Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 17.926
Filtrar
1.
Medicine (Baltimore) ; 100(3): e24351, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546067

RESUMEN

PURPOSE: Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke. METHODS: This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI). RESULTS: Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05). CONCLUSIONS: The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.


Asunto(s)
Terapia por Ejercicio/normas , Imágenes en Psicoterapia/normas , Accidente Cerebrovascular/complicaciones , Extremidad Superior/inervación , Adulto , Anciano , Distribución de Chi-Cuadrado , Terapia por Ejercicio/instrumentación , Terapia por Ejercicio/métodos , Femenino , Humanos , Imágenes en Psicoterapia/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función , Estadísticas no Paramétricas , Accidente Cerebrovascular/fisiopatología , Extremidad Superior/fisiopatología
2.
BMC Neurol ; 21(1): 38, 2021 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-33504334

RESUMEN

BACKGROUND: Ambulatory and balance functions are important for maintaining general health in humans. Gait analysis allows clinicians and researchers to identify the parameters to be focused on when assessing balance and ambulatory functions. In this study, we performed gait analysis with pressure sensors to identify the gait-analysis parameters related to balance and ambulatory functions in hemiplegic stroke patients. METHODS: We retrospectively reviewed the medical records of 102 patients with hemiplegic stroke who underwent gait analysis. Correlations between various temporospatial parameters in the gait analysis and the motor and balance functions assessed using functional ambulation category, modified Barthel index, and Berg balance scale were analyzed. RESULTS: Gait speed/height and the lower-limb stance-phase time/height were the only temporal and spatial parameters, respectively, that showed a statistical correlation with motor and balance functions. CONCLUSIONS: Measurements of walking speed and stance-phase time of the unaffected lower limb can allow clinicians to easily assess the ambulatory and balance functions of hemiplegic stroke patients. Rehabilitative treatment focusing on increasing gait speed and shortening the stance-phase time of the unaffected side may improve the ambulatory and balance functions in these patients.


Asunto(s)
Análisis de la Marcha/estadística & datos numéricos , Hemiplejía/fisiopatología , Equilibrio Postural/fisiología , Accidente Cerebrovascular/fisiopatología , Caminata/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemiplejía/complicaciones , Humanos , Extremidad Inferior/fisiopatología , Masculino , Persona de Mediana Edad , Modalidades de Fisioterapia , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones , Adulto Joven
3.
Trials ; 22(1): 91, 2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33494805

RESUMEN

BACKGROUND: The high incidence of cerebral apoplexy makes it one of the most important causes of adult disability. Gait disorder is one of the hallmark symptoms in the sequelae of cerebral apoplexy. The recovery of walking ability is critical for improving patients' quality of life. Innovative virtual reality technology has been widely used in post-stroke rehabilitation, whose effectiveness and safety have been widely verified. To date, however, there are few studies evaluating the effect of immersive virtual reality on stroke-related gait rehabilitation. This study outlines the application of immersive VR-assisted rehabilitation for gait rehabilitation of stroke patients for comparative evaluation with traditional rehabilitation. METHODS: The study describes a prospective, randomized controlled clinical trial. Thirty-six stroke patients will be screened and enrolled as subjects within 1 month of initial stroke and randomized into two groups. The VRT group (n = 18) will receive VR-assisted training (30 min) 5 days/week for 3 weeks. The non-VRT group (n = 18) will receive functional gait rehabilitation training (30 min) 5 days/week for 3 weeks. The primary outcomes and secondary outcomes will be conducted before intervention, 3 weeks after intervention, and 6 months after intervention. The primary outcomes will include time "up & go" test (TUGT). The secondary outcomes will include MMT muscle strength grading standard (MMT), Fugal-Meyer scale (FMA), motor function assessment scale (MAS), improved Barthel index scale (ADL), step with maximum knee angle, total support time, step frequency, step length, pace, and stride length. DISCUSSION: Virtual reality is an innovative technology with broad applications, current and prospective. Immersive VR-assisted rehabilitation in patients with vivid treatment scenarios in the form of virtual games will stimulate patients' interest through active participation. The feedback of VR games can also provide patients with performance awareness and effect feedback, which could be incentivizing. This study may reveal an improved method of stroke rehabilitation which can be helpful for clinical decision-making and future practice. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900025375 . Registered on 25 August 2019.


