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Ruscu M, Glavan D, Surugiu R, Doeppner TR, Hermann DM, Gresita A, Capitanescu B, Popa-Wagner A. Pharmacological and stem cell therapy of stroke in animal models: Do they accurately reflect the response of humans? Exp Neurol 2024; 376:114753. [PMID: 38490317 DOI: 10.1016/j.expneurol.2024.114753] [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: 11/19/2023] [Revised: 02/22/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
Cerebrovascular diseases are the second leading cause of death worldwide. Despite significant research investment, the only available therapeutic options are mechanical thrombectomy and tissue plasminogen activator thrombolysis. None of the more than a thousand drugs tested on animal models have proven successful in human clinical trials. Several factors contribute to this poor translation of data from stroke-related animal models to human stroke patients. Firstly, our understanding of the molecular and cellular processes involved in recovering from an ischemic stroke is severely limited. Secondly, although the risk of stroke is particularly high among older patients with comorbidities, most drugs are tested on young, healthy animals in controlled laboratory conditions. Furthermore, in animal models, the tracking of post-stroke recovery typically spans only 3 to 28 days, with occasional extensions to 60 days, whereas human stroke recovery is a more extended and complex process. Thirdly, young animal models often exhibit a considerably higher rate of spontaneous recovery compared to humans following a stroke. Fourth, only a very limited number of animals are utilized for each condition, including control groups. Another contributing factor to the much smaller beneficial effects in humans is that positive outcomes from numerous animal studies are more readily accepted than results reported in human trials that do not show a clear benefit to the patient. Useful recommendations for conducting experiments in animal models, with increased chances of translatability to humans, have been issued by both the STEPS investigative team and the STAIR committee. However, largely, due to economic factors, these recommendations are largely ignored. Furthermore, one might attribute the overall failures in predicting and subsequently developing effective acute stroke therapies beyond thrombolysis to potential design deficiencies in clinical trials.
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Affiliation(s)
- Mihai Ruscu
- Department of Neurology, University Hospital Essen, Essen 45147, Germany; Department of Psychiatry, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; Department of Neurology, University of Giessen Medical School, 35392 Giessen, Germany
| | - Daniela Glavan
- Department of Psychiatry, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Roxana Surugiu
- Department of Psychiatry, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; Department of Neurology, University Medical Center Göttingen, Göttingen 37075, Germany
| | - Thorsten R Doeppner
- Department of Neurology, University Medical Center Göttingen, Göttingen 37075, Germany; Department of Neurology, University of Giessen Medical School, 35392 Giessen, Germany
| | - Dirk M Hermann
- Department of Neurology, University Hospital Essen, Essen 45147, Germany
| | - Andrei Gresita
- Department of Biomedical Sciences, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY 115680-8000, USA
| | - Bogdan Capitanescu
- Department of Psychiatry, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; Department of Biomedical Sciences, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY 115680-8000, USA.
| | - Aurel Popa-Wagner
- Department of Psychiatry, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; Department of Biomedical Sciences, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY 115680-8000, USA.
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Droś J, Segiet N, Początek G, Klimkowicz-Mrowiec A. Five-year stroke prognosis. Influence of post-stroke delirium and post-stroke dementia on mortality and disability (Research Study - Part of the PROPOLIS Study). Neurol Sci 2024; 45:1109-1119. [PMID: 37851292 PMCID: PMC10858086 DOI: 10.1007/s10072-023-07129-5] [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: 05/31/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION With increasing life expectancy and the rising incidence of stroke in young adults, it is important to know the long-term prognosis of this condition. Post-stroke delirium and post-stroke dementia are common complications of stroke that negatively affect prognosis. The purpose of this study was to evaluate five-year mortality from stroke and to assess the influence of post-stroke delirium and post-stroke dementia on mortality and disability over the five-year period. METHODS Consecutive patients admitted to the stroke unit for acute stroke or transient ischemic attacks were screened for in-hospital delirium. At the three- and twelve-month follow-up, the same patients underwent neurocognitive testing. Diagnoses of in-hospital delirium and dementia after three and twelve months based on DSM-5 criteria. Five years after stroke surviving patients were reevaluated. Outcome assessment included place of stay, current functional status assessed by the modified Rankin Scale (mRS), or death. RESULTS At the five-years of follow-up, data were collected from 575 of 750 patients originally included in the study (76.67%). The mortality rate was 51.65%. In-hospital post-stroke delirium and post-stroke dementia diagnosed three and twelve months after stroke were independent risk factors for death and an increase in mRS score of ≥ 1 or ≥ 2 points. There was no significant association with institutionalization rate. CONCLUSIONS More than half of post-stroke patients die within five years of follow-up. Post-stroke delirium and post-stroke dementia are associated with an increased risk of death and disability.
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Affiliation(s)
- Jakub Droś
- Doctoral School in Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Natalia Segiet
- Doctoral School in Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Gabriela Początek
- The Doctoral School of the Medical University of Silesia, Katowice, Poland
| | - Aleksandra Klimkowicz-Mrowiec
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Ul. Jakubowskiego 2, 30-688, Kraków, Poland.
