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Hirano S, Saitoh E, Imoto D, Ii T, Tsunoda T, Otaka Y. Effects of robot-assisted gait training using the Welwalk on gait independence for individuals with hemiparetic stroke: an assessor-blinded, multicenter randomized controlled trial. J Neuroeng Rehabil 2024; 21:76. [PMID: 38745235 PMCID: PMC11092154 DOI: 10.1186/s12984-024-01370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000. METHODS An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score. RESULTS A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914-18.995], p = 0.065, HR 4.443 [95%CI 0.973-20.279], p = 0.054, respectively). CONCLUSIONS The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction. TRIAL REGISTRATION This study was registered with the Japan Registry of Clinical Trials ( https://jrct.niph.go.jp ; jRCT 042180078) on March 3, 2019.
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Affiliation(s)
- Satoshi Hirano
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Daisuke Imoto
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuma Ii
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Tetsuya Tsunoda
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Sasegbon A, Cheng I, Hamdy S. The neurorehabilitation of post-stroke dysphagia: Physiology and pathophysiology. J Physiol 2024. [PMID: 38517302 DOI: 10.1113/jp285564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
Swallowing is a complex process involving the precise contractions of numerous muscles of the head and neck, which act to process and shepherd ingested material from the oral cavity to its eventual destination, the stomach. Over the past five decades, information from animal and human studies has laid bare the complex network of neurones in the brainstem, cortex and cerebellum that are responsible for orchestrating each normal swallow. Amidst this complexity, problems can and often do occur that result in dysphagia, defined as impaired or disordered swallowing. Dysphagia is common, arising from multiple varied disease processes that can affect any of the neuromuscular structures involved in swallowing. Post-stroke dysphagia (PSD) remains the most prevalent and most commonly studied form of dysphagia and, as such, provides an important disease model to assess dysphagia physiology and pathophysiology. In this review, we explore the complex neuroanatomical processes that occur during normal swallowing and PSD. This includes how strokes cause dysphagia, the mechanisms through which natural neuroplastic recovery occurs, current treatments for patients with persistent dysphagia and emerging neuromodulatory treatments.
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Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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Geng Z, Yang C, Zhao Z, Yan Y, Guo T, Liu C, Wu A, Wu X, Wei L, Tian Y, Hu P, Wang K. Development and validation of a machine learning-based predictive model for assessing the 90-day prognostic outcome of patients with spontaneous intracerebral hemorrhage. J Transl Med 2024; 22:236. [PMID: 38439097 PMCID: PMC10910789 DOI: 10.1186/s12967-024-04896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/14/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (sICH) is associated with significant mortality and morbidity. Predicting the prognosis of patients with sICH remains an important issue, which significantly affects treatment decisions. Utilizing readily available clinical parameters to anticipate the unfavorable prognosis of sICH patients holds notable clinical significance. This study employs five machine learning algorithms to establish a practical platform for the prediction of short-term prognostic outcomes in individuals afflicted with sICH. METHODS Within the framework of this retrospective analysis, the model underwent training utilizing data gleaned from 413 cases from the training center, with subsequent validation employing data from external validation center. Comprehensive clinical information, laboratory analysis results, and imaging features pertaining to sICH patients were harnessed as training features for machine learning. We developed and validated the model efficacy using all the selected features of the patients using five models: Support Vector Machine (SVM), Logistic Regression (LR), Random Forest (RF), XGboost and LightGBM, respectively. The process of Recursive Feature Elimination (RFE) was executed for optimal feature screening. An internal five-fold cross-validation was employed to pinpoint the most suitable hyperparameters for the model, while an external five-fold cross-validation was implemented to discern the machine learning model demonstrating the superior average performance. Finally, the machine learning model with the best average performance is selected as our final model while using it for external validation. Evaluation of the machine learning model's performance was comprehensively conducted through the utilization of the ROC curve, accuracy, and other relevant indicators. The SHAP diagram was utilized to elucidate the variable importance within the model, culminating in the amalgamation of the above metrics to discern the most succinct features and establish a practical prognostic prediction platform. RESULTS A total of 413 patients with sICH patients were collected in the training center, of which 180 were patients with poor prognosis. A total of 74 patients with sICH were collected in the external validation center, of which 26 were patients with poor prognosis. Within the training set, the test set AUC values for SVM, LR, RF, XGBoost, and LightGBM models were recorded as 0.87, 0.896, 0.916, 0.885, and 0.912, respectively. The best average performance of the machine learning models in the training set was the RF model (average AUC: 0.906 ± 0.029, P < 0.01). The model still maintains a good performance in the external validation center, with an AUC of 0.817 (95% CI 0.705-0.928). Pertaining to feature importance for short-term prognostic attributes of sICH patients, the NIHSS score reigned supreme, succeeded by AST, Age, white blood cell, and hematoma volume, among others. In culmination, guided by the RF model's variable importance weight and the model's ROC curve insights, the NIHSS score, AST, Age, white blood cell, and hematoma volume were integrated to forge a short-term prognostic prediction platform tailored for sICH patients. CONCLUSION We constructed a prediction model based on the results of the RF model incorporating five clinically accessible predictors with reliable predictive efficacy for the short-term prognosis of sICH patients. Meanwhile, the performance of the external validation set was also more stable, which can be used for accurate prediction of short-term prognosis of sICH patients.
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Affiliation(s)
- Zhi Geng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Chaoyi Yang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Ziye Zhao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Yibing Yan
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Tao Guo
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, 230026, Anhui, China
| | - Chaofan Liu
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, 230026, Anhui, China
| | - Aimei Wu
- Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Xingqi Wu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Ling Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
- Department of Sleep Psychology, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China.
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China.
- Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, China.
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China.
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China.
- Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, China.
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Hamada T, Yoshimura Y, Nagano F, Matsumoto A, Shimazu S, Shiraishi A, Bise T, Kido Y. Prognostic Value of Dysphagia for Activities of Daily Living Performance and Cognitive Level after Stroke. Prog Rehabil Med 2024; 9:20240005. [PMID: 38327737 PMCID: PMC10844015 DOI: 10.2490/prm.20240005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives The purpose of this study was to examine the association between baseline dysphagia and the improvement of activities of daily living performance and cognitive level among inpatients after stroke. Methods This was a retrospective cohort study of patients undergoing convalescent rehabilitation after stroke. Dysphagia was assessed using the Food Intake LEVEL Scale. Outcomes were the motor and cognitive scores of the Functional Independence Measure (FIM) at discharge. Multiple regression analysis was performed to examine the association between dysphagia at admission and these outcomes. Results There were 499 participants with a median age of 74 years. A multiple regression analysis was carried out after adjusting for potential confounders including age and sex. Dysphagia at admission was independently and negatively associated with motor (β=-0.157, P<0.001) and cognitive (β=-0.066, P=0.041) FIM scores at discharge. Conclusions Baseline dysphagia in patients after stroke was negatively associated with improvement in performance of activities of daily living and cognitive level.
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Affiliation(s)
- Takenori Hamada
- Department of Rehabilitation, Kumamoto Rehabilitation
Hospital, Kikuyo, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Fumihiko Nagano
- Department of Rehabilitation, Kumamoto Rehabilitation
Hospital, Kikuyo, Japan
| | - Ayaka Matsumoto
- Pharmacy Department, Kumamoto Rehabilitation Hospital,
Kikuyo, Japan
| | - Sayuri Shimazu
- Department of Nutrition Management, Kumamoto Rehabilitation
Hospital, Kikuyo, Japan
| | - Ai Shiraishi
- Department of Dental Office, Kumamoto Rehabilitation
Hospital, Kikuyo, Kikuchi, Japan
| | - Takahiro Bise
- Department of Rehabilitation, Kumamoto Rehabilitation
Hospital, Kikuyo, Japan
| | - Yoshifumi Kido
- Department of Rehabilitation, Kumamoto Rehabilitation
Hospital, Kikuyo, Japan
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Baranovicova E, Kalenska D, Kaplan P, Kovalska M, Tatarkova Z, Lehotsky J. Blood and Brain Metabolites after Cerebral Ischemia. Int J Mol Sci 2023; 24:17302. [PMID: 38139131 PMCID: PMC10743907 DOI: 10.3390/ijms242417302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
The study of an organism's response to cerebral ischemia at different levels is essential to understanding the mechanism of the injury and protection. A great interest is devoted to finding the links between quantitative metabolic changes and post-ischemic damage. This work aims to summarize the outcomes of the most studied metabolites in brain tissue-lactate, glutamine, GABA (4-aminobutyric acid), glutamate, and NAA (N-acetyl aspartate)-regarding their biological function in physiological conditions and their role after cerebral ischemia/reperfusion. We focused on ischemic damage and post-ischemic recovery in both experimental-including our results-as well as clinical studies. We discuss the role of blood glucose in view of the diverse impact of hyperglycemia, whether experimentally induced, caused by insulin resistance, or developed as a stress response to the cerebral ischemic event. Additionally, based on our and other studies, we analyze and critically discuss post-ischemic alterations in energy metabolites and the elevation of blood ketone bodies observed in the studies on rodents. To complete the schema, we discuss alterations in blood plasma circulating amino acids after cerebral ischemia. So far, no fundamental brain or blood metabolite(s) has been recognized as a relevant biological marker with the feasibility to determine the post-ischemic outcome or extent of ischemic damage. However, studies from our group on rats subjected to protective ischemic preconditioning showed that these animals did not develop post-ischemic hyperglycemia and manifested a decreased metabolic infringement and faster metabolomic recovery. The metabolomic approach is an additional tool for understanding damaging and/or restorative processes within the affected brain region reflected in the blood to uncover the response of the whole organism via interorgan metabolic communications to the stressful cerebral ischemic challenge.
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Affiliation(s)
- Eva Baranovicova
- Biomedical Center BioMed, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia;
| | - Dagmar Kalenska
- Department of Anatomy, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia
| | - Peter Kaplan
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia (Z.T.)
| | - Maria Kovalska
- Department of Histology and Embryology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia
| | - Zuzana Tatarkova
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia (Z.T.)
| | - Jan Lehotsky
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia (Z.T.)
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Lee JS, Choi J, Shin HJ, Jung JM, Seo WK. Incidence and risk of stroke in Korean patients with congenital heart disease. J Stroke Cerebrovasc Dis 2023; 32:107408. [PMID: 37980821 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVES The incidence and risk of ischemic stroke (IS) and hemorrhagic stroke (HS) in Korean patients with CHD have not been reported, therefore, we aimed to investigate this. MATERIALS AND METHODS Participants were selected from the Korean National Health Insurance Service benefit records from 2006-2017. Cases were extracted using diagnosis codes related to CHD. Controls without CHD were selected through age- and sex-matched random sampling at a 1:10 ratio. RESULTS The case and control groups included 232,203 and 3,024,633 participants, respectively. The median (interquartile range) follow-up period was 7.28 (3.59-8.73) years. The incidence rates of IS and HS per 100,000 person-years were much higher in cases than in controls (IS: 135 vs. 47; HS: 41.7 vs. 24.9). After adjusting for confounders, CHD was a risk factor for IS and HS (subdistribution HR; 1.96 and 1.71, respectively). In patients with CHD, the following risk factors were identified: diabetes, heart failure, and atrial fibrillation for any stroke; hypertension, atrial septal defects, and use of antiplatelet agents for IS only; and coronary artery bypass graft surgery for HS only. CONCLUSIONS Korean patients with CHD have a high risk of stroke. A personalized preventive approach is needed to reduce the incidence of stroke in this population.
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Affiliation(s)
- Jue Seong Lee
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jongun Choi
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Ju Shin
- Department of Thoracic and Cardiovascular Surgery, Myoungju Hospital, Yongin, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea; Korea University Zebrafish Translational Medical Research Center, Ansan, Korea.
