Combined Effects of Transcranial Magnetic Stimulation and Argatroban on Balance Function and Daily Living Activities in Hemiplegic Patients Following Cerebral Infarction.

Objective: This study aimed to investigate the impact of combining transcranial magnetic stimulation (TMS) with argatroban on balance function and activities of daily living in patients with hemiplegia following cerebral infarction (CI). Methods: A retrospective analysis was conducted on the clinical data of 104 patients with hemiplegia after CI who were admitted to our hospital from July 2020 to July 2021. The patients were randomly assigned to either the experimental group (EG) or the control group (CG), with 52 patients in each group. The EG received TMS in combination with argatroban, while the CG received argatroban alone. The Berg Balance Scale (BBS) and modified Barthel index (BI) were used to assess the balance function and activities of daily living in both groups after treatment. Results: After treatment, the EG demonstrated significantly higher BBS and BI scores compared to the CG (P < .001). Additionally, the EG showed significantly improved upper limb and lower limb Functional Ambulation Profile (FAM) scores compared to the CG (P < .05). Conclusions: The combination of TMS and argatroban proves to be an effective approach for enhancing balance function and activities of daily living in hemiplegic patients with CI. Therefore, it is recommended as a valuable rehabilitation treatment for such patients.

Assessing the effect of transcranial magnetic stimulation on peak cough flow in patients with supratentorial cerebral infarction: A retrospective cohort study.

Respiratory dysfunction following supratentorial cerebral infarction leads to pneumonia and is a major cause of mortality. Decreased voluntary cough function impairs the ability to clear mucus or secretions from the airways and increases the risk of aspiration pneumonia. Peak cough flow (PCF) is one of the objective tools for evaluating voluntary cough function. Repetitive transcranial magnetic stimulation (rTMS) could be applied to the respiratory motor cortex to improve respiratory function. Little is known about the effect of rTMS on PCF in patients with supratentorial cerebral infarction during the subacute period. This study aimed to determine whether rTMS treatment could improve PCF in patients with supratentorial cerebral infarction. We retrospectively recruited patients with subacute supratentorial cerebral infarction who underwent a PCF test. The rTMS group received a combination of rTMS treatment for 2 weeks and conventional rehabilitation for 4 weeks. However, the control group underwent only conventional rehabilitation for 4 weeks. PCF tests were performed before and after treatment and the results were compared between the 2 groups. In total, 145 patients with supratentorial cerebral infarctions were recruited. The PCF parameters before and after treatment increased in both the rTMS and control groups. However, the rTMS group showed a greater increase in PCF values compared with the control group. In patients with supratentorial cerebral infarction, the combination of conventional rehabilitation and rTMS in the subacute period may be helpful in improving voluntary cough function compared with conventional rehabilitation alone.

Effects of atrial fibrillation on motor outcome in patients with cerebral infarction.

BACKGROUND: Atrial fibrillation (AF) has been a leading cause of cerebral infarction, but the association with motor outcome after cerebral infarction remains unreported. In this study, we attempted to identify whether AF affects motor outcomes after cerebral infarction. METHODS: Seventy-six patients with a first-incidence cerebral infarction and who completed 6 months of rehabilitation were recruited to this retrospective study. The patients were divided into two groups based on the presence of AF (AF and non-AF groups). The upper extremity motricity index, lower extremity motricity index (LMI), modified Brunnstrom classification, and functional ambulation category (FAC) were evaluated, and those results were obtained within the first day and after 6 months of onset. Clinical factors that could affect motor outcome after cerebral infarction were also obtained. RESULTS: Compared with the non-AF group, the AF group had an upper extremity motricity index (47.15 ± 20.30 vs 58.66 ± 19.19; P = .032), LMI (53.42 ± 12.27 vs 65.58 ± 13.86; P = .001), and FAC scores (2.39 ± 0.93 vs 3.35 ± 0.93; P < .001) at 6 months after onset. Moreover, the AF group showed a lower FAC score gain than the non-AF group at 6 months after onset (2.33 ± 0.95 vs 3.28 ± 0.94; P < .001). Multivariate linear regression analyses showed that presence of AF had negative correlation with LMI gain (ß = -0.197; P = .010) and FAC gain (ß = -0.254; P = .011). CONCLUSION: We observed that AF had a negative effect on the motor outcome of the affected leg and the recovery of gait function in patients with cerebral infarction.

