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Syndrome of the trephined (SoT) is an underrecognized complication after decompressive craniectomy. We aimed to investigate SoT incidence, clinical spectrum, risk factors, and the impact of the cranioplasty on neurologic recovery. Patients undergoing a large craniectomy (> 80 cm2) and cranioplasty were prospectively evaluated using modified Rankin score (mRS), cognitive (attention/processing speed, executive function, language, visuospatial), motor (Motricity Index, Jamar dynamometer, postural score, gait assessment), and radiologic evaluation within four days before and after a cranioplasty. The primary outcome was SoT, diagnosed when a neurologic improvement was observed after the cranioplasty. The secondary outcome was a good neurologic outcome (mRS 0-3) 4 days and 90 days after the cranioplasty. Logistic regression models were used to evaluate the risk factors for SoT and the impact of cranioplasty timing on neurologic recovery. We enrolled 40 patients with a large craniectomy; 26 (65%) developed SoT and improved after the cranioplasty. Brain trauma, hemorrhagic lesions, and shifting of brain structures were associated with SoT. After cranioplasty, a shift towards a good outcome was observed within 4 days (p = 0.025) and persisted at 90 days (p = 0.005). Increasing delay to cranioplasty was associated with decreased odds of improvement when adjusting for age and baseline disability (odds ratio 0.96; 95% CI, 0.93-0.99, p = 0.012). In conclusion, SoT is frequent after craniectomy and interferes with neurologic recovery. High suspicion of SoT should be exercised in patients who fail to progress or have a previous trauma, hemorrhage, or shifting of brain structures. Performing the cranioplasty earlier was associated with improved and quantifiable neurologic recovery. Graphical abstract.
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Craniectomía Descompresiva , Procedimientos de Cirugía Plástica , Craniectomía Descompresiva/efectos adversos , Humanos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Procedimientos de Cirugía Plástica/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Cráneo/cirugíaRESUMEN
After a brain lesion, emotional and behavioral disorders affect the quality of life of the patients and their relatives. This article aims to give some cues to manage three problems chosen for their high frequency: apathy, aggression and depression. It will be reviewed how to recognize, to evaluate and to treat them.
Les lésions cérébrales sont fréquemment suivies de troubles émotionnels et comportementaux qui altèrent la qualité de vie du patient et de ses proches. Trois de ces troubles, particulièrement fréquents, sont discutés dans cet article : l'apathie, l'agressivité et la dépression. Une attention particulière sera prêtée à ces symptômes, à leur gravité, ainsi qu'à leur prise en charge, leur traitement médicamenteux ou psychothérapeutique.
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Lesiones Encefálicas/fisiopatología , Lesiones Encefálicas/psicología , Encéfalo/fisiopatología , Emociones , Agresión/psicología , Apatía , Lesiones Encefálicas/terapia , Depresión/complicaciones , Depresión/terapia , Humanos , Calidad de VidaRESUMEN
In Switzerland, alcohol consumption is often trivialized and widely accepted as normal behavior. However, even in small quantities, repeated alcohol intake can cause injury to both the central nervous system and the peripheral one. Various mechanisms are involved : direct neurotoxicity, metabolic disorders, vitamin deficiencies, systemic injuries (hepatic, cardiovascular, immune), and accidents. This article describes potential neurological complications and their mechanisms, emphasizing the importance of early screenings for abusive consumption.
En Suisse, la consommation d'alcool est une pratique bien ancrée dans les mÅurs, considérée comme normale. Cependant, même pris en petites quantités, l'alcool peut provoquer une atteinte du système nerveux, tant central que périphérique. Les mécanismes impliqués sont divers : neurotoxicité directe, désordres métaboliques, carences vitaminiques, atteintes systémiques (en particulier du système hépatique, cardiovasculaire et immunitaire) ou accidents en tous genres. Cet article décrit les complications neurologiques possibles et évoque leurs mécanismes dans l'intention de souligner l'importance d'un dépistage précoce d'une consommation à risque.
