (ETDEWEB)

    William A. Goddard III; Yongchun Tang; Patrick Shuler; Mario Blanco; Seung Soon Jang; Shiang-Tai Lin; Prabal Maiti; Yongfu Wu; Stefan Iglauer; Xiaohang Zhang

    2004-09-01

    This report provides a summary of the work performed in this 3-year project sponsored by DOE. The overall objective of this project is to identify new, potentially more cost-effective surfactant formulations for improved oil recovery (IOR). The general approach is to use an integrated experimental and computational chemistry effort to improve our understanding of the link between surfactant structure and performance, and from this knowledge, develop improved IOR surfactant formulations. Accomplishments for the project include: (1) completion of a literature review to assemble current and new surfactant IOR ideas, (2) Development of new atomistic-level MD (molecular dynamic) modeling methodologies to calculate IFT (interfacial tension) rigorously from first principles, (3) exploration of less computationally intensive mesoscale methods to estimate IFT, Quantitative Structure Property Relationship (QSPR), and cohesive energy density (CED) calculations, (4) experiments to screen many surfactant structures for desirable low IFT and solid adsorption behavior, and (5) further experimental characterization of the more promising new candidate formulations (based on alkyl polyglycosides (APG) and alkyl propoxy sulfate surfactants). Important findings from this project include: (1) the IFT between two pure substances may be calculated quantitatively from fundamental principles using Molecular Dynamics, the same approach can provide qualitative results for ternary systems containing a surfactant, (2) low concentrations of alkyl polyglycoside surfactants have potential for IOR (Improved Oil Recovery) applications from a technical standpoint (if formulated properly with a cosurfactant, they can create a low IFT at low concentration) and also are viable economically as they are available commercially, and (3) the alkylpropoxy sulfate surfactants have promising IFT performance also, plus these surfactants can have high optimal salinity and so may be attractive for use in higher

  8. Development of Advanced Nuclide Separation and Recovery Methods using Ion-Exchanhge Techniques in Nuclear Backend

    Science.gov (United States)

    Miura, Hitoshi

    The development of compact separation and recovery methods using selective ion-exchange techniques is very important for the reprocessing and high-level liquid wastes (HLLWs) treatment in the nuclear backend field. The selective nuclide separation techniques are effective for the volume reduction of wastes and the utilization of valuable nuclides, and expected for the construction of advanced nuclear fuel cycle system and the rationalization of waste treatment. In order to accomplish the selective nuclide separation, the design and synthesis of novel adsorbents are essential for the development of compact and precise separation processes. The present paper deals with the preparation of highly functional and selective hybrid microcapsules enclosing nano-adsorbents in the alginate gel polymer matrices by sol-gel methods, their characterization and the clarification of selective adsorption properties by batch and column methods. The selective separation of Cs, Pd and Re in real HLLW was further accomplished by using novel microcapsules, and an advanced nuclide separation system was proposed by the combination of selective processes using microcapsules.

  9. Recovery of iron/iron oxide nanoparticles from solution: comparison of methods and their effects

    International Nuclear Information System (INIS)

    Nurmi, James T.; Sarathy, Vaishnavi; Tratnyek, Paul G.; Baer, Donald R.; Amonette, James E.; Karkamkar, Abhi

    2011-01-01

    Most methods currently being used to recover Fe 0 -core/oxide-shell nanoparticles from solutions (including the solvents they are synthesized or stored in) are potentially problematic because they may alter the particle composition (e.g., depositing salts formed from solutes) or leave the particles prone to transformations during subsequent storage and handling (e.g., due to residual moisture). In this study, several methods for recovery of nanoparticles from aqueous solution were studied to determine how they affect the structure and reactivity of the recovered materials. Simple washing of the nanoparticles during vacuum filtration (i.e., “flash drying”) can leave up to ∼17 wt% residual moisture. Modeling calculations suggest this moisture is mostly capillary or matric water held between particles and particle aggregates, which can be removed by drying for short periods at relative vapor pressures below 0.9. Flash drying followed by vacuum drying, all under N 2 , leaves no detectable residue from precipitation of solutes (detectable by X-ray photoelectron spectroscopy, XPS), no significant changes in overall particle composition or structure (determined by transmission electron microscopy, TEM), and negligible residual moisture (by thermogravimetric analysis, TGA). While this improved flash-drying protocol may be the preferred method for recovering nanoparticles for many purposes, we found that Fe 0 -core/oxide-shell nanoparticles still exhibit gradual aging during storage when characterized electrochemically with voltammetry.

  10. The Predictors of Mortality, Recurrence and Functional Recovery in Ischemic Cerebrovascular Disease

    Directory of Open Access Journals (Sweden)

