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Olszewska Z, Mirek E, Opoka-Kubica K, Szymon Pasiut SP, Filip M. Evaluating the Effects of Botulinum Toxin Injection and Physiotherapy on Post-Stroke Patients During One Year Observation - a Pilot Study. REHABILITACJA MEDYCZNA 2021. [DOI: 10.5604/01.3001.0015.5409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Stroke is a serious health problem in the modern population. Spasticity is one of the consequences of stroke and affects about 30% of people. Increased muscle tone affects postural control disorders. Due to the specificity of spasticity, therapy in post-stroke patients is a challenge for neurological physiotherapy. Therefore, it requires the development of appropriate management standards .
Study aim: The aim of the study was to evaluate the effectiveness of 3 combination therapy cycles based on botulinum toxin injection and physiotherapy for muscle tone, muscle strength and postural stability in post-stroke patients qualified for the spasticity treatment programme of the lower and upper limbs.
Material and methods: The pilot study involved 12 patients (6 from the lower limb and 6 from the upper limb programme). The 1-year combination therapy programmes included 3 botulinum toxin injections and 3 weeks of physiotherapy after each injection. Clinical evaluation was conducted before and after the 1-year observation cycle. The results were evaluated using: MAS (Modified Ashworth Scale), MRC (Medical Research Council Scale) and posture stability test on a balance platform (BiodexSD).
Results: A decrease was observed in muscle tone of the lower and upper limbs, as well as an increase in muscular strength of the upper limb. However, there were no noted statistical significance of the studied parameters.
Conclusions: Physiotherapy in combination with the botulinum toxin is an important element of improvement in post-stroke patients. However, further research is needed to explicitly confirm its effectiveness.
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Affiliation(s)
- Zuzanna Olszewska
- The Bogusław Frańczuk Orthopaedic and Rehabilitation Hospital in Kraków, Poland / Małopolski Szpital Ortopedyczno-Rehabilitacyjny im. Prof. Bogusława Frańczuka w Krakowie
| | - Elżbieta Mirek
- Department of Clinical Rehabilitation, Section of Rehabilitation in Neurology and Psychiatry, University of Physical Education in Kraków, Poland / Zakład Rehabilitacji w Neurologii i Psychiatrii, Wydział Rehabilitacji Ruchowej, Akademia AWF w Krakowie
| | - Kinga Opoka-Kubica
- Doctoral studies (Ph.D), Department of Physical Education, University of Physical Education in Kraków, Poland / Studia doktoranckie, AWF w Krakowie
| | - Szymon Pasiut Szymon Pasiut
- Department of Clinical Rehabilitation, Section of Rehabilitation in Neurology and Psychiatry, University of Physical Education in Kraków, Poland / Zakład Rehabilitacji w Neurologii i Psychiatrii, Wydział Rehabilitacji Ruchowej, Akademia AWF w Krakowie
| | - Magdalena Filip
- Department of Clinical Rehabilitation, Section of Rehabilitation in Neurology and Psychiatry, University of Physical Education in Kraków, Poland / Zakład Rehabilitacji w Neurologii i Psychiatrii, Wydział Rehabilitacji Ruchowej, Akademia AWF w Krakowie
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Suzuki ARCSY, Tsubakino S, Fujii H. Motor Function and Activities of Daily Living Recovery after Cardiogenic Internal Carotid Artery Infarction: A Retrospective Cohort study. J Stroke Cerebrovasc Dis 2021; 30:105734. [PMID: 33770642 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/27/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES this study determines recovery in physical activity and activities of daily living in the early stages after cardiogenic internal carotid artery infarction. MATERIALS AND METHODS this retrospective comfort study compares assessment data for 334 patients: 150 patients had atherosclerotic infarction (67 internal carotid artery, 87 middle cerebral artery) and 180 had cardiogenic infarction (32 internal carotid artery infarction, 148 middle cerebral artery). We used Brunnstrom recovery score, posture assessment scale for stroke, and functional independence measure. RESULTS on initial assessment, median Brunnstrom recovery for the cardiogenic internal carotid artery infarction group was I-II in the upper limb, I in the finger, I-II in the lower limb, and IV or higher in all other groups. The median Postural Assessment Scale for Stroke score for the cardiogenic internal carotid artery infarction group was 0; all other groups scored 14 or higher. The median Functional Independence Measure for the cardiogenic internal carotid artery infarction group was 18 (maximum of 100) and the median score for other infarct groups was 25-50 (maximum 126), with P < .01. After a month, final assessment results for the cardiogenic internal carotid artery infarction group were much lower than for the other groups. Only both internal carotid artery infarctions were compared. Atherosclerotic infarctions showed recovery across assessments, except understanding, onset, and memory (P < .01), and cardiogenic infarctions did not change from the initial assessment in all criteria assessed. CONCLUSIONS adapting cardiogenic internal carotid artery infarction as a stroke recovery model is difficult.