Acupuncture-Moxibustion Combined with Rehabilitation Training Is Conducive to Improving the Curative Effect, Cognitive Function, and Daily Activities of Patients with Cerebral Infarction.

Objective: To elucidate the effect of acupuncture-moxibustion combined with rehabilitation training (RHT) on the curative effect, cognitive function (CF), and activities of daily living (ADL) of patients with cerebral infarction (CI). Methods: This study enrolled 150 patients with CI admitted to the Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University from June 2020 to July 2021. Among them, 80 patients who were treated with acupuncture-moxibustion combined with RHT were included in the research group, and 70 patients who received acupuncture-moxibustion alone were included in the control group. The efficacy, CF, and ADL were observed in both groups, and the influences of the two therapies on serum uric acid (UA), high-sensitivity C-reactive protein (hs-CRP), and cystatin C (Cys-C) were compared. Among the various indexes, the CF of patients was assessed by the Montreal Cognitive Assessment (MoCA), and the ADL was evaluated by the Barthel index. Results: After treatment, the research group presented significantly better efficacy, CF, and ADL than the control group, with lower levels of serum UA, hs-CRP, and Cys-C than the control group and before treatment. Conclusion: Acupuncture-moxibustion combined with RHT can inhibit serum UA, hs-CRP, and Cys-C levels of patients with CI while improving the curative effect, CF, and ADL, which is worthy of clinical promotion.

Machine Learning for Predicting Motor Improvement After Acute Subcortical Infarction Using Baseline Whole Brain Volumes.

Background. Neuroimaging biomarkers are valuable predictors of motor improvement after stroke, but there is a gap between published evidence and clinical usage. Objective. In this work, we aimed to investigate whether machine learning techniques, when applied to a combination of baseline whole brain volumes and clinical data, can accurately predict individual motor outcome after stroke. Methods. Upper extremity Fugl-Meyer Assessments (FMA-UE) were conducted 1 week and 12 weeks, and structural MRI was performed 1 week, after onset in 56 patients with subcortical infarction. Proportional recovery model residuals were employed to assign patients to proportional and poor recovery groups (34 vs 22). A sophisticated machine learning scheme, consisting of conditional infomax feature extraction, synthetic minority over-sampling technique for nominal and continuous, and bagging classification, was employed to predict motor outcomes, with the input features being a combination of baseline whole brain volumes and clinical data (FMA-UE scores). Results. The proposed machine learning scheme yielded an overall balanced accuracy of 87.71% in predicting proportional vs poor recovery outcomes, a sensitivity of 93.77% in correctly identifying poor recovery outcomes, and a ROC AUC of 89.74%. Compared with only using clinical data, adding whole brain volumes can significantly improve the classification performance, especially in terms of the overall balanced accuracy (from 80.88% to 87.71%) and the sensitivity (from 92.23% to 93.77%). Conclusions. Experimental results suggest that a combination of baseline whole brain volumes and clinical data, when equipped with appropriate machine learning techniques, may provide valuable information for personalized rehabilitation planning after subcortical infarction.

Effects of paired associated stimulation with different stimulation position on motor cortex excitability and upper limb motor function in patients with cerebral infarction.