    Yakup Türkel

    2010-12-01

    Full Text Available OBJECTIVE: If the present data defining the prognostic predictors is examined carefully, a serious contradiction is noticed. In this study, we tried to determine which factors affect the sixth month mortality, recurrence and functional recovery measured quantitatively after ischemic stroke, among our own patients followed in a tertiary health care center. METHODS: Age, sex, the presence of hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus, hyperlipidemia, previous stroke, stroke subtype, admittance mean blood pressure, admittance blood sugar, hemotocrit, the presence of left ventricle hypertrophy and ejection fraction was recorded for 223 patients with ischemic stroke. The scores for National Institute of Health Stroke Scale (NIHSS, modified Rankin Scale (mRS and Barthel Index (BI were recorded at the beginning and at the end of six months. The correlation of these 14 clinical and laboratory parameters with mortality, recurrence and recovery was examined statistically. RESULTS: Mortality rate was 33%, recurrence rate was 3.8%. Factors related with mortality were age, female gender, coronary artery disease, atrial fibrillation, low ejection fraction, low hematocrit and high admittance blood glucose (p 0.05. In the multivariate analyses, only, the effect of age, gender and hyperlipidemia on mortality was persisting (p< 0.05. Considering NIHSS, patients with high mean admittance blood pressure, considering mRS and BI younger patients and patients with lacunar infarcts had better recovery levels, while patients with previous strokes had poorer recovery (p< 0.05. CONCLUSION: Higher age and high admittance blood sugar were the most important determinants of mortality after ischemic stroke. Hyperlipidemia reduces the risk of death after stroke probably because of the neuroprotective effects of lipid lowering drugs. None of these parameters clearly affect functional recovery at the end of six month

  11. The Predictors of Mortality, Recurrence and Functional Recovery in Ischemic Cerebrovascular Disease

    Directory of Open Access Journals (Sweden)

    Yakup Türkel

    2010-12-01

    Full Text Available OBJECTIVE: If the present data defining the prognostic predictors is examined carefully, a serious contradiction is noticed. In this study, we tried to determine which factors affect the sixth month mortality, recurrence and functional recovery measured quantitatively after ischemic stroke, among our own patients followed in a tertiary health care center. METHODS: Age, sex, the presence of hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus, hyperlipidemia, previous stroke, stroke subtype, admittance mean blood pressure, admittance blood sugar, hemotocrit, the presence of left ventricle hypertrophy and ejection fraction was recorded for 223 patients with ischemic stroke. The scores for National Institute of Health Stroke Scale (NIHSS, modified Rankin Scale (mRS and Barthel Index (BI were recorded at the beginning and at the end of six months. The correlation of these 14 clinical and laboratory parameters with mortality, recurrence and recovery was examined statistically. RESULTS: Mortality rate was 33%, recurrence rate was 3.8%. Factors related with mortality were age, female gender, coronary artery disease, atrial fibrillation, low ejection fraction, low hematocrit and high admittance blood glucose (p 0.05. In the multivariate analyses, only, the effect of age, gender and hyperlipidemia on mortality was persisting (p< 0.05. Considering NIHSS, patients with high mean admittance blood pressure, considering mRS and BI younger patients and patients with lacunar infarcts had better recovery levels, while patients with previous strokes had poorer recovery (p< 0.05. CONCLUSION: Higher age and high admittance blood sugar were the most important determinants of mortality after ischemic stroke. Hyperlipidemia reduces the risk of death after stroke probably because of the neuroprotective effects of lipid lowering drugs. None of these parameters clearly affect functional recovery at the end of six month.

  12. Transplantation of iPS cell-derived neural progenitors overexpressing SDF-1α increases regeneration and functional recovery after ischemic stroke.

    Science.gov (United States)

    Chau, Monica; Deveau, Todd C; Song, Mingke; Wei, Zheng Z; Gu, Xiaohuan; Yu, Shan Ping; Wei, Ling

    2017-11-14

    Ischemic stroke is a leading cause of human death and disability while clinical treatments are limited. The adult brain possesses endogenous regenerative activities that may benefit tissue repair after stroke. Trophic factors such as stromal cell-derived factor 1 alpha (SDF-1α) are upregulated in the ischemic brain, which promote endogenous regeneration. The regenerative response, however, is normally insufficient. Transplantation of exogenous cells has been explored as regenerative therapies. One promising cell type for transplantation is induced pluripotent stem (iPS) cells which are cells genetically reprogrammed from adult somatic cells. We hypothesized that transplanting neural progenitor cells derived from iPS cells (iPS-NPCs) could provide cell replacement and trophic support. The trophic factor SDF-1α was overexpressed in iPS-NPCs by lentiviral transduction to test if SDF-1α could increase regeneration in the ischemic brain. These SDF-1α-iPS-NPCs were differentiated in vitro to express mature neuronal and synaptic markers. Differentiated cells expressed functional Na + and K + channels, and fired action potentials. In the oxygen glucose deprivation (OGD) test, SDF-1α-iPS-NPCs survived significantly better compared to control iPS-NPCs. In mice subjected to focal cerebral ischemia in the sensorimotor cortex, iPS-NPCs and SDF-1α-iPS-NPCs were intracranially transplanted into the ischemic cortex 7 days after stroke. Neuronal differentiation of transplanted cells was identified using NeuN 14 days after transplantation. Mice that received SDF-1α-iPS-NPCs had greater numbers of NeuN/BrdU and Glut-1/BrdU co-labeled cells in the peri-infarct area and improved locomotion compared to the control iPS-NPC transplantation. Thus, SDF-1α upregulation in transplanted cells may be a therapeutic strategy to enhance endogenous neurovascular repair after ischemic stroke in adult mice.

  13. [The effect of floating-needle therapy combined with rehabilitation training for the hand function recovery of post-stroke patients].

    Science.gov (United States)

    Yang, Jiangxia; Xiao, Hong

    2015-08-01

    To explore the improvement of hand motion function,spasm and self-care ability of daily life for stroke patient