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Affiliation(s)
| | - Sachiko Tsubakino
- Division of Occupational Therapy, Yamagata City Hospital Saiseikan, 1-3-26 Nanukamachi, Yamagata 990-8533, Japan
| | - Hiromi Fujii
- Department of Occupational Therapy, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata 990-2212, Japan; Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata 990-2212, Japan
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Eating and Grooming Abilities Predict Outcomes in Patients with Early Middle Cerebral Infarction: A Retrospective Cohort Study. Occup Ther Int 2020; 2020:1374527. [PMID: 32536832 PMCID: PMC7267875 DOI: 10.1155/2020/1374527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022] Open
Abstract
Patients with cerebrovascular disorders are often forced to rest, with early prognosis made by bedside examination. However, overloading, for example, talking for a long time, may worsen the condition. We hypothesized that activities of daily living (ADL) from the Functional Independence Measure (FIM) that were actually performed regularly are useful to predict prognosis. The present study was aimed at determining the predictive items related to predicting prognosis from the status of early motor paralysis and ADL in patients with acute middle cerebral artery (MCA) infarction. We examined 367 patients with MCA infarction for Brunnstrom recovery stage (BRS) and FIM within 4 days of admission and modified the Rankin Scale before onset and just before discharge. Logistic regression analysis was used to compare two groups of patients based on their postdischarge destination (Home/another hospital or facility). The logistic regression analysis showed the following: BRS Hand: odds ratio (OR) 1.641 (95% CI 1.642 (1.336–2.017), p < 0.001); FIM Grooming: OR 1.279 (95% CI 1.220–1.807, p < 0.001); and FIM Eating: OR 1.280 (95% CI 1.102–1.488, p < 0.001). On the other hand, the ROC analysis showed the ROC area for Eating to be 0.830 (95% CI 0.787–0.874), for Grooming to be 0.81 (95% CI 0.765–0.865), and for BRS Hand to be 0.805 (95% CI 0.760–0.851). The BRS Hand and FIM Eating and Grooming domains were identified as predictive factors using the following cutoff points: BRS Hand stage V and FIM scores of 5 for Eating and 4 for Grooming. The cutoff points for the BRS Hand and FIM Eating revealed that, at a minimum, such patients can use the nonaffected hand. The presence of cognitive dysfunction or dysphagia affects these domains. Therefore, these results suggested that Eating and Grooming are appropriate as evaluation items.
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Lai YJ, Hanneman SK, Casarez RL, Wang J, McCullough LD. Blood biomarkers for physical recovery in ischemic stroke: a systematic review. Am J Transl Res 2019; 11:4603-4613. [PMID: 31497186 PMCID: PMC6731415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/11/2019] [Indexed: 06/10/2023]
Abstract
Stroke is a common cause of physical disability. Biomarkers have been used to predict prognosis in ischemic stroke, but studies linking biomarkers to physical recovery from ischemic stroke have not been systematically evaluated since 2011. The purpose of this paper is to report the findings of a systematic review of the intervening literature to identify potential predictive biomarkers for recovery of physical function following ischemic stroke. The PubMed, Embase, and CINAHL databases were searched for studies reported between January 1, 2011, and September 18, 2018. Search criteria were adult ischemic stroke patients, blood sample collection within 24 ± 6 hrs of stroke onset, and outcome measures, including physical function. Identified from 18 studies and representing four biological classifications, 34 biomarkers were significantly associated with physical recovery after ischemic stroke: (1) immune response (15, 44%); (2) lipids/metabolism (4, 12%); (3) neuronal function (4, 12%); and (4) blood vessel/circulation (11, 32%). Of the predictive biomarkers associated with 1-month recovery, 60% (6 of 10) was classified into blood vessel/circulation; 54% (14 of 26) of the biomarkers associated with 3-6 month physical recovery involved the immune response. Blood biomarkers might provide useful information to improve the prediction of physical outcome after ischemic stroke. The data suggest that biomarkers from four biological classifications may predict physical recovery in patients after ischemic stroke.