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Kurniawan M, Mulya Saputri K, Mesiano T, Yunus RE, Permana AP, Sulistio S, Ginanjar E, Hidayat R, Rasyid A, Harris S. Efficacy of endovascular therapy for stroke in developing country: A single-centre retrospective observational study in Indonesia from 2017 to 2021. Heliyon 2024; 10:e23228. [PMID: 38192863 PMCID: PMC10772374 DOI: 10.1016/j.heliyon.2023.e23228] [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: 06/09/2022] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024] Open
Abstract
Background Indonesia as a developing nation faces a plethora of challenges in applying endovascular therapy (EVT), mostly due to the lack of physicians specialized in neuro-intervention, high operational cost, and time limitation. The efficacy of EVT in improving functional outcomes of stroke in developing countries has not been previously studied. Methods This retrospective cohort study was conducted at Dr. Cipto Mangunkusumo Hospital (Jakarta, Indonesia) from January 2017 to December 2021. Large vessel occlusion (LVO) diagnosis was established based on a combination of clinical and imaging characteristics. We assessed patients' functional independence on day-90 based on modified Rankin Scale (mRS) between the endovascular treatment group and the conservative group (those receiving intravascular thrombolysis or medical treatment only). Functional independence was defined as mRS ≤2. Results Among 111 stroke patients with LVO, we included 32 patients in the EVT group and 50 patients in the conservative group for this study. Patients with younger age (p = 0.004), lower hypertension rate (p < 0.001), higher intubation rate (p = 0.014), and earlier onset of stroke were observed in the EVT group. The proportion of mRS ≤2 at day-90 in the EVT group was higher than the conservative group (28.1 % vs. 18.0 %; p = 0.280). Patients within mRS ≤2 group had earlier onset-to-puncture time (p = 0.198), onset-to-recanalization time (p = 0.341), lower NIHSS (p = 0.026) and higher ASPECTS (p = 0.001) on admission. In multivariate analysis, ASPECTS (aOR 2.43; 95%CI 1.26-4.70; p = 0.008) defined functional independence in the EVT group. Conclusion The endovascular therapy group had a higher proportion of mRS ≤2 at day-90 than the conservative group despite its statistical insignificance.
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Affiliation(s)
- Mohammad Kurniawan
- Department of Neurology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kevin Mulya Saputri
- Department of Neurology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Taufik Mesiano
- Department of Neurology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Reyhan E. Yunus
- Department of Radiology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Affan P. Permana
- Department of Neurosurgery, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Septo Sulistio
- Department of Emergency Medicine, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Eka Ginanjar
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rakhmad Hidayat
- Department of Neurology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Al Rasyid
- Department of Neurology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Salim Harris
- Department of Neurology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Vimolratana O, Aneksan B, Siripornpanich V, Hiengkaew V, Prathum T, Jeungprasopsuk W, Khaokhiew T, Vachalathiti R, Klomjai W. Effects of anodal tDCS on resting state eeg power and motor function in acute stroke: a randomized controlled trial. J Neuroeng Rehabil 2024; 21:6. [PMID: 38172973 PMCID: PMC10765911 DOI: 10.1186/s12984-023-01300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Anodal transcranial direct current stimulation (tDCS) is a beneficial adjunctive tool in stroke rehabilitation. However, only a few studies have investigated its effects on acute stroke and recruited only individuals with mild motor deficits. This study investigated the effect of five consecutive sessions of anodal tDCS and conventional physical therapy on brain activity and motor outcomes in individuals with acute stroke, with low and high motor impairments. METHODS Thirty participants were recruited and randomly allocated to either the anodal or sham tDCS group. Five consecutive sessions of tDCS (1.5 mA anodal or sham tDCS for 20 min) were administered, followed by conventional physical therapy. Electroencephalography (EEG), Fugl-Meyer Motor Assessment (FMA), and Wolf Motor Function Test (WMFT) were performed at pre-, post-intervention (day 5), and 1-month follow-up. Sub-analyses were performed on participants with low and high motor impairments. The relationship between EEG power and changes in motor functions was assessed. RESULTS Linear regression showed a significant positive correlation between beta bands and the FMA score in the anodal group. Elevated high frequency bands (alpha and beta) were observed at post-intervention and follow-up in all areas of both hemispheres in the anodal group, while only in the posterior area of the non-lesioned hemisphere in the sham group; however, such elevation induced by tDCS was not greater than sham. Lower limb function assessed by FMA was improved in the anodal group compared with the sham group at post-intervention and follow-up only in those with low motor impairment. For the upper limb outcomes, no difference between groups was found. CONCLUSIONS Five consecutive days of anodal tDCS and physical therapy in acute stroke did not result in a superior improvement of beta bands that commonly related to stroke recovery over sham, but improved lower extremity functions with a post-effect at 1-month follow-up in low motor impairment participants. The increase of beta bands in the lesioned brain in the anodal group was associated with improvement in lower limb function. TRIAL REGISTRATION NCT04578080, date of first registration 10/01/2020.
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Affiliation(s)
- O Vimolratana
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
- Neuro Electrical Stimulation Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
- School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, 57100, Thailand
| | - B Aneksan
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
- Neuro Electrical Stimulation Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - V Siripornpanich
- Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - V Hiengkaew
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
| | - T Prathum
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
- Neuro Electrical Stimulation Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - W Jeungprasopsuk
- Faculty of Medical Technology, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - T Khaokhiew
- Faculty of Medical Technology, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - R Vachalathiti
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
| | - W Klomjai
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand.
- Neuro Electrical Stimulation Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand.
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Wrzeciono A, Cieślik B, Kiper P, Szczepańska-Gieracha J, Gajda R. Exploratory analysis of the effectiveness of virtual reality in cardiovascular rehabilitation. Sci Rep 2024; 14:281. [PMID: 38168468 PMCID: PMC10762219 DOI: 10.1038/s41598-023-50788-9] [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: 06/13/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
Virtual reality therapy has been shown to be effective in coping with psychological disorders accompanied by cardiovascular disease. Age appears to be a factor that can affect the effectiveness of psychological therapy in a virtual environment. Therefore, the aim of the study was to explore whether there are age-related differences in the effectiveness of reducing levels of depression and anxiety during a virtual reality psychological intervention implemented for rehabilitation. The study included 25 younger (< 65 years) and 25 older (65 +) patients with cardiovascular disease who participated in virtual reality therapy to cope with anxiety and depression. The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive disorders before and after intervention. Significant reductions in anxiety and depression scores after intervention were observed in both age-matched groups, and no significant differences were found between the younger and older participants. Further evaluation of patient age as a predictor of the effectiveness of psychological intervention in virtual reality did not show a significant effect of age on effectiveness in reducing anxiety and depressive disorders. The results obtained suggest that older patients benefit similarly to younger patients from psychological intervention in a virtual environment. Furthermore, age does not appear to be considered a predictor of effectiveness in reducing the level of anxiety and depression in patients with cardiovascular disease using virtual reality therapy.
