Subacute functional connectivity correlates with cognitive recovery six months after stroke.

BACKGROUND AND PURPOSE: Cognitive impairment is a common consequence of stroke, and the rewiring of the surviving brain circuits might contribute to cognitive recovery. Studies investigating how the functional connectivity of networks change across time and whether their remapping relates to cognitive recovery in stroke patients are scarce. We aimed to investigate whether resting-state functional connectivity was associated with cognitive performance in stroke patients and if any alterations in these networks were correlated with cognitive recovery. METHODS: Using an fMRI ROI-ROI approach, we compared the ipsilesional, contralesional and interhemispheric functional connectivity of three resting-state networks involved in cognition - the Default Mode (DMN), Salience (SN) and Central Executive Networks (CEN), in subacute ischemic stroke patients (time 1, n = 37, stroke onset: 24.32 ± 7.44 days, NIHSS: 2.66 ± 3.45) with cognitively healthy controls (n = 20). Patients were reassessed six months after the stroke event (time 2, n = 20, stroke onset: 182.05 ± 8.17 days) to verify the subsequent reorganization of functional connections and whether such reorganization was associated with cognitive recovery. RESULTS: At time 1, patients had weaker interhemispheric connectivity in the DMN than controls; better cognitive performance at time 1 was associated with stronger interhemispheric and ipsilesional DMN connectivity, and weaker contralesional SN connectivity. At time 2, there were no changes in functional connectivity in stroke patients, compared to time 1. Better cognitive recovery measured at time 2 (time 2 - time 1) was associated with stronger functional connectivity in the DMN, and weaker interhemispheric subacute connectivity in the SN, both from time 1. CONCLUSIONS: Stroke disrupts the functional connectivity of the DMN, not only at the lesioned hemisphere but also between hemispheres. Six months after the stroke event, we could not detect the remapping of networks. Cognitive recovery was associated with the connectivity of both the DMN and SN of time 1. Our findings may be helpful for facilitating further understanding of the potential mechanisms underlying post-stroke cognitive performance.

Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment.

OBJECTIVE: To establish correlations between nutritional, functional and respiratory indices of patients with amyotrophic lateral sclerosis (ALS). METHOD: Twenty patients (13 appendicular-GA and 7 bulbar-GB) were included in the multidisciplinary study at the Neurological Clinic Ambulatory of the University of Campinas Hospital. RESULTS: Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r=-0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss (%WL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with %WL. With regard to the GB, correlation was found between MEP and body mass index (BMI) (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat (%), arm and wrist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm2). CONCLUSION: It is suggested that the application of simple anthropometric measurements could be useful in routine monitoring of patients with ALS.

Depression and anxiety symptoms are associated to disruption of default mode network in subacute ischemic stroke.

Depression and anxiety symptoms are common after stroke and associated to reduction in quality of life and poor physical and social outcomes. The Default Mode Network (DMN) plays an important role in the emotional processing. We investigated whether these symptoms are associated to a disruption of DMN functional connectivity in the first month after stroke. Thirty-four subacute ischemic stroke patients were submitted to: 1) behavioral assessment through Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Structured Clinical Interview for DSM Disorders; 2) neuropsychological assessment using Mini Mental State Examination and Montreal Cognitive Assessment; 3) resting state functional magnetic resonance imaging acquisition using a 3 T scanner (Philips Achieva). Patients with depression and/or anxiety symptoms showed an increased DMN functional connectivity in left inferior parietal gyrus and left basal nuclei, when compared to stroke controls. Specific correlation between BDI/BAI scores and DMN functional connectivity indicated that depression symptoms are correlated with increased functional connectivity in left inferior parietal gyrus, while anxiety symptoms are correlated with increased functional connectivity in cerebellum, brainstem and right middle frontal gyrus. Our study provides new insights into the underlying mechanisms of post stroke depression and anxiety, suggesting an alternate explanation other than regional structural damage following ischemic event, that these psychiatric symptoms are related to brain network dysfunction.

Brain Connectivity and Functional Recovery in Patients With Ischemic Stroke.

BACKGROUND: Brain mapping studies have demonstrated that functional poststroke brain reorganization is associated with recovery of motor function. Nonetheless, the specific mechanisms associated with functional reorganization leading to motor recovery are still partly unknown. In this study, we performed a cross-sectional evaluation of poststroke subjects with the following goals: (1) To assess intra- and interhemispheric functional brain activation patterns associated with motor function in poststroke patients with variable degrees of recovery; (2) to investigate the involvement of other nonmotor functional networks in relationship with recovery. METHODS: We studied 59 individuals: 13 patients with function Rankin > 1 and Barthel < 100; 19 patients with preserved function with Rankin 0-1 and Barthel = 100; and 27 healthy controls. All subjects underwent structural and functional magnetic resonance imaging (3T Philips Achieva, Holland) using the same protocol (TR = 2 seconds, TE = 30 ms, FOV = 240 × 240 × 117, slice = 39). Resting state functional connectivity was used by in-house software, based on SPM12. Among patients with and without preserved function, the functional connectivity between the primary motor region (M1) and the contralateral hemisphere was increased compared with controls. Nonetheless, only patients with decreased function exhibited decreased functional connectivity between executive control, sensorimotor and visuospatial networks. CONCLUSION: Functional recovery after stroke is associated with preserved functional connectivity of motor to nonmotor networks.

