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Jochems ACC, Muñoz Maniega S, Chappell FM, Clancy U, Arteaga C, Jaime Garcia D, Hamilton OKL, Hewins W, Locherty R, Backhouse EV, Barclay G, Jardine C, McIntyre D, Gerrish I, Cheng Y, Liu X, Zhang J, Kampaite A, Sakka E, Valdés Hernández M, Wiseman S, Stringer MS, Thrippleton MJ, Doubal FN, Wardlaw JM. Impact of long-term white matter hyperintensity changes on mobility and dexterity. Brain Commun 2024; 6:fcae133. [PMID: 38715716 PMCID: PMC11074793 DOI: 10.1093/braincomms/fcae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 06/30/2024] Open
Abstract
White matter hyperintensities (WMH), a common feature of cerebral small vessel disease, are related to worse clinical outcomes after stroke. We assessed the impact of white matter hyperintensity changes over 1 year after minor stroke on change in mobility and dexterity, including differences between the dominant and non-dominant hands and objective in-person assessment versus patient-reported experience. We recruited participants with lacunar or minor cortical ischaemic stroke, performed medical and cognitive assessments and brain MRI at presentation and at 1 year. At both time points, we used the timed-up and go test and the 9-hole peg test to assess mobility and dexterity. At 1 year, participants completed the Stroke Impact Scale. We ran two linear mixed models to assess change in timed-up and go and 9-hole peg test, adjusted for age, sex, stroke severity (National Institutes of Health Stroke Scale), dependency (modified Rankin Score), vascular risk factor score, white matter hyperintensity volume (as % intracranial volume) and additionally for 9-hole peg test: Montreal cognitive assessment, hand (dominant/non-dominant), National Adult Reading Test (premorbid IQ), index lesion side. We performed ordinal logistic regression, corrected for age and sex, to assess relations between timed-up and go and Stroke Impact Scale mobility, and 9-hole peg test and Stroke Impact Scale hand function. We included 229 participants, mean age 65.9 (standard deviation = 11.13); 66% male. 215/229 attended 1-year follow-up. Over 1 year, timed-up and go time increased with aging (standardized β [standardized 95% Confidence Interval]: 0.124[0.011, 0.238]), increasing National Institutes of Health Stroke Scale (0.106[0.032, 0.180]), increasing modified Rankin Score (0.152[0.073, 0.231]) and increasing white matter hyperintensity volume (0.176[0.061, 0.291]). Men were faster than women (-0.306[0.011, 0.238]). Over 1 year, slower 9-hole peg test was related to use of non-dominant hand (0.290[0.155, 0.424]), aging (0.102[0.012, 0.192]), male sex (0.182[0.008, 0.356]), increasing National Institutes of Health Stroke Scale (0.160 [0.094, 0.226]), increasing modified Rankin Score (0.100[0.032, 0.169]), decreasing Montreal cognitive assessment score (-0.090[-0.167, -0.014]) and increasing white matter hyperintensity volume (0.104[0.015, 0.193]). One year post-stroke, Stroke Impact Scale mobility worsened per second increase on timed-up and go, odds ratio 0.67 [95% confidence interval 0.60, 0.75]. Stroke Impact Scale hand function worsened per second increase on the 9-hole peg test for the dominant hand (odds ratio 0.79 [0.71, 0.86]) and for the non-dominant hand (odds ratio 0.88 [0.83, 0.93]). Decline in mobility and dexterity is associated with white matter hyperintensity volume increase, independently of stroke severity. Mobility and dexterity declined more gradually for stable and regressing white matter hyperintensity volume. Dominant and non-dominant hands might be affected differently. In-person measures of dexterity and mobility are associated with self-reported experience 1-year post-stroke.
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Affiliation(s)
- Angela C C Jochems
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Susana Muñoz Maniega
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Francesca M Chappell
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Una Clancy
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Carmen Arteaga
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Daniela Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Olivia K L Hamilton
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, G12 8TB Glasgow, United Kingdom
| | - Will Hewins
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Rachel Locherty
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Ellen V Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Gayle Barclay
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Charlotte Jardine
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Donna McIntyre
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Iona Gerrish
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Yajun Cheng
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Department of Neurology, West China Hospital of Sichuan University, 610041 Chengdu, China
| | - Xiaodi Liu
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Junfang Zhang
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of medicine, 200080 Shanghai, China
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Eleni Sakka
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Maria Valdés Hernández
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Stewart Wiseman
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Michael S Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- MRC UK Dementia Research Institute at the University of Edinburgh, EH16 4SB Edinburgh, United Kingdom
- Edinburgh Imaging Facility, Royal Infirmary of Edinburgh, EH16 4TJ Edinburgh, United Kingdom
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Roelofs JMB, Zandvliet SB, Schut IM, Huisinga ACM, Schouten AC, Hendricks HT, de Kam D, Aerden LAM, Bussmann JBJ, Geurts ACH, Weerdesteyn V. Mild Stroke, Serious Problems: Limitations in Balance and Gait Capacity and the Impact on Fall Rate, and Physical Activity. Neurorehabil Neural Repair 2023; 37:786-798. [PMID: 37877724 PMCID: PMC10685695 DOI: 10.1177/15459683231207360] [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] [Indexed: 10/26/2023]
Abstract
BACKGROUND After mild stroke persistent balance limitations may occur, creating a risk factor for fear of falling, falls, and reduced activity levels. Objective. To investigate whether individuals in the chronic phase after mild stroke show balance and gait limitations, elevated fall risk, reduced balance confidence, and physical activity levels compared to healthy controls. METHODS An observational case-control study was performed. Main outcomes included the Mini-Balance Evaluation Systems Test (mini-BEST), Timed Up and Go (TUG), 10-m Walking Test (10-MWT), and 6-item version Activity-specific Balance Confidence (6-ABC) scale which were measured in 1 session. Objectively measured daily physical activity was measured for 7 consecutive days. Fall rate in daily life was recorded for 12 months. Individuals after a mild stroke were considered eligible when they: (1) sustained a transient ischemic attack or stroke longer than 6 months ago, resulting in motor and/or sensory loss in the contralesional leg at the time of stroke, (2) showed (near-) complete motor function, that is, ≥24 points on the Fugl-Meyer Assessment-Lower Extremity (range: 0-28). RESULTS Forty-seven healthy controls and 70 participants after mild stroke were included. Participants with stroke fell more than twice as often as healthy controls, had a 2 point lower median score on the mini-BEST, were 1.7 second slower on TUG, 0.6 km/h slower on the 10-MWT, and had a 12% lower 6-ABC score. Intensity for both total activity (8%) as well as walking activity (6%) was lower in the participants with stroke, while no differences were found in terms of duration. CONCLUSIONS Individuals in the chronic phase after a mild stroke demonstrate persistent balance limitations and have an increased fall risk. Our results point at an unmet clinical need in this population.