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Tan SML, Ong SH, Yeo TT, Nga VDW, Chew E, Tam PK, Su P, Ng MB, Lim HS, Yeo LL, Sharma VK, Sia CH, Lim MJR, Tan BYQ. Ischemic and hemorrhagic strokes in young adults: Comparison of functional outcomes and return to work after stroke. Clin Neurol Neurosurg 2023; 233:107964. [PMID: 37717357 DOI: 10.1016/j.clineuro.2023.107964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Functional recovery and return to work (RTW) after stroke are important rehabilitation goals that have significant impact on quality of life. Comparisons of functional outcomes and RTW between ischemic stroke (IS) and hemorrhagic stroke (HS), especially among young adults with stroke, have either been limited or yielded inconsistent results. We aimed to assess functional outcomes and ability to RTW in young adults with IS and HS, specifically primary spontaneous intracranial hemorrhage (SICH). METHODS Young adults with IS or SICH aged 18-50-years-old were included. Outcome measures were modified Rankins score (mRS) on discharge and 3-months and RTW at 3-months after stroke. Good functional outcome was defined as an mRS of 0-2. RESULTS We included 459 patients (71.5% male) with a mean age of 43.3 ± 5.7 years, comprising 49.2% IS and 50.8% SICH. Patients with SICH were more likely to have unfavourable shifts in ordinal mRS on discharge (OR 7.52, CI 5.18-10.87, p < 0.001) and at 3-months (OR 6.41, CI 4.17-9.80, p < 0.001). Patients with IS more likely achieved good functional outcomes (80.2% vs. 51.8%, p < 0.001) and were able to RTW at 3-months (54.4% vs. 36.3%, p = 0.004). Among all stroke patients with good functional outcomes, one-third did not RTW at 3-months. Patients with longer length of hospitalisation and higher National Institutes of Health Stroke Scale (NIHSS) score on admission, especially in the domain categories of level of consciousness, vision, motor function, language and neglect, were less likely to RTW at 3-months. CONCLUSION Patients with IS were more likely to RTW when compared to SICH patients. Many young stroke patients did not RTW despite good functional outcomes. Further research should therefore address differences in prognosis and identify predictors that influence ability to RTW after stroke in the young adult population.
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Affiliation(s)
- Sarah Ming Li Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Shi Hui Ong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Vincent Diong Weng Nga
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Effie Chew
- Division of Rehabilitation Medicine, Department of Medicine, National University Hospital, Singapore
| | - Pui Kit Tam
- Division of Rehabilitation Medicine, Department of Medicine, National University Hospital, Singapore
| | - Peijing Su
- Division of Rehabilitation Medicine, Department of Medicine, National University Hospital, Singapore
| | - Megan Bj Ng
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hui Shi Lim
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard Ll Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mervyn Jun Rui Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Tamakoshi K, Meguro K, Takahashi Y, Oshimi R, Iwasaki N. Comparison of motor function recovery and brain changes in intracerebral hemorrhagic and ischemic rats with similar brain damage. Neuroreport 2023; 34:332-337. [PMID: 36966806 DOI: 10.1097/wnr.0000000000001898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
In this study, we compared the mechanisms of brain recovery in intracerebral hemorrhage and ischemia, focusing on synapses, glial cells, and dopamine expression, which are considered fundamental for neural recovery after stroke. Male Wistar rats were divided into intracerebral hemorrhage, ischemia, and sham surgery (SHAM) groups. The intracerebral hemorrhage group was injected with a collagenase solution, the ischemia group was injected with an endothelin-1 solution, and the SHAM group was injected with physiological saline. The motor function of these rats was evaluated using a rotarod test on days 7, 14, 21, and 28 post-surgery. On postoperative day 29, lesion volume was analyzed using Nissl staining. In addition, the protein expression levels of NeuN, GFAP, tyrosine hydroxylase, and PSD95 were analyzed in the striatum and motor cortex. There was no significant difference between the ischemia and intracerebral hemorrhage groups in terms of lesion volume in the striatum; however, the motor recovery of the intracerebral hemorrhage group occurred more rapidly than that of the ischemia group, and the intracerebral hemorrhage group exhibited higher GFAP protein expression in the motor cortex. The rapid motor recovery in intracerebral hemorrhage rats relative to that in ischemia rats may be associated with changes in astrocytes in brain regions remote from the injury site.
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Affiliation(s)
- Keigo Tamakoshi
- Department of Physical Therapy, Niigata University of Health and Welfare
- Institute for Human Movement and Medical Sciences
| | - Kota Meguro
- Department of Rehabilitation, Kaetsu Hospital
| | | | - Ryu Oshimi
- Department of Rehabilitation, Saigata Medical Center, National Hospital Organization
| | - Natsuka Iwasaki
- Department of Rehabilitation, Azuma Neurosurgical Hospital, Niigata, Japan
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Ikenaga Y, Fudeya M, Kusunoki T, Yamaguchi H. Factors Contributing to Complete Oral Intake in Dysphagic Stroke Patients with Enteral Feeding Tubes in Convalescent Rehabilitation Wards. Prog Rehabil Med 2023; 8:20230011. [PMID: 37006382 PMCID: PMC10061229 DOI: 10.2490/prm.20230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives: This study investigated the factors contributing to complete oral intake (COI) in dysphagic stroke patients with enteral feeding tubes in the local clinical setting. Methods: Data of patients with percutaneous endoscopic gastrostomy (PEG) or nasogastric tube (NGT) feeding on admission to convalescent rehabilitation wards (CRWs) were extracted from the Kaga Regional Cooperation Clinical Pathway for Stroke database for multiple centers including 19 acute care hospitals and 11 hospitals with CRWs. Patients were divided into two groups based on their status regarding COI or incomplete oral intake (ICOI) at discharge. Logistic regression analysis with forced-entry variables was used to identify factors contributing to COI. Results: On discharge from CRWs, COI and ICOI were observed in 140 and 207 cases, respectively. The COI group was younger, had a higher rate of initial stroke, higher Functional Oral Intake Scale (FOIS) scores, higher Functional Independence Measure (FIM) motor and cognitive scores, higher Body Mass Index (BMI), lower rate of patients with PEG, and shorter stays in acute care wards. Logistic regression analysis with forced entry revealed that younger age; initial stroke; higher FOIS score, FIM cognitive score, and BMI; and shorter stay in the acute care ward contributed to COI. Conclusions: The primary factors contributing to COI in dysphagic stroke patients with enteral feeding tubes were younger age, initial stroke, higher swallowing and cognitive function, good nutritional status, and shorter stay in the acute care ward.
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Affiliation(s)
- Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu, Japan
- Council of Kaga Local Stroke Network, Nonoichi, Ishikawa, Japan
| | - Masami Fudeya
- Council of Kaga Local Stroke Network, Nonoichi, Ishikawa, Japan
| | | | - Hiromi Yamaguchi
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu, Japan
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10
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Recovery of Patients With Upper Limb Paralysis Due to Stroke Who Underwent Intervention Using Low-Frequency Repetitive Transcranial Magnetic Stimulation Combined With Occupational Therapy: A Retrospective Cohort Study. Neuromodulation 2023:S1094-7159(23)00104-6. [PMID: 36932028 DOI: 10.1016/j.neurom.2023.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES The combination of repetitive transcranial magnetic stimulation (rTMS) and motor practice is based on the theory of neuromodulation and use-dependent plasticity. Predictive planning of occupational therapy (OT) is important for patients with rTMS conditioning. Recovery characteristics based on the severity of pretreatment upper extremity paralysis can guide the patient's practice plan for using the paretic hand. Therefore, we evaluated the recovery of patients with upper limb paralysis due to stroke who underwent a novel intervention of rTMS combined with OT (NEURO) according to the severity of upper limb paralysis based on the scores of the Fugl-Meyer assessment for upper extremity (FMA-UE) with recovery in proximal upper extremity, wrist, hand, and coordination. MATERIALS AND METHODS In this multicenter retrospective cohort study, the recovery of 1397 patients with upper limb paralysis was analyzed by severity at six hospitals that were accredited by the Japanese Stimulation Therapy Society for treatment. The delta values of the FMA-UE scores before and after NEURO were compared among the groups with severe, moderate, and mild paralysis using the generalized linear model. RESULTS NEURO significantly improved the FMA-UE total score according to the severity of paralysis (severe = 5.3, moderate = 6.0, and mild = 2.9). However, when the FMA-UE subscores were analyzed separately, the results indicated specific improvements in shoulder/elbow, wrist, fingers, and coordination movements, depending on the severity. CONCLUSIONS This study had enough patients who were divided according to severity and stratified by lesion location and handedness parameters. Our results suggest that independently of these factors, the extent of recovery of upper limb motor parts after NEURO varies according to the severity of paralysis.
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11
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Song J, Chen W, Ye W. Stroke and the risk of gastrointestinal disorders: A Mendelian randomization study. Front Neurol 2023; 14:1131250. [PMID: 36895909 PMCID: PMC9989308 DOI: 10.3389/fneur.2023.1131250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open
Abstract
Background The issue of whether a stroke is causally related to gastrointestinal disorders was still not satisfactorily understood. Therefore, we investigated if there is a connection between stroke and the most prevalent gastrointestinal disorders, including peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). Methods We applied two-sample Mendelian randomization to investigate relationships with gastrointestinal disorders. We obtained genome-wide association study (GWAS) summary data of any stroke, ischemic stroke, and its subtypes from the MEGASTROKE consortium. From the International Stroke Genetics Consortium (ISGC) meta-analysis, we acquired GWAS summary information on intracerebral hemorrhage (ICH), including all ICH, deep ICH, and lobar ICH. Several sensitivity studies were performed to identify heterogeneity and pleiotropy, while inverse-variance weighted (IVW) was utilized as the most dominant estimate. Results No evidence for an effect of genetic predisposition to ischemic stroke and its subtypes on gastrointestinal disorders were found in IVW. The complications of deep ICH are a higher risk for PUD and GERD. Meanwhile, lobar ICH has a higher risk of complications for PUD. Conclusion This study provides proof of the presence of a brain-gut axis. Among the complications of ICH, PUD and GERD were more common and associated with the site of hemorrhage.
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Affiliation(s)
- Jingru Song
- Department of Gastroenterology, Hangzhou Traditional Chinese Medicine (TCM) Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenjing Chen
- Department of Gastroenterology, Hangzhou Traditional Chinese Medicine (TCM) Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wei Ye
- Department of Gastroenterology, Hangzhou Traditional Chinese Medicine (TCM) Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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12
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Zhakhina G, Zhalmagambetov B, Gusmanov A, Sakko Y, Yerdessov S, Matmusaeva E, Imanova A, Crape B, Sarria-Santamera A, Gaipov A. Incidence and mortality rates of strokes in Kazakhstan in 2014-2019. Sci Rep 2022; 12:16041. [PMID: 36163245 PMCID: PMC9512804 DOI: 10.1038/s41598-022-20302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022] Open
Abstract
There is a lack of information on the epidemiology of acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in developing countries. This research presents incidence and mortality rates of stroke patients based on hospital admission and discharge status in one of the Central Asian countries by analysis of large-scale healthcare data. The registry data of 177,947 patients admitted to the hospital with the diagnosis of stroke between 2014 and 2019 were extracted from the National Electronic Health System of Kazakhstan. We provide descriptive statistics and analyze the association of socio-demographic and medical characteristics such as comorbidities and surgical treatments. Among all stroke patients, the incidence rate based on hospital admission of AIS was significantly higher compared to SAH and ICH patients. In 5 year follow-up period, AIS patients had a better outcome than SAH and ICH patients (64.7, 63.1 and 57.3% respectively). The hazard ratio (HR) after the trepanation and decompression surgery was 2.3 and 1.48 for AIS and SAH patients; however, it was protective for ICH (HR = 0.87). The investigation evaluated an increase in the all-cause mortality rates based on the discharge status of stroke patients, while the incidence rate decreased over time.
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Affiliation(s)
- Gulnur Zhakhina
- Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek street 5/1, 010000, Nur-Sultan City, Republic of Kazakhstan
| | - Bakhytbek Zhalmagambetov
- Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek street 5/1, 010000, Nur-Sultan City, Republic of Kazakhstan
| | - Arnur Gusmanov
- Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek street 5/1, 010000, Nur-Sultan City, Republic of Kazakhstan
| | - Yesbolat Sakko
- Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek street 5/1, 010000, Nur-Sultan City, Republic of Kazakhstan
| | - Sauran Yerdessov
- Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek street 5/1, 010000, Nur-Sultan City, Republic of Kazakhstan
| | - Elzar Matmusaeva
- Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek street 5/1, 010000, Nur-Sultan City, Republic of Kazakhstan
| | - Aliya Imanova
- Department of Neurology, Multidisciplinary City Hospital #2, Nur-Sultan, Kazakhstan
| | - Byron Crape
- Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek street 5/1, 010000, Nur-Sultan City, Republic of Kazakhstan
| | - Antonio Sarria-Santamera
- Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek street 5/1, 010000, Nur-Sultan City, Republic of Kazakhstan
| | - Abduzhappar Gaipov
- Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek street 5/1, 010000, Nur-Sultan City, Republic of Kazakhstan. .,Clinical Academic Department of Internal Medicine, CF "University Medical Center", Nur-Sultan, Kazakhstan.