Amyotrophic lateral sclerosis: prospective study on respiratory parameters.

OBJECTIVE: To verify how efficient respiratory parameters are in the follow-up of subjects with amyotrophic lateral sclerosis (ALS) and to observe possible correlations between respiratory and nutritional functions. METHOD: Sixteen patients with probable or defined ALS were selected and evaluated over eight months using the following respiratory parameters: spirometry, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), arterial gasometry and pulse oximetry; and nutritional parameters such as body mass index (BMI) and percentage weight loss. RESULTS: P(a)CO(2) was a significant parameter to follow up disease evolution (p=0.051). There was significant correlation between MIP and MEP (r: 0.83); BMI and MIP (r: 0.70); BMI and MEP (r: 0.72); pulse oximetry and forced vital capacity (r: 0.57). CONCLUSION: P(a)CO(2) was shown to be an efficient and significant parameter in the measurement of respiratory impairment; the correlations among MIP, MEP and BMI indicated that these are significant parameters for periodic clinical evaluation.

Effect of nutritional supplementation with milk whey proteins in amyotrophic lateral sclerosis patients.

OBJECTIVE: We evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70%WPI:30%MS), on nutritional and functional parameters of patients with ALS. METHOD: A prospective randomized double-blind study was performed with 16 ALS patients, divided in two groups, the treatment group received (70%WPI:30%MS) and the control group received (maltodextrin). They underwent prospective nutritional and functional assessment for 4 months. RESULTS: Patients in the treatment group presented weight gain, increased body mass index (BMI), increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced creatine-kinase, aspartate aminotransferase and alanine aminotransferase. In the control group, biochemical parameters did not change, but weight and BMI declined. CONCLUSION: Our results indicate that the agglomerate 70%WPI:30%MS may be useful in the nutritional therapy of patients with ALS.

Amyotrophic lateral sclerosis: prospective study on respiratory parameters / Esclerose lateral amiotrófica: estudo prospectivo de parâmetros respiratórios

OBJECTIVE: To verify how efficient respiratory parameters are in the follow-up of subjects with amyotrophic lateral sclerosis (ALS) and to observe possible correlations between respiratory and nutritional functions. METHOD: Sixteen patients with probable or defined ALS were selected and evaluated over eight months using the following respiratory parameters: spirometry, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), arterial gasometry and pulse oximetry; and nutritional parameters such as body mass index (BMI) and percentage weight loss. RESULTS: PaCO2 was a significant parameter to follow up disease evolution (p=0.051). There was significant correlation between MIP and MEP (r: 0.83); BMI and MIP (r: 0.70); BMI and MEP (r: 0.72); pulse oximetry and forced vital capacity (r: 0.57). CONCLUSION: PaCO2 was shown to be an efficient and significant parameter in the measurement of respiratory impairment; the correlations among MIP, MEP and BMI indicated that these are significant parameters for periodic clinical evaluation.

OBJETIVO: Verificar a eficácia dos parâmetros respiratórios na evolução de indivíduos com esclerose lateral amiotrófica (ELA) e identificar possíveis correlações entre função respiratória e nutricional. MÉTODO: 16 pacientes com diagnóstico provável ou definido de ELA foram selecionados por critérios definidos e avaliados, durante 8 meses, através de parâmetros respiratórios: espirometria, pressão inspiratória máxima (PIM), pressão expiratória máxima (PEM), gasometria arterial e oximetria de pulso; e parâmetros nutricionais: índice de massa corporal (IMC) e porcentagem de perda de peso. RESULTADOS: PaCO2 foi um parâmetro significativo para acompanhar a evolução da doença (p=0.051). Houve correlação significante entre PIM e PEM (r: 0.83); IMC e PIM (r: 0.70); IMC e PEM (r: 0.72); oximetria de pulso e capacidade vital forçada (r: 0.57). CONCLUSÃO: PaCO2 foi marcador eficaz e significante para medir o comprometimento respiratório; correlações entre PIM, PEM e IMC indicaram ser bons parâmetros nas avaliações clínicas periódicas.

