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Rajamanickam G, Lee ATH, Liao P. Role of Brain Derived Neurotrophic Factor and Related Therapeutic Strategies in Central Post-Stroke Pain. Neurochem Res 2024:10.1007/s11064-024-04175-z. [PMID: 38856889 DOI: 10.1007/s11064-024-04175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/08/2024] [Accepted: 05/22/2024] [Indexed: 06/11/2024]
Abstract
Brain-derived neurotrophic factor (BDNF) is vital for synaptic plasticity, cell persistence, and neuronal development in peripheral and central nervous systems (CNS). Numerous intracellular signalling pathways involving BDNF are well recognized to affect neurogenesis, synaptic function, cell viability, and cognitive function, which in turn affects pathological and physiological aspects of neurons. Stroke has a significant psycho-socioeconomic impact globally. Central post-stroke pain (CPSP), also known as a type of chronic neuropathic pain, is caused by injury to the CNS following a stroke, specifically damage to the somatosensory system. BDNF regulates a broad range of functions directly or via its biologically active isoforms, regulating multiple signalling pathways through interactions with different types of receptors. BDNF has been shown to play a major role in facilitating neuroplasticity during post-stroke recovery and a pro-nociceptive role in pain development in the nervous system. BDNF-tyrosine kinase receptors B (TrkB) pathway promotes neurite outgrowth, neurogenesis, and the prevention of apoptosis, which helps in stroke recovery. Meanwhile, BDNF overexpression plays a role in CPSP via the activation of purinergic receptors P2X4R and P2X7R. The neuronal hyperexcitability that causes CPSP is linked with BDNF-TrkB interactions, changes in ion channels and inflammatory reactions. This review provides an overview of BDNF synthesis, interactions with certain receptors, and potential functions in regulating signalling pathways associated with stroke and CPSP. The pathophysiological mechanisms underlying CPSP, the role of BDNF in CPSP, and the challenges and current treatment strategies targeting BDNF are also discussed.
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Affiliation(s)
- Gayathri Rajamanickam
- Calcium Signalling Laboratory, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Andy Thiam Huat Lee
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Ping Liao
- Calcium Signalling Laboratory, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Li Z, Guo H, Yuan Y, Liu X. The effect of moderate and vigorous aerobic exercise training on the cognitive and walking ability among stroke patients during different periods: A systematic review and meta-analysis. PLoS One 2024; 19:e0298339. [PMID: 38394189 PMCID: PMC10889575 DOI: 10.1371/journal.pone.0298339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE The study examined whether rehabilitation using aerobic exercise is more appropriate for patients less than 3 months post-stroke or more appropriate for patients more than 3 months post-stroke. METHOD PubMed, Embase, Web of Science, Scopus and CNKI databases were searched from inception to September 2023. All studies included must be written in English and grey literature was excluded. The quality of the study was evaluated using the PEDro scale. Standard mean difference (SMD) and 95% confidence interval (CI) were calculated. The primary outcomes are cognitive ability and walking ability. The intervention of the experimental group must be or include high-intensity aerobic training or moderate-intensity aerobic training. In addition, we required low intensity routine exercises in control group. RESULT Only 15 studies were included in this meta-analysis. The results showed that aerobic exercise has a positive rehabilitation effect on cognitive and walking ability of stroke patients. Global Cognitive Function (SMD = 0.81 95%CI 0.49-1.12), Walking Capacity (SMD = 1.19, 95%CI 0.75-1.62), VO2peak (SMD = 0.97, 95%CI 0.66-1.28), and brain-derived neurotrophic factor (SMD = 2.73, 95%CI 2.03-3.43). We further observed that patients who suffered a stroke within the past three months exhibited superior rehabilitation outcomes compared to patients who suffered a stroke more than three months ago, specifically in terms of cognitive ability, walking tests, and cardiopulmonary function. CONCLUSIONS It is recommended to carry out treatment for patients in the initial stage of stroke, and it is required to pay attention to exercise intensity in the process of treatment to ensure patient safety.