OBJECTIVE: To investigate the effects of paired associated stimulation (PAS) with different stimulation position on motor cortex excitability and upper limb motor function in patients with cerebral infarction. METHOD: A total of 120 volunteers with cerebral infarction were randomly divided into four groups. Based on conventional rehabilitation treatment, the PAS stimulation group was given the corresponding position of PAS treatment once a day for 28 consecutive days. The MEP amplitude and RMT of both hemispheres were assessed before and after treatment, and a simple upper limb Function Examination Scale (STEF) score, simplified upper limb Fugl-Meyer score (FMA), and improved Barthel Index (MBI) were used to assess upper limb motor function in the four groups. RESULTS: Following PAS, the MEP amplitude decreased, and the RMT of abductor pollicis brevis (APB) increased on the contralesional side, while the MEP amplitude increased and the RMT of APB decreased on the ipsilesional side. After 28 consecutive days the scores of STEF, FMA, and MBI in the bilateral stimulation group were significantly better than those in the ipsilesional stimulation group and the contralesional stimulation group, but there was no significant difference in the scores of STEF, FMA, and MBI between the ipsilesional stimulation group and the contralesional stimulation group. CONCLUSION: The excitability of the motor cortex can be changed when the contralesional side or the ipsilesional side was given the corresponding PAS stimulation, while the bilateral PAS stimulation can more easily cause a change of excitability of the motor cortex, resulting in better recovery of the upper limb function.

[Comprehensive post-stroke rehabilitation: its long-term effects and the socio-environmental factors conditioning access to it]. / Rehabilitación integral postictus: efectos a largo plazo y factores socioambientales condicionantes del acceso.

INTRODUCTION: Recovery of all brain functions affected after stroke is essential for the patient's quality of life, with comprehensive rehabilitation key. OBJECTIVES: Identify social and environmental factors affecting access to comprehensive post-ictus rehabilitation, and assess long-term effects of comprehensive rehabilitation on patient functionality. PATIENTS AND METHOD: 171 consecutive patients (84 women and 87 men) hospitalized in 2015 in Neurology Service with first ischemic stroke, without prior functional dependence, candidates for comprehensive rehabilitation are studied. Various socio-environmental and clinical variables potentially associated with access to it are analyzed. The long-term prognostic impact (average period of 54 months) on the functional situation is studied using the Barthel index. RESULTS: The average age of patients is 69 years. Only 53% were able to access the recommended comprehensive rehabilitation. Predictor variables of access were resulted: residence in urban environment (OR: 2,957; 95% CI: 1,067-8,199; p = 0.037), complement with private rehabilitation (OR: 2,89; 95% CI: 1,130-7,392; p = 0.027), best Rankin to high (OR: 22,437; 95% CI: 3,247-155,058; p = 0.014). After average follow-up for 54 months, of the 137 survivors, access to comprehensive post-ictus rehabilitation was independently associated with better long-term functional situation (OR: 12,441; 95% CI: 4.7-32.5; p < 0.001). CONCLUSIONS: Comprehensive post-ictus rehabilitation is associated with better long-term prognosis, but access to it is conditioned by environmental and social factors such as the place of residence and the possibility of contracting private services.

TITLE: Rehabilitación integral postictus: efectos a largo plazo y factores socioambientales condicionantes del acceso.Introducción. La recuperación de todas las funciones cerebrales afectadas tras un ictus es esencial para la calidad de vida del paciente y la rehabilitación integral resulta clave. Objetivos. Identificar los factores sociales y ambientales condicionantes del acceso a la rehabilitación integral postictus, y valorar los efectos a largo plazo de la rehabilitación integral en la funcionalidad del paciente. Pacientes y método. Se estudia a 171 pacientes consecutivos (84 mujeres y 87 hombres) hospitalizados en 2015 en el servicio de neurología con un primer ictus isquémico, sin dependencia funcional previa, candidatos a rehabilitación integral. Se analizan diversas variables socioambientales y clínicas potencialmente asociadas al acceso a ésta. Se estudia el impacto pronóstico a largo plazo (período medio de 54 meses) sobre la situación funcional mediante el índice de Barthel. Resultados. La edad media de los pacientes era de 69 años. Sólo el 53% pudo acceder a la rehabilitación integral recomendada. Resultaron variables predictoras del acceso: residencia en medio urbano ­odds ratio (OR): 2,957; intervalo de confianza al 95% (IC 95%): 1,067-8,199; p = 0,037­, complemento con rehabilitación privada (OR: 2,89; IC 95%: 1,13-7,392; p = 0,027) y mejor Rankin en el momento del alta (OR: 22,437; IC 95%: 3,247-155,058; p = 0,014). Tras un seguimiento medio durante 54 meses de los 137 supervivientes, el acceso a rehabilitación integral postictus se asoció independientemente a mejor situación funcional a largo plazo (OR: 12,441; IC 95%: 4,7-32,5; p menor de 0,001). Conclusiones. La rehabilitación integral postictus está asociada a un mejor pronóstico a largo plazo, pero su acceso está condicionado por factores ambientales y sociales, como el lugar de residencia y la posibilidad de contratar servicios privados.