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Affiliation(s)
- Adam Wrzeciono
- Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612, Wroclaw, Poland
| | - Błażej Cieślik
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126, Venezia, Italy.
| | - Paweł Kiper
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126, Venezia, Italy
| | | | - Robert Gajda
- Gajda-Med District Hospital, 06-100, Pultusk, Poland
- Department of Kinesiology and Health Prevention, Jan Dlugosz University, 42-200, Czestochowa, Poland
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Wang R, Huang J, Mohseni A, Hoseinyazdi M, Kotha A, Hamam O, Gudenkauf J, Heo HY, Nabi M, Huang J, Gonzalez F, Ansari G, Radmard M, Luna L, Caplan J, Xu R, Yedavalli V. Predictors of mTICI 2c/3 over 2b in patients successfully recanalized with mechanical thrombectomy. Ann Clin Transl Neurol 2024; 11:89-95. [PMID: 37930267 PMCID: PMC10791022 DOI: 10.1002/acn3.51935] [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: 06/23/2023] [Revised: 09/21/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE For patients presenting with acute ischemic stroke (AIS) caused by large vessel occlusions (LVO), mechanical thrombectomy (MT) is the treatment standard of care in eligible patients. Modified Thrombolysis in Cerebral Infarction (mTICI) grades of 2b, 2c, and 3 are all considered successful reperfusion; however, recent studies have shown achieving mTICI 2c/3 leads to better outcomes than mTICI 2b. This study aims to investigate whether any baseline preprocedural or periprocedural parameters are predictive of achieving mTICI 2c/3 in successfully recanalized LVO patients. METHODS We conducted a retrospective multicenter cohort study of consecutive patients presenting with AIS caused by a LVO from 1 January 2017 to 1 January 2023. Baseline and procedural data were collected through chart review. Univariate and multivariate analysis were applied to determine significant predictors of mTICI 2c/3. RESULTS A total of 216 patients were included in the study, with 159 (73.6%) achieving mTICI 2c/3 recanalization and 57 (26.4%) achieving mTICI 2b recanalization. We found that a higher groin puncture to first pass time (OR = 0.976, 95%CI: 0.960-0.992, p = 0.004), a higher first pass to recanalization time (OR = 0.985, 95%CI: 0.972-0.998, p = 0.029), a higher admission NIHSS (OR = 0.949, 95%CI: 0.904-0.995, p = 0.031), and a lower age (OR = 1.032, 95%CI: 1.01-1.055, p = 0.005) were associated with a decreased probability of achieving mTICI 2c/3. INTERPRETATION A lower groin puncture to first pass time, a lower first pass to recanalization time, a lower admission NIHSS, and a higher age were independent predictors of mTICI 2c/3 recanalization.
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Affiliation(s)
- Richard Wang
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Jing Huang
- School of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Alireza Mohseni
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Meisam Hoseinyazdi
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Apoorva Kotha
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Omar Hamam
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Julie Gudenkauf
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Hye Young Heo
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Mehreen Nabi
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Judy Huang
- Department of NeurosurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Fernando Gonzalez
- Department of NeurosurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Golnoosh Ansari
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Mahla Radmard
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Licia Luna
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Justin Caplan
- Department of NeurosurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Risheng Xu
- Department of NeurosurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Vivek Yedavalli
- Department of Radiology and Radiological Sciences, Division of NeuroradiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
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Liu S, Zhang K, Li X, Li C, Peng M. Effects of the different intensities of task-oriented training on the upper extremity motor function and self-care ability of stroke survivors: study protocol for a multiarm parallel-group randomised controlled trial in a tertiary hospital in China. BMJ Open 2023; 13:e074106. [PMID: 38070930 PMCID: PMC10729097 DOI: 10.1136/bmjopen-2023-074106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/19/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Although task-oriented training (TOT) may provide added therapeutic value to stroke survivors, current TOT guidance offers insufficient advice on standardisation, particularly choices of intensity, for clinical practice. Therefore, this study aims to explore the effects of different intensities of TOT on motor function and self-care ability of stroke survivors. METHODS AND ANALYSIS This randomised controlled clinical trial will recruit 72 participants from a tertiary hospital, diagnosed with decreased self-care ability and upper limb motor dysfunction post-stroke. All participants will be randomly assigned to one of three experimental groups or the control group to undergo intervention for 8 weeks. The participants in the control group (n=18) will receive traditional occupational therapy, while those in the experimental groups will receive different intensities of TOT (50%, 75% and 100% intensity for groups A, B and C, respectively). This protocol designed a more innovative and optimised TOT programme to explore the optimal intensity of TOT on stroke survivors. The primary outcome is Canadian Occupational Performance Measure, and the secondary outcomes include Modified Barthel Index, Wolf Motor Function Test and Motor Activity Log. ETHICS AND DISSEMINATION The Second Affiliated Hospital of Hainan Medical University Ethics Committee approved the medical and ethical protocol for this study (LW2022015). All participants will sign an informed consent form. The results will be presented in scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2200056390.