Asunto(s)
Marcha/fisiología , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/fisiopatología , Terapia de Exposición Mediante Realidad Virtual/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Método Simple Ciego , Accidente Cerebrovascular/diagnóstico , Rehabilitación de Accidente Cerebrovascular/efectos adversos , Rehabilitación de Accidente Cerebrovascular/instrumentación , Resultado del Tratamiento , Terapia de Exposición Mediante Realidad Virtual/instrumentación , Prueba de Paso/estadística & datos numéricos
4.
J Alzheimers Dis ; 79(3): 931-948, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33459706

RESUMEN

Proinflammatory cytokines such as tumor necrosis factor (TNF), with its now appreciated key roles in neurophysiology as well as neuropathophysiology, are sufficiently well-documented to be useful tools for enquiry into the natural history of neurodegenerative diseases. We review the broader literature on TNF to rationalize why abruptly-acquired neurodegenerative states do not exhibit the remorseless clinical progression seen in those states with gradual onsets. We propose that the three typically non-worsening neurodegenerative syndromes, post-stroke, post-traumatic brain injury (TBI), and post cardiac arrest, usually become and remain static because of excess cerebral TNF induced by the initial dramatic peak keeping microglia chronically activated through an autocrine loop of microglial activation through excess cerebral TNF. The existence of this autocrine loop rationalizes post-damage repair with perispinal etanercept and proposes a treatment for cerebral aspects of COVID-19 chronicity. Another insufficiently considered aspect of cerebral proinflammatory cytokines is the fitness of the endogenous cerebral anti-TNF system provided by norepinephrine (NE), generated and distributed throughout the brain from the locus coeruleus (LC). We propose that an intact LC, and therefore an intact NE-mediated endogenous anti-cerebral TNF system, plus the DAMP (damage or danger-associated molecular pattern) input having diminished, is what allows post-stroke, post-TBI, and post cardiac arrest patients a strong long-term survival advantage over Alzheimer's disease and Parkinson's disease sufferers. In contrast, Alzheimer's disease and Parkinson's disease patients remorselessly worsen, being handicapped by sustained, accumulating, DAMP and PAMP (pathogen-associated molecular patterns) input, as well as loss of the LC-origin, NE-mediated, endogenous anti-cerebral TNF system. Adrenergic receptor agonists may counter this.


Asunto(s)
Lesiones Encefálicas/fisiopatología , Enfermedades Neurodegenerativas/fisiopatología , Accidente Cerebrovascular/fisiopatología , Factor de Necrosis Tumoral alfa/fisiología , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/fisiopatología , Enfermedad de Alzheimer/terapia , Antiinflamatorios no Esteroideos/uso terapéutico , Encéfalo/fisiopatología , Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/terapia , /fisiopatología , Progresión de la Enfermedad , Etanercept/uso terapéutico , Paro Cardíaco/diagnóstico , Paro Cardíaco/fisiopatología , Paro Cardíaco/terapia , Humanos , Locus Coeruleus/fisiopatología , Enfermedades Neurodegenerativas/diagnóstico , Enfermedades Neurodegenerativas/terapia , Norepinefrina/fisiología , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/terapia , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Sobrevivientes , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores
5.
Cardiol Rev ; 29(1): 39-42, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33136582

RESUMEN

Patients older than 65 years hospitalized with COVID-19 have higher rates of intensive care unit admission and death when compared with younger patients. Cardiovascular conditions associated with COVID-19 include myocardial injury, acute myocarditis, cardiac arrhythmias, cardiomyopathies, cardiogenic shock, thromboembolic disease, and cardiac arrest. Few studies have described the clinical course of those at the upper extreme of age. We characterize the clinical course and outcomes of 73 patients with 80 years of age or older hospitalized at an academic center between March 15 and May 13, 2020. These patients had multiple comorbidities and often presented with atypical clinical findings such as altered sensorium, generalized weakness and falls. Cardiovascular manifestations observed at the time of presentation included new arrhythmia in 7/73 (10%), stroke/intracranial hemorrhage in 5/73 (7%), and elevated troponin in 27/58 (47%). During hospitalization, 38% of all patients required intensive care, 13% developed a need for renal replacement therapy, and 32% required vasopressor support. All-cause mortality was 47% and was highest in patients who were ever in intensive care (71%), required mechanical ventilation (83%), or vasopressors (91%), or developed a need for renal replacement therapy (100%). Patients older than 80 years old with COVID-19 have multiple unique risk factors which can be associated with increased cardiovascular involvement and death.