Training in a cooperative bimanual skilled reaching task, the popcorn retrieval task, improves unimanual function after motor cortical infarcts in rats.

Disuse of the paretic hand after stroke is encouraged by compensatory reliance on the nonparetic hand, to exacerbate impairment and potentially constrain motor rehabilitation efficacy. Rodent stroke model findings support that learning new unimanual skills with the nonparetic forelimb diminishes functional improvements that can be driven by rehabilitative training of the paretic forelimb. The influence of learning new ways of skillfully using the two hands together on paretic side function is much less clear. To begin to explore this, we developed a new cooperative bimanual skilled reaching task for rats, the Popcorn Retrieval Task. After motor cortical infarcts impaired an established unimanual reaching skill in the paretic forelimb, rats underwent a 7 week period of de novo bimanual training (BiT) or no-training control procedures (Cont). Probes of paretic forelimb unimanual performance revealed significant improvements during and after the training period in BiT vs. Cont. We additionally observed a striking change in the bimanual task strategy over training days: a switch from the paretic to the nonparetic forelimb for initiating reach-to-grasp sequences. This motivated another study to test whether rats that established the bimanual skill prior to the infarcts would similarly switch handedness, which they did not, though paretic paw use for manipulative movements diminished. These results indicate that unimanual function of the paretic side can be improved by novel bimanual skill practice, even when it involves compensatory reliance on the nonparetic hand. They further support the suitability of the Popcorn Retrieval Task for studying bimanual skill learning effects in rats.

Relationship between recovery of motor function and neuropsychological functioning in cerebral infarction patients: the importance of social functioning in motor recovery.

Impaired motor function is a common disabling sequela after stroke. It is closely associated with the patient's quality of life and independence. Neuropsychological dysfunctions also frequently occur in stroke patients. In this paper, we evaluate the relationship between the recovery of motor function and neuropsychological functions, including cognition, language, emotion, behavior, personality, and social interaction, to provide appropriate and effective therapy for stroke patients. Motor function, neuropsychological status, social functioning, as well as emotional aspects such as depression and anxiety symptoms, were initially evaluated one month after cerebral infarction onset. The evaluations were repeated three months after the onset. Motor function was assessed with the Modified Barthel Index. The neuropsychological status was evaluated using the Mini-Mental State Examination, Global Deterioration Scale, digit span test, Korean-Boston Naming Test, Vineland Social Maturity Scale, Neuropsychiatric Inventory, Beck's Depression Inventory, and Beck Anxiety Inventory. In the results, the Modified Barthel Index, Mini-Mental State Examination, Global Deterioration Scale, digit span test, and Vineland Social Maturity Scale were significantly different between the two-time points (P < 0.05). Initial Social Maturity Scale Social Age and Social Maturity Scale Social Quotient categories of the Vineland Social Maturity Scale and Mini-Mental State Examination scores were significantly correlated with Modified Barthel Index improvement (P < 0.05). The amount of change in the Social Maturity Scale Social Age and Social Maturity Scale Social Quotient scores was significantly correlated with Modified Barthel Index improvement (P < 0.05). In multiple linear regression analysis, only the initial Social Maturity Scale Social Quotient score and the amount of score change in Social Maturity Scale Social Quotient showed a significant correlation with Modified Barthel Index improvement (P < 0.05). Social function and interaction are important in motor recovery of ischemic stroke patients.

Motor recovery by the aberrant pyramidal pathway in a patient with cerebral infarct.