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Affiliation(s)
- Shengfeng Liu
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Kai Zhang
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Xuecha Li
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Chunxiang Li
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Mengsi Peng
- Department of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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Bumbea AM, Rogoveanu OC, Turcu-Stiolica A, Pirici I, Cioroianu G, Stanca DI, Criciotoiu O, Biciusca V, Traistaru RM, Caimac DV. Management of Upper-Limb Spasticity Using Modern Rehabilitation Techniques versus Botulinum Toxin Injections Following Stroke. Life (Basel) 2023; 13:2218. [PMID: 38004358 PMCID: PMC10672122 DOI: 10.3390/life13112218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Our purpose is to emphasize the role of botulinum toxin in spasticity therapy and functional recovery in patients following strokes. Our retrospective study compared two groups, namely ischemic and hemorrhagic stroke patients. The study group (BT group) comprised 80 patients who received focal botulinum toxin as therapy for an upper limb with spastic muscle three times every three months. The control group (ES group) comprised 80 patients who received only medical rehabilitation consisting of electrostimulation and radial shockwave therapy for the upper limb, which was applied three times every three months. Both groups received the same stretching program for spastic muscles as a home training program. We evaluated the evolution of the patients using muscle strength, Ashworth, Tardieu, Frenchay, and Barthel scales. The analysis indicated a statistically significant difference between the two groups for all scales, with better results for the BT group (p < 0.0001 for all scales). In our study, the age at disease onset was an important prediction factor for better recovery in both groups but not in all scales. Better recovery was obtained for younger patients (in the BT group, MRC scale: rho = -0.609, p-value < 0.0001; Tardieu scale: rho = -0.365, p-value = 0.001; in the ES group, MRC scale: rho = -0.445, p-value < 0.0001; Barthel scale: rho = -0.239, p-value = 0.033). Our results demonstrated the effectiveness of botulinum toxin therapy compared with the rehabilitation method, showing a reduction of the recovery time of the upper limb, as well as an improvement of functionality and a reduction of disability. Although all patients followed a specific kinetic program, important improvements were evident in the botulinum toxin group.
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Affiliation(s)
- Ana Maria Bumbea
- Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, Petru Rares 2, 200349 Craiova, Romania; (A.M.B.); (O.C.R.)
| | - Otilia Constantina Rogoveanu
- Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, Petru Rares 2, 200349 Craiova, Romania; (A.M.B.); (O.C.R.)
| | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, Petru Rares 2, 200349 Craiova, Romania;
| | - Ionica Pirici
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, Petru Rares 2, 200349 Craiova, Romania
| | - George Cioroianu
- Doctoral School, University of Medicine and Pharmacy of Craiova, Petru Rares 2, 200349 Craiova, Romania;
| | - Diana Iulia Stanca
- Department of Neurology, University of Medicine and Pharmacy of Craiova, Petru Rares 2, 200349 Craiova, Romania;
| | - Oana Criciotoiu
- Department of Neurology, University of Medicine and Pharmacy of Craiova, Petru Rares 2, 200349 Craiova, Romania;
| | - Viorel Biciusca
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Petru Rares 2, 200349 Craiova, Romania;
| | - Rodica Magdalena Traistaru
- Medical Rehabilitation Department, Nursing Faculty, University of Medicine and Pharmacy, Petru Rares 2, 200349 Craiova, Romania; (R.M.T.); (D.V.C.)
| | - Danut Visarion Caimac
- Medical Rehabilitation Department, Nursing Faculty, University of Medicine and Pharmacy, Petru Rares 2, 200349 Craiova, Romania; (R.M.T.); (D.V.C.)
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Feitosa JA, Casseb RF, Camargo A, Brandao AF, Li LM, Castellano G. Graph analysis of cortical reorganization after virtual reality-based rehabilitation following stroke: a pilot randomized study. Front Neurol 2023; 14:1241639. [PMID: 37869147 PMCID: PMC10587561 DOI: 10.3389/fneur.2023.1241639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Stroke is the leading cause of functional disability worldwide. With the increase of the global population, motor rehabilitation of stroke survivors is of ever-increasing importance. In the last decade, virtual reality (VR) technologies for rehabilitation have been extensively studied, to be used instead of or together with conventional treatments such as physiotherapy or occupational therapy. The aim of this work was to evaluate the GestureCollection VR-based rehabilitation tool in terms of the brain changes and clinical outcomes of the patients. Methods Two groups of chronic patients underwent a rehabilitation treatment with (experimental) or without (control) complementation with GestureCollection. Functional magnetic resonance imaging exams and clinical assessments were performed before and after the treatment. A functional connectivity graph-based analysis was used to assess differences between the connections and in the network parameters strength and clustering coefficient. Results Patients in both groups showed improvement in clinical scales, but there were more increases in functional connectivity in the experimental group than in the control group. Discussion The experimental group presented changes in the connections between the frontoparietal and the somatomotor networks, associative cerebellum and basal ganglia, which are regions associated with reward-based motor learning. On the other hand, the control group also had results in the somatomotor network, in its ipsilateral connections with the thalamus and with the motor cerebellum, which are regions more related to a purely mechanical activity. Thus, the use of the GestureCollection system was successfully shown to promote neuroplasticity in several motor-related areas.
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Affiliation(s)
- Jamille Almeida Feitosa
- Gleb Wataghin Institute of Physics, University of Campinas – UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology – BRAINN, Campinas, Brazil
| | - Raphael Fernandes Casseb
- Brazilian Institute of Neuroscience and Neurotechnology – BRAINN, Campinas, Brazil
- Neuroimaging Laboratory, Department of Neurology, University of Campinas – UNICAMP, Campinas, Brazil
| | - Alline Camargo
- Neuroimaging Laboratory, Department of Neurology, University of Campinas – UNICAMP, Campinas, Brazil
| | - Alexandre Fonseca Brandao
- Gleb Wataghin Institute of Physics, University of Campinas – UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology – BRAINN, Campinas, Brazil
| | - Li Min Li
- Brazilian Institute of Neuroscience and Neurotechnology – BRAINN, Campinas, Brazil
- Neuroimaging Laboratory, Department of Neurology, University of Campinas – UNICAMP, Campinas, Brazil
| | - Gabriela Castellano
- Gleb Wataghin Institute of Physics, University of Campinas – UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology – BRAINN, Campinas, Brazil
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10
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Pluta R. The Dual Role of Autophagy in Postischemic Brain Neurodegeneration of Alzheimer's Disease Proteinopathy. Int J Mol Sci 2023; 24:13793. [PMID: 37762096 PMCID: PMC10530906 DOI: 10.3390/ijms241813793] [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: 08/16/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Autophagy is a self-defense and self-degrading intracellular system involved in the recycling and elimination of the payload of cytoplasmic redundant components, aggregated or misfolded proteins and intracellular pathogens to maintain cell homeostasis and physiological function. Autophagy is activated in response to metabolic stress or starvation to maintain homeostasis in cells by updating organelles and dysfunctional proteins. In neurodegenerative diseases, such as cerebral ischemia, autophagy is disturbed, e.g., as a result of the pathological accumulation of proteins associated with Alzheimer's disease and their structural changes. Postischemic brain neurodegeneration, such as Alzheimer's disease, is characterized by the accumulation of amyloid and tau protein. After cerebral ischemia, autophagy was found to be activated in neuronal, glial and vascular cells. Some studies have shown the protective properties of autophagy in postischemic brain, while other studies have shown completely opposite properties. Thus, autophagy is now presented as a double-edged sword with possible therapeutic potential in brain ischemia. The exact role and regulatory pathways of autophagy that are involved in cerebral ischemia have not been conclusively elucidated. This review aims to provide a comprehensive look at the advances in the study of autophagy behavior in neuronal, glial and vascular cells for ischemic brain injury. In addition, the importance of autophagy in neurodegeneration after cerebral ischemia has been highlighted. The review also presents the possibility of modulating the autophagy machinery through various compounds on the development of neurodegeneration after cerebral ischemia.