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Affiliation(s)
- Jolanda M. B. Roelofs
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sarah B. Zandvliet
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ingrid M. Schut
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Alfred C. Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Henk T. Hendricks
- Department of Rehabilitation Medicine, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
| | - Digna de Kam
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leo A. M. Aerden
- Department of Neurology, Reinier de Graafgasthuis, Delft, The Netherlands
| | - Johannes B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek, Research, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek, Research, Nijmegen, The Netherlands
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Dalli LL, Borschmann K, Cooke S, Kilkenny MF, Andrew NE, Scott D, Ebeling PR, Lannin NA, Grimley R, Sundararajan V, Katzenellenbogen JM, Cadilhac DA. Fracture Risk Increases After Stroke or Transient Ischemic Attack and Is Associated With Reduced Quality of Life. Stroke 2023; 54:2593-2601. [PMID: 37581266 DOI: 10.1161/strokeaha.123.043094] [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: 03/01/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Fractures are a serious consequence following stroke, but it is unclear how these events influence health-related quality of life (HRQoL). We aimed to compare annualized rates of fractures before and after stroke or transient ischemic attack (TIA), identify associated factors, and examine the relationship with HRQoL after stroke/TIA. METHODS Retrospective cohort study using data from the Australian Stroke Clinical Registry (2009-2013) linked with hospital administrative and mortality data. Rates of fractures were assessed in the 1-year period before and after stroke/TIA. Negative binomial regression, with censoring at death, was used to identify factors associated with fractures after stroke/TIA. Respondents provided HRQoL data once between 90 and 180 days after stroke/TIA using the EuroQoL 5-dimensional 3-level instrument. Adjusted logistic regression was used to assess differences in HRQoL at 90 to 180 days by previous fracture. RESULTS Among 13 594 adult survivors of stroke/TIA (49.7% aged ≥75 years, 45.5% female, 47.9% unable to walk on admission), 618 fractures occurred in the year before stroke/TIA (45 fractures per 1000 person-years) compared with 888 fractures in the year after stroke/TIA (74 fractures per 1000 person-years). This represented a relative increase of 63% (95% CI, 47%-80%). Factors associated with poststroke fractures included being female (incidence rate ratio [IRR], 1.34 [95% CI, 1.05-1.72]), increased age (per 10-year increase, IRR, 1.35 [95% CI, 1.21-1.50]), history of prior fracture(s; IRR, 2.56 [95% CI, 1.77-3.70]), and higher Charlson Comorbidity Scores (per 1-point increase, IRR, 1.18 [95% CI, 1.10-1.27]). Receipt of stroke unit care was associated with fewer poststroke fractures (IRR, 0.67 [95% CI, 0.49-0.93]). HRQoL at 90 to 180 days was worse among patients with prior fracture across the domains of mobility, self-care, usual activities, and pain/discomfort. CONCLUSIONS Fracture risk increases substantially after stroke/TIA, and a history of these events is associated with poorer HRQoL at 90 to 180 days after stroke/TIA.
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Affiliation(s)
- Lachlan L Dalli
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
| | - Karen Borschmann
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia (K.B., M.F.K., D.A.C.)
- Allied Health Department, St Vincent's Hospital, Melbourne, VIC, Australia (K.B.)
| | - Shae Cooke
- Eastern Health, Box Hill, VIC, Australia (S.C.)
| | - Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia (K.B., M.F.K., D.A.C.)
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia (N.E.A.)
- National Centre for Healthy Ageing, Frankston, VIC, Australia (N.E.A.)
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia (D.S.)
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia (N.A.L.)
- Alfred Health, Melbourne, VIC, Australia (N.A.L.)
| | - Rohan Grimley
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
- Sunshine Coast Clinical School, School of Medicine, Griffith University, Birtinya, QLD, Australia (R.G.)
| | - Vijaya Sundararajan
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, University of Melbourne, VIC, Australia (V.S.)
| | - Judith M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Australia (J.M.K.)
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia (K.B., M.F.K., D.A.C.)
