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Li X, He Y, Wang D, Rezaei MJ. Stroke rehabilitation: from diagnosis to therapy. Front Neurol 2024; 15:1402729. [PMID: 39193145 PMCID: PMC11347453 DOI: 10.3389/fneur.2024.1402729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/28/2024] [Indexed: 08/29/2024] Open
Abstract
Stroke remains a significant global health burden, necessitating comprehensive and innovative approaches in rehabilitation to optimize recovery outcomes. This paper provides a thorough exploration of rehabilitation strategies in stroke management, focusing on diagnostic methods, acute management, and diverse modalities encompassing physical, occupational, speech, and cognitive therapies. Emphasizing the importance of early identification of rehabilitation needs and leveraging technological advancements, including neurostimulation techniques and assistive technologies, this manuscript highlights the challenges and opportunities in stroke rehabilitation. Additionally, it discusses future directions, such as personalized rehabilitation approaches, neuroplasticity concepts, and advancements in assistive technologies, which hold promise in reshaping the landscape of stroke rehabilitation. By delineating these multifaceted aspects, this manuscript aims to provide insights and directions for optimizing stroke rehabilitation practices and enhancing the quality of life for stroke survivors.
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Affiliation(s)
- Xiaohong Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanjin He
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dawu Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Perez-Corredor PA, Oluwatomilayo-Ojo P, Gutierrez-Vargas JA, Cardona-Gómez GP. Obesity induces extracellular vesicle release from the endothelium as a contributor to brain damage after cerebral ischemia in rats. Nutr Neurosci 2022:1-16. [PMID: 36039918 DOI: 10.1080/1028415x.2022.2078173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Cerebral ischemia is the most common cause of disability, the second most common cause of dementia, and the fourth most common cause of death in the developed world [Sveinsson OA, Kjartansson O, Valdimarsson EM. Heilablóðþurrð/heiladrep: Faraldsfræði, orsakir og einkenni [Cerebral ischemia/infarction - epidemiology, causes and symptoms]. Laeknabladid. 2014 May;100(5):271-9. Icelandic. doi:10.17992/lbl.2014.05.543]. Obesity has been associated with worse outcomes after ischemia in rats, triggering proinflammatory cytokine production related to the brain microvasculature. The way obesity triggers these effects remains mostly unknown. Therefore, the aim of this study was to elucidate the cellular mechanisms of damage triggered by obesity in the context of cerebral ischemia. METHODS We used a rat model of obesity induced by a 20% high fructose diet (HFD) and evaluated peripheral alterations in plasma (lipid and cytokine profiles). Then, we performed cerebral ischemia surgery using two-vessel occlusion (2VO) and analyzed neurological/motor performance and glial activation. Next, we treated endothelial cell line cultures with glutamate in vitro to simulate an excitotoxic environment, and we added 20% plasma from obese rats. Subsequently, we isolated EVs released from endothelial cells and treated primary cultures of astrocytes with them. RESULTS Rats fed a HFD had an increased BMI with dyslipidemia and high levels of proinflammatory cytokines. Glia from the obese rats exhibited altered morphology, suggesting hyperreactivity related to neurological and motor deficits. Plasma from obese rats induced activation of endothelial cells, increasing proinflammatory signals and releasing more EVs. Similarly, these EVs caused an increase in NF-κB and astrocyte cytotoxicity. Together, the results suggest that obesity activates proinflammatory signals in endothelial cells, resulting in the release of EVs that simultaneously contribute to astrocyte activation.