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Affiliation(s)
- Ryszard Pluta
- Department of Pathophysiology, Medical University of Lublin, 20-090 Lublin, Poland
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11
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Influence of Age on the Success of Neurorehabilitation. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2023. [DOI: 10.3390/ctn7010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
There is a general understanding that older adults suffering from a stroke have poorer outcomes and might benefit less from neurorehabilitation. This narrative review analyzes the conflicting evidence for the effect of aging on the success of neurorehabilitation after a stroke. While there is convincing evidence that functional outcomes are negatively impacted by age, functional gains made during rehabilitation are less clearly impacted, and the effect of age seems to be related to other factors such as prestroke independence and therapy intensity, as well as the population studied. There is no evidence that would justify withholding high-intensity neurorehabilitation on the sole basis of age.
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Direct Cell Reprogramming and Phenotypic Conversion: An Analysis of Experimental Attempts to Transform Astrocytes into Neurons in Adult Animals. Cells 2023; 12:cells12040618. [PMID: 36831283 PMCID: PMC9954435 DOI: 10.3390/cells12040618] [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: 11/29/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Central nervous system (CNS) repair after injury or disease remains an unresolved problem in neurobiology research and an unmet medical need. Directly reprogramming or converting astrocytes to neurons (AtN) in adult animals has been investigated as a potential strategy to facilitate brain and spinal cord recovery and advance fundamental biology. Conceptually, AtN strategies rely on forced expression or repression of lineage-specific transcription factors to make endogenous astrocytes become "induced neurons" (iNs), presumably without re-entering any pluripotent or multipotent states. The AtN-derived cells have been reported to manifest certain neuronal functions in vivo. However, this approach has raised many new questions and alternative explanations regarding the biological features of the end products (e.g., iNs versus neuron-like cells, neural functional changes, etc.), developmental biology underpinnings, and neurobiological essentials. For this paper per se, we proposed to draw an unconventional distinction between direct cell conversion and direct cell reprogramming, relative to somatic nuclear transfer, based on the experimental methods utilized to initiate the transformation process, aiming to promote a more in-depth mechanistic exploration. Moreover, we have summarized the current tactics employed for AtN induction, comparisons between the bench endeavors concerning outcome tangibility, and discussion of the issues of published AtN protocols. Lastly, the urgency to clearly define/devise the theoretical frameworks, cell biological bases, and bench specifics to experimentally validate primary data of AtN studies was highlighted.
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Gular K, Sivasubramanian V, Reddy RS, Tedla JS, Dixit S. The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15644. [PMID: 36497718 PMCID: PMC9738511 DOI: 10.3390/ijerph192315644] [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: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The trunk acts as proximal support with which limbs execute smooth and purposeful movement. Furthermore, as upper extremity functions are an integral component of daily living activities, exploring the association between trunk and upper extremity recovery will guide therapists in developing appropriate rehabilitation goals and interventions. The objectives of this study were to (1) assess the association between trunk and upper extremity recovery in the subacute stroke population and (2) assess the effect of trunk control on upper extremity impairment and function with age, gender, and duration of stroke as mediators using mediation analysis in subacute stroke individuals. METHODS This cross-sectional study included 54 subacute stroke participants with a mean age of 58.37 ± 6.11 years. The trunk impairment scale (TIS) assessed the trunk's stability, mobility, and coordination. The level of upper extremity impairment was evaluated using the Fugl-Meyer Assessment scale (FMA). The quality and quantity of upper limb motor functions were measured using the Wolf motor function test (WMFT). RESULTS The TIS exhibited moderate positive correlations with the FMA-UE, WMFT-time scale (TS), and WMFT-functional ability scale (FAS) at p < 0.001. The mediation analysis reported a profound mediation effect of post-stroke duration on the association of trunk and upper limb recovery. CONCLUSIONS The study results substantiated that trunk control significantly correlates with upper limb impairment and the quality and quantity of its use in the subacute stroke population. Post-stroke duration proved to mediate the association between trunk and upper limb recovery. Therefore, the assessment and intervention of trunk and upper extremity motor control considering the post-stroke duration is vital and should be incorporated in stroke rehabilitation aiming at functional independence.