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Gonçalves M, Lima MJ, Fonseca Â, Duque C, Costa AR, Cruz VT. Study protocol for a pilot randomised controlled trial evaluating the feasibility and effectiveness of non-pharmacological interventions to recover functionality after a transient ischaemic attack or a minor stroke: the 'Back to Normal' trial. BMJ Open 2023; 13:e069593. [PMID: 37117001 PMCID: PMC10151926 DOI: 10.1136/bmjopen-2022-069593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION Transient ischaemic attack (TIA) and minor stroke are frequently assumed as temporary or non-disabling events. However, evidence suggests that these patients can experience relevant impairment and functional disability. Therefore, the present study aims to evaluate the feasibility and effectiveness of a 3-month multidomain intervention programme, composed of five non-pharmacological strategies, aimed at accelerating return to pre-event level of functionality in patients with TIA or minor stroke. METHODS AND ANALYSIS Patients diagnosed with a TIA or a minor stroke are being recruited at the emergency or neurology departments of the Hospital Pedro Hispano, located in Matosinhos, Portugal (n=70). Those who accept to participate will be randomly allocated to two groups (1:1): (a) Intervention-receives a 3 months combined approach, initiating early post-event, composed of cognitive training, physical exercise, nutrition, psychoeducation and assessment/correction of hearing loss; (b) Control-participants will not be subject to any intervention. Both groups will receive the usual standard of care provided to these diseases. Recruitment began in May 2022 and is expected to continue until March 2023. Socio-demographic characteristics, lifestyles, health status, cognitive function, symptoms of anxiety and depression and quality of life will be assessed; as well as anthropometry, blood pressure and physical condition. Time to complete or partial recovery of instrumental activities of daily living will be assessed using an adapted version of the Frenchay Activities Index. All participants will be evaluated before the intervention and after 3 months. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the Local Health Unit of Matosinhos (Ref. 75/CES/JAS). Written informed consent will be required from all the participants; data protection and confidentiality will be also ensured. The findings of this project are expected to be submitted for publication in scientific articles, and the main results will be presented at relevant scientific meetings. TRIAL REGISTRATION NUMBER NCT05369637.
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Affiliation(s)
- Micaela Gonçalves
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Maria João Lima
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Portugal
| | - Ângelo Fonseca
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Portugal
| | - Cristina Duque
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Portugal
| | - Ana Rute Costa
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Vitor Tedim Cruz
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Portugal
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Association between physical activity levels and depressive symptoms in patients with minor ischemic stroke. J Stroke Cerebrovasc Dis 2022; 31:106641. [PMID: 35834937 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106641] [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: 05/25/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Post-stroke depression is associated with stroke recurrence and it is necessary to identify its influencing factors. The study aims to determine whether physical activity during hospitalization, as measured by accelerometer, was associated with depression after discharge in patients with minor ischemic stroke. MATERIALS AND METHODS This prospective observational study assessed 76 patients with minor ischemic stroke (aged 71.2 years) admitted to an acute care hospital. Depressive symptoms 3 months after discharge from the hospital was assessed using a questionnaire sent by mail. Baseline was set during hospitalization, and accelerometers were used to measure sedentary behavior, light and moderate-to-vigorous physical activities during hospitalization. RESULTS Three months after hospital discharge, 14 patients (18.4%) were placed in the depressive symptom group, with significantly more sedentary behavior (p = 0.021), less light physical activity (p = 0.016) and more depressive symptoms during hospitalization (p = 0.005) than in the non-depressive symptom group. Logistic regression analysis showed that sedentary behavior (odds ratio = 1.130, 95% confidence interval = 1.013‒1.281, p = 0.028) and light-intensity physical activity (odds ratio = 0.853, 95% confidence interval = 0.746‒0.976, p = 0.021) were independent factors for depressive symptoms at three months after discharge. Moderate to vigorous physical activity was not an independent factor. CONCLUSIONS Sedentary behavior and light-intensity physical activity during hospitalization were associated with depressive symptoms in patients with minor ischemic stroke after discharge. Reducing sedentary behavior and increasing light-intensity physical activity as part of inpatient rehabilitation may help prevent post-stroke depression.
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Ashizawa R, Honda H, Take K, Yoshizawa K, Ooba Y, Kameyama Y, Yoshimoto Y. Approaches to Promote Reduction in Sedentary Behavior in Patients With Minor Ischemic Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 103:255-262.e4. [PMID: 34562434 DOI: 10.1016/j.apmr.2021.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/09/2021] [Accepted: 08/16/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether an approach that promotes reduction in sedentary behavior (SB) during hospitalization and after hospital discharge reduces SB in patients with minor ischemic stroke (MIS) compared with an approach that promotes an increase in physical activity levels. DESIGN Randomized controlled trial design. SETTING During hospitalization and after hospital discharge. PARTICIPANTS We randomly assigned patients (N=61) with MIS (average age, 71.3±8.3y; 65.6% men) admitted to an acute hospital to either the intervention group (reduced SB, n=31) or the control group (increased physical activity levels, n=30). INTERVENTIONS During hospitalization, the intervention group received education on reducing SB, goal setting for SB after hospital discharge, and self-monitoring of SB and step count. In contrast, the control group received education on increasing physical activity levels and self-monitoring of step count. Patients in both groups wore an accelerometer during hospitalization until 3 months after hospital discharge. The intervention group received self-monitoring of SB and step count, stickers including information about reducing their SB, and phone calls once every 2 weeks for encouragement and feedback. The control group only wore the accelerometer. MAIN OUTCOME MEASURES The primary outcome was SB (in percentage) at 3 months after hospital discharge. RESULTS There was an interaction between the 2 groups for SB. Compared with the control group, the intervention group showed a significantly reduced SB (intervention group: baseline, 70.5%; 3 months after hospital discharge, 48.6%; control group: baseline, 71.5%; 3 months after hospital discharge, 57.5%; F value=5.981; P=.018). CONCLUSIONS The results suggested that an approach that promotes SB reduction during hospitalization and after hospital discharge is effective in reducing SB in patients with MIS 3 months after hospital discharge.