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13
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Jo YJ, Kim DH, Sohn MK, Lee J, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Chang WH, Kim YH, Kim DY. Clinical Characteristics and Risk Factors of First-Ever Stroke in Young Adults: A Multicenter, Prospective Cohort Study. J Pers Med 2022; 12:jpm12091505. [PMID: 36143290 PMCID: PMC9504439 DOI: 10.3390/jpm12091505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 01/10/2023] Open
Abstract
Stroke in young adults has catastrophic consequences and has increased in prevalence, contrary to the trends of most other diseases. This study aimed to determine the major characteristics and risk factors for stroke in younger adults compared with older adults. From the Korean Stroke Cohort for Functioning and Rehabilitation, 10,584 patients with first-ever stroke between August 2012 and March 2015 were enrolled retrospectively and divided into younger (age ≤ 45) and older groups (age > 45). The clinical characteristics and risk factors of stroke were compared between the younger and older groups. The younger group comprised 915 patients (8.6%). The proportion of hemorrhage strokes in the younger group (42.3%) was significantly higher than in the older group (20.0%) (p < 0.001). Obesity, current smoking, and heavy alcohol consumption were significantly more common risk factors in the younger group than in the older group for all stroke types, whereas hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, and coronary heart disease were significantly more frequent in the older group (both p < 0.001). The major risk factors in the younger group may be lifestyle-related. Therefore, increasing awareness of lifestyle-related risk factors may be necessary to prevent stroke in young adults.
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Affiliation(s)
- Yea Jin Jo
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dae Hyun Kim
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejon 34134, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 46241, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan 51538, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu 41566, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan 51538, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju 63243, Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Kwangju 61186, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chunchon 24252, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University, Seoul 03063, Korea
- Correspondence: (Y.-H.K.); (D.Y.K.)
| | - Deog Young Kim
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: (Y.-H.K.); (D.Y.K.)
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14
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Mondal MBA, Hasan ATMH, Khan N, Mohammad QD. Prevalence and risk factors of stroke in Bangladesh: A nationwide population-based survey. eNeurologicalSci 2022; 28:100414. [PMID: 35769921 PMCID: PMC9234580 DOI: 10.1016/j.ensci.2022.100414] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background A paucity of high-quality epidemiological survey on stroke in Bangladesh emphasizes the need for a drastic effort at the national level to study the burden of stroke in Bangladesh. Therefore, this community survey was conducted with to estimate the prevalence of stroke and its associated common risk factors among Bangladeshi population. Methods This was a population-based cross-sectional study, carried out in 8 administrative divisions and 64 districts to estimate the prevalence of stroke throughout the country. The study adopted a two-stage cluster random sampling approach. The calculated sample size was 25,287. A semi-structured questionnaire was used to identify suspected stroke patients who were subsequently confirmed by consultant neurologists. Result In the first stage, a total number of 25,287 respondents were interviewed throughout the country. Interviewers identified 561 respondents as suspected stroke through the Questionnaire for Verifying Stroke Free Status (QVSFS) system in 64 districts. Of the 25,287 respondents 13,878 (54.9%) were male and 11,409 (45.1%) were female. Mean age was 39.9 years. In the second stage, all suspected stroke cases (561) were further examined by neurologists and finally 288 patients were confirmed as stroke which provided a prevalence of 11.39 per 1000 population. The highest stroke prevalence (14.71 per thousand) were found in Mymensingh division and lowest (7.62 per thousand) found in Rajshahi division. The stroke prevalence varied in different age groups. It was 30.10 per thousand in the age group of >60 years and 4.60 in the age group below 40 years. The prevalence of stroke among male was twice that of female (13.62 versus 8.68 per thousand). The prevalence was slightly higher in rural areas (11.85 versus 11.07). About 50.4% respondents had some idea about stroke. Out of a total of 288 cases, 79.7% (213) patients had an ischemic stroke, 15.7% (42) had hemorrhagic, and 4.6% (12) were diagnosed as subarachnoid hemorrhage. The majority of the stroke patients had hypertension (79.2%), followed by dyslipidemia (38.9%), tobacco use in any form (37.2%), diabetes (28.8%), ischemic heart disease (20.1%). Conclusion We have found a stroke prevalence of 11.39 per 1000 population, the highest being in the Mymensingh division. The prevalence was much higher in the elderly and male population. More than three fourth had an ischemic stroke. Hypertension, dyslipidemia, tobacco use, diabetes, ischemic heart disease are the most common risk factors observed among stroke patients. New FindingsThis is the first-ever nationwide survey in Bangladesh that revealed a stroke prevalence of 11.39 per thousand. There was a wide regional variation in stroke prevalence. The prevalence was twice among males.
Impact of the study resultThe study result will help the policymakers in deciding and planning regional policy guidelines to tackle the stroke burden. It will also help the clinicians to identify common risk factors among stroke patients and take precautionary measures
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Affiliation(s)
| | - A T M Hasibul Hasan
- Neurology, National Institute of Neurosciences and Hospital, Dhaka-1207, Bangladesh
| | | | - Quazi Deen Mohammad
- Neurology, National Institute of Neurosciences and Hospital, Dhaka-1207, Bangladesh
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15
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Ratha Krishnan R, Yeo EQY, Lim CJ, Chua KSG. The Impact of Stroke Subtype on Recovery and Functional Outcome after Inpatient Rehabilitation: A Retrospective Analysis of Factors. Life (Basel) 2022; 12:life12091295. [PMID: 36143332 PMCID: PMC9502826 DOI: 10.3390/life12091295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
The aims of this study were to compare inpatient rehabilitation outcomes between acute stroke subtypes of Cerebral Infarction (CI) and Intracerebral Hemorrhage (ICH), and to determine the predictors of discharge outcomes. A retrospective study of stroke inpatients was carried out using the discharge Functional Independence Measure (FIM) as the primary outcome measure. Relationships between stroke subtype, rehabilitation impairments, and medical complications on FIM -gain were analyzed. Altogether, 280 datasets including 211 (75.4%) CI and 69 (24.6%) ICH were analyzed. ICH patients were significantly younger than CI patients (55 years ICH vs. 64.0 years CI years, p < 0.001), had a 10-fold higher proportion needing ICU admission (ICH 82.6% vs. CI 7.6%, p < 0.001), and had significantly lower total admission FIM scores (67 points ICH vs. 74 CI points, p = 0.006), with lower motor-FIM scores in particular (38 points ICH vs. 48 points CI, p = 0.003). Significant functional improvements after inpatient rehabilitation, i.e., FIM gain, occurred regardless of stroke subtype (FIM-ICH Δ 27 vs. FIM-CI Δ 21, p = 0.05). Despite significantly worse initial stroke severity, ICH patients achieved similar functional gains, independence levels, and return-home rates compared with their CI counterparts after inpatient rehabilitation.
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Affiliation(s)
- Rathi Ratha Krishnan
- Centre of Rehabilitation Excellence (CORE), Tan Tock Seng Hospital Rehabilitation Centre, Singapore 569766, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Correspondence:
| | - Edgar Quan Yi Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- MOH Holdings, Singapore 099253, Singapore
| | - Chien Joo Lim
- Department of Orthopaedic Surgery, Woodlands Health, Singapore 768024, Singapore
| | - Karen Sui Geok Chua
- Centre of Rehabilitation Excellence (CORE), Tan Tock Seng Hospital Rehabilitation Centre, Singapore 569766, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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16
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Lee EY, Sohn MK, Lee JM, Kim DY, Shin YI, Oh GJ, Lee YS, Lee SY, Song MK, Han JH, Ahn JH, Lee YH, Chang WH, Choi SM, Lee SK, Joo MC, Kim YH. Changes in Long-Term Functional Independence in Patients with Moderate and Severe Ischemic Stroke: Comparison of the Responsiveness of the Modified Barthel Index and the Functional Independence Measure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9612. [PMID: 35954971 PMCID: PMC9367998 DOI: 10.3390/ijerph19159612] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/26/2022]
Abstract
This study investigated the long-term functional changes in patients with moderate-to-severe ischemic stroke. In addition, we investigated whether there was a difference between the modified Barthel Index (MBI) and Functional Independence Measure (FIM) according to severity. To evaluate the changes in the long-term functional independence of the subjects, six evaluations were conducted over 2 years, and the evaluation was performed using MBI and FIM. A total of 798 participants participated in this study, of which 673 were classified as moderate and 125 as severe. During the first 3 months, the moderate group showed greater recovery than the severe group. The period of significant change in the National Institutes of Health Stroke Scale (NIHSS) score was up to 6 months after onset in the moderate group, and up to 3 months after onset in the severe group. In the severe group, MBI evaluation showed significant changes up to 6 months after onset, whereas FIM showed significant changes up to 18-24 months. Our results showed that functional recovery of patients with ischemic stroke in the 3 months after onset was greater in the moderate group than in the severe group. FIM is more appropriate than MBI for evaluating the functional status of patients with severe stroke.
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Affiliation(s)
- Eun Young Lee
- Department of Rehabilitation Medicine, Institute of Brain Science Research, Wonkwang University School of Medicine, Iksan 54538, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Jong Min Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea
| | - Gyung Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan 54538, Korea
| | - Yang Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu 41566, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju 63241, Korea
| | - Min Keun Song
- Department of Physical and Rehabilitation Medicine, Chunnam National University Medical School, Kwangju 61469, Korea
| | - Jun Hee Han
- Department of Statistics, Hallym University, Chuncheon 24252, Korea
| | - Jeong Hoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Korea
| | - Young Hoon Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu 41566, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Soo Mi Choi
- Division of Chronic Disease Prevention, Korea Centers for Disease Control and Prevention, Center for Disease, Cheongju 28159, Korea
| | - Seon Kui Lee
- Division of Chronic Disease Prevention, Korea Centers for Disease Control and Prevention, Center for Disease, Cheongju 28159, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan 54538, Korea
| | - Yun Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
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17
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Akyea RK, Georgiopoulos G, Iyen B, Kai J, Qureshi N, Ntaios G. Comparison of risk of serious cardiovascular events after haemorrhagic versus ischaemic stroke: a population-based study. Thromb Haemost 2022; 122:1921-1931. [PMID: 35688459 DOI: 10.1055/a-1873-9092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with ischaemic stroke are considered a very-high risk population for subsequent cardiovascular events and guidelines recommend intensive preventive strategies. In contrast, there is no clear recommendation that patients with haemorrhagic stroke should also be regarded as a very-high cardiovascular risk population. OBJECTIVE To compare the risk of subsequent cardiovascular morbidity/mortality between patients with incident haemorrhagic versus ischaemic stroke. METHODS Patients aged >18 years with incident haemorrhagic or ischaemic stroke between 1998-2017, and no prior history of serious vascular event were identified from UK Clinical Practice Research Datalink (CPRD-GOLD) linked to Hospital Episode Statistics (HES) data. RESULTS The cohort included 32,091 patients with an overall follow-up of 381,237 person-years (median: 11.8 years). After adjusting for potential confounders, patients with incident haemorrhagic stroke had no significantly different risk of subsequent cardiovascular morbidity compared with patients with incident ischaemic stroke - CHD [HR:0.86, 95%CI:0.56-1.32], recurrent stroke [HR:0.92, 95%CI:0.83-1.02], PVD [HR:1.15, 95%CI:0.56-2.38], or heart failure [HR:1.03, 95%CI:0.61-1.74]. Patients with incident haemorrhagic stroke had significantly higher risk of subsequent CVD-related mortality [HR:2.35, 95%CI:2.04-2.72] and all-cause mortality [HR:2.16, 95%CI: 1.94-2.41]. Propensity-score matched analysis of 1,039 patients with haemorrhagic stroke and 1,039 with ischaemic stroke showed similar risk in subsequent cardiovascular morbidity - CHD [stratified hazard ratio (sHR):0.92, 95%CI:0.55-1.54], recurrent stroke [sHR:0.93, 95%CI:0.82-1.02)], PVD [sHR:1.04 95%CI:0.45-2.41], or heart failure [HR:0.71, 95%CI:0.39-1.27]. CONCLUSIONS The risk of subsequent cardiovascular events is similar between patients with incident haemorrhagic or ischaemic stroke. Patients with previous haemorrhagic stroke should be regarded as a population at very-high risk of subsequent CVD.