Asunto(s)
Lesión Renal Aguda/terapia , Mortalidad Hospitalaria , Terapia de Reemplazo Renal/estadística & datos numéricos , Respiración Artificial/estadística & datos numéricos , Vasoconstrictores/uso terapéutico , Centros Médicos Académicos , Accidentes por Caídas , Lesión Renal Aguda/etiología , Anciano de 80 o más Años , Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , Aspartato Aminotransferasas/metabolismo , Proteína C-Reactiva/metabolismo , /metabolismo , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/metabolismo , Enfermedades Cardiovasculares/fisiopatología , Causas de Muerte , Trastornos de la Conciencia/fisiopatología , Disnea/fisiopatología , Femenino , Ferritinas/metabolismo , Fiebre/fisiopatología , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Hospitalización , Humanos , Hipoxia/fisiopatología , Hipoxia/terapia , Vida Independiente , Unidades de Cuidados Intensivos/estadística & datos numéricos , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/fisiopatología , Recuento de Leucocitos , Hepatopatías/etiología , Hepatopatías/metabolismo , Recuento de Linfocitos , Masculino , Debilidad Muscular/fisiopatología , Péptido Natriurético Encefálico/metabolismo , Casas de Salud , Terapia por Inhalación de Oxígeno , Polipéptido alfa Relacionado con Calcitonina/metabolismo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Troponina I/metabolismo
6.
Vasc Endovascular Surg ; 55(1): 77-80, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32869715

RESUMEN

We report a case in which endovascular treatment (EVT) was performed for vertebral and basilar artery (VA and BA) tandem occlusion beyond 24 hours from onset of stroke. A 78-year-old man was admitted to our institution with dysarthria and disturbance of gait. MRI revealed occlusion of the BA with acute ischemic change in bilateral cerebellum and brain stem. At 36 hours after onset and 30 hours after administration, EVT was performed because of deteriorating neurological symptom. Successful revascularization was achieved with percutaneous transluminal angioplasty for VA and thrombectomy for BA occlusion. The neurological symptoms were improved in postoperative course.


Asunto(s)
Angioplastia de Balón , Accidente Cerebrovascular/terapia , Trombectomía , Tiempo de Tratamiento , Insuficiencia Vertebrobasilar/cirugía , Anciano , Humanos , Masculino , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/fisiopatología
7.
PLoS One ; 15(12): e0242466, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33370282

RESUMEN

BACKGROUND: In real-world practice settings, there is insufficient evidence on the efficacy of antiplatelet drugs, including clopidogrel, aspirin, and ticlopidine, in stroke prevention. PURPOSE: To compare the efficacies between aspirin and clopidogrel and aspirin and ticlopidine in stroke prevention. METHODS: This population-based case-cohort study utilized the data obtained from a randomized sample of one million subjects in the Taiwan National Health Insurance Research Database. Patients who were hospitalized owing to the primary diagnosis of ischemic stroke from January 1, 2000 to December 31, 2010 and treated with aspirin, ticlopidine, or clopidogrel were included in the study. Propensity score matching with a 1:4 ratio was performed to compare aspirin with ticlopidine and clopidogrel. The criteria for inclusion were the use of one of the three antiplatelet drugs for more than 14 days within the first month after the stroke and then continued use of the antiplatelet drugs until the study endpoint of recurrent stroke. RESULTS: During the 3-year follow-up period, the recurrent stroke rates were 1.62% (42/2585), 1.48% (3/203), and 2.55% (8/314) in the aspirin, ticlopidine, and clopidogrel groups, respectively. Compared with the patients treated with aspirin, those treated with clopidogrel and ticlopidine showed competing risk-adjusted hazard ratios of recurrent stroke of 2.27 (1.02-5.07) and 0.62 (0.08-4.86), respectively. CONCLUSION: Compared with the patients treated with aspirin, those treated with clopidogrel were at a higher risk of recurrent stroke. For stroke prevention, aspirin was superior to clopidogrel whereas ticlopidine was not inferior to aspirin.