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Affiliation(s)
- Kumar Gular
- Division of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar 608 002, India
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Viswanathan Sivasubramanian
- Division of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar 608 002, India
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
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Shin S, Lee Y, Chang WH, Sohn MK, Lee J, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Kim YH. Multifaceted Assessment of Functional Outcomes in Survivors of First-time Stroke. JAMA Netw Open 2022; 5:e2233094. [PMID: 36149652 PMCID: PMC9508656 DOI: 10.1001/jamanetworkopen.2022.33094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE Because stroke causes diverse functional deficits, understanding the long-term recovery pattern of each functional domain may inform prognosis and therapeutic strategies. OBJECTIVE To observe long-term changes in functional status and residual disability in survivors of first-time stroke. DESIGN, SETTING, AND PARTICIPANTS This cohort study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. Between August 2012 and May 2015, 7858 of 10 636 screened patients with first-time strokes from 9 district hospitals in Korea provided informed consent to participate. Data were analyzed from September 2021 through February 2022. EXPOSURE First-time stroke. MAIN OUTCOMES AND MEASURES Study data include multifaceted face-to-face functional assessments obtained at 8 to 9 points until 60 months after stroke onset. The Korean Mini-Mental State Examination (K-MMSE), Fugl-Meyer Assessment, Functional Ambulatory Category, American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, and Short Korean version of the Frenchay Aphasia Screening Test were performed from 7 days to 60 months after stroke. The Korean Modified Barthel Index was measured from 3 months to 60 months after stroke. RESULTS A total of 4443 patients (2649 men [59.62%]; mean [SD] age 62.13 [12.43] years) who underwent repeated functional assessments for 60 months after stroke (3508 patients with ischemic and 935 patients with hemorrhagic stroke) were included. Overall, functions plateaued between 12 and 18 months after stroke and declined after 30 months; for example, mean (SD) K-MMSE improved from 7 days (22.89 [7.89]) to 12 months (26.03 [5.48]) (P < .001), plateaued until 36 months (26.03 [5.84]), and decreased to 48 months (26.02 [5.82]) (P < .001). Interaction associations were found between time after stroke and age, stroke severity, and stroke type in functional assessment outcomes. For example, mean (SE) FMA for ages 65 years or younger vs older than 65 years was 81.64 (0.63) vs 80.69 (0.68) at 7 days and 91.28 (0.47) vs 88.46 (0.58) at 6 months (P for interaction < .001), and for IS vs HS, it was 84.46 (0.47) vs 69.02 (1.24) at 7 days and 91.20 (0.38) vs 85.51 (0.98) at 6 months (P for interaction < .001). Mean (SE) FMA was 94.39 (0.21) at 7 days and 97.57 (0.14) at 6 months for mild stroke, 44.69 (1.18) at 7 days and 70.43 (1.21) at 6 months for moderate stroke, and 13.22 (0.99) at 7 days and 48.07 (2.62) at 6 months for severe stroke (P for interaction < .001). Factors associated with activities of daily living independence at 60 months included older age (β per 1-year increase = -0.35; standard error [SE], 0.03; P < .001), male sex (β = 2.12; SE, 0.73; P = .004), and hemorrhagic stroke type (β vs ischemic stroke = 2.35; SE, 0.81; P = .004). CONCLUSIONS AND RELEVANCE This study found that long-term recovery patterns in multifaceted functional domains differed from one another and varied by patient age, stroke severity, and stroke type. Understanding the diversity of long-term functional recovery patterns and factors associated with these outcomes in survivors of stroke may help clinicians develop strategies for effective stroke care and rehabilitation.
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Affiliation(s)
- Seyoung Shin
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yaesuel Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju City, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Science and Technology, Department of Medical Devices Management and Research, Department of Digital Healthcare, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Kameyama Y, Ashizawa R, Honda H, Take K, Yoshizawa K, Yoshimoto Y. Sarcopenia affects Functional Independence Measure motor scores in elderly patients with stroke. J Stroke Cerebrovasc Dis 2022; 31:106615. [PMID: 35780719 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES There is no unified view of the relationship between sarcopenia and the activities of daily living (ADL) in stroke patients. This study aimed to determine whether sarcopenia affects the ADL in elderly patients with stroke. MATERIALS AND METHODS This case-control study included 472 stroke patients aged ≥ 65 years who were admitted to the convalescent rehabilitation ward. Sarcopenia was defined as a decrease in both the skeletal muscle mass index and handgrip strength, based on the Asian Working Group for Sarcopenia 2019 criteria cut-off, which was assessed on admission. ADL was assessed using the Functional Independence Measure-motor (FIM-m) score at discharge. The Charlson comorbidity index, Mini Nutritional Assessment-Short Form, Brunnstrom recovery stage of the upper limb, Brunnstrom recovery stage of the lower limb and total amount of rehabilitation during hospitalization were evaluated as confounding factors. To clarify whether sarcopenia affects the ADL in patients with stroke, we conducted a multiple regression analysis with the presence of sarcopenia as the independent variable and FIM-m at discharge as the objective variable. RESULTS The final analysis included 283 patients; among them, 163 (57.6%) patients had sarcopenia at the time of admission to the convalescent rehabilitation ward. In the multiple regression analysis, sarcopenia was independently associated with FIM-m at hospital discharge, even after adjusting for confounders (β = -0.100, p = 0.034). CONCLUSIONS Sarcopenia at admission in elderly patients with stroke affected the FIM-m at discharge, even after adjusting for multiple confounders.
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Affiliation(s)
- Yuto Kameyama
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8511, Japan; Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu 433-8558, Japan.
| | - Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Hamamatsu 433-8558, Japan
| | - Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu 433-8558, Japan; Department of Rehabilitation, Hanadaira Care Center, Hamamatsu 431-2211, Japan
| | - Koki Take
- Visiting Nurse Station Takaoka, Seirei Care Center Takaoka, Hamamatsu 433-8117, Japan
| | - Kohei Yoshizawa
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8511, Japan; Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu 433-8558, Japan
| | - Yoshinobu Yoshimoto
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu 433-8558, Japan
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Zhou J, Liu F, Zhou M, Long J, Zha F, Chen M, Li J, Yang Q, Zhang Z, Wang Y. Functional status and its related factors among stroke survivors in rehabilitation departments of hospitals in Shenzhen, China: a cross-sectional study. BMC Neurol 2022; 22:173. [PMID: 35546388 PMCID: PMC9092870 DOI: 10.1186/s12883-022-02696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Many stroke survivors have multiple chronic diseases and complications coupled with various other factors which may affect their functional status. We aimed to investigate the factors associated with poor functional status in hospitalized patients with stroke in Shenzhen, China. Methods In this cross-sectional study, four urban hospitals were selected using convenient sampling, and all stroke patients in these four hospitals were included using cluster sampling. The functional status of stroke survivors was evaluated using Longshi Scale. Explanatory variables (factors affecting functional status comprising age, sex, body mass index, smoking, alcohol consumption, complications, and chronic conditions) were collected. Ordinal logistic regression was used to examine which factors were associated with poor functional status. Results Stroke survivors with poor functional status accounted for 72.14% and were categorised as the bedridden group based on Longshi scale, 21.67% of patients with moderate functional limitation were categorised as the domestic group, and 6.19% of the patients with mild functional restriction were categorised as the community group. The highest dependence scores were noted for feeding (73.39%), bowel and bladder management (69.74%) and entertainment (69.53%) among the bedridden group, and housework (74.29%) among the domestic group. In the adjusted model, the odds of poor functional status were higher among stroke patients with older age (odds ratio [OR] = 2.39, 95% CI: 1.55–3.80), female sex (OR = 1.73, 95% CI: 1.08–2.77), duration of stroke more than 12 months (OR = 1.94, 95% CI: 1.28–2.95), with pulmonary infection (OR = 10.91, 95% CI: 5.81–20.50), and with deep venous thrombosis (OR = 3.00, 95% CI: 1.28–7.04). Conclusions Older adults (age ≥ 60 years) and women were more likely to exhibit poor functional status post-stroke. Pulmonary infection and deep venous thrombosis were related to an increased risk of being dependent on activities of daily living. Therefore, clinical and rehabilitation interventions aimed at preventing or treating these common complications should be addressed to deal with subsequent dysfunction post-stroke. Since all data were obtained in metropolitan areas where the economy is well developed, future studies should be conducted in rural areas and economically less developed cities. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02696-0.
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Affiliation(s)
- Jing Zhou
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Fang Liu
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Mingchao Zhou
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Jianjun Long
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Fubing Zha
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Miaoling Chen
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Jiehui Li
- Shandong University of Traditional Chinese Medicine, Shandong Province, 4655 Daxue Road, Changqing District, Jinan, 250355, China
| | - Qingqing Yang
- Shandong University of Traditional Chinese Medicine, Shandong Province, 4655 Daxue Road, Changqing District, Jinan, 250355, China
| | - Zeyu Zhang
- Shandong University of Traditional Chinese Medicine, Shandong Province, 4655 Daxue Road, Changqing District, Jinan, 250355, China
| | - Yulong Wang
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China.
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Astrakas LG, Li S, Elbach S, Tzika AA. The Severity of Sensorimotor Tracts Degeneration May Predict Motor Performance in Chronic Stroke Patients, While Brain Structural Network Dysfunction May Not. Front Neurol 2022; 13:813763. [PMID: 35432180 PMCID: PMC9008887 DOI: 10.3389/fneur.2022.813763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Although the relationship between corticospinal tract (CST) fiber degeneration and motor outcome after stroke has been established, the relationship of sensorimotor cortical areas with CST fibers has not been clarified. Also limited research has been conducted on how abnormalities in brain structural networks are related to motor recovery. To address these gaps in knowledge, we conducted a diffusion tensor imaging (DTI) study with 12 chronic stroke patients (CSPs) and 12 age-matched healthy controls (HCs). We compared fractional anisotropy (FA) and mean diffusivity (MD) in 60 CST segments using the probabilistic sensorimotor area tract template (SMATT). Least Absolute Shrinkage and Selection Operator (LASSO) regressions were used to select independent predictors of Fugl-Meyer upper extremity (FM-UE) scores among FA and MD values of SMATT regions. The Graph Theoretical Network Analysis Toolbox was used to assess the structural network of each subject's brain. Global and nodal metrics were calculated, compared between the groups, and correlated with FM-UE scores. Mann–Whitney U-tests revealed reduced FA values in CSPs, compared to HCs, in many ipsilesional SMATT regions and in two contralesional regions. Mean FA value of the left (L.) primary motor cortex (M1)/supplementary motor area (SMA) region was predictive of FM-UE score (P = 0.004). Mean MD values for the L. M1/ventral premotor cortex (PMv) region (P = 0.001) and L. PMv/SMA region (P = 0.001) were found to be significant predictors of FM-UE scores. Network efficiency was the only global metric found to be reduced in CSPs (P = 0.006 vs. HCs). Nodal efficiency of the L. hippocampus, L. parahippocampal gyrus, L. fusiform gyrus (P = 0.001), and nodal local efficiency of the L. supramarginal gyrus (P < 0.001) were reduced in CSPs relative to HCs. No graph metric was associated with FM-UE scores. In conclusion, the integrity of CSTs connected to M1, SMA, and PMv were shown to be independent predictors of motor performance in CSPs, while stroke-induced topological changes in the brain's structural connectome may not be. A sensorimotor cortex-specific tract template can refine CST degeneration data and the relationship of CST degeneration with motor performance.
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Affiliation(s)
- Loukas G. Astrakas
- Department of Medical Physics, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Shasha Li
- Department of Radiology, Athinoula A. Martinos Center of Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sabrina Elbach
- Department of Radiology, Athinoula A. Martinos Center of Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - A. Aria Tzika
- Department of Radiology, Athinoula A. Martinos Center of Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- *Correspondence: A. Aria Tzika
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Yi HJ, Lee DH, Hong BY, Song SY, Yoo YJ, Yoon MJ, Sung JH, Lim SH. The Long-Term Functional Effect of Thrombectomy on Patients with Middle Cerebral Artery Occlusion Who Exhibit Moderate to Severe Disability. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:509. [PMID: 34069555 PMCID: PMC8161388 DOI: 10.3390/medicina57050509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Endovascular thrombectomy (EVT is an emerging gold standard treatment for acute cerebral infarction and may allow functional improvement after subacute cerebral infarction. However, the long-term functional benefits of EVT in patients with moderate to severe disability remain unclear. We investigated the effects of EVT on the activities of daily living (ADL), handicap, gait, and eating in patients with middle cerebral artery (MCA) occlusion who exhibited moderate to severe disability (score of 3-5 on the modified Rankin scale (mRS)) due to stroke, up to six months after onset. Materials and Methods: This retrospective longitudinal case-control study assessed 45 patients with MCA occlusion who exhibited moderate to severe disability (mRS score ≥ 3): 15 underwent EVT and 30 served as controls. Clinical assessments were conducted at two weeks (12-16 days), four weeks (26-30 days), and six months (180-210 days) after stroke onset. Functional assessments comprised the Korean version of the modified Barthel index (MBI), mRS, functional ambulation category (FAC), and dysphagia outcome severity scale (DOSS) to assess disability, handicap, gait, and eating. Results: The MBI, mRS, FAC, and DOSS scores all improved significantly (all p < 0.05) in the EVT group, compared to the controls. Conclusions: EVT has favorable effects on performing routine ADL, the handicap itself, walking, and eating. Therefore, EVT is recommended for patients with acute MCA occlusion, including those with severe disability at the initial assessment.