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Affiliation(s)
- Ralph Kwame Akyea
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Georgios Georgiopoulos
- National and Kapodistrian University of Athens School of Medicine Therapeutic Clinic, Athens, Greece.,School of Biomedical Engineering and Imaging Sciences,, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Barbara Iyen
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Joe Kai
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Nadeem Qureshi
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
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18
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Qian H, Chen S, Chen Y, Chang Y, Li Y, Dou S, Chen Q, Wang G, Xie M. Community-Based Rehabilitation Promotes the Functional Recovery of Patients After Intracerebral Hemorrhage. Neurologist 2022; 27:89-94. [PMID: 34855671 DOI: 10.1097/nrl.0000000000000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH), a severe disorder with the high death rate, high recurrence rate and high disability rate, affected the quality of human life. Community-based rehabilitation (CBR) helps disabled people at both community and family levels. However, the effect of CBR on the recovery of people after ICH remains unclear. METHODS Patients were treated with the CBR training program, subsequently, medication compliance test, clinical neural impairment measurements, functional comprehensive assessments, improved Barthel index score, and life qualities assessments were to performed at 3-month or 6-month intervention of CBR to evaluate the influence of CBR on the medication compliance, physical function and life quality of patients after ICH. RESULTS After the treatment of CBR, we observed that, the rate of medication compliance, motor function, functional comprehensive rating scale score, modified Barthel index score, and generic quality of life inventory-74 in the CBR-treated group were significantly higher than that in the control group; the neural impairment measure score in the CBR-treated group was significantly decreased in comparison to the control group. CONCLUSION CBR increased the medication compliance, promoted the recovery of the neurological function and improved the life qualities of ICH patients.
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Affiliation(s)
- Hong Qian
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
- Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Shuangxi Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Yarui Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Yunqian Chang
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Yihui Li
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Shiying Dou
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Qianlan Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Gang Wang
- Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Ming Xie
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
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Kurosaki M, Tosaka M, Ibe Y, Arii H, Tomono J, Tazawa M, Shimizu T, Aihara M, Yoshimoto Y, Wada N. Functional Recovery after Rehabilitation in Patients with Post-stroke Severe Hemiplegia. Prog Rehabil Med 2022; 7:20220039. [PMID: 35975271 PMCID: PMC9346303 DOI: 10.2490/prm.20220039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: Stroke patients with hemiplegia can sometimes achieve independent life at home or in light care facilities after rehabilitation. This study examined the outcomes of rehabilitation in stroke patients with severe hemiplegia. Methods: This study included 50 patients with Brunnstrom recovery stage I–II hemiplegia at the start of rehabilitation for stroke. Good outcome after rehabilitation was defined as independent life with functional independence measure (FIM) score of 100 or greater. Predictors for post-rehabilitation functional recovery were statistically analyzed. Results: FIM scores of 100 or greater in 12 of 50 patients (24%) allowed independent life after stroke rehabilitation. According to univariate analysis, factors associated with a FIM score of 100 or greater and good prognosis after rehabilitation were younger age (<70 years), paralysis caused by intracerebral hematoma (ICH), no cortical lesions, short time from admission to comprehensive inpatient rehabilitation (CIR) for stroke (within 1 month), and good status at the start of early rehabilitation and CIR. Eleven of the 12 patients with good prognosis (FIM ≥100) had ICH and a basal ganglia lesion with no cortical damage. Analysis of the location of lesions suggested that many patients with basal ganglia ICH lesions and little cortical involvement have good prognoses. Conclusions: Stroke patients with severe hemiplegia showed a slightly different distribution of lesions between ICH and cerebral ischemia. Cortical involvement may be a prognostic factor for outcome after rehabilitation in stroke patients with severe hemiplegia. More aggressive rehabilitation interventions may be important for patients with severe hemiplegia, especially without cortical involvement.
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Affiliation(s)
- Minori Kurosaki
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Masahiko Tosaka
- Department of Neurosurgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Yoko Ibe
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hironori Arii
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Junichi Tomono
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Masayuki Tazawa
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tatsuya Shimizu
- Department of Neurosurgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Masanori Aihara
- Department of Neurosurgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Naoki Wada
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Kokolevich ZM, Biros E, Tirosh O, Reznik JE. Distinct Ground Reaction Forces in Gait between the Paretic and Non-Paretic Leg of Stroke Patients: A Paradigm for Innovative Physiotherapy Intervention. Healthcare (Basel) 2021; 9:healthcare9111542. [PMID: 34828588 PMCID: PMC8620401 DOI: 10.3390/healthcare9111542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
This case report study aims to identify the differences in the ground reaction forces (GRF) placed on the forefoot, hindfoot, and entire foot between the paretic and non-paretic legs in two stroke patients to identify potential targets for improved physiotherapy treatment. A digital gait analysis foot pressure insole was fitted inside the participants’ shoes to measure the percentage of body weight taken during the stance phase, and the vertical GRF of the two subjects are reported in this paper. Both patients presented noteworthy differences in gait parameters individually and between their paretic and non-paretic legs. The trend shows a decreased percentage of body weight on the paretic forefoot and hindfoot, although the percentage bodyweight placed on the entire foot remained similar in both feet. The gait patterns shown were highly individual and indicated that both legs were affected to some degree. These findings identify key motion targets for an improved physiotherapy treatment following a stroke, suggesting that physiotherapy treatment should be targeted and individually tailored and should include both extremities.
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Affiliation(s)
- Zoe Mass Kokolevich
- “Eshel Avraham” Centre for Special Needs Adults, Ezer Mizion, Bnei Brak 51553, Israel;
| | - Erik Biros
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
| | - Oren Tirosh
- Biomechanics School of Health Sciences, Swinburne University of Technology, Melbourne, VIC 3122, Australia;
| | - Jacqueline Elise Reznik
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
- Correspondence:
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21
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Hewitt J, Bains N, Wallis K, Gething S, Pennington A, Carter B. The Use of Patient Reported Outcome Measures (PROMs) 6 Months Post-Stroke and Their Association with the National Institute of Health Stroke Scale (NIHSS) on Admission to Hospital. Geriatrics (Basel) 2021; 6:geriatrics6030088. [PMID: 34562989 PMCID: PMC8482088 DOI: 10.3390/geriatrics6030088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/26/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022] Open
Abstract
Patient Reported Outcome Measures (PROMs) assess clinical outcomes from the perspective of the patient. The stroke community recommended fifteen questions for use in stroke survivors, based on the established PROMIS10 with five additional stroke-specific questions. This study aimed to determine its association with the National Institute of Health Stroke Scale (NIHSS) on admission. PROM responses were taken from an existing randomised control trial and, using secondary analysis, the total score was calculated out of 100. The association between PROMs and NIHSS was estimated. Using a multivariable regression, an adjusted mean difference (aMD) in PROM total score for the baseline clinical characteristics was calculated. 343 participants (16.3%) completed the PROM; mean age 71.7 (30–94) years; 133 women (38.8%). There was a strong association between increasing NIHSS Scores on admission to hospital and worsening PROM scores at 6 months (p = 0.002). There was consistency between the NIHSS and modified Rankin score with the stroke-specific domain and total PROM scores. When adjusted, women had lower (worse) total PROM scores, with aMD = −3.85 (95% CI −6.30–−1.41; p = 0.002) and so did haemorrhagic strokes, with a reduction of 3.88 (95% CI −0.61–7.37; p = 0.097). This study contributes to the evaluation process of this stroke-specific PROM and emphasises that stroke severity on admission correlates with poorer patient outcomes 6 months following a stroke, especially in women and those suffering haemorrhagic stroke.
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Affiliation(s)
- Jonathan Hewitt
- Division of Population Medicine, Cardiff University, Cardiff CF10 3AT, UK; (N.B.); (K.W.); (S.G.); (A.P.)
- Correspondence: ; Tel.:+44-2920-716982
| | - Natalie Bains
- Division of Population Medicine, Cardiff University, Cardiff CF10 3AT, UK; (N.B.); (K.W.); (S.G.); (A.P.)
| | - Katherine Wallis
- Division of Population Medicine, Cardiff University, Cardiff CF10 3AT, UK; (N.B.); (K.W.); (S.G.); (A.P.)
| | - Stephanie Gething
- Division of Population Medicine, Cardiff University, Cardiff CF10 3AT, UK; (N.B.); (K.W.); (S.G.); (A.P.)
| | - Anna Pennington
- Division of Population Medicine, Cardiff University, Cardiff CF10 3AT, UK; (N.B.); (K.W.); (S.G.); (A.P.)
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK;
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22
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Functional recovery of patients with intracerebral haemorrhage and cerebral infarction after rehabilitation. Int J Rehabil Res 2021; 44:222-225. [PMID: 34034286 DOI: 10.1097/mrr.0000000000000476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To investigate potential differences in functional recovery after rehabilitation between intracerebral haemorrhage and cerebral infarction, we retrospectively compared the outcomes of patients with intracerebral haemorrhage (N = 208) and cerebral infarction (N = 480) who were consecutively discharged from our convalescent rehabilitation hospital between January 2013 and December 2018. Functional improvement was estimated by functional independence effectiveness measurements (proportion of potential for improvement achieved) upon discharge. Univariate analysis showed no significant differences in functional improvement between the two groups possibly because of the demographic variations upon admission. Multiple regression analysis demonstrated that the impact and type of factors related to functional improvement (functional independence measure upon admission, age, length of hospital stay, and time to admission after onset) were similar in both groups. Nevertheless, stratified analysis revealed, compared with patients with cerebral infarction, better improvement in patients with intracerebral haemorrhage that were admitted early after onset (<20 days), which exhibited high or moderate severity upon admission (functional independence measure: 36-89), or had a long hospital stay (>129 days). The present study showed differences as well as similarities in functional recovery between two stroke subtypes and suggests that better functional improvement might be expected in patients with intracerebral haemorrhage compared with those with cerebral infarction through an earlier start of intensive rehabilitation or longer rehabilitation in the hospital even if they exhibited relatively severe impairment upon admission. The type of stroke should be taken into consideration when predicting functional recovery and planning rehabilitation management in stroke patients.
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Wang HP, Sung SF, Yang HY, Huang WT, Hsieh CY. Associations between stroke type, stroke severity, and pre-stroke osteoporosis with the risk of post-stroke fracture: A nationwide population-based study. J Neurol Sci 2021; 427:117512. [PMID: 34082148 DOI: 10.1016/j.jns.2021.117512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/08/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Background Recognizing the post-stroke fracture risk factors is crucial for targeted intervention and primary fracture prevention. We aimed to investigate whether stroke types, stroke severity, and pre-stroke osteoporosis are associated with post-stroke fracture. Methods In a nationwide cohort, we identified previously fracture-free patients who suffered from first-ever stroke, either acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH), between 2003 and 2015. Information regarding stroke severity, osteoporosis, comorbidity, and medication information was collected. The outcomes analyzed included hip fracture, spine fracture, and other fractures. Cumulative incidence functions (CIFs) were used to estimate the cumulative incidence of fractures over time after accounting for competing risk of death. Multivariable Fine and Gray models were used to determine the adjusted hazard ratio (HR) and 95% confidence interval (CI). Results Of the 41,895 patients with stroke, the 5-year CIFs of any incident fracture, hip fracture, spine fracture, and other fractures were 8.03%, 3.42%, 1.87%, and 3.05%, respectively. The fracture risk did not differ between patients with AIS and ICH. While osteoporosis increased the risk of post-stroke fracture (adjusted HR [95% CI],1.42 [1.22-1.66]), stroke severity was inversely associated with post-stroke fracture (moderate, 0.88 [0.81-0.96] and severe, 0.39 [0.34-0.44], compared with mild stroke severity). Conclusions Stroke survivors had an over 8% fracture risk at 5 years after stroke. Mild stroke severity and osteoporosis were significantly associated with post-stroke fracture risk, whereas stroke type was not. Our results call for effective measures for bone health screening and fracture prevention in patients with stroke.