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Affiliation(s)
- Yun-Ju Lai
- Cizik School of Nursing, University of Texas Health Science Center at HoustonHouston, TX 77030, USA
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at HoustonHouston, TX 77030, USA
| | - Sandra K Hanneman
- Cizik School of Nursing, University of Texas Health Science Center at HoustonHouston, TX 77030, USA
| | - Rebecca L Casarez
- Cizik School of Nursing, University of Texas Health Science Center at HoustonHouston, TX 77030, USA
| | - Jing Wang
- School of Nursing, University of Texas Health Science Center at San AntonioSan Antonio, TX 78229, USA
| | - Louise D McCullough
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at HoustonHouston, TX 77030, USA
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[Top-down and bottom-up approaches for the treatment of unilateral spatial neglect in stroke patients: A systematic review]. Rehabilitacion (Madr) 2019; 53:93-103. [PMID: 31186102 DOI: 10.1016/j.rh.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of top-down and bottom-up approaches in the rehabilitation of unilateral spatial neglect in stroke patients. METHODOLOGY We carried out a systematic review of randomized controlled trials from January of 2013 to March of 2017. The following databases were searched: Scopus, Science Direct, Web of Science, Pubmed and CINHAL. The methodological quality, level of scientific evidence and the strength of recommendation were evaluated. RESULTS We included 13 studies (294 subjects): nine studies (188 patients) carried out therapies with a bottom-up approach such us eye patching, virtual reality, optokinetic stimulation, transcranial magnetic stimulation and prism adaption; three studies (94 patients) evaluated therapies with a top-down approach such us visual scanning, sensory feedback and mental practice; one study incorporated both approaches. Nine of these studies showed improvements in spatial neglect scales; five of these used bottom-up approaches, another three used top-down approaches and the remaining study combined both approaches. Disability was evaluated by nine studies, and only three reported improvements. Three studies reported significant improvements in motor function in the intervention groups. CONCLUSIONS Top-down and bottom-up approaches could improve unilateral spatial neglect, disability and motor function in patients with stroke.
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Farzadfard MT, Sheikh Andalibi MS, Thrift AG, Morovatdar N, Stranges S, Amiri A, Kapral MK, Behrouz R, Juibary AG, Mokhber N, Azarpazhooh MR. Long-term disability after stroke in Iran: Evidence from the Mashhad Stroke Incidence Study. Int J Stroke 2018; 14:44-47. [DOI: 10.1177/1747493018789839] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Accurate information about disability rate after stroke remains largely unclear in many countries. Population-based studies are necessary to estimate the rate and determinants of disability after stroke. Methods Patients were recruited from the Mashhad Stroke Incidence Study and followed for five years after their index event. Disability was measured using the modified Rankin scale and functional dependency was measured using the Barthel index. Results Among 684 patients registered in this study, 624 were first-ever strokes. In total, 69.0% (n = 409) of patients either died or remained disabled at five-year follow-up. Among the first-ever stroke survivors, 18.5% (n = 69) at one year and 15.9% (n = 31) at five years required major assistance in their daily activities. Patients with a history of stroke (before the study period) compared with first-ever strokes were more likely to be disabled at one year (modified Rankin scale>2 in 40.0% vs. 19.1%; P < 0.001). Advanced age, severity of stroke at the time of admission, diabetes mellitus, and educational level (<12 years) were independently associated with greater disability and functional dependency. Conclusion We found that significant disability and functional dependency after stroke in Northeast Iran were largely attributable to the effects of stroke severity and prior dependency.
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Affiliation(s)
- Mohammad Taghi Farzadfard
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | | | - Amanda G Thrift
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Negar Morovatdar
- Clinical Research Unit, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Saverio Stranges
- Department of Epidemiology & Biostatistics, Western University, London, Canada
- Department of Family Medicine, Western University, London, Canada
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Amin Amiri
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Moira K Kapral
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Reza Behrouz
- Department of Neurology, Lozano-Long School of Medicine, University of Texas Health, San Antonio, TX, USA
| | - Ali Ghabeli Juibary
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Naghmeh Mokhber
- Department of Psychiatry & Behavioral Neurosciences, Western University, London, Canada
- Department of Psychiatry, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Mahmoud Reza Azarpazhooh
- Department of Epidemiology & Biostatistics, Western University, London, Canada
- Department of Clinical Neurological Science, University Hospital, Western University, London, Canada
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