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Affiliation(s)
- Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka; Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka.
| | - Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka; Department of Rehabilitation, Hanadaira Care Center, Hamamatsu, Shizuoka
| | - Koki Take
- Visiting Nurse Station Takaoka, Seirei Care Center Takaoka, Hamamatsu, Shizuoka
| | - Kohei Yoshizawa
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka; Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshihiro Ooba
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Yuto Kameyama
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka; Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshinobu Yoshimoto
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka
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Huang WY, Li MH, Lee CH, Tuan SH, Sun SF, Liou IH. Efficacy of lateral stair walking training in patients with chronic stroke: A pilot randomized controlled study. Gait Posture 2021; 88:10-15. [PMID: 33946024 DOI: 10.1016/j.gaitpost.2021.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with chronic stroke have reduced capacity for performing activities of daily living (ADLs) and are at increased risk for falls during walking due to long-term changes to muscle tone and force, as well as movement control. RESEARCH QUESTION To investigate the efficacy of lateral stair walking training on muscle strength of affected lower extremities, balance, ADLs, and gait ability in patients with chronic stroke. METHODS The experimental group received 15 min of lateral stair walking exercise along with 15 min of traditional physiotherapy, whereas the control group received only traditional physiotherapy for 30 min. Both groups received the intervention once a week for 12 weeks. Outcome measurements included muscle strength, postural assessment scale for stroke patients (PASS), Fugal-Meyer assessment for lower extremity (FMA-LE), Barthel index (BI), timed up and go test (TUG), and the gait parameters which were determined by the Reha-Watch system. RESULTS A total of 24 participants completed the study. The experimental group showed significant improvements in hip extensor, flexor, and abductor strength of the affected limb, FMA-LE, BI, TUG, and gait parameters of stride length, velocity, and cadence. Significant differences in affected limb ankle plantar strength (p = 0.024), PASS (p = 0.017), BI (p = 0.039), TUG (p = 0.049), and gait velocity (p < 0.001) were observed between the 2 groups. SIGNIFICANCE Lateral stair walking training alongside physical therapy resulted in significant improvements in hip muscle strength and gait parameters in patients with chronic stroke. Our results support the incorporation of lateral stair walking training into clinical rehabilitation programs. Lateral stair walking training in patients with chronic stroke can be used as an effective treatment to improve gait, balance performance, and ADLs.
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Affiliation(s)
- Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Taiwan.
| | - Chao-Hsien Lee
- Department of Health Business Administration, Meiho University, Pingtung, Taiwan.
| | - Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan.
| | - Shu-Fen Sun
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - I-Hsiu Liou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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8
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Dong K, Meng S, Guo Z, Zhang R, Xu P, Yuan E, Lian T. The Effects of Transcranial Direct Current Stimulation on Balance and Gait in Stroke Patients: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:650925. [PMID: 34113308 PMCID: PMC8186497 DOI: 10.3389/fneur.2021.650925] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Balance dysfunction after stroke often results in individuals unable to maintain normal posture, limits the recovery of gait and functional independence. We explore the short-term effects of transcranial direct current stimulation (tDCS) on improving balance function and gait in stroke patients. Methods: We systematically searched on PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar for studies that explored the effects of tDCS on balance after stroke until August 2020. All involved studies used at least one measurement of balance, gait, or postural control as the outcome. Results: A total of 145 studies were found, of which 10 (n = 246) met the inclusion criteria and included in our studies. The present meta-analysis showed that active tDCS have beneficial effects on timed up and go test (TUGT) [mean difference (MD): 0.35; 95% confidence interval (CI): 0.11 to 0.58] and Functional Ambulation Category (FAC) (MD: −2.54; 95% CI: −3.93 to −1.15) in stroke patients. However, the results were not significant on the berg balance scale (BBS) (MD: −0.20; 95% CI: −1.44 to 1.04), lower extremity subscale of Fugl-Meyer Assessment (FMA-LE) (MD: −0.43; 95% CI: −1.70 to 0.84), 10-m walk test (10 MWT) (MD: −0.93; 95% CI: −2.68 to 0.82) and 6-min walking test (6 MWT) (MD: −2.55; 95% CI: −18.34 to 13.23). Conclusions: In conclusion, we revealed that tDCS might be an effective option for restoring walking independence and functional ambulation for stroke patients in our systematic review and meta-analysis. Systematic Review Registration: CRD42020207565.
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Affiliation(s)
- Ke Dong
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.,First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Shifeng Meng
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ziqi Guo
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.,First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Rufang Zhang
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.,First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Panpan Xu
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.,First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Erfen Yuan
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.,First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Tao Lian
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
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9
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Nonleisure-Time Physical Activity Guidance Following Minor Ischemic Stroke: A Randomized Clinical Trial. Adapt Phys Activ Q 2021; 38:329-347. [PMID: 33631714 DOI: 10.1123/apaq.2020-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
The purpose of this single-masked randomized clinical trial was to examine whether nonleisure-time physical activity guidance (NLTPAG) improves physical activity levels in patients after minor ischemic stroke. Patients who had been hospitalized for minor ischemic stroke in an acute care hospital (National Health Institute Stroke Scale ≤ 5) were randomized to either an NLTPAG group (n = 17) or a leisure-time physical activity guidance group (n = 16). NLTPAG focused on reducing sedentary behavior and increasing the frequency of walking for shopping and household activities to improve physical activity levels in daily life. Physical activity levels significantly improved only in participants in the NLTPAG group (initial assessment: metabolic equivalents of task = 12.6; final assessment: metabolic equivalents of task = 14.8; p = .035, r = .51). These results suggest that NLTPAG may be effective for improving physical activity levels in patients after minor ischemic stroke.