INTRODUCTION: The aberrant pyramidal tract (APT) refers to the collateral pathway of the pyramidal tract (PT) descending through the medial lemniscus in the midbrain and pons. We report on a patient who showed changes of the APT from the early stage to the chronic stage concurrent with motor recovery following an infarct in the cerebral peduncle. PATIENT CONCERNS: An 84-year-old female patient presented with moderate motor weakness of her upper and lower extremities (2/2) due to cerebral infarct on the right cerebral peduncle of midbrain. One week after her stroke, her motor weakness was similar to that at the onset (2/2). During 5 weeks' rehabilitation, her motor weakness recovered to the point that she was able to move upper and lower extremities against gravity with some resistance (4/4). DIAGNOSIS: Cerebral infarct on the right cerebral peduncle of midbrain INTERVENTIONS:: She participated in a comprehensive rehabilitative management program, including movement therapy, neurotrophic drugs, and neuromuscular electrical stimulation therapy of the left finger extensor and ankle dorsiflexor muscles. OUTCOMES: On 1-week and 6-week diffusion tensor tractographys (DTTs), the right PT was not reconstructed, but the right APT, which descended through the medial lemniscus pathway at the midbrain and pons and the pyramid at the medulla, was observed. The right APT became thicker on six-week DTT compared with 1-week DTT. On 1-week transcranial magnetic stimulation study, an motor evoked potential with delayed latency and decreased amplitude was evoked from the affected (right) hemisphere (latency: 24.4 msec and amplitude: 0.2uV). In contrast, its latency was decreased and amplitude was increased on six-week transcranial magnetic stimulation study (latency: 21.8 msec, amplitude: 0.8 uV) CONCLUSIONS:: We demonstrated changes in the APT from the early stage to the chronic stage concurrent with motor recovery in a patient with an infarct in the cerebral peduncle. Our findings have important implications that a spared APT could contribute to the motor recovery in patients with cerebral infarct when the PTis completely injured at the onset of cerebral infarct,.

Effects of exercise timing and intensity on neuroplasticity in a rat model of cerebral infarction.

Exercise therapy plays key roles in functional improvements during neurorehabilitation. However, it may be difficult for some people to properly perform exercise because mobility and endurance might be restricted by neurological deficits due to stroke. Additionally, there is little evidence detailing the biological mechanisms underlying the most effective swimming exercise protocols for neuroplasticity after stroke. Thus, the present study investigated the effects of swimming exercise on neuroplasticity in a cerebral infarction rat model according to the timing and intensity of exercise. A total of 45 male Sprague-Dawley rats (300 ±â€¯50 g, 10 weeks old) were subjected to photothrombotic cerebral infarction and randomly divided into five groups: non-exercise (group A, n = 9); early submaximal (group B, n = 9); early maximal (group C, n = 9); late submaximal (group D, n = 9); and late maximal (group E, n = 9). Swimming exercise was performed five times a week for 4 weeks, and cognition was evaluated with the Morris water maze (MWM) test. Assessments of superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels and immunohistochemical analyses of brain-derived neurotrophic factor (BDNF) were conducted in the ipsilesional hippocampus region. After 4 weeks of exercise, the escape latency was shorter and velocity was greater in group B than in groups A, C, D, and E (p = 0.046, p <  0.001, respectively). Furthermore, SOD activity was higher and MDA levels were lower in group B than in groups A, C, D, and E (p = 0.004, p = 0.019). The immunohistochemistry results revealed that the greatest BDNF immunoreactivity was in group B. Taken together, these results indicate that early submaximal swimming exercise may be the most effective protocol for the recovery of neurological deficits in a rat model of cerebral infarction.

Effect of unstable surface sitting on paretic anterior tibial muscle following stroke.

INTRODUCTION: Postural reactions have been used to facilitate dorsiflexor activity following stroke. However, the effectiveness of this method is not clear in the literature. This study is designed to test the effect of postural reactions provoked by sitting in an unstable surface on dorsiflexor activity in acute stroke. METHODS: Fifteen first-time acute hemispheric cerebral infarct patients with hemiplegia and 15 age-matched healthy adults participated in the study. Subjects performed static sitting, forward reach and lateral reach on a stool and Swiss ball. The anterior tibial activity was recorded in the normal and affected lower limbs in hemiplegic patients and both lower limbs of healthy adults. Non-parametric testing was used with alpha less than 0.05. RESULTS: All the subjects showed an increase in anterior tibial activity in Swiss ball sitting compared to stool sitting. Lateral reaching resulted in higher levels of anterior tibial activity among the participants. In hemiplegic patients, anterior tibial activity in the affected side was lesser than in the normal side on stable and unstable surfaces. In healthy adults there was no inter-limb difference. The normal side activity in stroke patients was greater than that recorded in healthy individuals (p < 0.05). The anterior tibial activity in the affected side reached values equal to those of healthy adults when using the Swiss ball. CONCLUSION: Postural reactions provoked from sitting on a unstable surface is effective in facilitating dorsiflexor activity in acute stroke.