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Affiliation(s)
- Hung-Ping Wang
- Division of Rheumatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Hsin-Yi Yang
- Clinical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Wan-Ting Huang
- Clinical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan; School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Okuda Y, Aoike F, Matsuzaki J, Shiraishi S, Sugiyama S, Yoshida T, Kitamura E, Nishida F, Tanaka N, Sugiyama Y, Enami T, Yanagihara T. Functional recoveries of patients with branch atheromatous disease after rehabilitation: Comparison with other types of cerebral infarction and importance of stratification by clinical categories. Restor Neurol Neurosci 2021; 39:139-147. [PMID: 33967074 DOI: 10.3233/rnn-211163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Functional recoveries after rehabilitation of patients with branch atheromatous disease (BAD) have not been well investigated, however, clinical category of cerebral infarction including BAD itself could be a potential predictive factor for functional outcome. OBJECTIVE To describe characteristics of functional recoveries of patients with BAD through comparison with other types of cerebral infarction. METHODS We retrospectively compared outcomes of patients with BAD (N = 222), cardioembolic cerebral infarction (CE: N = 177) and atherothrombotic cerebral infarction (AT: N = 219) by using functional independence measure (FIM) and FIM effectiveness (the proportion of potential for improvement achieved). RESULTS Univariate analysis showed that FIM on discharge was comparable among three types of cerebral infarction, but that FIM effectiveness in patients with BAD was significantly higher than those with CE or AT. Stratified analysis revealed higher FIM effectiveness in patients with BAD compared to patients with CE or AT, if they were male, younger (≤72 years) or had supratentorial brain lesions. Multiple regression analysis demonstrated that location of the brain lesion (supratentorial vs infratentorial) and gender (male vs female) were significantly associated with FIM on discharge, and that cognitive function on admission as well as gender were significantly associated with FIM effectiveness in patients with BAD, but not in patients with CE or AT. CONCLUSIONS Outcomes after rehabilitation of patients with BAD may be characterized by better functional improvement, especially if patients are male, relatively younger or with supratentorial lesions. The impact and the type of factors related to functional recoveries of patients with BAD may be different from other types of stroke. The present study suggested that clinical category of stroke should be taken into consideration in prediction of outcomes and planning of rehabilitation management.
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Affiliation(s)
| | | | - Jo Matsuzaki
- Department of Neurology, Tane General Hospital, Osaka, Japan
| | | | | | - Tomoko Yoshida
- Department of Neurology, Tane General Hospital, Osaka, Japan
| | - Emi Kitamura
- Department of Neurology, Tane General Hospital, Osaka, Japan
| | - Fukuko Nishida
- Department of Neurology, Tane General Hospital, Osaka, Japan
| | - Natsuki Tanaka
- Department of Neurology, Tane General Hospital, Osaka, Japan
| | - Yasuko Sugiyama
- Department of Neurology, Tane General Hospital, Osaka, Japan
| | - Tomomi Enami
- Department of Neurology, Tane General Hospital, Osaka, Japan
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Salvadori E, Papi G, Insalata G, Rinnoci V, Donnini I, Martini M, Falsini C, Hakiki B, Romoli A, Barbato C, Polcaro P, Casamorata F, Macchi C, Cecchi F, Poggesi A. Comparison between Ischemic and Hemorrhagic Strokes in Functional Outcome at Discharge from an Intensive Rehabilitation Hospital. Diagnostics (Basel) 2020; 11:diagnostics11010038. [PMID: 33379391 PMCID: PMC7824133 DOI: 10.3390/diagnostics11010038] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 01/04/2023] Open
Abstract
Comparison studies on recovery outcomes in ischemic (IS) and hemorrhagic strokes (HS) have yielded mixed results. In this retrospective observational study of consecutive IS and HS patients, we aimed at evaluating functional outcomes at discharge from an intensive rehabilitation hospital, comparing IS vs. HS, analyzing possible predictors. Modified Rankin Scale (mRS) at discharge was the main outcome. Out of the 229 patients included (mean age 72.9 ± 13.9 years, 48% males), 81 had HS (35%). Compared with IS (n = 148), HS patients were significantly younger (75 ± 12.5 vs. 68.8 ± 15.4 years, p = 0.002), required longer hospitalizations both in acute (23.9 ± 36.7 vs. 35.2 ± 29.9 days, p = 0.019) and rehabilitation hospitals (41.5 ± 31.8 vs. 77.2 ± 51.6 days, p = 0.001), and had more severe initial clinical deficit (mean number of neurological impairments: 2.0 ± 1.1 vs. 2.6 ± 1.4, p = 0.001) and mRS scores at admission (p = 0.046). At discharge, functional status change, expressed as mRS, was not significantly different between IS and HS (F = 0.01, p = 0.902), nor was the discharge destination (p = 0.428). Age and clinical severity were predictors of functional outcome in both stroke types. On admission in an intensive rehabilitation hospital, HS patients presented a worse functional and clinical status compared to IS. Despite this initial gap, the two stroke types showed an overlapped trajectory of functional recovery, with age and initial stroke severity as the main prognostic factors.
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Affiliation(s)
- Emilia Salvadori
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
| | - Gioele Papi
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (G.P.); (G.I.)
| | - Greta Insalata
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (G.P.); (G.I.)
| | - Valentina Rinnoci
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
| | - Ida Donnini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
| | - Monica Martini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
| | - Catuscia Falsini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
| | - Annamaria Romoli
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
| | - Carmen Barbato
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
| | - Paola Polcaro
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
| | - Francesca Casamorata
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (E.S.); (V.R.); (I.D.); (M.M.); (C.F.); (B.H.); (A.R.); (C.B.); (P.P.); (F.C.); (C.M.); (F.C.)
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (G.P.); (G.I.)
- Correspondence:
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Namale G, Kamacooko O, Makhoba A, Mugabi T, Ndagire M, Ssanyu P, Ddamulira JBM, Yperzeele L, Cras P, Ddumba E, Seeley J, Newton R. Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study. BMC Cardiovasc Disord 2020; 20:442. [PMID: 33032527 PMCID: PMC7545850 DOI: 10.1186/s12872-020-01724-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background We report here on a prospective hospital-based cohort study that investigates predictors of 30-day and 90-day mortality and functional disability among Ugandan stroke patients. Methods Between December 2016 and March 2019, we enrolled consecutive hemorrhagic stroke and ischemic stroke patients at St Francis Hospital Nsambya, Kampala, Uganda. The primary outcome measure was mortality at 30 and 90 days. The modified Ranking Scale wasused to assess the level of disability and mortality after stroke. Stroke severity at admission was assessed using the National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS). Examination included clinical neurological evaluation, laboratory tests and brain computed tomography (CT) scan. Kaplan-Meier curves and multivariate Cox proportional hazard model were used for unadjusted and adjusted analysis to predict mortality. Results We enrolled 141 patients; 48 (34%) were male, mean age was 63.2 (+ 15.4) years old; 90 (64%) had ischemic and 51 (36%) had hemorrhagic stroke; 81 (57%) were elderly (≥ 60 years) patients. Overall mortality was 44 (31%); 31 (23%) patients died within the first 30 days post-stroke and, an additional 13 (14%) died within 90 days post-stroke. Mortality for hemorrhagic stroke was 19 (37.3%) and 25 (27.8%) for ischemic stroke. After adjusting for age and sex, a GCS score below < 9 (adjusted hazard ratio [aHR] =3.49, 95% CI: 1.39–8.75) was a significant predictor of 30-day mortality. GCS score < 9 (aHR =4.34 (95% CI: 1.85–10.2), stroke severity (NIHSS ≥21) (aHR = 2.63, 95% CI: (1.68–10.5) and haemorrhagic stroke type (aHR = 2.30, 95% CI: 1.13–4.66) were significant predictors of 90-day mortality. Shorter hospital stay of 7–13 days (aHR = 0.31, 95% CI: 0.11–0.93) and being married (aHR = 0.22 (95% CI: 0.06–0.84) had protective effects for 30 and 90-day mortality respectively. Conclusion Mortality is high in the acute and sub-acute phase of stroke. Low levels of consciousness at admission, stroke severity, and hemorrhagic stroke were associated with increased higher mortality in this cohort of Ugandan stroke patients. Being married provided a protective effect for 90-day mortality. Given the high mortality during the acute phase, critically ill stroke patients would benefit from early interventions established as the post-stroke- standard of care in the country.
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Affiliation(s)
- Gertrude Namale
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.
| | - Onesmus Kamacooko
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda
| | - Anthony Makhoba
- St. Francis Hospital Nsambya affiliated to Uganda Martyrs University, Kampala, Uganda
| | - Timothy Mugabi
- St. Francis Hospital Nsambya affiliated to Uganda Martyrs University, Kampala, Uganda
| | - Maria Ndagire
- St. Francis Hospital Nsambya affiliated to Uganda Martyrs University, Kampala, Uganda
| | - Proscovia Ssanyu
- St. Francis Hospital Nsambya affiliated to Uganda Martyrs University, Kampala, Uganda
| | - John Bosco M Ddamulira
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Laetitia Yperzeele
- Stroke unit and Antwerp Neuro-Vascular Center, department of Neurology, University Hospital Antwerp, Antwerp Belgium and Research group on Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Patrick Cras
- Born Bunge Institute, University of Antwerp and Antwerp University Hospital, Department of Neurology, Antwerp, Belgium
| | - Edward Ddumba
- St. Francis Hospital Nsambya affiliated to Uganda Martyrs University, Kampala, Uganda
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.,London School of Hygiene &Tropical Medicine, London, UK
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.,University of York, York, UK
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Kimura T. Interaction between locomotion and three subcategories for patients with stroke demonstrating fewer than 37 points on the total functional independence measure upon admission to the recovery ward. J Phys Ther Sci 2020; 32:516-523. [PMID: 32884173 PMCID: PMC7443547 DOI: 10.1589/jpts.32.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/13/2020] [Indexed: 12/02/2022] Open
Abstract
[Purpose] To investigate the interaction between locomotion and improvements in
performing self-care. [Participants and Methods] We retrospectively analyzed 930 patients
with stroke who were registered in the Japanese Rehabilitation Database. We performed a
correlation analysis to evaluate the relationships among all the collected data. Then,
hierarchical multiple regression analysis was performed using the self-care motor score of
the Functional Independent Measure (FIM) as the dependent variable. “Model 1” used two
independent variables (National Institute of Health Stroke and Rankin Scale), “model 2”
used two independent variables (locomotion gain and gain of an item with the closest
coefficient correlation added to model 1), and “model 3” used a mean-centering value,
which was added to model 2. R2 values were calculated using a simple slope
analysis. [Results] Locomotion showed an interaction with three self-care activities. The
R2 changes in models 1 and 2 (ΔR2) were significant for dressing
upper body (ΔR2=0.001), bowel management (ΔR2=0.006), and toileting
(ΔR2=0.006). The results of the simple slope analysis were significant.
[Conclusion] Locomotion demonstrated an interaction with various activities for improving
self-care. There were varying degrees of improvement in self-care despite a uniform
improvement in the degree of locomotion. Therefore, locomotion interaction should be
considered for each intervention that targets activities of daily living.