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10
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Hamre C, Fure B, Helbostad JL, Wyller TB, Ihle-Hansen H, Vlachos G, Ursin MH, Tangen GG. Factors Associated with Level of Physical Activity After Minor Stroke. J Stroke Cerebrovasc Dis 2021; 30:105628. [PMID: 33508728 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105628] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To explore factors from the acute phase, and after three and 12 months, associated with level of self-reported physical activity 12 months after a minor ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 in persons 70 years or younger. MATERIALS AND METHOD In this longitudinal cohort study patients were recruited consecutively from two stroke units. Activity level were measured with three sets of questions addressing the average number of frequency (times exercising each week), the average intensity, and duration (the average time), and a sum score was constructed. The association between physical activity 12 months after stroke and sociodemographic factors, NIHSS, body mass index, balance, and neuropsychiatric symptoms were explored using multiple linear regression. RESULTS This study included 101 patients, with mean age (SD) 55.5 (11.4) years, NIHSS median (Q1, Q3) 0.0 (0.0, 1.0), and 20 % were female. Multiple linear regression analyses showed sick leave status at stroke onset, balance at three and 12 months, and anxiety, depression, apathy, and fatigue at 12 months to be factors associated with physical activity at 12 months after stroke. CONCLUSION We found that pre-stroke sick leave, post-stroke balance, and neuropsychiatric symptoms were associated with the level of physical activity one year after minor stroke. This might be of importance when giving information about physical activity and deciding about post-stroke follow-up.
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Affiliation(s)
- Charlotta Hamre
- Department of Physiotherapy, Oslo University Hospital (OUS), Norway; Department of Geriatric Medicine, OUS, Norway; Institute of Clinical Medicine, University of Oslo (UiO), Norway; Department of Neurology, OUS, Norway.
| | - Brynjar Fure
- Department of Internal Medicine, Central Hospital, Karlstad, Sweden; Department of Neurology, Central Hospital, Karlstad and Örebro, Sweden; School of Medical Sciences, Örebro University, Sweden.
| | - Jorunn Lægdheim Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Norway.
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, OUS, Norway; Institute of Clinical Medicine, University of Oslo (UiO), Norway.
| | - Hege Ihle-Hansen
- Department of Geriatric Medicine, OUS, Norway; Department of Neurology, OUS, Norway.
| | | | - Marie Helene Ursin
- Department of Geriatric Medicine, Bærum Hospital, Vestre Viken Trust, Norway
| | - Gro Gujord Tangen
- Department of Geriatric Medicine, OUS, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway.
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11
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Li N, Li J, Gao T, Wang D, Du Y, Zhao X. Gait and Balance Disorder in Patients with Transient Ischemic Attack or Minor Stroke. Neuropsychiatr Dis Treat 2021; 17:305-314. [PMID: 33568910 PMCID: PMC7868302 DOI: 10.2147/ndt.s289158] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/19/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Transient ischemic attack (TIA) and minor stroke had a high recurrence rate, resulting in potential neurological impairment. Only a few previous studies focused on gait and balance disorder in TIA and minor stroke. This study aimed to explore the relationship between gait and balance disorder and TIA/minor stroke. PATIENTS AND METHODS Eighty-two patients with TIA/minor stroke and fifty-two healthy control participants were recruited. The gait and balance function of the two groups was tested with six measurements (Four Square Step, Tandem, Functional Reach, Gait and Pivot Turn, Timed "Up and Go", and Single Leg Balance tests). The associations between these measures and TIA/minor stroke were determined through linear and logistic regression analyses. RESULTS There were no significant group differences in age, gender, body mass index, vision, and cognitive function. People with TIA/minor stroke had poorer performance in all six gait and balance measures (all p<0.05). Logistic regression analysis showed TIA/minor stroke was strongly associated with gait and balance disorder (Four Square Step Test [OR, 24.07; 95% CI 5.90-98.13; p<0.001], Tandem Test [OR, 5.50; 95% CI 1.64-18.40; p=0.006], Functional Reach Test [OR, 4.25; 95% CI 1.04-17.33; p=0.044], Gait and Pivot Turn Test [OR, 3.78; 95% CI 1.22-11.31; p=0.021], Timed"Up and Go"Test [OR, 15.79; 95% CI 2.32-107.48; p=0.005], and Single Leg Balance Test [OR, 8.96; 95% CI 2.34-34.01; p=0.001]). TIA/minor stroke patients with older age, cognitive dysfunction, high K-CRP level, and severe atherosclerosis in lower limbs were more likely to have gait and balance disorder. CONCLUSION Our findings highlight the significant relationship between gait and balance disorder and TIA/minor stroke. It seems that people with TIA/minor stroke had a higher possibility to get gait and balance disorder. Gait and balance disorder following a minor stroke or TIA may be attributed to cognitive function in these patients.
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Affiliation(s)
- Ning Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jinxin Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ting Gao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dandan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Yang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
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12
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Lin YY, Guo SJ, Quan H, Zhao YX, Huang DY. Donepezil Improves Gait Performance in Patients with an Acute Cerebral Infarction: A Prospective Observational Cohort Study. Curr Neurovasc Res 2020; 17:304-311. [PMID: 32282302 DOI: 10.2174/1567202617666200413130101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 12/18/2022]
Abstract
Background:
Hemiplegia is a common symptom after acute cerebral infarction.
Objective:
This study aimed to explore the influence factors of gait performance and investigate
whether donepezil could improve gait performance in patients with an acute cerebral infarction.
Methods:
A total of 107 patients who experienced unilateral paresis after an acute cerebral infarction
incident were enrolled in this prospectively observational study. Participants underwent a 3-
month assessment. At the study's conclusion, patients were divided into 2 groups-those who received
donepezil daily (observation Group) and those who did not (Control Group).