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Consumo de Bebidas Alcohólicas , Enfermedades del Sistema Nervioso , Consumo de Bebidas Alcohólicas/efectos adversos , Sistema Nervioso Central/efectos de los fármacos , Humanos , Hígado/efectos de los fármacos , Enfermedades del Sistema Nervioso/etiología , SuizaRESUMEN
INTRODUCTION: Syndrome of the trephined (ST) is a post-craniectomy complication. It is characterized by the appearance of new neurological symptoms following the craniectomy, which are relieved after cranioplasty. The purpose of our work was to identify radiological signs and imaging biomarkers of the ST. METHODS: CT images of 32 patients were retrospectively analyzed (ST = 13, controls = 19). While the shapes of craniectomy flap were qualitatively assessed, deviation of the midline structures, relative intracranial cerebrospinal fluid (CSF) volume, and the 3rd ventricle's volume were quantitatively measured. RESULTS: We did not find between-group differences in the mean age or number of post-craniectomy days. ST was diagnosed during the second post-craniectomy month. The occurrence of a sunken skin flap sign was similar in both groups (69.23 % in ST group, 57.89 % in control group). Occurrence of paradoxical herniation and deviation of the midline structures were not significantly different between groups. Mean relative intracranial CSF volume was significantly smaller in ST patients (ST = 5.59 %, controls = 8.12 %, p = 0.01). ST patients, compared to controls, had also significantly smaller mean 3rd ventricle volumes (ST = 1748 mm(3), controls = 2772.97 mm(3), p = 0.03). CONCLUSIONS: ST is an infrequent and delayed post-craniectomy complication. The most common radiological findings (paradoxical herniation, deviation of the midline structures, and sunken skin flap sign) might not be specific for ST. Significantly lower 3rd ventricle, and relative intracranial CSF volumes, suggest that altered biophysical CSF properties underlie ST pathophysiology. Therefore, volume measurements of 3rd ventricle could be useful for identification of patients who have higher probability of developing the ST.
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Encéfalo/diagnóstico por imagen , Encéfalo/patología , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Anomalías Cutáneas/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Trepanación/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Craniectomía Descompresiva/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/etiología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Anomalías Cutáneas/etiología , Anomalías Cutáneas/patología , SíndromeRESUMEN
Aphasia in bilingual patients is a therapeutic challenge since both languages can be impacted by the same lesion. Language control has been suggested to play an important role in the recovery of first (L1) and second (L2) language in bilingual aphasia following stroke. To test this hypothesis, we collected behavioral measures of language production (general aphasia evaluation and picture naming) in each language and language control (linguistic and nonlinguistic switching tasks), as well as fMRI during a naming task at one and four months following stroke in five bilingual patients suffering from poststroke aphasia. We further applied dynamic causal modelling (DCM) analyses to the connections between language and control brain areas. Three patients showed parallel recovery in language production, one patient improved in L1, and one improved in L2 only. Language-control functions improved in two patients. Consistent with the dynamic view of language recovery, DCM analyses showed a higher connectedness between language and control areas in the language with the better recovery. Moreover, similar degrees of connectedness between language and control areas were found in the patients who recovered in both languages. Our data suggest that engagement of the interconnected language-control network is crucial in the recovery of languages.
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Afasia/diagnóstico por imagen , Cognición/fisiología , Multilingüismo , Recuperación de la Función/fisiología , Accidente Cerebrovascular/diagnóstico por imagen , Anciano , Afasia/etiología , Ganglios Basales/diagnóstico por imagen , Ganglios Basales/fisiología , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/fisiología , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/fisiología , Desempeño Psicomotor/fisiología , Accidente Cerebrovascular/complicacionesRESUMEN
Neurologic dysphagia is frequent and has consequences which can be severe, such as, denutrition andpneumonia. In most cases, it can be detected with a clinical exam. The management includes some general measures, an adaptation of textures, specific rehabilitation, and nutritional assessment to judge whether complementary enteral nutrition is needed.
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Bronconeumonía/prevención & control , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/rehabilitación , Nutrición Enteral , Esofagoscopía , Desnutrición/prevención & control , Trastornos de Deglución/fisiopatología , Nutrición Enteral/métodos , Esofagoscopía/métodos , Humanos , Evaluación Nutricional , Educación del Paciente como Asunto , Factores de Riesgo , Resultado del TratamientoRESUMEN
Semantic memory impairment is classically associated with lesion of the anterior temporal lobe. We report the case of a patient with severe semantic knowledge impairment and anterograde amnesia after bilateral ischemic lesion of the fornix and of the basal forebrain following surgical clipping of an aneurysm of the anterior communicating artery. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed a temporal hypometabolism. Severe semantic impairment is a rare complication after rupture of an anterior communicating artery aneurysm and may result from disconnection of the temporal lobe.