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Affiliation(s)
- Takashi Kimura
- Department of Physical Therapy, ASO Rehabilitation College: 3-2-1 Higashi-Hie, Hakata-ku, Fukuoka-Shi, Fukuoka 812-0007, Japan.,Department of Rehabilitation Medicine, Saga University Hospital, Japan
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A Retrospective Analysis of Factors Impacting Rehabilitation Outcomes in Patients With Spontaneous Intracerebral Hemorrhage. Am J Phys Med Rehabil 2020; 99:1004-1011. [DOI: 10.1097/phm.0000000000001459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Pahuja M, Chehab O, Ranka S, Mishra T, Ando T, Yassin AS, Thayer KL, Shah P, Kimmelstiel CD, Salehi P, Kapur NK. Incidence and clinical outcomes of stroke in
ST
‐elevation myocardial infarction and cardiogenic shock. Catheter Cardiovasc Interv 2020; 97:217-225. [DOI: 10.1002/ccd.28919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Mohit Pahuja
- Division of Cardiology, Department of Internal Medicine Detroit Medical Center/Wayne State University School of Medicine Detroit Michigan USA
| | - Omar Chehab
- Department of Internal Medicine Detroit Medical Center/Wayne State University School of Medicine Detroit Michigan USA
| | - Sagar Ranka
- Division of Cardiology, Department of Internal Medicine Kansas University Medical Center Kansas City Kansas USA
| | - Tushar Mishra
- Department of Internal Medicine Detroit Medical Center/Wayne State University School of Medicine Detroit Michigan USA
| | - Tomo Ando
- Division of Cardiology, Department of Internal Medicine Columbia University Medical Center New York New York USA
| | - Ahmed S. Yassin
- Department of Internal Medicine Detroit Medical Center/Wayne State University School of Medicine Detroit Michigan USA
| | - Katherine L. Thayer
- Division of Cardiology, Department of Internal Medicine Tuft University Medical Center Boston Massachusetts USA
| | - Palak Shah
- Division of Cardiology Inova Heart and Vascular Institute Fairfax Virginia USA
| | - Carey D. Kimmelstiel
- Division of Cardiology, Department of Internal Medicine Tuft University Medical Center Boston Massachusetts USA
| | - Payam Salehi
- Division of Cardiology, Department of Internal Medicine Tuft University Medical Center Boston Massachusetts USA
| | - Navin K. Kapur
- Division of Cardiology, Department of Internal Medicine Tuft University Medical Center Boston Massachusetts USA
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A Comparison of Motor Functional Recovery and Brain Damage between Striatal Lesions Induced by Ischemia and Hemorrhage in Rats. J Stroke Cerebrovasc Dis 2020; 29:104668. [PMID: 32184024 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/01/2020] [Accepted: 01/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the natural recovery process and tissue injury associated with cerebral hemorrhage and cerebral infarction, which were induced to the same degree, in the striatum of rats. METHODS Male Wistar rats were divided into intracerebral hemorrhagic (ICH) and ischemia (ISC) groups, with the ICH group injected with a collagenase solution and the ISC group injected with an endothelin-1 solution. In the SHAM group, physiological saline was injected. Motor function was evaluated by the ladder and forelimb placing tests on the first day before surgery and the first, seventh, and 14th day after surgery. On day 15 after surgery, brain tissue was harvested and frozen sections were prepared. Nissl staining was performed, and the tissue loss, ventricular, and hemispheric volumes were analyzed. RESULTS On the first day of surgery, the ICH group had significantly decreased motor function compared with the ISC group. However, subsequent recovery of motor function was faster in the ICH group than that in the ISC group. In addition, tissue loss and hemispheric volumes were significantly higher in the ISC group than those in the ICH group, whereas the ventricular volume was significantly higher in the ICH group than that in the ISC group. CONCLUSIONS Collectively, our findings indicate that, in ICH and ISC where the brain damage involves the same site and is approximately the same size, motor function is recovered faster in ICH than that in ISC. As such, differences in secondary degeneration are likely affected.
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Chu CL, Chen YP, Chen CCP, Chen CK, Chang HN, Chang CH, Pei YC. Functional Recovery Patterns of Hemorrhagic and Ischemic Stroke Patients Under Post-Acute Care Rehabilitation Program. Neuropsychiatr Dis Treat 2020; 16:1975-1985. [PMID: 32884273 PMCID: PMC7431596 DOI: 10.2147/ndt.s253700] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tailored rehabilitation programs for stroke patients cannot be made without knowledge of their recovery potential. The aim of this study is to characterize the functional recovery patterns of ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients under post-acute care stroke rehabilitation. METHODS This retrospective study analyzed the data of patients enrolled in the Post-Acute Care-Cerebrovascular Disease (PAC-CVD) rehabilitation program, which provides an individualized 1- to 3-hour intensive physical, occupational, and speech and language therapy for post-acute stroke patients in Taoyuan Chang Gung Memorial hospital in Taiwan. Our primary endpoint measure was Barthel Index (BI), and secondary endpoint measures included other 12 functional measures. RESULTS A total of 489 patients were included for analysis. Patients with stroke history had less BI improvement than those who suffered their first-ever stroke. In first-ever stroke patients who had completed 6 to 12 weeks of PAC-CVD program, subcortical ICH patients had greater BI, quality of life, sensation, and balance improvements, and had greater late-phase recovery than their IS counterparts. In IS patients, those with age >75 had less BI improvement; those with National Institute of Health Stroke Scale (NIHSS) score 1-5 had greater Motor Activity Log quality of use (MAL-quality) improvement than those with NIHSS score >5; those with Mini-Mental State Examination (MMSE) score ≥24 had greater BI and instrumental activities of daily living (IADL) improvement. Using the general linear model, previous stroke (ß: -6.148, p=0.01) and subcortical ICH (ß: 5.04, p=0.03) were factors associated with BI improvement. CONCLUSION Subcortical ICH patients have greater functional improvement and greater late-phase recovery than their IS counterparts following PAC rehabilitation. More studies are needed to validate our findings and unravel the underlying mechanisms of stroke recovery to optimize the treatment strategy following a stroke.
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Affiliation(s)
- Chan-Lin Chu
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Peng Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Carl C P Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chih-Kuang Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hsiang-Ning Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chien-Hung Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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32
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Yeo SH, Yau WP. Temporal Trends and Predictors of Drug Utilization and Outcomes in First-Ever Stroke Patients: A Population-Based Study Using the Singapore Stroke Registry. CNS Drugs 2019; 33:791-815. [PMID: 31313138 DOI: 10.1007/s40263-019-00648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Drug utilization and outcomes research in multi-ethnic Asian stroke populations is lacking. OBJECTIVES Our objective was to examine temporal trends and predictors of drug utilization and outcomes in a multi-ethnic Asian stroke population. METHODS This registry-based study included ischemic and hemorrhagic first-ever stroke patients hospitalized between 2009 and 2016. Utilization of medications included in-hospital thrombolytic agents, early antithrombotics (antiplatelets, anticoagulants) within 48 h of admission, and antithrombotics and statins at discharge. Outcomes analyzed were in-hospital all-cause mortality; 28-day, 90-day, and 1-year case fatality (CF); and discharge destination. RESULTS Of the 36,615 included patients, 81.6% had ischemic stroke and 18.4% had hemorrhagic stroke (15.5% intracerebral hemorrhage [ICH] and 2.8% subarachnoid hemorrhage [SAH]). For ischemic stroke, the combined use of all three guideline medications (in-hospital thrombolytic therapy, as well as antithrombotics and statins at discharge) increased (P = 0.006). Being on the stroke pathway was associated with prescription of all three guideline medications in ischemic stroke. Decreasing trends for in-hospital mortality, 28-day, 90-day, and 1-year CF and proportion of patients discharged home without rehabilitation appointment were observed in ischemic stroke (P < 0.05) but not in ICH or SAH (apart from 28-day CF). Ischemic stroke patients who received guideline medications were less likely to die or be discharged to nursing homes and chronic sick hospitals. Hemorrhagic stroke patients prescribed statins at discharge were less likely to have 28-day and 1-year CF. CONCLUSIONS Prescription of secondary stroke preventive medications (particularly in ischemic stroke) was associated with more favorable outcomes, highlighting the importance of physician adherence to evidence-based pharmacotherapy.
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Affiliation(s)
- See-Hwee Yeo
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Republic of Singapore
| | - Wai-Ping Yau
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Republic of Singapore.
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33
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Nozoe M, Kanai M, Kubo H, Yamamoto M, Shimada S, Mase K. Prestroke Sarcopenia and Stroke Severity in Elderly Patients with Acute Stroke. J Stroke Cerebrovasc Dis 2019; 28:2228-2231. [PMID: 31129104 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/20/2019] [Accepted: 05/02/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The association between prestroke sarcopenia and stroke severity has not been evaluated previously. The purpose of this study was to determine whether prestroke sarcopenia is associated with stroke severity in elderly patients with acute stroke. METHODS We assessed prestroke sarcopenia of elderly patients with acute stroke by using a questionnaire for sarcopenia (SARC-F). Patients were divided into groups according to their SARC-F score: SARC-F score less than 4 (nonsarcopenia) and SARC-F score ≥4 (prestroke sarcopenia). Stroke severity was assessed according to the National Institute of Health Stroke Scale. Logistic regression was used to derive crude and adjusted odds ratio for the presence of prestroke sarcopenia and stroke severity. RESULTS Among the 183 patients enrolled (age, median [interquartile range]: 75 [11] years; 103 men), the prevalence of prestroke sarcopenia was 15% (n = 27). Crude odds ratio for the presence of prestroke sarcopenia and moderate-to-severe stroke (National Institute of Health Stroke Scale score > 5) was 4.00 (95% confidence interval, 1.68-9.53; P = .002). After adjusting for confounding variables (age, sex, and stroke risk factors), the presence of prestroke sarcopenia remained an independent predictor of severe stroke, with an odds ratio of 3.54 (95% confidence interval, 1.32-9.49; P= .01). CONCLUSIONS Prestroke sarcopenia can predict moderate to severe stroke in elderly patients with acute stroke.
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan.
| | - Masashi Kanai
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Miho Yamamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
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Tilling EJ, El Tawil S, Muir KW. Do Clinicians Overestimate the Severity of Intracerebral Hemorrhage? Stroke 2019; 50:344-348. [DOI: 10.1161/strokeaha.118.022606] [Citation(s) in RCA: 390] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Elliot J. Tilling
- From the Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Scotland, UK
| | - Salwa El Tawil
- From the Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Scotland, UK
| | - Keith W. Muir
- From the Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Scotland, UK
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Koyama T, Uchiyama Y, Domen K. Associations of Diffusion-Tensor Fractional Anisotropy and FIM Outcome Assessments After Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2018; 27:2869-2876. [PMID: 30072174 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/20/2018] [Accepted: 06/14/2018] [Indexed: 12/16/2022] Open
Abstract
AIM This study aimed to clarify the associations between fiber tract degeneration evaluated by diffusion-tensor imaging (DTI) and outcomes following intracerebral hemorrhage (ICH). METHODS In total, data of 40 patients from our previously published reports were assessed. Acquisition of fractional anisotropy (FA) maps was performed using DTI 14-21 days after onset; tract-based spatial statistics (TBSS) was used for the analysis. Mean FA values within the corticospinal tract (CST), the superior longitudinal fasciculus (SLF), the inferior longitudinal fasciculus, and the uncinate fasciculus were extracted from individual TBSS data. By using multivariate regression analysis, ratios of FA between lesioned and nonlesioned hemispheres were modeled to fit outcomes assessed by Brunnstrom stage (BRS) shoulder/elbow/forearm, hand/finger, and lower extremity functions and Functional Independence Measure (FIM) motor and cognition scores. RESULTS Multivariate regression analyses only took the CST data into the final models for FIM-motor (adjusted R2 = .145), BRS shoulder/elbow/forearm, hand/finger, and lower extremity outcomes (adjusted R2 = .485, .503, and .425, respectively). In contrast, only the SLF data were taken into the final model for the FIM-cognition outcomes (adjusted R2 = .177). CONCLUSIONS Fiber tract degeneration in the CST mainly affected motor-related outcomes such as FIM-motor and affected extremity functions assessed by using BRS, whereas that in the SLF associated with poorer cognition-related outcomes. These findings imply that, by using DTI, outcomes of patients after ICH may be predictable by assessing fiber tract degeneration in the CST and the SLF.