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Affiliation(s)
- P A Perez-Corredor
- Neuroscience Group of Antioquia, Cellular and Molecular Neurobiology Area, School of Medicine, SIU, University of Antioquia, Medellin, Colombia
| | - P Oluwatomilayo-Ojo
- Neuroscience Group of Antioquia, Cellular and Molecular Neurobiology Area, School of Medicine, SIU, University of Antioquia, Medellin, Colombia.,Division of Neuroendocrinology, Department of Anatomy, Faculty of Basic Medical Science, University of Ilorin, Ilorin, Nigeria
| | - J A Gutierrez-Vargas
- Neuroscience Group of Antioquia, Cellular and Molecular Neurobiology Area, School of Medicine, SIU, University of Antioquia, Medellin, Colombia.,Grupo de Investigación de Neurociencias y Envejecimiento (GISAM), Corporación Universitaria Remington, Medellín, Colombia
| | - G P Cardona-Gómez
- Neuroscience Group of Antioquia, Cellular and Molecular Neurobiology Area, School of Medicine, SIU, University of Antioquia, Medellin, Colombia
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Wearable sensors and machine learning in post-stroke rehabilitation assessment: A systematic review. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103197] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Cichoń N, Bijak M, Miller E, Saluk J. Extremely low frequency electromagnetic field (ELF-EMF) reduces oxidative stress and improves functional and psychological status in ischemic stroke patients. Bioelectromagnetics 2017; 38:386-396. [DOI: 10.1002/bem.22055] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/04/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Natalia Cichoń
- Department of General Biochemistry; University of Lodz; Lodz Poland
| | - Michał Bijak
- Department of General Biochemistry; University of Lodz; Lodz Poland
| | - Elżbieta Miller
- Department of Physical Medicine; Medical University of Lodz; Lodz Poland
- Neurorehabilitation Ward; III General Hospital in Lodz; Lodz Poland
| | - Joanna Saluk
- Department of General Biochemistry; University of Lodz; Lodz Poland
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Naghdi S, Ansari NN, Raji P, Shamili A, Amini M, Hasson S. Cross-cultural validation of the Persian version of the Functional Independence Measure for patients with stroke. Disabil Rehabil 2016; 38:289-98. [PMID: 25885666 DOI: 10.3109/09638288.2015.1036173] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To translate and cross-culturally adapt the Functional Independence Measure (FIM) into the Persian language and to test the reliability and validity of the Persian FIM (PFIM) in patients with stroke. METHOD In this cross-sectional study carried out in an outpatient stroke rehabilitation center, 40 patients with stroke (mean age 60 years) were participated. A standard forward-backward translation method and expert panel validation was followed to develop the PFIM. Two experienced occupational therapists (OTs) assessed the patients independently in all items of the PFIM in a single session for inter-rater reliability. One of the OTs reassessed the patients after 1 week for intra-rater reliability. RESULTS There were no floor or ceiling effects for the PFIM. Excellent inter-rater and intra-rater reliability was noted for the PFIM total score, motor and cognitive subscales (ICC(agreement)0.88-0.98). According to the Bland-Altman agreement analysis, there was no systematic bias between raters and within raters. The internal consistency of the PFIM was with Cronbach's alpha from 0.70 to 0.96. The principal component analysis with varimax rotation indicated a three-factor structure: (1) self-care and mobility; (2) sphincter control and (3) cognitive that jointly accounted for 74.8% of the total variance. Construct validity was supported by a significant Pearson correlation between the PFIM and the Persian Barthel Index (r = 0.95; p < 0.001). CONCLUSIONS The PFIM is a highly reliable and valid instrument for measuring functional status of Persian patients with stroke. IMPLICATIONS FOR REHABILITATION The Functional Independence Measure (FIM) is an outcome measure for disability based on the International Classification of Functioning, Disability and Health (ICF). The FIM was cross-culturally adapted and validated into Persian language. The Persian version of the FIM (PFIM) is reliable and valid for assessing functional status of patients with stroke. The PFIM can be used in Persian speaking countries to assess the limitations in activities of daily living of patients with stroke.
