Effectiveness of Adjunct Robotic Therapy With a Patient-Guided Suspension System for Stroke Rehabilitation Using a 7-Days-a-Week Model of Care: A Comparison With Conventional Rehabilitation

Objective

To determine and compare the effectiveness of robotic therapy with a patient-guided suspension system for stroke rehabilitation using a 7-days-a-week model of care with that of conventional rehabilitation.

Design

Retrospective cohort study.

Setting

Inpatient rehabilitation unit of an acute general hospital.

Participants

A total of 100 consecutive patients with stroke (N=100) admitted within a 7-month period who fulfilled the criteria to undergo robotic therapy with a patient-guided suspension system were enrolled in this study.

Interventions

Patients either underwent robotic therapy in addition to conventional therapy (robotic group) or conventional therapy only (control group). There were 50 patients in each cohort.

Main Outcome Measures

FIM and its derivatives (FIM gain and FIM efficiency); Berg Balance Scale (BBS), functional ambulation category (FAC); modified Rankin Scale (mRS); and National Institutes of Health Stroke Scale.

Results

The average FIM gains in both groups were statistically significant (P<.01). The robotic group had greater improvement in FAC scores (1.24 vs 0.78, P=.007). However, other measurements such as FIM efficiency, BBS, and mRS were not significantly different between the 2 groups. The robotics group reported high patient satisfaction rates, with most patients finding the intervention both beneficial and desirable.

Conclusions

Adjunct robotic therapy has the potential to increase the efficacy of stroke rehabilitation. However, further studies are needed to strengthen the evidence.

Efficacy of Low-Frequency Repetitive Transcranial Magnetic Stimulation in Ischemic Stroke: A Double-Blind Randomized Controlled Trial

Objective

To investigate the role of low-frequency repetitive transcranial magnetic stimulation (rTMS) along with conventional physiotherapy in the functional recovery of patients with subacute ischemic stroke.

Design

Double-blind, parallel group, randomized controlled trial.

Setting

The outpatient department of a tertiary hospital participants: first ever ischemic stroke patients (N=96) in the previous 15 days were recruited and were randomized after a run-in period of 75±7 days into real rTMS (n=47) and sham rTMS (n=49) groups.

Intervention

Conventional physical therapy was given to both the groups for 90±7 days postrecruitment. Total 10 sessions of low-frequency rTMS on contralesional premotor cortex was administered to real rTMS group (n=47) over a period of 2 weeks followed by physiotherapy regime for 45-50 minutes.

Main Outcome Measures

The primary efficacy outcomes were change in modified Barthel Index (mBI) score (pre- to postscore) and proportion of participants with mBI score more than 90, measured at 90±7 days postrecruitment. The secondary outcomes were change in Fugl-Meyer Assessment–upper extremity, Fugl-Meyer Assessment–lower extremity, Hamilton Depression Scale, modified Rankin Scale, and National Institute of Health and Stroke Scale (pre- to post-rTMS) scores at 90±7 days post recruitment.

Results

Modified intention to treat analysis showed a significant increase in the mBI score from pre- to post-rTMS in real rTMS group (4.96±4.06) versus sham rTMS group (2.65±3.25). There was no significant difference in proportion of patients with mBI>90 (55% vs 59%; P=.86) at 3 months between the groups.

Conclusion

In patients with subacute ischemic stroke, 1-Hz low-frequency rTMS on contralesional premotor cortex along with conventional physical therapy resulted in significant change in mBI score.

Successful basilar artery dilatation in pure bilateral cerebral peduncular infarctions using balloon angioplasty

•

An extremely rare case of bilateral cerebral peduncular infarctions (BCPI) is reported.

•

The detection of the pure Mickey Mouse ears sign on MRI is an indicator of a need for reperfusion therapy.

•

Severe stenosis of the basilar artery (BA) and a poor collateral supply from both posterior cerebral arteries were seen.

•

Balloon angioplasty for the BA stenosis ameliorated the stenosis and produced a favorable outcome.

Microsurgery for a ruptured intracranial aneurysm in a 3-year-old child: A case report

•

Intracranial aneurysms are rare in children, only case reports and case series published.

•

Subarachnoid hemorrhage is the most common feature of pediatric intracranial aneurysm with good clinical grade.

•

Microsurgical clipping is safe and effective in treatment of pediatric intracranial aneurysms.

Introduction

Pediatric intracranial aneurysms are rare, with some different characteristics from those in adults. Here, we present a case of distal anterior cerebral artery aneurysm which we believe the first case from Vietnam.

Presentation of case

A 3 years old boy presented with headache, lethargic and hemiparesis was diagnosed ruptured distal anterior cerebral artery aneurysm with CTA. 10 days before admission in our hospital, the toddler was admitted in local hospital with diagnosis of SAH without more accurate findings. Clipping microsurgery of aneurysms with left interhemispheric approach was done with good outcome.