Asunto(s)
Aspirina/uso terapéutico , Isquemia Encefálica/prevención & control , Clopidogrel/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular/prevención & control , Ticlopidina/uso terapéutico , Adulto , Anciano , Isquemia Encefálica/sangre , Isquemia Encefálica/fisiopatología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Recurrencia , Prevención Secundaria/métodos , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/fisiopatología , Taiwán
8.
Proc Natl Acad Sci U S A ; 117(52): 33578-33585, 2020 12 29.
Artículo en Inglés | MEDLINE | ID: mdl-33318200

RESUMEN

Stroke patients with small central nervous system infarcts often demonstrate an acute dysexecutive syndrome characterized by difficulty with attention, concentration, and processing speed, independent of lesion size or location. We use magnetoencephalography (MEG) to show that disruption of network dynamics may be responsible. Nine patients with recent minor strokes and eight age-similar controls underwent cognitive screening using the Montreal cognitive assessment (MoCA) and MEG to evaluate differences in cerebral activation patterns. During MEG, subjects participated in a visual picture-word matching task. Task complexity was increased as testing progressed. Cluster-based permutation tests determined differences in activation patterns within the visual cortex, fusiform gyrus, and lateral temporal lobe. At visit 1, MoCA scores were significantly lower for patients than controls (median [interquartile range] = 26.0 [4] versus 29.5 [3], P = 0.005), and patient reaction times were increased. The amplitude of activation was significantly lower after infarct and demonstrated a pattern of temporal dispersion independent of stroke location. Differences were prominent in the fusiform gyrus and lateral temporal lobe. The pattern suggests that distributed network dysfunction may be responsible. Additionally, controls were able to modulate their cerebral activity based on task difficulty. In contrast, stroke patients exhibited the same low-amplitude response to all stimuli. Group differences remained, to a lesser degree, 6 mo later; while MoCA scores and reaction times improved for patients. This study suggests that function is a globally distributed property beyond area-specific functionality and illustrates the need for longer-term follow-up studies to determine whether abnormal activation patterns ultimately resolve or another mechanism underlies continued recovery.


Asunto(s)
Red Nerviosa/fisiopatología , Accidente Cerebrovascular/fisiopatología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Conducta , Mapeo Encefálico , Femenino , Humanos , Imagen por Resonancia Magnética , Magnetoencefalografía , Masculino , Persona de Mediana Edad , Red Nerviosa/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Síndrome , Análisis y Desempeño de Tareas , Factores de Tiempo , Adulto Joven
9.
Eur Rev Med Pharmacol Sci ; 24(24): 13044-13048, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33378056

RESUMEN

As a severe and highly contagious infection, coronavirus disease (COVID-19) affects all aspects of society and has become a global public health problem. Because of the complexity of the pathology of COVID-19, it is difficult to treat. An increasing number of reports have indicated that COVID-19 may have neurological complications, including stroke. The nervous system complications of COVID-19 have gradually attracted research attention. In this review, we summarize the latest findings related to COVID 19, elaborate on the possible mechanism of COVID 19 related onset of stroke, and summarize current treatment options because an improved understanding and appropriate treatments may improve the prognosis of patients with COVID-19-related stroke.


Asunto(s)
/fisiopatología , Cefalea/fisiopatología , Accidente Cerebrovascular/fisiopatología , Trastornos del Gusto/fisiopatología , /metabolismo , Anticoagulantes/uso terapéutico , Trastornos de la Coagulación Sanguínea/complicaciones , Trastornos de la Coagulación Sanguínea/fisiopatología , /inmunología , Trastornos de la Conciencia/fisiopatología , Citocinas/inmunología , Endotelio Vascular/metabolismo , Endotelio Vascular/fisiopatología , Humanos , Sistema Renina-Angiotensina , Medias de Compresión , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/inmunología , Accidente Cerebrovascular/terapia , Terapia Trombolítica
10.
Cerebrovasc Dis ; 49(5): 550-555, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33091908