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Affiliation(s)
- Soofia Naghdi
- a Department of Physiotherapy , School of Rehabilitation, Tehran University of Medical Sciences , Tehran , Iran
| | - Noureddin Nakhostin Ansari
- a Department of Physiotherapy , School of Rehabilitation, Tehran University of Medical Sciences , Tehran , Iran
| | - Parvin Raji
- b Department of Occupational Therapy , School of Rehabilitation Sciences, Iran University of Medical Sciences , Tehran , Iran
| | - Aryan Shamili
- c Department of Occupational Therapy , School of Rehabilitation, Tabriz University of Medical Sciences , Tabriz , Iran , and
| | - Malek Amini
- b Department of Occupational Therapy , School of Rehabilitation Sciences, Iran University of Medical Sciences , Tehran , Iran
| | - Scott Hasson
- d Department of Physical Therapy , Georgia Regents University , Augusta , GA , USA
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Okorie CK, Ogbole GI, Owolabi MO, Ogun O, Adeyinka A, Ogunniyi A. Role of Diffusion-weighted Imaging in Acute Stroke Management using Low-field Magnetic Resonance Imaging in Resource-limited Settings. WEST AFRICAN JOURNAL OF RADIOLOGY 2015; 22:61-66. [PMID: 26709342 DOI: 10.4103/1115-3474.162168] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A variety of imaging modalities exist for the diagnosis of stroke. Several studies have been carried out to ascertain their contribution to the management of acute stroke and to compare the benefits and limitations of each modality. Diffusion-weighted imaging (DWI) has been described as the optimal imaging technique for diagnosing acute ischemic stroke, yet limited evidence is available on the value of DWI in the management of ischemic stroke with low-field magnetic resonance (MR) systems. Although high-field MR imaging (MRI) is desirable for DWI, low-field scanners provide an acceptable clinical compromise which is of importance to developing countries posed with the challenge of limited availability of high-field units. The purpose of this paper was to systematically review the literature on the usefulness of DWI in acute stroke management with low-field MRI scanners and present the experience in Nigeria.
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Affiliation(s)
| | - Godwin I Ogbole
- Department of Radiology, University of Ibadan, Ibadan, Nigeria
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Lu H, Zhang T, Wen M, Sun L. Impact of repetitive transcranial magnetic stimulation on post-stroke dysmnesia and the role of BDNF Val66Met SNP. Med Sci Monit 2015; 21:761-8. [PMID: 25770310 PMCID: PMC4370352 DOI: 10.12659/msm.892337] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Little is known about the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on dysmnesia and the impact of brain nucleotide neurotrophic factor (BDNF) Val66Met single-nucleotide polymorphism (SNP). This study investigated the impact of low-frequency rTMS on post-stroke dysmnesia and the impact of BDNF Val66Met SNP. Material/Methods Forty patients with post-stroke dysmnesia were prospectively randomized into the rTMS and sham groups. BDNF Val66Met SNP was determined using restriction fragment length polymorphism. Montreal Cognitive Assessment (MoCA), Loewenstein Occupational Therapy of Cognitive Assessment (LOTCA), and Rivermead Behavior Memory Test (RBMT) scores, as well as plasma BDNF concentrations, were measured at baseline and at 3 days and 2 months post-treatment. Results MoCA, LOTCA, and RBMT scores were higher after rTMS. Three days after treatment, BDNF decreased in the rTMS group but it increased in the sham group (P<0.05). Two months after treatment, RMBT scores in the rTMS group were higher than in the sham group, but not MoCA and LOTCA scores. Conclusions Low-frequency rTMS may improve after-stoke memory through various pathways, which may involve polymorphisms and several neural genes, but not through an increase in BDNF levels.
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Affiliation(s)
- Haitao Lu
- Department of Neurorehabilitation, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing, China (mainland)
| | - Tong Zhang
- Department of Neurorehabilitation, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing, China (mainland)
| | - Mei Wen
- Department of Neurorehabilitation, Institute of Rehabilitation Medicine of China, China Rehabilitation Research Center, Beijing, China (mainland)
| | - Li Sun
- Department of Neurology, China Rehabilitation Research Center, Beijing, China (mainland)
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Elisabet Nilsagård Y, Forsberg A. Practicability and Sensitivity to Change of the Activities-specific Balance Confidence Scale and 12-Item Walking Scale for Stroke. Top Stroke Rehabil 2015; 19:13-22. [DOI: 10.1310/tsr1901-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chen DW, Jin YB, Liu W, Du WJ, Li HJ, Chen JW, Xu W. Factors Associated with Performance-based Physical Function of Older Veterans of the PLAAF: A Pilot Study. J Phys Ther Sci 2014; 26:171-7. [PMID: 24648625 PMCID: PMC3944282 DOI: 10.1589/jpts.26.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/25/2013] [Indexed: 11/30/2022] Open
Abstract
[Purpose] This study investigated the factors associated with performance-based physical
function of older veterans of the People’s Liberation Army Air Force of China (PLAAF).