Proposta de um protocolo para reabilitação vestibular em vestibulopatias periféricas / Protocol's proposal for vestibular rehabilitation in outlying vestibulopatia

INTRODUÇÃO: A reabilitação vestibular tem sido reconhecida como tratamento de escolha para pacientes com persistência da vertigem, por causa da disfunção vestibular periférica, proporcionando acentuada melhora na qualidade de vida. Dentre os tratamentos indicados, tem-se os exercícios de Cawthorne e Cooksey, integração sensorial e plataformas com movimentação corpórea. OBJETIVO:O objetivo da pesquisa foi criar um protocolo de exercícios em um balanço, associando os exercícios de Cawthorne e Cooksey à Integração Sensorial. METODOLOGIA: Foi desenvolvido um relatode caso para avaliar uma paciente por meio das seguintes escalas: Escala de Equilíbrio de Berg eDynamic Gait Índex (DGI) para verificar o equilíbrio; Five Times Sit-to-Stand (FTSTS) para avaliara atividade de sentar e levantar; Dizziness Handicap Inventory (DHI) para verificar sintomas de vertigem; Escala de Sintomas após Tratamento Fisioterapêutico (ESATF), que gradua a sintomatologia após exercícios. Foi desenvolvido um protocolo associando as duas técnicas, nas quais os exercícios oculares, cefálicos e de tronco eram associados ao balanço. Foram realizadas 10 das 20 sessões previstas, por causa da frequência irregular do paciente às sessões. RESULTADOS: O paciente melhorou de 19 para 22 pontos na DGI, manteve a pontuação na Berg e melhorou de 74 para 67pontos na DHI. Na escala FTSTS, diminuiu o tempo de 15 para 14 segundos para realizar atividade de sentar e levantar. Na ESATF, houve oscilação da pontuação. CONCLUSÕES: Após o tratamento,a paciente manteve e obteve melhora no equilíbrio e na capacidade funcional e diminuiu o tempo gasto para realizar a atividade de sentar e levantar cinco vezes de uma cadeira com os membros superiores cruzados. Estudos adicionais com o protocolo proposto devem ser realizados, com um número maior de pacientes e maior assiduidade para haver habituação e reabilitação mais precoce.

Effect of nutritional supplementation with milk whey proteins in amyotrophic lateral sclerosis patients / Efeito da suplementação nutricional com proteínas do soro de leite em pacientes com esclerose lateral amiotrófica

OBJECTIVE: We evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70 percentWPI:30 percentMS), on nutritional and functional parameters of patients with ALS. METHOD: A prospective randomized double-blind study was performed with 16 ALS patients, divided in two groups, the treatment group received (70 percentWPI:30 percentMS) and the control group received (maltodextrin). They underwent prospective nutritional and functional assessment for 4 months. RESULTS: Patients in the treatment group presented weight gain, increased body mass index (BMI), increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced creatine-kinase, aspartate aminotransferase and alanine aminotransferase. In the control group, biochemical parameters did not change, but weight and BMI declined. CONCLUSION: Our results indicate that the agglomerate 70 percentWPI:30 percentMS may be useful in the nutritional therapy of patients with ALS.

OBJETIVO: Avaliar a eficácia da suplementação nutricional oral com proteínas do soro do leite e amido modificado (70 por centoWPI:30 por centoMS), nos parâmetros nutricionais e funcionais de pacientes com esclerose lateral amiotrófica (ELA). MÉTODO: Foi realizado estudo randomizado duplo-cego, com 16 pacientes com ELA, divididos em dois grupos, um que recebeu 70 por centoWPI:30 por centoMS e um controle que recebeu maltodextrina. Os pacientes foram submetidos a avaliação nutricional e funcional durante quatro meses. RESULTADOS: Nos pacientes que receberam o suplemento 70 por centoWPI:30 por centoMS, foi observado ganho de peso, aumento na contagem de linfócitos e redução de creatina kinase, aspartato aminotransferase and alanina aminotransferase. No grupo controle, os parâmetros bioquímicos não sofreram modificações; no entanto, peso e índice de massa corporal diminuíram. CONCLUSÃO: Nossos resultados indicam que o aglomerado 70 por centoWPI:30 por centoMS pode ser útil na terapia de pacientes com ALS.