Remarkable cell recovery from cerebral ischemia in rats using an adaptive escalator-based rehabilitation mechanism.

Currently, many ischemic stroke patients worldwide suffer from physical and mental impairments, and thus have a low quality of life. However, although rehabilitation is acknowledged as an effective way to recover patients' health, there does not exist yet an adaptive training platform for animal tests so far. For this sake, this paper aims to develop an adaptive escalator (AE) for rehabilitation of rats with cerebral ischemia. Rats were observed to climb upward spontaneously, and a motor-driven escalator, equipped with a position detection feature and an acceleration/deceleration mechanism, was constructed accordingly as an adaptive training platform. The rehabilitation performance was subsequently rated using an incline test, a rotarod test, the infarction volume, the lesion volume, the number of MAP2 positive cells and the level of cortisol. This paper is presented in 3 parts as follows. Part 1 refers to the escalator mechanism design, part 2 describes the adaptive ladder-climbing rehabilitation mechanism, and part 3 discusses the validation of an ischemic stroke model. As it turned out, a rehabilitated group using this training platform, designated as the AE group, significantly outperformed a control counterpart in terms of a rotarod test. After the sacrifice of the rats, the AE group gave an average infarction volume of (34.36 ± 3.8)%, while the control group gave (66.41 ± 3.1)%, validating the outperformance of the escalator-based rehabilitation platform in a sense. An obvious difference between the presented training platform and conventional counterparts is the platform mechanism, and for the first time in the literature rats can be well and voluntarily rehabilitated at full capacity using an adaptive escalator. Taking into account the physical diversity among rats, the training strength provided was made adaptive as a reliable way to eliminate workout or secondary injury. Accordingly, more convincing arguments can be made using this mental stress-free training platform.

Predictive value of the combination of lesion location and volume of ischemic infarction with rehabilitation outcomes.

PURPOSE: In acute ischemic stroke, infarct location and volume have, separately, been used to determine long-term outcomes after stroke. Little information exists on the combination of these imaging characteristics on rehabilitation outcomes. We evaluated the association between infarct lesion location volume with the Functional Independence Measure (FIM) measure during inpatient rehabilitation facility (IRF) in ischemic stroke patients. METHODS: Between 2012 and 2014, we prospectively enrolled consecutive acute ischemic stroke patients admitted from a Comprehensive Stroke Center and followed to an IRF in Chicago, Illinois. We adjudicated infarct volumes in specific lesion locations using a validated brain atlas. Volumes were calculated using an automated pipeline. FIM measure was extracted from IRF charts. We analyzed the association between acute infarct characteristics and functional measures using adjusted Spearman's correlation. RESULTS: Among 162 stroke patients (mean age 67.6 years, 48.1% male, 58.6% Caucasian), the median FIM at IRF was 52 (IQR 36-62). In an adjusted analysis, infarct volumes in the left basal ganglia (rs = - 0.45, p = 0.02) and left frontal lobe (rs = - 0.38, p = 0.04) were negatively correlated with FIM scores. CONCLUSIONS: There is an association between specific infarct lesion location volume and subsequent FIM scores assessed at IRF. Our findings suggest that imaging during index stroke hospitalization could be used to predict outcomes assessed during IRF.

[Influence of Pre-existing Cognitive Impairment on Rehabilitation Outcomes in Patients with Cerebral Infarction].