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Affiliation(s)
- Zecheng Li
- College of Sports Science, Harbin Normal University, Harbin, China
| | - Hongpeng Guo
- College of Sports Science, Harbin Normal University, Harbin, China
| | - Yuan Yuan
- College of Medical Information Engineering, Shandong First Medical University, Tai'an, China
| | - Xuebin Liu
- College of Sports Science, Harbin Normal University, Harbin, China
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Pereira TA, de Oliveira MPB, Serrão PRMDS, Tsen C, Coutinho NB, Letieri RV, Santos ATS, Reis LMD. Effect of lower limb resistance training on ICF components in chronic stroke: A systematic review and meta-analysis of RCTs. Ann Phys Rehabil Med 2023; 66:101766. [PMID: 37883831 DOI: 10.1016/j.rehab.2023.101766] [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: 11/13/2022] [Revised: 03/02/2023] [Accepted: 04/23/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Resistance training (RT) effectively promotes functional independence after stroke. OBJECTIVES To investigate the effect of lower limb RT on body structure and function (muscle strength, postural balance), activity (mobility, gait) and participation (quality of life, impact of stroke on self-perceived health) outcomes in individuals with chronic stroke. METHODS Six databases were searched from inception until September 2022 for randomized controlled trials comparing lower limb RT to a control intervention. The random-effects model was used in the meta-analyses. Effect sizes were reported as standardized mean differences (SMD). Quality of evidence was assessed using the GRADE approach. RESULTS Fourteen studies were included. Significant improvements were found in body structure and function after lower limb RT: knee extensors (paretic side - SMD: 1.27; very low evidence), knee flexors (paretic side - SMD: 0.51; very low evidence; non-paretic side - SMD: 0.52; low evidence), leg press (paretic side - SMD: 0.83; very low evidence) and global lower limb muscle strength (SMD: -1.47; low evidence). No improvement was found for knee extensors (p = 0.05) or leg press (p = 0.58) on the non-paretic side. No improvements were found in the activity domain after lower limb RT: mobility (p = 0.16) and gait (walking speed-usual: p = 0.17; walking speed-fast: p = 0.74). No improvements were found in the participation domain after lower limb RT: quality of life (p > 0.05), except the bodily pain dimension (SMD: 1.02; low evidence) or the impact of stroke on self-perceived health (p = 0.38). CONCLUSION Lower limb RT led to significant improvements in the body structure and function domain (knee extensors and flexors, leg press, global lower limb muscle strength) in individuals with chronic stroke. No improvements were found in the activity (mobility, gait [walking speed]) or participation (quality of life, impact of stroke on self-perceived health) domains. PROSPERO REGISTRATION NUMBER CRD42021272645.
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Affiliation(s)
- Tales Andrade Pereira
- Department of Physical Therapy, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Marcos Paulo Braz de Oliveira
- Healthy Aging Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Paula Regina Mendes da Silva Serrão
- Rheumatology and Hand Rehabilitation Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Carolina Tsen
- Healthy Aging Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | - Rubens Vinícius Letieri
- Department of Physical Education, Federal University of North Tocantins, Araguaia, Tocantins, Brazil
| | | | - Luciana Maria Dos Reis
- Department of Physical Therapy, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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Hu Y, Qiu X, Ji C, Wang F, He M, He L, Chen L. Post-stroke experiences and health information needs among Chinese elderly ischemic stroke survivors in the internet environment: a qualitative study. Front Psychol 2023; 14:1150369. [PMID: 37663326 PMCID: PMC10471187 DOI: 10.3389/fpsyg.2023.1150369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background Elderly stroke survivors are encouraged to receive appropriate health information to prevent recurrences. After discharge, older patients seek health information in everyday contexts, examining aspects that facilitate or impair healthy behavior. Objectives To explore the experiences of older stroke patients when searching for health information, focusing on search methods, identification of health information, and difficulties faced during the search process. Methods Using the qualitative descriptive methodology, semi-structured interviews were conducted with fifteen participants. Results Participants associated the health information they sought with concerns about future life prospects triggered by perceived intrusive changes in their living conditions. Based on the participants' descriptions, four themes were refined: participants' motivation to engage in health information acquisition behavior, basic patterns of health information search, source preferences for health information, and difficulties and obstacles in health information search, and two search motivation subthemes, two search pattern subthemes, four search pathway subthemes, and four search difficulty subthemes were further refined. Conclusion Older stroke patients face significant challenges in searching for health information online. Healthcare professionals should assess survivors' health information-seeking skills, develop training programs, provide multichannel online access to health resources, and promote secondary prevention for patients by improving survivors' health behaviors and self-efficacy.