Discussion

The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed. We also discussed our thoughts about our case within the limited-resource condition such as in Vietnam.

Conclusion

Pediatric intracranial anerusyms are rare but should be recognised in neurosurgical practice. Surgery is an effective treatment method.

Effects of In-Bed Cycle Exercise in Patients With Acute Stroke: A Randomized Controlled Trial

Objective

To investigate the effects of in-bed cycle exercise in addition to usual care in patients with acute stroke, National Institutes of Health Stroke Scale (NIHSS) 7-42, regarding walking ability, functional outcomes, and inpatient care days.

Design

Randomized controlled trial.

Setting

Hospital care.

Participants

Patients (N=56) with stroke NIHSS 7-42 were recruited 24-48 hours after stroke onset from 2 stroke units in Sweden.

Interventions

Both groups received usual care. The intervention group also received 20 minutes bed cycling 5 days per week with a maximum of 15 sessions.

Main Outcome Measures

The primary outcome was median change in walking ability measured with the 6-minute walk test (6MWT). Secondary outcome measures included the median change in modified Rankin Scale (mRS), Barthel Index (BI) for activities of daily living, and inpatient care days. Measurements were performed at baseline, post intervention (3 weeks), and at 3-month follow-up.

Results

There was no significant difference in change of walking ability (6MWT) from baseline to follow-up between the intervention and control groups (median, 105m [interquartile range [IQR, 220m] vs 30m [IQR, 118m], respectively, P=.147, d=0.401). There were no significant differences between groups regarding mRS, BI, or inpatient care days. Patients with less serious stroke (NIHSS 7-12) seemed to benefit from the intervention.

Conclusion

Although this study may have been underpowered, patients with stroke NIHSS 7-42 did not benefit from in-bed cycle exercise in addition to usual care after acute stroke. A larger study is needed to confirm our results.

Reducing Door-to-Reperfusion Time for Mechanical Thrombectomy With a Multitiered Notification System for Acute Ischemic Stroke

OBJECTIVE

To reduce door-to-angiographic reperfusion (DTR) time to 120 minutes for patients presenting with acute ischemic stroke attributed to anterior circulation large-vessel occlusion amenable to endovascular mechanical thrombectomy.

PATIENTS AND METHODS

Patients treated with mechanical thrombectomy before (April 10, 2015, through April 11, 2016) and after (April 12, 2016, through May 10, 2017) implementation of a multitiered notification system were studied. Lean process mapping was used to assess inefficiencies with multidisciplinary triage. A 3-tiered paging platform, which rapidly alerts essential personnel of the acute ischemic stroke team at advancing decision points, was introduced.

RESULTS

Sixty-two patients were analyzed before and after implementation (34 vs 28, respectively). Following intervention, DTR time was reduced by 43 minutes (mean DTR, 170 minutes vs 127 minutes; P=.02). At 90-day follow up, 5 of the 28 patients in the postintervention cohort (19%) had excellent neurologic outcomes, defined as a modified Rankin Scale score of 0, compared to 0 of 34 (0%) in the preintervention cohort (P=.89). Reductions were also seen in the length of stay on the neurocritical care service (mean, 6 vs 3 days; P=.006), and total hospital charges for combined groups (mean, $100,083 vs $161,458; P<.001).

CONCLUSION

The multitiered notification system was a feasible solution for improving DTR within our institution, resulting in reductions of overall DTR time, neurocritical care service length of stay, and total hospital charges.

Time dependent transition of the levels of protein-conjugated acrolein (PC-Acro), IL-6 and CRP in plasma during stroke

Objective

Measurement of plasma levels of protein-conjugated acrolein (PC-Acro) together with IL-6 and CRP can be used to identify silent brain infarction (SBI) with high sensitivity and specificity. The aim of this study was to determine how these biomarkers vary during stroke.

Methods

Levels of PC-Acro, IL-6 and CRP in plasma were measured on day 0, 2, 7 and 14 after the onset of ischemic or hemorrhagic stroke.

Results

After the onset of stroke, the level of PC-Acro in plasma was elevated corresponding to the size of stroke. It returned to near control levels by day 2, and remained similar through day 14. The degree of the decrease in PC-Acro on day 2 was greater when the size of brain infarction or hemorrhage was larger. An increase in IL-6 and CRP occurred after the increase in PC-Acro, and it was well correlated with the size of the injury following infarction or hemorrhage. The results suggest that acrolein becomes a trigger for the production of IL-6 and CRP, as previously observed in a mouse model of stroke and in cell culture systems. The increase in IL-6 and CRP was also correlated with poor outcome judging from mRS.

Conclusion

The results indicate that the degree of the decrease in PC-Acro and the increase in IL-6 and CRP from day 0 to day 2 was correlated with the size of brain infarction, and the increase in IL-6 and CRP with poor outcome at discharge.