BACKGROUND AND PURPOSE: The present study determined the effects of pre-existing cognitive impairment (PreCI) on the rehabilitation outcomes in patients with cerebral infarction. METHODS: From June 2013 to August 2015, we classified 52 patients with unilateral cerebral hemispheric infarction into the PreCI and non-PreCI group based on three-dimensional stereotactic surface projection (3D-SSP) cerebral blood flow (CBF) decrease images and the past history of dementia. Furthermore we investigated the related clinical factors and functional independence measure (FIM). RESULTS: 1. Multivariate analysis revealed that the most important factors that affect total FIM at discharge were age, National institutes of Health Stroke Scale (NIHSS) and the Mini-Mental State Examination (MMSE) (R2=0.756). 2. The mean CBF values (P<0.05) were significantly associated with lesion volume, (P<0.001, P<0.05), the NIHSS score (P<0.001, P<0.01), the MMSE score (P<0.001, P<0.005), and total FIM (P<0.005, P<0.05) at discharge. 3. Both cognitive and motor FIM at discharge were significantly lower in the PreCI group (P<0.005, P<0.005). 4. The MMSE score of ZSAM abnormal group was significantly lower in the case of NIHSS score<10 of lesion and non lesion sides. CONCLUSIONS: PreCI, age, and neurological severity, affected the outcomes of stroke rehabilitation Therefore, the diagnosis of PreCI is considered important for effective stroke rehabilitation. (Received August 3, 2017; Accepted February 9, 2018; Published June 1, 2018).

Efficacy of neuromuscular electrical stimulation in improving the negative psychological state in patients with cerebral infarction and dysphagia.

Objective To observe the improvement of negative affect disorders in patients with cerebral infarction and dysphagia by neuromuscular electrical stimulation. Methods One hundred and twelve patients with cerebral infarction and dysphagia were selected and randomized into treatment (n = 59) and control (n = 53) groups. Similar swallowing function was found in both groups before treatment: (1) Water-drinking test in the treatment group proved swallowing function Level III in 24 cases, Level IV in 22 cases and Level V in 13 cases; (2) in the control group, swallowing function was Level III in 21 cases, Level IV in 20 cases and Level V in 12 cases. Both groups received conventional drug therapy and swallowing training. The treatment group additionally received neuromuscular electrical stimulation. Both groups underwent water-drinking test evaluation, Hamilton Anxiety Scale test, and Hamilton Depression Scale test before and after treatment. Results After two courses of treatment, the rate of improvement in swallowing function was 88.1% in the treatment group while 69.8% in the control group. Somatic anxiety, psychogenic anxiety and total scores in the Hamilton Anxiety Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.01). Anxiety, cognitive disorder, psychomotor retardation and total scores in the Hamilton Depression Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.05). Conclusion Patients with cerebral infarction and dysphagia have varying degrees of anxiety, depression, and other negative affect disorders, which could be minimized by neuromuscular electrical stimulation in conjunction with conventional therapy.

Ritanserin, a serotonin-2 receptor antagonist, inhibits functional recovery after cerebral infarction.

It has been suggested that serotonin (5-HT) may be implicated in functional recovery after stroke; however, the underlying molecular mechanisms remain unknown. Here, the role of 5-HT was verified using ritanserin, a potent 5-HT2A receptor antagonist, and protein expression and modification were analyzed to further understand the association between paralysis recovery and molecular mechanisms in the brain. Experimental cerebral cortex infarctions were induced by photothrombosis in rats. Voluntary exercise was initiated 2 days after surgery. Motor performance was then measured using the rotarod test. Differences in protein expression and phosphorylation in the perilesional cortex were analyzed using western blot. In behavioral evaluations, performance in the rotarod test was significantly increased by exercise. However, there was a significantly lower value in time until falling after combined exercise and ritanserin administration compared with that of exercise alone. Protein expression analysis revealed that phosphorylation of protein kinase C (PKC) α, PKCε, and growth-associated protein 43 (GAP43) was significantly upregulated by exercise. These effects were attenuated by ritanserin administration. These data suggest that 5-HT may be related to the underlying mechanisms of exercise-dependent paralysis recovery, that is, exercise-dependent plasticity through the phosphorylation of PKC and GAP43.

Effects of action observation therapy on upper extremity function, daily activities and motion evoked potential in cerebral infarction patients.