[Subjects and Methods] A cross-sectional survey of 146 older veterans of the PLAAF was
carried out. Their physical function was measured using the Chinese Mini-Physical
Performance Testing (CM-PPT). The demographics and health status (including physical
measures, blood chemical tests, chronic diseases, and number of morbidities) were
collected from health examination reports and computer records of case history. Cognition
was measured using the Mini-Mental Status Examination (MMSE). [Results] In multiple linear
regressions, age, MMSE, Parkinsonism, and chronic obstructive pulmonary disease were
independently associated with CM-PPT, while previous stroke and albumin level reached
borderline statistical significance. The association between the number of morbidities and
CM-PPT was significant after adjustment for MMSE and demographics. The CM-PPT of low (0 or
1), medium (2 to 4) and high count (5 or more) morbidities were 11.3±3.9, 10.2±4.1,
6.1±3.8 respectively, and the difference among these three groups was significant.
[Conclusion] Some modified conditions and the number of chronic diseases might be
associated with the physical function of older veterans of the PLAAF.
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Affiliation(s)
- Da-Wei Chen
- Department of Neurology, Geriatric Institute, the General Hospital of the Air Force, PLA (the Chinese People's Liberation Army), China
| | - Yan-Bin Jin
- Department of Neurology, Geriatric Institute, the General Hospital of the Air Force, PLA (the Chinese People's Liberation Army), China
| | - Wei Liu
- Department of Neurology, Geriatric Institute, the General Hospital of the Air Force, PLA (the Chinese People's Liberation Army), China
| | - Wen-Jin Du
- Department of Neurology, Geriatric Institute, the General Hospital of the Air Force, PLA (the Chinese People's Liberation Army), China
| | - Hua-Jun Li
- Department of Neurology, Geriatric Institute, the General Hospital of the Air Force, PLA (the Chinese People's Liberation Army), China
| | - Jin-Wen Chen
- Department of Neurology, Geriatric Institute, the General Hospital of the Air Force, PLA (the Chinese People's Liberation Army), China
| | - Wei Xu
- Department of Neurology, Geriatric Institute, the General Hospital of the Air Force, PLA (the Chinese People's Liberation Army), China
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Nadathur SG, Warren JR. Formal-Transfer In and Out of Stroke Care Units. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2011. [DOI: 10.4018/jhisi.2011070103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The positive impact of stroke care units (SCUs) on patient outcome has been previously reported. In this study, long-term stroke patients that are formally admitted to teaching-hospitals are compared with and without SCUs. The authors focus on the patients’ experience with ongoing care or formal transfers following current care as this cohort is often high users of the system with associated high costs. Bayesian Networks were employed to analyze routinely collected public-hospital administrative data. The results illustrate that the teaching-hospitals with SCUs, while achieving shorter length of stay, in fact deal with younger patients with lower overall patient complexity than non-SCU teaching-hospitals. Other differences include SCUs predominantly treating subarachnoid hemorrhages whereas the non-SCUs treat more cerebral infarctions. This study illustrates the power of Bayesian Networks to expose the nature of caseload and outcomes recorded in hospital-administrative data as a means to gain insight on current practice and create opportunities for benchmarking and improving care.
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Bashir S, Mizrahi I, Weaver K, Fregni F, Pascual-Leone A. Assessment and modulation of neural plasticity in rehabilitation with transcranial magnetic stimulation. PM R 2011; 2:S253-68. [PMID: 21172687 DOI: 10.1016/j.pmrj.2010.10.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 10/20/2010] [Indexed: 01/21/2023]
Abstract
Despite intensive efforts to improve outcomes after acquired brain injury, functional recovery is often limited. One reason for this limitation is the challenge in assessing and guiding plasticity after brain injury. In this context, transcranial magnetic stimulation (TMS), a noninvasive tool of brain stimulation, could play a major role. TMS has been shown to be a reliable tool for measuring plastic changes in the motor cortex associated with interventions in the motor system, such as motor training and motor cortex stimulation. In addition, as illustrated by the experience in promoting recovery from stroke, TMS is a promising therapeutic tool to minimize motor, speech, cognitive, and mood deficits. In this review, we will focus on stroke to discuss how TMS can provide insights into the mechanisms of neurologic recovery and how it can be used for measurement and modulation of plasticity after an acquired brain insult.
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Affiliation(s)
- Shahid Bashir
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02215, USA
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