Results:
There was a significant difference (t=3.269, P=0.001) of Wisconsin Gait Scale (WGS)
score between single site infarction (27.11±6.65) and multiple sites infarction (31.54±6.42). For
gender, smoking, drinking, hypertension, hyperlipidemia and diabetes, there was no difference in
WGS scores between subgroups (P>0.05), respectively. The patient's admission National Institute
of Health Stroke Scale(NIHSS) score had a strongly positive correlation with WGS score (r=0.850,
P<0.001). Besides, age (r=0.218, P=0.024), glycosylated hemoglobin (r=0.274, P=0.004), MMSE
(r=-0.261, P=0.007) and Montreal Cognitive Assessment (MoCA) (r=-0.272, P=0.005) had a weak
correlation with WGS scores. Multivariate analysis showed age (95% CI: 0.042~0.188, P=0.002),
admission NIHSS score (95% CI: 2.405~3.137, P<0.001) and multiple sites infarction (95% CI:
0.044~2.983, P=0.044) were independent risk factors of WGS scores. WGS scores of both observation
and control groups gradually decreased after admission (P<0.001). At 3 months after admission,
WGS score of the observation group was significantly lower than the control group
(t=2.468, P=0.015). There were no significant differences between observation and control group
at admission and 1 month after admission (P>0.05) and WGS scores of both single site and multiple
sites infarction gradually decreased at one month and three months after admission (P<0.001),
while there was no significant difference between two groups (P>0.05).
Conclusion:
Admission NIHSS score, age and multiple sites infarction were independent risk factors
of WGS score. Donepezil could improve gait performance in patients with acute cerebral infarction.
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Affiliation(s)
- Ying-Ying Lin
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Shi-Jie Guo
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Hui Quan
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Yan-Xin Zhao
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Dong-Ya Huang
- Department of Neurology, Tongji University School of Medicine, East Hospital, 150 Jimo Road, Shanghai 200120, China
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13
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Hamre C, Fure B, Helbostad JL, Wyller TB, Ihle-Hansen H, Vlachos G, Ursin M, Tangen GG. Balance and Gait After First Minor Ischemic Stroke in People 70 Years of Age or Younger: A Prospective Observational Cohort Study. Phys Ther 2020; 100:798-806. [PMID: 31944247 DOI: 10.1093/ptj/pzaa010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/22/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients <70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group. OBJECTIVE The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients ≤70 years with minor ischemic stroke (National Institutes of Health Stroke Scale score ≤3). This study also explored factors predicting impaired balance after 12 months. DESIGN This study was designed as an explorative longitudinal cohort study. METHODS Patients were recruited consecutively from 2 stroke units. Balance and gait were assessed with the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, and preferred gait speed. Predictors for impaired balance were explored using logistic regression. RESULTS This study included 101 patients. Mean (SD) age was 55.5 (11.4) years, 20% were female, and mean (SD) National Institutes of Health Stroke Scale score was 0.6 (0.9) points. The Mini-BESTest, gait speed, and Timed Up and Go improved significantly from the acute phase to 3 months, and gait speed also improved from 3 to 12 months. At 12 months, 26% had balance impairments and 33% walked slower than 1.0 m/s. Poor balance in the acute phase (odds ratio = 0.92, 95% confidence interval = 0.85-0.95) was the only predictor of balance impairments (Mini-BESTest score ≤22) at 12 months poststroke. LIMITATIONS Limitations include lack of information about pre-stroke balance and gait impairment and poststroke exercise. Few women limited the generalizability. CONCLUSION This study observed improvements in both balance and gait during the follow-up; still, about one-third had balance or gait impairments at 12 months poststroke. Balance in the acute phase predicted impaired balance at 12 months.
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Affiliation(s)
- Charlotta Hamre
- Department of Physiotherapy, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0424 Norway.,Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital
| | - Brynjar Fure
- Department of Internal Medicine and Department of Neurology, Central Hospital, Karlstad and School of Medical Sciences, Örebro University, Karlstad, Sweden
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torgeir B Wyller
- Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Geriatric Medicine, Oslo University Hospital and Department of Neurology, Oslo University Hospital
| | - Georgios Vlachos
- Department of Geriatric Medicine, Oslo University Hospital and Department of Neurology, Oslo University Hospital
| | - Marie Ursin
- Department of Geriatric Medicine, Bærum Hospital, Vestre Viken Trust, Drammen, Norway
| | - Gro Gujord Tangen
- Department of Geriatric Medicine, Oslo University Hospital.,Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tonsberg, Norway.,Department of Interdisciplinary Health Sciences, University of Oslo
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14
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Lodha N, Patel P, Harrell J, Casamento-Moran A, Zablocki V, Christou EA, Poisson SN. Motor impairments in transient ischemic attack increase the odds of a positive diffusion-weighted imaging: A meta-analysis. Restor Neurol Neurosci 2020; 37:509-521. [PMID: 31594263 DOI: 10.3233/rnn-190940] [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] [Indexed: 01/16/2023]
Abstract