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Affiliation(s)
- Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan; Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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36
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Shams Vahdati S, Ala A, Mousavi Aghdas SA, Adib A, Mirza-Aghazadeh-Attari M, Aliar F. Association Between the Subtypes of Stroke and the Various Risk Factors of Cerebrovascular Accidents: A Cross-Sectional Study. Eurasian J Med 2018; 50:86-90. [PMID: 30002573 DOI: 10.5152/eurasianjmed.2018.17322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/06/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Stroke is a common heterogeneous disease classified into two subtypes: ischemic and hemorrhagic. Many risk factors have been associated with stroke, and the most well-known is hypertension. Although the relation between stroke and these risk factors has been emphasized before, there is inconclusive evidence about the relation between the different risk factors and the subtypes of stroke. The present study aims to fill this gap. Materials and Methods In the present retrospective, cross-sectional study, 827 patients with diagnosed stroke were included. Demographic data and the acquired risk factors were determined using pre-designed questionnaires. Statistical analysis was conducted using chi-square test, Student t-test, and Pearson correlation coefficient. Results Among the included 827 patients, 432 (52.2%) were men and 395 (47.8%) were women. The mean±standard deviation of age was 68.41±12.46 y in men and 67.89±11.85 y in women, respectively, and the difference was not significant. Of all the patients, 672 had ischemic strokes and 155 had hemorrhagic strokes. The most common risk factor in the patients was hypertension with a prevalence of 66.7%. Of all the risk factors, only hypertension, atrial fibrillation (AF), age, and a positive family history were significantly related to a subtype of stroke. Conclusion Knowing that the prevalence of hypertension, AF, age, and positive family history are significantly different between the two subtypes, the patients having these risk factors can be entered into more specified public health measures, which puts more emphasis on the subtype that they are more prone to.
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Affiliation(s)
- Samad Shams Vahdati
- Department of Emergency, Emergency Medicine Research Team, Tabriz University of Medical Sciences, Iran
| | - Alireza Ala
- Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Ali Adib
- Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Fatemeh Aliar
- Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Thompson K, Mattern-Baxter K. Intensive, functional training leads to optimal outcomes in a young woman post brain stem hemorrhage due to cerebral cavernous malformation. Physiother Theory Pract 2018; 36:741-752. [PMID: 29979899 DOI: 10.1080/09593985.2018.1493166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Cerebral cavernous malformations (CCMs) can cause intracranial hemorrhages and account for 5-15% of all cerebral vascular malformations. The purpose of this retrospective case report is to describe the unusual motor recovery of a young woman following a large hemorrhage of a previously unknown brainstem CCM, otherwise not reported in the literature. Case Description: The patient was a 29-year-old female who presented with severe hemiparesis on the left 6 weeks after a first-ever hemorrhage. She had demonstrated minimal improvement in her motor recovery to date, was dependent on a walker for ambulation, and had no distal left upper extremity function. An intensive evidence-based plan of care over 6 weeks included progressive task-specific strengthening, treadmill training, and dynamic balance training. Outcomes: The patient achieved complete motor recovery, indicated by improvement from 23/66 to 64/66 in the Fugl-Meyer Upper Extremity Subscale score and from 12/30 to 30/30 in the Functional Gait Assessment. She returned to independent ambulation with functional gait speeds and kinematics. Discussion: This case report demonstrates an unusual clinical course of unexpected full recovery in a young woman after a large brainstem CCM after an intensive 6-week course of physical therapy. Other patients with a similar presentation after CCM may benefit from an intensive plan of care. Clinicians should be aware of the possibility of unusual recovery in this population as not to limit expectations for recovery.
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Affiliation(s)
- Kasey Thompson
- Dignity Health, Mercy San Juan Medical Center ,Carmichael, CA
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Toudou Daouda M, Bouchal S, Chtaou N, Midaoui A, Souirti Z, Belahsen F. Thrombolysis Alert in Hassan II University Teaching Hospital of Fez (Morocco): A Prospective Study of 2 Years. J Stroke Cerebrovasc Dis 2018; 27:1100-1106. [PMID: 29290532 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/05/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Thrombolysis alert (TA) is a procedure triggered every time a patient consults for sudden focal neurological deficit within 4.5 hours. OBJECTIVE We aimed to determine firstly the etiological profile of TA and secondly to evaluate the delays in the management not only of thrombolyzed patients but also of nonthrombolyzed patients to determine the intrahospital delays to optimize. METHODS Patients aged over 18 years who consulted for sudden focal neurological deficit within 4.5 hours for whom a TA has been triggered were included. Patients admitted within 4.5 hours for which a TA has not been triggered were not included. Patients with sudden focal neurological deficit who consulted more than 4.5 hours, but for whom TA has been triggered, were also included. RESULTS We included 313 patients. The average onset-to-door time was 125.59 ± 62.78 minutes with an average National Institutes of Health Stroke Scale scores of 11.29 ± 5.98. The average door-to-imaging time was 28.36 ± 20.62 minutes. Ischemic stroke (IS) was the most common cause (70.3%), followed by hemorrhagic stroke (11.8%). Other nonstroke causes (stroke mimics) represented 17.9% of cases. They were seizures (46.4%), conversion disorders (26.8%), hypoglycemia (10.7%), brain tumors (10.7%), chronic subdural hematoma (1.8%), carbon monoxide intoxication (1.8%), and cavernoma (1.8%). Forty-six patients had been thrombolyzed. The average door-to-needle time was 90.89 ± 34.48 minutes. After 3 months, 52.1% of thrombolyzed patients were autonomous (modified Rankin scale between 0 and 2). Two patients had died (4.3%), all in the first week after the IS. CONCLUSION Our study shows that efforts need to be made at the extra-hospital and intra-hospital level to improve delays to increase the proportion of the thrombolyzed patients.
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Affiliation(s)
| | - Siham Bouchal
- Department of Neurology, Hassan II University Teaching Hospital, Fez, Morocco
| | - Naima Chtaou
- Department of Neurology, Hassan II University Teaching Hospital, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Aouatef Midaoui
- Department of Neurology, Hassan II University Teaching Hospital, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Zouahyr Souirti
- Department of Neurology, Hassan II University Teaching Hospital, Fez, Morocco; Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco; Sleep Medicine Center, Hassan II University Teaching Hospital, Fez, Morocco
| | - Faouzi Belahsen
- Department of Neurology, Hassan II University Teaching Hospital, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
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39
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Kitago T, Ratan RR. Rehabilitation following hemorrhagic stroke: building the case for stroke-subtype specific recovery therapies. F1000Res 2017; 6:2044. [PMID: 29250322 PMCID: PMC5701438 DOI: 10.12688/f1000research.11913.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 01/07/2023] Open
Abstract
Intracerebral hemorrhage (ICH), a form of brain bleeding and minor subtype of stroke, leads to significant mortality and long-term disability. There are currently no validated approaches to promote functional recovery after ICH. Research in stroke recovery and rehabilitation has largely focused on ischemic stroke, but given the stark differences in the pathophysiology between ischemic and hemorrhagic stroke, it is possible that strategies to rehabilitate the brain in distinct stroke subtypes will be different. Here, we review our current understanding of recovery after primary intracerebral hemorrhage with the intent to provide a framework to promote novel, stroke-subtype specific approaches.
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Affiliation(s)
- Tomoko Kitago
- Department of Neurology, Columbia University, New York, USA.,Burke Medical Research Institute, White Plains, New York, USA
| | - Rajiv R Ratan
- Burke Medical Research Institute, White Plains, New York, USA.,Departments of Neurology and Neuroscience, Weill Cornell Medicine, New York, USA
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40
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Dierick F, Dehas M, Isambert JL, Injeyan S, Bouché AF, Bleyenheuft Y, Portnoy S. Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy? PLoS One 2017; 12:e0178636. [PMID: 28575054 PMCID: PMC5456343 DOI: 10.1371/journal.pone.0178636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/16/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Contrary to common belief of clinicians that hemorrhagic stroke survivors have better functional prognoses than ischemic, recent studies show that ischemic survivors could experience similar or even better functional improvements. However, the influence of stroke subtype on gait and posture outcomes following an intervention blending conventional physiotherapy with robotic-assisted gait therapy is missing. OBJECTIVE This study compared gait and posture outcome measures between ambulatory hemorrhagic patients and ischemic patients, who received a similar 4 weeks' intervention blending a conventional bottom-up physiotherapy approach and an exoskeleton top-down robotic-assisted gait training (RAGT) approach with Lokomat. METHODS Forty adult hemiparetic stroke inpatient subjects were recruited: 20 hemorrhagic and 20 ischemic, matched by age, gender, side of hemisphere lesion, stroke severity, and locomotor impairments. Functional Ambulation Category, Postural Assessment Scale for Stroke, Tinetti Performance Oriented Mobility Assessment, 6 Minutes Walk Test, Timed Up and Go and 10-Meter Walk Test were performed before and after a 4-week long intervention. Functional gains were calculated for all tests. RESULTS Hemorrhagic and ischemic subjects showed significant improvements in Functional Ambulation Category (P<0.001 and P = 0.008, respectively), Postural Assessment Scale for Stroke (P<0.001 and P = 0.003), 6 Minutes Walk Test (P = 0.003 and P = 0.015) and 10-Meter Walk Test (P = 0.001 and P = 0.024). Ischemic patients also showed significant improvements in Timed Up and Go. Significantly greater mean Functional Ambulation Category and Tinetti Performance Oriented Mobility Assessment gains were observed for hemorrhagic compared to ischemic, with large (dz = 0.81) and medium (dz = 0.66) effect sizes, respectively. CONCLUSION Overall, both groups exhibited quasi similar functional improvements and benefits from the same type, length and frequency of blended conventional physiotherapy and RAGT protocol. The use of intensive treatment plans blending top-down physiotherapy and bottom-up robotic approaches is promising for post-stroke rehabilitation.
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Affiliation(s)
- Frédéric Dierick
- Forme & Fonctionnement Humain Research Unit, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, Montignies sur Sambre, Belgium
- Faculty of Motor Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- * E-mail:
| | - Mélanie Dehas
- Forme & Fonctionnement Humain Research Unit, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, Montignies sur Sambre, Belgium
| | | | - Soizic Injeyan
- « Le Normandy » Rehabilitation Center, Granville, France
| | - Anne-France Bouché
- Forme & Fonctionnement Humain Research Unit, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, Montignies sur Sambre, Belgium
- Rehabilitation Unit, « Le Richemont », Bioul, Belgium
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Sigal Portnoy
- Department of Occupational Therapy, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gaughan J, Gravelle H, Santos R, Siciliani L. Long-term care provision, hospital bed blocking, and discharge destination for hip fracture and stroke patients. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2017; 17:10.1007/s10754-017-9214-z. [PMID: 28247174 PMCID: PMC5703024 DOI: 10.1007/s10754-017-9214-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/13/2017] [Indexed: 05/28/2023]
Abstract
We examine the relationship between long-term care supply (care home beds and prices) and (i) the probability of being discharged to a care home and (ii) length of stay in hospital for patients admitted to hospital for hip fracture or stroke. Using patient level data from all English hospitals and allowing for a rich set of demographic and clinical factors, we find no association between discharge destination and long-term care beds supply or prices. We do, however, find evidence of bed blocking: hospital length of stay for hip fracture patients discharged to a care home is shorter in areas with more long-term care beds and lower prices. Length of stay is over 30% shorter in areas in the highest quintile of care home beds supply compared to those in the lowest quintile.
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Affiliation(s)
- James Gaughan
- Centre for Health Economics, University of York, York, UK.
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Rita Santos
- Centre for Health Economics, University of York, York, UK
| | - Luigi Siciliani
- Centre for Health Economics, University of York, York, UK
- Department of Economics and Related Studies, University of York, York, UK
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Persson HC, Opheim A, Lundgren-Nilsson Å, Alt Murphy M, Danielsson A, Sunnerhagen KS. Upper extremity recovery after ischaemic and haemorrhagic stroke: Part of the SALGOT study. Eur Stroke J 2016; 1:310-319. [PMID: 31008293 DOI: 10.1177/2396987316672809] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/12/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction The purpose was to explore if there are differences in extent of change in upper extremity motor function and activity capacity, in persons with ischaemic versus haemorrhagic stroke, during the first year post stroke. Patients and methods One hundred seventeen persons with stroke (ischaemic n = 98, haemorrhagic n = 19) and reduced upper extremity function 3 days after onset were consecutively included to the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT) from a stroke unit. Upper extremity motor function (Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE)) and activity capacity (Action Research Arm Test (ARAT)) were assessed at 6 assessments during the first year; age and initial stroke severity were recorded. Differences between groups in extent of change over time of upper extremity motor function and activity capacity were analysed with mixed models repeated measurements method. Results Significant improvements were found in function and activity in both groups within the first month (p = 0.001). Higher age and more severe stroke had a negative impact on recovery in both groups. Larger improvements of function and activity were seen in haemorrhagic stroke compared to ischaemic, both from 3 days to 3- and 12 months, and from 1 month to 3 months. Both groups reached similar levels of function and activity at 3 months post stroke. Conclusion Although persons with haemorrhagic stroke had initially lower scores than those with ischaemic stroke, they had a larger improvement within the first 3 months, and thereafter both groups had similar function and activity.
