Noninvasive Intracranial Pressure Monitoring in Chronic Stroke Patients with Sedentary Behavior: A Pilot Study.

OBJECTIVE: This study aimed to correlate the P2/P1 ratio of intracranial pressure waveforms with sedentary behavior during the chronic stage of stroke. MATERIALS AND METHODS: Eight patients from São Carlos, Brazil, who had hemiparesis and stroke onset within the previous 6 months, participated in this study. To monitor their intracranial pressure, we used noninvasive Brain4Care® intracranial pressure monitoring during a postural change maneuver involving 15 min in a supine position and 15 min in an orthostatic position. The patients' sedentary behavior was continually monitored at home using a StepWatch Activity Monitor™ for 1 week. Moreover, the patients completed the International Physical Activity Questionnaire before and after using the StepWatch Activity Monitor™. RESULTS: In the supine and orthostatic positions, the P2/P1 ratios were 0.84 ± 0.14 and 0.98 ± 0.17, respectively. The percentage of time spent in inactivity was 71 ± 11%, and the number of steps walked per day was 4220 ± 2239. We found a high positive correlation (r = 0.881, p = 0.004) between the P2/P1 ratio and the percentage of time spent in inactivity. CONCLUSION: This preliminary study showed a correlation between sedentary behavior and cerebral compliance. Thus, monitoring of intracranial pressure during the late stage of a stroke could guide the clinician's treatment to reduce sedentary behavior and the risks of recurrent stroke and cardiovascular diseases.

Could aerobic exercise applied before constraint-induced movement therapy change circulating molecular biomarkers in chronic post-stroke?

BACKGROUND: Integrating aerobic exercise (AE) into rehabilitation programs for post-stroke individuals could enhance motor recovery and cardiovascular health by increasing brain-derived neurotrophic factor (BDNF) and the myokine irisin. Chronic stroke survivors typically exhibit elevated matrix metalloproteinase-9 (MMP-9) activity, which is negatively correlated with steps and time in medium cadence, although the impact of AE on this biomarker remains unclear. OBJECTIVE: To evaluate the effect of high-intensity AE training prior to modified constraint-induced movement therapy (mCIMT) on BDNF and irisin concentration, and on MMP-2 and MMP-9 activity in chronic post-stroke individuals and to associate these results with functional improvements. METHODS: Nine participants received AE combined with mCIMT for two weeks, while the control group (n = 7) received mCIMT alone. Manual dexterity and functional capacity were assessed before and after the intervention. Serum samples were analyzed for BDNF, irisin, MMP-2 and MMP-9. RESULTS: There were no significant main effects of assessment, group or interaction on molecular biomarkers. However, the AE group had a significant increase in MMP-9 activity post-intervention (p = .033; d = 0.67). For the Box and Block Test, there were significant main effects of assessment (F [1, 14] = 33.27, p = .000, ηp2 = 0.70) and group (F [1, 14] = 5.43, p = .035, ηp2 = .28). No correlations were found between biomarkers and clinical assessments. CONCLUSION: AE prior to mCIMT did not influence circulating BDNF and irisin levels but did induce an acute rise in MMP-9 activity, suggesting potential effects on cardiovascular remodeling in this population.