BACKGROUND Unilateral motor impairment is a key symptom used in the diagnosis of transient ischemic attack (TIA). Diffusion-weighted imaging (DWI) is a promising diagnostic tool for detecting ischemic lesions. While both motor impairments and DWI abnormalities are linked to the diagnosis of TIA, the association between these prognostic factors is not well understood. OBJECTIVE To examine the association between unilateral motor impairments and the odds of a positive DWI in TIA. Further, to determine whether the time between symptom onset and neuroimaging (delay to scan) influences the odds of a positive DWI. METHODS We used PRISMA guidelines to conduct a systematic search from 1989 to 2018. We included studies that reported number of individuals with/without unilateral motor symptoms and a positive/negative DWI. RESULTS Twenty-four studies from North America, Australia, Asia, and Europe were submitted to a meta-analysis. A pooled odds ratio of 1.80 (95% CI, 1.45-2.24, p = 0.00; I2 = 57.38) suggested that the odds of a positive DWI are greater in TIA individuals who experience motor symptoms as compared with those who experience no motor symptoms. Further, increasing the time delay to scan from the symptom onset (>2 days) did not influence the odds of a positive DWI as compared with an earlier scan (≤2 days). CONCLUSIONS The current meta-analysis provides cumulative evidence from 6710 individuals with TIA that the presence of motor symptoms increases the odds of a positive DWI by two-folds. These findings transform the clinical perception into evidence-based knowledge that motor impairments elevate the risk for brain tissue damage. Unilateral motor impairments in a cerebrovascular event should increase a physician's suspicion of detecting brain infarctions. These findings may influence the clinical management of TIA by generating faster response to motor impairments in TIA and accelerating referral to specialized stroke clinic.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Jane Harrell
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | | | - Victoria Zablocki
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Sharon N Poisson
- Department of Neurology, University of Colorado, Aurora, CO, USA
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15
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Magaard G, StÅLnacke BM, SÖrlin A, Öhberg F, Berggren S, Grollmuss E, Hu X. Identifying Sub-Acute Rehabilitation Needs Among Individuals After Transient Ischaemic Attack Using Rehab-Compass as a Simple Screening Tool in the Outpatient Clinic. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2019; 2:1000018. [PMID: 33884119 PMCID: PMC8008729 DOI: 10.2340/20030711-1000018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 11/16/2022]
Abstract
Objective To evaluate comprehensive unmet rehabilitation needs by using a novel graphic screening tool, Rehab-Compass, among individuals in the sub-acute stage after first-ever transient ischaemic attack. Methods A pilot prospective cohort study investigated 47 individuals with first-ever transient ischaemic attack in an outpatient clinic setting. By using Rehab-Compass, based on well-validated patient-reported outcome measure questionnaires, this study examined comprehensive unmet rehabilitation needs among individuals at 4-month follow-up after the onset of transient ischaemic attack. Results Rehab-Compass identified that most participants were independent in their daily lives (modified Rankin Scale; mRS 0-1) with a relatively good quality of life (median EuroQol 5 dimensions (EQ-5D) 0.85), but certain limitations in participation in their daily lives. Rehab-Compass showed that, at 4 months after transient ischaemic attack, the most common condition affected was mood (reported by 89% of participants), followed by bladder function (70%), sexual life (52%), strength (51%) and fatigue (26%). Symptoms of depression and anxiety were reported by 6% and 17% of participants, respectively. Conclusion This pilot study indicates that RehabCompass might be a suitable simple screening tool for use in the outpatient clinic setting to identify the multidimensional rehabilitation needs of individuals after transient ischaemic attack.
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Affiliation(s)
- Gustaf Magaard
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | | | - Ann SÖrlin
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Fredrik Öhberg
- Department of Radiation Sciences/Biomedical Engineering, University Hospital of Northern Sweden, Umeå, Sweden
| | - Stina Berggren
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Emma Grollmuss
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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16
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Soh SH, Joo MC, Yun NR, Kim MS. Randomized Controlled Trial of the Lateral Push-Off Skater Exercise for High-Intensity Interval Training vs Conventional Treadmill Training. Arch Phys Med Rehabil 2019; 101:187-195. [PMID: 31562872 DOI: 10.1016/j.apmr.2019.08.480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/13/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the therapeutic effects of the lateral push-off skater exercise vs conventional treadmill training on health-related quality of life, cardiorespiratory fitness (CRF), and balance. DESIGN Single-blinded, randomized controlled trial. SETTING Outpatient clinic at a tertiary hospital. PARTICIPANTS Patients after minor stroke (N=36) with National Institutes of Health Stroke Scale scores≤3 between 20 and 65 years of age were randomly assigned to the intervention group (n=18) or the control group (n=18). INTERVENTIONS Thirty-minute sessions of the skater exercise were performed 3 times weekly for 12 weeks in the intervention group. Conventional treadmill aerobic exercise was conducted in the control group at the same frequency and duration as the experimental group exercise. MAIN OUTCOME MEASURES The primary outcome was measured using the European Quality of Life-5 Dimension (EQ-5D). Secondary outcomes included CRF and balance indicators. Assessments were performed at baseline (T0), 12 weeks from T0 (T1), and 16 weeks from T0 (T2). RESULTS Significant improvements in EQ-5D, peak oxygen uptake (VO2peak), peak oxygen pulse, peak minute ventilation (VE), Dynamic Gait Index (DGI), and Berg Balance Scale (BBS) were found in the intervention group after performing the skater exercise (P<.05, all), and these improvements were sustained at T2 (P<.05, all). Between-group comparisons demonstrated greater improvements in EQ-5D, VO2peak, peak oxygen pulse, peak VE, DGI, and BBS in the intervention group than those in the control group at both T1 (P<.05, all) and T2 (P<0.05, all). Correlation analysis showed significant relationships between EQ-5D and VO2peak, peak VE, DGI, and BBS (P<.05, all). CONCLUSIONS The skater exercise improved health-related quality of life, CRF, and balance in patients after minor stroke more effectively than conventional treadmill-based aerobic exercise. We recommend the skater exercise as a high-intensity interval training program for patients after minor stroke.
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Affiliation(s)
- Soo-Hyun Soh
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Na Ri Yun
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea.