BACKGROUND: The aim of this study was to explore the effects of action observation therapy on motor function of upper extremity, activities of daily living, and motion evoked potential in cerebral infarction patients. METHOD: Cerebral infarction survivors were randomly assigned to an experimental group (28 patients) or a control group (25 patients). The conventional rehabilitation treatments were applied in both groups, but the experimental group received an additional action observation therapy for 8 weeks (6 times per week, 20 minutes per time). Fugl-Meyer assessment (FMA), Wolf Motor Function Test (WMFT), Modified Barthel Index (MBI), and motor evoked potential (MEP) were used to evaluate the upper limb movement function and daily life activity. RESULTS: There were no significant differences between experiment and control group in the indexes, including FMA, WMFT, and MBI scores, before the intervention. However, after 8 weeks treatments, these indexes were improved significantly. MEP latency and center-motion conduction time (CMCT) decreased from 23.82 ±â€Š2.16 and 11.15 ±â€Š1.68 to 22.69 ±â€Š2.11 and 10.12 ±â€Š1.46 ms. MEP amplitude increased from 0.61 ±â€Š0.22 to 1.25 ±â€Š0.38 mV. A remarkable relationship between the evaluations indexes of MEP and FMA was found. CONCLUSIONS: Combination of motion observation and traditional upper limb rehabilitation treatment technology can significantly elevate the movement function of cerebral infarction patients in subacute seizure phase with upper limb dysfunction, which expanded the application range of motion observation therapy and provided an effective therapy strategy for upper extremities hemiplegia in stroke patients.

[Brain plasticity and early rehabilitative care for children after neonatal arterial cerebral infarction]. / Plasticité cérébrale et prise en charge rééducative précoce des enfants après infarctus cérébral artériel néonatal.

Currently, in the literature of the evidence based medicine, little data are available to confirm the benefit and the specific procedures of an early intervention for a neonatal arterial ischemic stroke. However, data about the effect of an early physical rehabilitation program on the cerebral plasticity, and preliminary results of clinical studies in children with cerebral palsy strongly suggest the benefit of an early rehabilitation with a multidisciplinary approach. The type of the rehabilitation and its frequency must be determined because a wide variability in the practices exists. A comprehensive care, of the children and his family is necessary to limit the orthopaedics but also the social consequences of a neonatal stroke.

Effects of task-specific rehabilitation training on tau modification in rat with photothrombotic cortical ischemic damage.

Although stroke elicits progressive cognitive decline and is a leading cause of dementia, molecular interplay between stroke and Alzheimer's disease (AD) pathology has not been fully elucidated. Furthermore, studies on the effects of post-stroke rehabilitation on AD pathology are limited. We evaluated the acute effect of stroke on tau modification, and the molecular effects of task-specific training (TST) on tau modification using a model of photochemically-induced thrombosis (PIT)-induced cortical infarction. Following PIT in the dominant side of sensorimotor cortex, the rehabilitation group received 4-weeks of TST rehabilitation once daily by single pellet reaching training, whereas the sedentary control group did not received any type of training. Cortical expression levels of proteins related to tau modification were evaluated on post-stroke day 1 (PSD1) and 28; functional tests were also evaluated performed every week. The expression levels of acetyl-tau, phosphorylated-tau (p-tau), cyclooxygenase-2 and Akt-mTORC1-p70S6K pathway in infarcted cortices on PSD1 were significantly greater, whereas the expression levels of p-AMPK were significantly lower than in the paired contralateral sides. TST rehabilitation for 4 weeks greatly improved functional motor performance but not memory, which concurred with the down-regulations of ipsilateral p-AMPK, cyclooxygenase-2, Akt-mTORC1-p70S6K pathway, and p-tau in rehabilitation group. PIT-induced cortical infarction was found to induce cortical tau modification through the Akt-mTORC1-p70S6K activation, and to suppress the expression of AMPK-related proteins. TST rehabilitation greatly improved motor function, but not memory, and suppressed p-tau expression and neuroinflammation. Nevertheless, the role of TST-mediated regulation of tau hyperphosphorylation required further clarification.