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Affiliation(s)
- Yufan Hu
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xichenhui Qiu
- Health Science Center, Shenzhen University, Shenzhen, China
| | - Cuiling Ji
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Fang Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Manlan He
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Lei He
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Lu Chen
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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Muñoz-Tomás MT, Burillo-Lafuente M, Vicente-Parra A, Sanz-Rubio MC, Suarez-Serrano C, Marcén-Román Y, Franco-Sierra MÁ. Telerehabilitation as a Therapeutic Exercise Tool versus Face-to-Face Physiotherapy: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4358. [PMID: 36901375 PMCID: PMC10002129 DOI: 10.3390/ijerph20054358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED Digital physiotherapy, often referred to as "Telerehabilitation", consists of applying rehabilitation using telecommunication technologies. The objective is to evaluate the effectiveness of therapeutic exercise when it is telematically prescribed. METHODS We searched PubMed, Embase, Scopus, SportDiscus and PEDro (30 December 2022). The results were obtained by entering a combination of MeSH or Emtree terms with keywords related to telerehabilitation and exercise therapy. RCTs on patients over 18 years and two groups were included, one working with therapeutic exercise through telerehabilitation and one working with conventional physiotherapy group. RESULTS a total of 779 works were found. However, after applying the inclusion criteria, only 11 were selected. Telerehabilitation is most frequently used to treat musculoskeletal, cardiac and neurological pathologies. The preferred telerehabilitation tools are videoconferencing systems, telemonitoring and online platforms. Exercise programs ranged from 10 to 30 min and were similar in both intervention and control groups. In all the studies, results proved to be similar for telerehabilitation and face-to-face rehabilitation in both groups when measuring functionality, quality of life and satisfaction. CONCLUSION this review generally concludes that intervention through telerehabilitation programs is as feasible and efficient as conventional physiotherapy in terms of functionality level and quality of life. In addition, telerehabilitation shows high levels of patients' satisfaction and adherence, being values equivalent to traditional rehabilitation.
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Affiliation(s)
| | | | | | - Mª Concepción Sanz-Rubio
- Physiotherapy Primary Care, Department of Nursing, Physiotherapy and Occupational Therapy, University of Zaragoza, 50009 Zaragoza, Spain
| | | | - Yolanda Marcén-Román
- Department of Anatomy and Human Embryology, IIS Aragón, University of Zaragoza, 50009 Zaragoza, Spain
| | - Mª Ángeles Franco-Sierra
- Department of Nursing, Physiotherapy and Occupational Therapy, IIS Aragón, University of Zaragoza, 50009 Zaragoza, Spain
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Zhang Y, Qiu X, Jin Q, Ji C, Yuan P, Cui M, Zhang J, Chen L. Influencing factors of home exercise adherence in elderly patients with stroke: A multiperspective qualitative study. Front Psychiatry 2023; 14:1157106. [PMID: 37091695 PMCID: PMC10113471 DOI: 10.3389/fpsyt.2023.1157106] [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] [Received: 02/02/2023] [Accepted: 03/06/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Evidence has shown that stroke exercise rehabilitation is the most effective way to improve disease prognosis, but home exercise adherence in elderly patients with stroke is low due to they are more likely to have movement disorders, cognitive disorders, mental disorders, etc. Currently, most studies on exercise adherence in elderly patients with stroke are quantitative, and there is a lack of qualitative studies from the perspective of patients, caregivers, and medical staff. Considering the importance of home exercise adherence in elderly patients with stroke, the present study aimed to explore the influencing factors of home exercise adherence in them and summarize the potential ways to improve it. Methods From October to December 2022, 9 medical staff, 12 elderly patients with stroke and 7 caregivers from a level A tertiary hospital and community health service center in Nanjing, Jiangsu Province were selected by the purposive sampling and were interviewed in a face-to-face semi-structured way. The data were analyzed and summarized by the phenomenological analysis of Colaizzi's method. Results The influencing factors of home exercise adherence in elderly patients with stroke can be summarized into 3 themes and 8 subthemes. These were individual factors (physical impairment, exercise self-efficacy, and depression), family factors (caregiving ability and emotional support); and stroke rehabilitation environment (exercise prescription, monitoring and feedback, and organizational policy). Conclusion Home exercise adherence in elderly patients with stroke was influenced by many factors. Medical staff should assess the patient's physical function and depression, establish a multi-support system, formulate personalized exercise prescription, pay attention to the monitoring and feedback of home-based exercise rehabilitation, and improve the home-based rehabilitation model for stroke, so as to improve the home exercise adherence in elderly patients with stroke and promote the best rehabilitation effect.
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Affiliation(s)
- Yuanxing Zhang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xichenhui Qiu
- Health Science Center, Shenzhen University, Shenzhen, China
| | - Qiansheng Jin
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Cuiling Ji
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ping Yuan
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Mengjiao Cui
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Juanjuan Zhang
- Department of Dermatology, Liuyang Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Hunan University of Chinese Medicine, Changsha, Hunan, China
- *Correspondence: Juanjuan Zhang,
| | - Lu Chen
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Lu Chen,
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