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17
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Kang N, Lee RD, Lee JH, Hwang MH. Functional Balance and Postural Control Improvements in Patients With Stroke After Noninvasive Brain Stimulation: A Meta-analysis. Arch Phys Med Rehabil 2019; 101:141-153. [PMID: 31568760 DOI: 10.1016/j.apmr.2019.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/22/2019] [Accepted: 09/05/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The postural imbalance poststroke limits individuals' walking abilities as well as increase the risk of falling. We investigated the short-term treatment effects of noninvasive brain stimulation (NIBS) on functional balance and postural control in patients with stroke. DATA SOURCES We started the search via PubMed and the Institute for Scientific Information's Web of Science on March 1, 2019 and concluded the search on April 30, 2019. STUDY SELECTION The meta-analysis included studies that used either repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) for the recovery of functional balance and postural control poststroke. All included studies used either randomized controlled trial or crossover designs with a sham control group. DATA EXTRACTION Three researchers independently performed data extraction and assessing methodological quality and publication bias. We calculated overall and individual effect sizes using random effects meta-analysis models. DATA SYNTHESIS The random effects meta-analysis model on the 18 qualified studies identified the significant positive effects relating to NIBS in terms of functional balance and postural control poststroke. The moderator-variable analyses revealed that these treatment effects were only significant in rTMS across patients with acute, subacute, and chronic stroke whereas tDCS did not show any significant therapeutic effects. The meta-regression analysis showed that a higher number of rTMS sessions was significantly associated with more improvements in functional balance and postural control poststroke. CONCLUSIONS Our systematic review and meta-analysis confirmed that NIBS may be an effective option for restoring functional balance and postural control for patients with stroke.
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Affiliation(s)
- Nyeonju Kang
- From the Division of Sport Science & Sport Science Institute, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea.
| | - Ru Da Lee
- Department of Human Movement Science, Incheon National University, Incheon, South Korea
| | - Joon Ho Lee
- From the Division of Sport Science & Sport Science Institute, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea
| | - Moon Hyon Hwang
- Department of Human Movement Science, Incheon National University, Incheon, South Korea; Division of Health and Kinesiology, Incheon National University, Incheon, South Korea
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18
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Huang WY, Tuan SH, Li MH, Liu XY, Hsu PT. Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes. Hong Kong Physiother J 2019; 39:115-124. [PMID: 31889762 PMCID: PMC6900335 DOI: 10.1142/s1013702519500100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients. Objective: We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke. Methods: This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age 60.20±11.12 years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20 m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser. Results: The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 (p=0.02,<0.01, and =0.05, respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser. Conclusion: Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.
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Affiliation(s)
- Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Cheng Kung University, Institute of Allied Health Sciences, Tainan, Taiwan
| | - Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Xin-Yu Liu
- Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Pei-Te Hsu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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19
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Simmatis LER, Scott SH, Jin AY. The Impact of Transient Ischemic Attack (TIA) on Brain and Behavior. Front Behav Neurosci 2019; 13:44. [PMID: 30914931 PMCID: PMC6421333 DOI: 10.3389/fnbeh.2019.00044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/18/2019] [Indexed: 01/15/2023] Open
Abstract
Transient ischemic attack (TIA) was originally defined as self-resolving focal cerebral ischemia with symptoms lasting <24 h. The newer definition also added the limitation that there should be no evidence of acute brain tissue infarction, to recognize that acute injury to the brain can result from ischemia of <24-h duration. However, several recent findings suggest that having a TIA correlates with deficits that can persist far beyond the resolution of clinical symptoms, even in the absence of imaging evidence of ischemic tissue injury. These deficits may be the result of subtle perturbations to brain structure and/or function that are not easily appreciated using the standard clinical and imaging tools that are currently employed in practice. Here, we will discuss evidence that suggests that TIA may lead to lasting changes to the structure and function of the brain.
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Affiliation(s)
- Leif E R Simmatis
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Albert Y Jin
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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20
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Lodha N, Harrell J, Eisenschenk S, Christou EA. Motor Impairments in Transient Ischemic Attack Increase the Odds of a Subsequent Stroke: A Meta-Analysis. Front Neurol 2017. [PMID: 28638365 PMCID: PMC5461338 DOI: 10.3389/fneur.2017.00243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background and purpose Transient ischemic attack (TIA) increases the risk for a subsequent stroke. Typical symptoms include motor weakness, gait disturbance, and loss of coordination. The association between the presence of motor impairments during a TIA and the chances of a subsequent stroke has not been examined. In the current meta-analysis, we examine whether the odds of a stroke are greater in TIA individuals who experience motor impairments as compared with those who do not experience motor impairments. Methods We conducted a systematic search of electronic databases as well as manual searches of the reference lists of retrieved articles. The meta-analysis included studies that reported an odds ratio relating motor impairments to a subsequent stroke, or the number of individuals with or without motor impairments who experienced a subsequent stroke. We examined these studies using rigorous meta-analysis techniques including random effects model, forest and funnel plots, I2, publication bias, and fail-safe analysis. Results Twenty-four studies with 15,129 participants from North America, Australia, Asia, and Europe qualified for inclusion. An odds ratio of 2.11 (95% CI, 1.67–2.65, p = 0.000) suggested that the chances of a subsequent stroke are increased by twofolds in individuals who experience motor impairments during a TIA compared with those individuals who have no motor impairments. Conclusion The presence of motor impairments during TIA is a significantly high-risk clinical characteristic for a subsequent stroke. The current evidence for motor impairments following TIA relies exclusively on the clinical reports of unilateral motor weakness. A comprehensive examination of motor impairments in TIA will enhance TIA prognosis and restoration of residual motor impairments.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Jane Harrell
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Stephan Eisenschenk
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
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