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Prosencéfalo Basal/patología , Fórnix/patología , Trastornos de la Memoria/etiología , Trastornos de la Memoria/patología , Semántica , Femenino , Humanos , Persona de Mediana Edad , Pruebas NeuropsicológicasRESUMEN
Environmental reduplicative paramnesia (ERP) is characterized by the involuntary attribution of a false identity to a place. ERP has rarely been examined experimentally; its mechanisms therefore remain speculative. Here, we describe a patient with extended traumatic right fronto-temporal damage and severe persistent ERP, in whom we were able to modulate ERP by exposing him to various typical landmarks of the town where he was hospitalized. When landmarks were ambiguous as regards location (e.g., unknown buildings), the patient erroneously localized himself in his hometown, which was more than two thousand kilometers away. In contrast, when he visited distinct landmarks of the place where he actually resided, his ERP was immediately corrected, and spatial orientation was restored. These findings indicate that ERP may be temporarily modifiable through perception of unequivocal topographic information.
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Amnesia/fisiopatología , Percepción Espacial/fisiología , Amnesia/patología , Lóbulo Frontal/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Lóbulo Temporal/patologíaRESUMEN
A 57-year-old man suffered severe amnesia and disorientation, accompanied by content-specific confabulation, due to an alcoholic Wernicke-Korsakoff syndrome. For months, he was deeply concerned about a single obligation that he thought he had to respond to, but which he had already assumed 20 years previously. This monothematic, prospective confabulation was associated with failures of reality filtering as previously documented in behaviorally spontaneous confabulation and disorientation: the patient failed to suppress the interference of currently irrelevant memories and to abandon anticipations that were no longer valid (impaired extinction capacity). Magnetic resonance imaging showed damage to the mamillary bodies and the dorsomedial thalamic nucleus. Positron emission tomography (FDG-PET) showed extended orbitofrontal hypometabolism. We suggest that isolated prospective confabulation shares the core feature (acts and thoughts based on currently irrelevant memory), mechanism (failure of reality filtering), and anatomical basis (orbitofrontal dysfunction) with behaviorally spontaneous confabulations.
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Deluciones/psicología , Síndrome de Korsakoff/psicología , Alcoholismo/complicaciones , Alcoholismo/psicología , Encéfalo/patología , Deluciones/rehabilitación , Extinción Psicológica , Fluorodesoxiglucosa F18 , Humanos , Síndrome de Korsakoff/patología , Síndrome de Korsakoff/rehabilitación , Imagen por Resonancia Magnética , Masculino , Memoria/fisiología , Memoria Episódica , Recuerdo Mental/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Tomografía de Emisión de Positrones , Desempeño Psicomotor/fisiología , Radiofármacos/metabolismo , Test de Stroop , Aprendizaje Verbal , Escalas de WechslerRESUMEN
OBJECTIVES: Recovery from stroke-related oro-facial impairment has rarely been investigated. In this longitudinal study chewing efficiency, maximum lip and bite force as well as masseter muscle thickness were evaluated and compared with hand-grip force. MATERIALS AND METHODS: Thirty-one hospitalized stroke patients and 24 controls were recruited for this cohort study with 2-year follow-up. Chewing efficiency was evaluated with a color mixing ability test, lip forces with a traction dynamometer, bite force with a digital gauge, masseter muscle thickness using ultrasound measurements and grip strength with a hand dynamometer. RESULTS: During the 2-year observation period, patients were evaluated four times. A total of 21 patients dropped out of the study. Stroke patients showed significantly impaired chewing efficiency and lower lip forces than controls with no significant improvement over time. Bite forces were not different between ipsi- and contralesional sides, in contrast to contralesional hand-grip strength which was significantly impaired and did not improve during the observation period. On the first examination with a median of 40 days after stroke, masseter thickness was reduced contralesional, but did not continue to show significant side-differences during follow-up. CONCLUSIONS: Stroke affects the upper limb and the masseter muscles differently on a functional and morphological level. Further research is needed to evaluate the predictive value of oro-facial parameters on functional outcome after stroke. CLINICAL RELEVANCE: Impaired chewing efficiency and reduced lip force are quantifiable symptoms in stroke patients which seem not to improve in absence of oro-facial rehabilitation procedures.