Efeito do peso para membros inferiores no equilíbrio estático e dinâmico nos portadores de ataxia / The effect of weights on lower limbs in static and dynamic balance for ataxia sufferers

O objetivo da pesquisa foi avaliar o efeito do uso do peso em membros inferiores durante a marcha, nos indivíduos com ataxia. Acredita-se que o peso em membros inferiores traz benefícios na qualidade da marcha nos pacientes atáxicos, alterando a programação motora e conexões neurais cerebelares que são possíveis de alterações na aprendizagem motora. Divididos aleatoriamente, 21 indivíduos em 2 grupos: com peso (GP n=10) e sem peso (SP n=11). Todos realizaram 20 sessões de fisioterapia, avaliados antes (primeira avaliação), depois do tratamento (segunda) e após 30 dias (terceira), através das escalas de Equilíbrio de Berg, Dynamic Gait Index, Equiscale, International Cooperative Ataxia Rating Scale e Medida de Independência Funcional. Foi utilizada a análise ANOVA para medidas repetidas para comparar a evolução das variáveis ao longo do tempo, com nível de significância p ? 0.05. Os indivíduos do GP conseguiram melhores resultados após o tratamento quanto ao equilíbrio, coordenação e independência funcional comparados ao SP, sendo estatisticamente significantes. O GP conseguiu manter o ganho da primeira para a terceira avaliação demonstrada por quase todas as escalas, exceto a DGI. O estudo comprovou a efetividade do peso, melhorando o equilíbrio estático e dinâmico, coordenação da marcha e independência funcional.

The object of this research was to evaluate the effect of ataxia sufferers using weights on the lower members while walking. It is believed that weights on lower members benefits the gait quality of ataxia patients, altering the motor programming and neural connections in the cerebellum that are alterable in motor learning. Twenty-one individuals were randomly divided into two groups: with weights (GP n=10) and without weights (SP n=11). Everyone did 20 sessions of physiotherapy and were evaluated before (first evaluation), after treatment (second evaluation), and after 30 days (third evaluation), by means of the Berg Balance, Dynamic Gait Index, Equiscale, International Cooperative Ataxia Rating Scale, Functional Independence Measure. The ANOVA analysis was used for repeated measurements to compare the evolution of variables over time, with a significance level of p ? 0.05. After treatment and with statistical significance, the GP individuals managed better results with balance, coordination, and functional independence than those without weights. The GP group managed to maintain the benefit from the first through third evaluations on all scales except the DGI. The study proved the effectiveness of weights in improving the static and dynamic balance, the gait coordination, and functional independence.

Equiscala: versão brasileira e estudo de confiabilidade e validade da Equiscale / Brazilian version, reliability and validity study of the Equiscale

Este estudo consistiu na tradução para o português e na verificacao da confiabilidade e validade do teste original de equilíbrio Equiscale. A versão brasileira foi testada em 11 indivíduos com esclerose múltipla selecionados aleatoriamente, que foram inicialmente avaliados pela Escala de Equilíbrio de Berg (EEB)...

This article presents the Brazilian-Portuguese version of the Equiscale and assesses its reliability and validity. The translation was tested on 11 ramdomly-selected patients with multiple sclerosis, who were also assessed by Berg Balance Escale (BBS)...

Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment / Esclerose lateral amiotrófica: correlações dos indicadores da avaliação nutricional, funcional e respiratória

OBJECTIVE: To establish correlations between nutritional, functional and respiratory indices of patients with amyotrophic lateral sclerosis (ALS). METHOD: Twenty patients (13 appendicular - GA and 7 bulbar - GB) were included in the multidisciplinary study at the Neurological Clinic Ambulatory of the University of Campinas Hospital. RESULTS: Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r= -0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss ( percentWL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with percentWL. With regard to the GB, correlation was found between MEP and body mass index (BMI) (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat ( percent), arm and wrist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm²). CONCLUSION: It is suggested that the application of simple anthropometric measurements could be useful in routine monitoring of patients with ALS.

OBJETIVO: Correlacionar os indicadores utilizados na avaliação nutricional, funcional e respiratória de indivíduos com esclerose lateral amiotrófica (ELA). MÉTODO: Vinte pacientes (13 apendiculares - GA e 7 bulbares - GB) foram incluídos no estudo usando parâmetros nutricionais, respiratórios e escala funcional (ALSFRS-R). RESULTADOS: Entre os pacientes do GA, as correlações observadas foram: pressão inspiratória máxima (PImax) e expiratória máxima (PEmax) (r= -0,76); PEmax e oximetria de pulso (r=0,58); PImax e porcentagem de perda de peso ( por centoPP) (r=0,59); e entre PImax, escore ALSFRS-R com por centoPP. No GB, houve correlação entre MEP e índice de massa corporal (IMC) (r=0,97). Em GA e GB, observaram-se correlação entre IMC e as variáveis: massa, gordura ( por cento), circunferência braquial e punho, pregas cutâneas tricipital, subescapular e supra-ilíaca, circunferência muscular do braço (cm), área muscular gordurosa do braço (mm²). CONCLUSÃO: Sugere-se a aplicação deste conjunto de medidas durante a evolução clínica de indivíduos com ELA.