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Affiliation(s)
- Ho-Jun Yi
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea;
| | - Dong-Hoon Lee
- Cerebrovascular & Endovascular Center, Department of Neurosurgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (D.-H.L.); (S.-Y.S.)
| | - Bo-Young Hong
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (B.-Y.H.); (Y.-J.Y.); (M.-J.Y.)
| | - Seung-Yoon Song
- Cerebrovascular & Endovascular Center, Department of Neurosurgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (D.-H.L.); (S.-Y.S.)
| | - Yeun-Jie Yoo
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (B.-Y.H.); (Y.-J.Y.); (M.-J.Y.)
| | - Mi-Jeong Yoon
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (B.-Y.H.); (Y.-J.Y.); (M.-J.Y.)
| | - Jae-Hoon Sung
- Cerebrovascular & Endovascular Center, Department of Neurosurgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (D.-H.L.); (S.-Y.S.)
| | - Seong-Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea; (B.-Y.H.); (Y.-J.Y.); (M.-J.Y.)
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van Dongen L, Hafsteinsdóttir TB, Parker E, Bjartmarz I, Hjaltadóttir I, Jónsdóttir H. Stroke survivors' experiences with rebuilding life in the community and exercising at home: A qualitative study. Nurs Open 2021; 8:2567-2577. [PMID: 33690972 PMCID: PMC8363348 DOI: 10.1002/nop2.788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/04/2021] [Accepted: 01/31/2021] [Indexed: 01/27/2023] Open
Abstract
Aim This study aimed to explore how stroke survivors deal with stroke‐related impairments when rebuilding their lives in the community and their experiences of exercising at home. Design An explorative and descriptive qualitative study. Methods A purposive sample of ten stroke survivors residing at home was recruited to explore experiences of rebuilding their lives in the community and exercising at home. One focus group interview was conducted followed by semi‐structured interviews. Data were analysed using thematic analysis. Results Three main themes were identified: “Framing exercise within the context of everyday life” describes how stroke survivors integrate exercise in everyday activities with varying success and the social importance of exercising; “Managing the challenges of physical impairment” describes the taxing undertakings in daily living, loss of concentration and identity; “Long‐term challenges of everyday life” describes how the stroke survivors manage depression and live with a sense of uncertainty.
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Affiliation(s)
- Lisa van Dongen
- Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thóra B Hafsteinsdóttir
- Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Ethna Parker
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Ingibjörg Hjaltadóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspítali University Hospital, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspítali University Hospital, Reykjavík, Iceland
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Lee KB, Yoo SW, Ji EK, Hwang WS, Yoo YJ, Yoon MJ, Hong BY, Lim SH. Is Lateropulsion Really Related with a Specific Lesion of the Brain? Brain Sci 2021; 11:354. [PMID: 33802116 PMCID: PMC8000189 DOI: 10.3390/brainsci11030354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 11/17/2022] Open
Abstract
Lateropulsion (pusher syndrome) is an important barrier to standing and gait after stroke. Although several studies have attempted to elucidate the relationship between brain lesions and lateropulsion, the effects of specific brain lesions on the development of lateropulsion remain unclear. Thus, the present study investigated the effects of stroke lesion location and size on lateropulsion in right hemisphere stroke patients. The present retrospective cross-sectional observational study assessed 50 right hemisphere stroke patients. Lateropulsion was diagnosed and evaluated using the Scale for Contraversive Pushing (SCP). Voxel-based lesion symptom mapping (VLSM) analysis with 3T-MRI was used to identify the culprit lesion for SCP. We also performed VLSM controlling for lesion volume as a nuisance covariate, in a multivariate model that also controlled for other factors contributing to pusher behavior. VLSM, combined with statistical non-parametric mapping (SnPM), identified the specific region with SCP. Lesion size was associated with lateropulsion. The precentral gyrus, postcentral gyrus, inferior frontal gyrus, insula and subgyral parietal lobe of the right hemisphere seemed to be associated with the lateropulsion; however, after adjusting for lesion volume as a nuisance covariate, no lesion areas were associated with the SCP scores. The size of the right hemisphere lesion was the only factor most strongly associated with lateropulsion in patients with stroke. These results may be useful for planning rehabilitation strategies of restoring vertical posture and understanding the pathophysiology of lateropulsion in stroke patients.
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Affiliation(s)
| | | | | | | | | | | | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (K.B.L.); (S.W.Y.); (E.K.J.); (W.S.H.); (Y.J.Y.); (M.-J.Y.)
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (K.B.L.); (S.W.Y.); (E.K.J.); (W.S.H.); (Y.J.Y.); (M.-J.Y.)
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Ji EK, Wang HH, Jung SJ, Lee KB, Kim JS, Jo L, Hong BY, Lim SH. Graded motor imagery training as a home exercise program for upper limb motor function in patients with chronic stroke: A randomized controlled trial. Medicine (Baltimore) 2021; 100:e24351. [PMID: 33546067 PMCID: PMC7837923 DOI: 10.1097/md.0000000000024351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/24/2020] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke. METHODS This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI). RESULTS Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05). CONCLUSIONS The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.
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