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Fuerza de la Mordida , Parálisis Facial/etiología , Fuerza de la Mano , Músculo Masetero/anatomía & histología , Masticación , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Estudios de Casos y Controles , Estudios de Cohortes , Índice CPO , Músculos Faciales/fisiopatología , Parálisis Facial/fisiopatología , Femenino , Humanos , Labio/fisiopatología , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estadísticas no Paramétricas , Accidente Cerebrovascular/complicacionesRESUMEN
(1) Background: panic attack is often regarded as a benign disorder with variable physical and psychological symptoms. (2) Case Presentation: We here report the case of a 22-year-old patient known for an episode of motor functional neurological disorder a year earlier who presented a panic attack with hyperventilation causing severe hypophosphatemia and rhabdomyolysis, as well as mild tetraparesis. Electrolyte disturbances quickly resolved after phosphate substitution and rehydration. However, clinical signs suggesting a relapse of a motor functional neurological disorder appeared (improved walking with dual tasks). Diagnostic workup, including brain and spinal magnetic resonance imaging, as well as electroneuromyography and genetic testing for hypokalemic periodic paralysis, was unremarkable. Tetraparesis, lack of endurance, and fatigue eventually improved after several months. (3) Conclusions: the present case report highlights the intertwined relationship between a psychiatric disorder, leading to hyperventilation and acute metabolic disturbances, and functional neurological manifestations.
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Research in animal models has implicated N-methyl-D-aspartate (NMDA) receptors (NMDARs) in the control of food intake. Until now, these findings have been not replicated in humans. Here we describe a 22-year-old woman with anti-NMDAR encephalitis and no prior neurological or psychiatric history. Her clinical course was marked by successive eating disorders: anorexia followed by hyperphagia. We propose that, much as they do in other animals, NMDARs in humans interact with the neuroendocrine, homeostatic, and reward systems controlling food intake in the central and peripheral nervous system structures related to feeding and satiety.
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Encefalitis Antirreceptor N-Metil-D-Aspartato/fisiopatología , Ingestión de Alimentos , Conducta Alimentaria , Receptores de N-Metil-D-Aspartato/fisiología , Encefalitis Antirreceptor N-Metil-D-Aspartato/diagnóstico , Autoanticuerpos/sangre , Autoanticuerpos/líquido cefalorraquídeo , Femenino , Humanos , Saciedad , Adulto JovenRESUMEN
BACKGROUND: Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. AIM: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. METHODS: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. RESULTS: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. CONCLUSIONS: We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.
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Afasia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Anciano , Femenino , Humanos , Recién Nacido , Masculino , Afasia/rehabilitación , Lenguaje , Logopedia/métodos , Accidente Cerebrovascular/complicacionesRESUMEN
OBJECTIVE: The aim of this study was to test the hypothesis that impairment of orofacial function following stroke affects the patients' oral health-related quality of life (OHRQoL). MATERIAL AND METHODS: From the University Hospitals of Geneva, 31 stroke patients (18 men, 13 women, mean age 69.0 ± 12.7 years) with unilateral facial and limb palsy were recruited (patient group, PG). In the study, the Oral Health Impact Profile (OHIP)-EDENT was utilised to assess OHRQoL. Further examinations comprised a test of masticatory efficiency and lip force, stroke severity National Institute of Health Stroke Scale and dental state. The control group (CG) consisted of 24 subjects with similar age, gender and dental state. RESULTS: The PG mean OHIP-EDENT sum score was 18.8 ± 15.5 and proved higher than one of the CG, indicating a lower OHRQoL in the PG (p < 0.01). The score of the sub-domains 'functional limitation' and 'physical pain' were significantly higher in PG (p < 0.03 and p < 0.02, respectively). The masticatory efficiency was significantly lower in the PG (p < 0.0001) and was associated with the OHIP-EDENT sum score and its sub-domains, except for 'physical disability'. This effect was not present in the CG. CONCLUSION: The OHRQoL is significantly reduced in hospitalised stroke patients whereby functional impairment seems predominant when compared with psychological and psycho-social aspects.
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Hospitalización , Salud Bucal , Calidad de Vida , Accidente Cerebrovascular/psicología , Anciano , Ansiedad/psicología , Isquemia Encefálica/fisiopatología , Isquemia Encefálica/psicología , Hemorragia Cerebral/fisiopatología , Hemorragia Cerebral/psicología , Retención de Dentadura , Dentadura Parcial Removible , Personas con Discapacidad/psicología , Ingestión de Alimentos/fisiología , Parálisis Facial/fisiopatología , Parálisis Facial/psicología , Femenino , Humanos , Relaciones Interpersonales , Arcada Parcialmente Edéntula/clasificación , Labio/fisiopatología , Masculino , Masticación/fisiología , Dolor/psicología , Parálisis/fisiopatología , Parálisis/psicología , Estrés Mecánico , Accidente Cerebrovascular/fisiopatologíaRESUMEN
Behaviorally spontaneous confabulation is characterized by a confusion of reality evident in currently inappropriate acts that patients justify with confabulations and in disorientation. Here, we describe a 38-year-old woman lawyer hospitalized because of non-herpetic, presumably autoimmune, limbic encephalitis. For months, she considered herself at work and desperately tried to respect her falsely believed professional obligations. In contrast to a completely erroneous concept of reality, she did not confabulate about her remote personal past. In tasks proposed to test strategic retrieval monitoring, she produced no confabulations. As expected, she failed in tasks of reality filtering, previously shown to have high sensitivity and specificity for behaviorally spontaneous confabulation and disorientation: she failed to suppress the interference of currently irrelevant memories and she had deficient extinction capacity. The observation underscores the special status of behaviorally spontaneous confabulation among confabulatory phenomena and of reality filtering as a thought control mechanism. We suggest that different processes may underlie the generation of false memories and their verbal expression. We also emphasize the need to present theories of confabulation together with experimental tasks that allow one to empirically verify the theories and to explore underlying physiological mechanisms.