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Affiliation(s)
- Hanna C Persson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Arve Opheim
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Åsa Lundgren-Nilsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Margit Alt Murphy
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anna Danielsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.,Unit of Physiotherapy, Division of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Meijer R, van Limbeek J, Peusens G, Rulkens M, Dankoor K, Vermeulen M, de Haan RJ. The Stroke unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study. Clin Rehabil 2016; 19:770-8. [PMID: 16250197 DOI: 10.1191/0269215505cr875oa] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate which factors during the subacute phase post stroke have predictive value for the discharge outcome from the hospital stroke unit. Methods: In a prospective cohort of 338 patients admitted to a hospital stroke unit 26 potentially prognostic factors, arranged in clinical and social subdomains, were scored and analysed by binary logistic regression analysis. The outcome of the research consisted of the various discharge destinations. Results: The overall predictive value of the discharge model is high (91%). Factors predictive of a poor discharge outcome are a low Barthel Index score (odds ratio (OR) 0.78 per point increase; p < 0.001), a poor sitting balance (OR 5.96; p < 0.001), a depression (OR 7.23; p < 0.001), poststroke cognitive disability (OR 3.51; p = 0.007) and older age (OR 1.05 per point increase; p = 0.008). If present, a personality disorder, premorbid cognitive disability and premorbid functional disability all show a tendency towards poor discharge outcome, but these factors did not reach statistical significance in this study, possibly due to their low prevalence. Readiness of the family circle to provide support was only significant in the univariate analysis. Conclusions: Somatic, biological and psychological factors predict the discharge outcome. Functional and cognitive factors play a decisive role in the future ability to live independently after a stroke. The prognostic importance of social factors could not be demonstrated. Urinary incontinence did not emerge as a prognostic factor. This is in contrast to scientific findings till now, but in accordance with clinical experience.
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Affiliation(s)
- R Meijer
- Department of Neurological Rehabilitation, Rehabilitation Centre Groot Klimmendaal, P.O. Box 9044, 6800 GG Arnhem, The Netherlands.
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Abstract
About half of patients survive intracerebral hemorrhage (ICH), but most are left with significant disability. Rehabilitation after ICH is the mainstay of treatment to reduce impairment, improve independence in activities, and return patients to meaningful participation in the community. The authors discuss the neuroplastic mechanisms underlying recovery in ICH, preclinical and clinical interventional studies to augment recovery, and the rehabilitative and medical management of post-ICH patients.
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Affiliation(s)
- Michael F Saulle
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York
| | - Heidi M Schambra
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York
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Suda S, Yang B, Schaar K, Xi X, Pido J, Parsha K, Aronowski J, Savitz SI. Autologous Bone Marrow Mononuclear Cells Exert Broad Effects on Short- and Long-Term Biological and Functional Outcomes in Rodents with Intracerebral Hemorrhage. Stem Cells Dev 2015; 24:2756-66. [PMID: 26414707 DOI: 10.1089/scd.2015.0107] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Autologous bone marrow-derived mononuclear cells (MNCs) are a potential therapy for ischemic stroke. However, the effect of MNCs in intracerebral hemorrhage (ICH) has not been fully studied. In this study, we investigated the effects of autologous MNCs in experimental ICH. ICH was induced by infusion of autologous blood into the left striatum in young and aged male Long Evans rats. Twenty-four hours after ICH, rats were randomized to receive an intravenous administration of autologous MNCs (1 × 10(7) cells/kg) or saline. We examined brain water content, various markers related to the integrity of the neurovascular unit and inflammation, neurological deficit, neuroregeneration, and brain atrophy. We found that MNC-treated young rats showed a reduction in the neurotrophil infiltration, the number of inducible nitric oxide synthase-positive cells, and the expression of inflammatory-related signalings such as the high-mobility group protein box-1, S100 calcium binding protein B, matrix metalloproteinase-9, and aquaporin 4. Ultimately, MNCs reduced brain edema in the perihematomal area compared with saline-treated animals at 3 days after ICH. Moreover, MNCs increased vessel density and migration of doublecortin-positive cells, improved motor functional recovery, spatial learning, and memory impairment, and reduced brain atrophy compared with saline-treated animals at 28 days after ICH. We also found that MNCs reduced brain edema and brain atrophy and improved spatial learning and memory in aged rats after ICH. We conclude that autologous MNCs can be safely harvested and intravenously reinfused in rodent ICH and may improve long-term structural and functional recovery after ICH. The results of this study may be applicable when considering future clinical trials testing MNCs for ICH.
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Affiliation(s)
- Satoshi Suda
- 1 Department of Neurological Science, Graduate School of Medicine, Nippon Medical School , Tokyo, Japan
| | - Bing Yang
- 2 Department of Neurology, University of Texas Medical School at Houston , Houston, Texas
| | - Krystal Schaar
- 2 Department of Neurology, University of Texas Medical School at Houston , Houston, Texas
| | - Xiaopei Xi
- 2 Department of Neurology, University of Texas Medical School at Houston , Houston, Texas
| | - Jennifer Pido
- 2 Department of Neurology, University of Texas Medical School at Houston , Houston, Texas
| | - Kaushik Parsha
- 2 Department of Neurology, University of Texas Medical School at Houston , Houston, Texas
| | - Jaroslaw Aronowski
- 2 Department of Neurology, University of Texas Medical School at Houston , Houston, Texas
| | - Sean I Savitz
- 2 Department of Neurology, University of Texas Medical School at Houston , Houston, Texas
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Messaggi-Sartor M, Guillen-Solà A, Depolo M, Duarte E, Rodríguez DA, Barrera MC, Barreiro E, Escalada F, Orozco-Levi M, Marco E. Inspiratory and expiratory muscle training in subacute stroke: A randomized clinical trial. Neurology 2015; 85:564-72. [PMID: 26180145 DOI: 10.1212/wnl.0000000000001827] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 04/15/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the effectiveness, feasibility, and safety of short-term inspiratory and expiratory muscle training (IEMT) in subacute stroke patients. METHODS Within 2 weeks of stroke onset, 109 patients with a first ischemic stroke event were randomly assigned to the IEMT (n = 56) or sham IEMT (n = 53) study group. The IEMT consisted of 5 sets of 10 repetitions, twice a day, 5 days per week for 3 weeks, at a training workload equivalent to 30% of maximal respiratory pressures. Patients and researchers assessing outcome variables were blinded to the assigned study group. The main outcome was respiratory muscle strength assessed by maximal inspiratory and expiratory pressures (PImax, PEmax). Respiratory complications at 6 months were also recorded. RESULTS Both groups improved respiratory muscle strength during the study. IEMT was associated with significantly improved %PImax and %PEmax: effect size d = 0.74 (95% confidence interval [CI] 0.28-1.20) and d = 0.56 (95% CI 0.11-1.02), respectively. No significant training effect was observed for peripheral muscle strength. Respiratory complications at 6 months occurred more frequently in the sham group (8 vs 2, p = 0.042), with an absolute risk reduction of 14%. The number needed to treat to prevent one lung infection event over a follow-up of 6 months was 7. No major adverse events or side effects were observed. CONCLUSION IEMT induces significant improvement in inspiratory and expiratory muscle strength and could potentially offer an additional therapeutic tool aimed to reduce respiratory complications at 6 months in stroke patients. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that short-term training may have the potential to improve respiratory muscle strength in patients with subacute stroke.
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Affiliation(s)
- Monique Messaggi-Sartor
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Anna Guillen-Solà
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Marina Depolo
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Esther Duarte
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Diego A Rodríguez
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria-Camelia Barrera
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Esther Barreiro
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ferran Escalada
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mauricio Orozco-Levi
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ester Marco
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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Rehabilitation Outcomes: Ischemic versus Hemorrhagic Strokes. Behav Neurol 2015; 2015:891651. [PMID: 26246694 PMCID: PMC4515256 DOI: 10.1155/2015/891651] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/20/2015] [Accepted: 06/24/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Ischemic and hemorrhagic strokes have different pathophysiologies and possibly different long-term cerebral and functional implications. Hemorrhagic strokes expose the brain to irritating effects of blood and ischemic strokes reflect localized or diffuse cerebral vascular pathology. Methods. Participants were individuals who suffered either an ischemic (n = 172) or hemorrhagic stroke (n = 112) within the past six months and were involved in a postacute neurorehabilitation program. Participants completed three months of postacute neurorehabilitation and the Mayo Portland Adaptability Inventory-4 (MPAI-4) at admission and discharge. Admission MPAI-4 scores and level of functioning were comparable. Results. Group ANOVA comparisons show no significant group differences at admission or discharge or difference in change scores. Both groups showed considerably reduced levels of productivity/employment after discharge as compared to preinjury levels. Conclusions. Though the pathophysiology of these types of strokes is different, both ultimately result in ischemic injuries, possibly accounting for lack of findings of differences between groups. In the present study, participants in both groups experienced similar functional levels across all three MPAI-4 domains both at admission and discharge. Limitations of this study include a highly educated sample and few outcome measures.
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Massa MS, Wang N, Bickerton WL, Demeyere N, Riddoch MJ, Humphreys GW. On the importance of cognitive profiling: A graphical modelling analysis of domain-specific and domain-general deficits after stroke. Cortex 2015; 71:190-204. [PMID: 26232552 DOI: 10.1016/j.cortex.2015.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 11/08/2014] [Accepted: 06/10/2015] [Indexed: 12/11/2022]
Abstract
Cognitive problems following stroke are typically analysed using either short but relatively uninformative general tests or through detailed but time consuming tests of domain specific deficits (e.g., in language, memory, praxis). Here we present an analysis of neuropsychological deficits detected using a screen designed to fall between other screens by being 'broad' (testing multiple cognitive abilities) but 'shallow' (sampling the abilities briefly, to be time efficient) - the BCoS. Assessment using the Birmingham Cognitive Screen (BCoS) enables the relations between 'domain specific' and 'domain general' cognitive deficits to be evaluated as the test generates an overall cognitive profile for individual patients. We analysed data from 287 patients tested at a sub-acute stage of stroke (<3 months). Graphical modelling techniques were used to investigate the associative structure and conditional independence between deficits within and across the domains sampled by BCoS (attention and executive functions, language, memory, praxis and number processing). The patterns of deficit within each domain conformed to existing cognitive models. However, these within-domain patterns underwent substantial change when the whole dataset was modelled, indicating that domain-specific deficits can only be understood in relation to linked changes in domain-general processes. The data point to the importance of using over-arching cognitive screens, measuring domain-general as well as domain-specific processes, in order to account for neuropsychological deficits after stroke. The paper also highlights the utility of using graphical modelling to understand the relations between cognitive components in complex datasets.
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Affiliation(s)
- M Sofia Massa
- Department of Statistics, Oxford University, Oxford, UK
| | - Naxian Wang
- Department of Statistics, Oxford University, Oxford, UK
| | | | - Nele Demeyere
- Department of Experimental Psychology, Oxford University, Oxford, UK
| | - M Jane Riddoch
- Department of Experimental Psychology, Oxford University, Oxford, UK
| | - Glyn W Humphreys
- Department of Experimental Psychology, Oxford University, Oxford, UK.
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Mortensen J, Figlewski K, Andersen H. Combined transcranial direct current stimulation and home-based occupational therapy for upper limb motor impairment following intracerebral hemorrhage: a double-blind randomized controlled trial. Disabil Rehabil 2015; 38:637-43. [DOI: 10.3109/09638288.2015.1055379] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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50
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Koyama T, Marumoto K, Uchiyama Y, Miyake H, Domen K. Outcome Assessment of Hemiparesis due to Intracerebral Hemorrhage Using Diffusion Tensor Fractional Anisotropy. J Stroke Cerebrovasc Dis 2015; 24:881-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 11/25/2022] Open
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