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Confusión/etiología , Encefalitis/complicaciones , Encefalitis/patología , Sistema Límbico/fisiopatología , Trastornos de la Memoria/etiología , Adulto , Aprendizaje por Asociación , Confusión/complicaciones , Extinción Psicológica , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Trastornos de la Memoria/complicaciones , Pruebas Neuropsicológicas , Prueba de Realidad , Estadística como Asunto , Encuestas y CuestionariosRESUMEN
Locked-in syndrome (LIS) after basilar artery occlusion is associated with poor prognosis. For a patient with LIS, rehabilitation aims to restore communication, avoid complications, and ensure a certain comfort. We describe a case with remarkable recovery. After 2 years the patient was independent for daily living activities, walks independently and has comprehensible speech.
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Arteriopatías Oclusivas/cirugía , Arteria Basilar/cirugía , Cuadriplejía/etiología , Cuadriplejía/rehabilitación , Actividades Cotidianas , Anciano , Arteriopatías Oclusivas/rehabilitación , Humanos , Masculino , Pronóstico , CaminataRESUMEN
Background: Speech and language therapy (SLT) benefits people with aphasia following stroke. Group level summary statistics from randomised controlled trials hinder exploration of highly complex SLT interventions and a clinically relevant heterogeneous population. Creating a database of individual participant data (IPD) for people with aphasia aims to allow exploration of individual and therapy-related predictors of recovery and prognosis. Aim: To explore the contribution that individual participant characteristics (including stroke and aphasia profiles) and SLT intervention components make to language recovery following stroke. Methods and procedures: We will identify eligible IPD datasets (including randomised controlled trials, non-randomised comparison studies, observational studies and registries) and invite their contribution to the database. Where possible, we will use meta- and network meta-analysis to explore language performance after stroke and predictors of recovery as it relates to participants who had no SLT, historical SLT or SLT in the primary research study. We will also examine the components of effective SLT interventions. Outcomes and results: Outcomes include changes in measures of functional communication, overall severity of language impairment, auditory comprehension, spoken language (including naming), reading and writing from baseline. Data captured on assessment tools will be collated and transformed to a standardised measure for each of the outcome domains. Conclusion: Our planned systematic-review-based IPD meta- and network meta-analysis is a large scale, international, multidisciplinary and methodologically complex endeavour. It will enable hypotheses to be generated and tested to optimise and inform development of interventions for people with aphasia after stroke. Systematic review registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018110947).
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OBJECTIVE: To examine the effects of 3 different walking aids on walking capacity, temporo-spatial gait parameters, and patient satisfaction. DESIGN: Observational study. SETTING: University Hospital of Geneva. PARTICIPANTS: Hemiparetic inpatients (N=25) with impaired gait, at an early stage of rehabilitation, unfamiliar with any of the walking aids tested. INTERVENTIONS: On 3 consecutive days subjects used, in random order, 1 of 3 walking aids: 4-point cane, simple cane with ergonomic handgrip, and Nordic stick. MAIN OUTCOME MEASURES: Maximal walking distance in 6 minutes, temporo-spatial gait parameters determined with a commercial electronic gait analysis system, and patients' preference on a subjective ranking scale. RESULTS: Walking distance was greatest with the simple cane with an ergonomic handgrip, followed by the 4-point cane and the Nordic walking stick. Walking velocity was highest with the simple cane, which was also indicated as the preferred walking aid by the patients. There was no significant difference in step length symmetry. CONCLUSIONS: The simple cane with the ergonomic handgrip was not only preferred by patients, but was also the most efficient among 3 commonly used walking aids. It appears justified to take patients' subjective preference into account when prescribing a walking aid.