RESUMEN

BACKGROUND: The evolution of the symptomatic intracranial occlusion during transfers from primary stroke centers (PSCs) to comprehensive stroke centers (CSCs) for endovascular treatment (EVT) is not widely known. Our aim was to identify factors related to partial or complete recanalization (REC) at CSC arrival in patients with a documented large vessel occlusion (LVO) in PSC transferred for EVT evaluation to better define the workflow at CSC of this group of patients. METHODS: We conducted an observational, multicenter study from a prospective, government-mandated, population-based registry of stroke patients with documented LVO at PSC transferred to CSC for EVT from January 2017 to June 2019. The primary end point was defined as partial or complete REC that precluded EVT at CSC arrival (REC). We evaluated the association between baseline, treatment variables and time intervals with the presence of REC. RESULTS: From 589 patients, the rate of REC at CSC was 10.5% in all LVO patients transferred from PSC to CSC for EVT evaluation. On univariate analysis, lower PSC-NIHSS (median 12vs.16, p = 0.001), tPA treatment at PSC (13.7 vs. 5.0%; p = 0.001), presence of M2 occlusion on PSC (16.8 vs. 9%; p = 0.023), and clinical improvement at CSC arrival (21.7 vs. 9.6% p = 0.001) were associated with REC at CSC. On multivariate analysis, clinical improvement at CSC arrival (p < 0.001, OR: 5.96 95% CI: 2.5-13.9) and PSC tPA treatment predicted REC (p = 0.003, OR: 4.65, 95% CI: 1.73-12.4). CONCLUSION: REC at CSC arrival occurs exceptionally in patients with a documented LVO on PSC. Repeating a second vascular study before EVT would not be necessary in most patients. Despite its modest effect, tPA treatment at PSC was an independent predictor of REC.


Asunto(s)
Isquemia Encefálica/terapia , Procedimientos Endovasculares , Fibrinolíticos/administración & dosificación , Transferencia de Pacientes , Reperfusión , Accidente Cerebrovascular/terapia , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatología , Procedimientos Endovasculares/efectos adversos , Femenino , Fibrinolíticos/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Reperfusión/efectos adversos , Estudios Retrospectivos , España , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento , Flujo de Trabajo
11.
BMC Neurol ; 20(1): 385, 2020 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-33092554

RESUMEN

BACKGROUND: Training with brain-computer interface (BCI) technology in the rehabilitation of patients after a stroke is rapidly developing. Numerous RCT investigated the effects of BCI training (BCIT) on recovery of motor and brain function in patients after stroke. METHODS: A systematic literature search was performed in Medline, IEEE Xplore Digital Library, Cochrane library, and Embase in July 2018 and was repeated in March 2019. RCT or controlled clinical trials that included BCIT for improving motor and brain recovery in patients after a stroke were identified. Data were meta-analysed using the random-effects model. Standardized mean difference (SMD) with 95% confidence (95%CI) and 95% prediction interval (95%PI) were calculated. A meta-regression was performed to evaluate the effects of covariates on the pooled effect-size. RESULTS: In total, 14 studies, including 362 patients after ischemic and hemorrhagic stroke (cortical, subcortical, 121 females; mean age 53.0+/- 5.8; mean time since stroke onset 15.7+/- 18.2 months) were included. Main motor recovery outcome measure used was the Fugl-Meyer Assessment. Quantitative analysis showed that a BCI training compared to conventional therapy alone in patients after stroke was effective with an SMD of 0.39 (95%CI: 0.17 to 0.62; 95%PI of 0.13 to 0.66) for motor function recovery of the upper extremity. An SMD of 0.41 (95%CI: - 0.29 to 1.12) for motor function recovery of the lower extremity was found. BCI training enhanced brain function recovery with an SMD of 1.11 (95%CI: 0.64 to 1.59; 95%PI ranging from 0.33 to 1.89). Covariates such as training duration, impairment level of the upper extremity, and the combination of both did not show significant effects on the overall pooled estimate. CONCLUSION: This meta-analysis showed evidence that BCI training added to conventional therapy may enhance motor functioning of the upper extremity and brain function recovery in patients after a stroke. We recommend a standardised evaluation of motor imagery ability of included patients and the assessment of brain function recovery should consider neuropsychological aspects (attention, concentration). Further influencing factors on motor recovery due to BCI technology might consider factors such as age, lesion type and location, quality of performance of motor imagery, or neuropsychological aspects. TRIAL REGISTRATION: PROSPERO registration: CRD42018105832 .


Asunto(s)
Interfaces Cerebro-Computador , Imaginación , Recuperación de la Función , Rehabilitación de Accidente Cerebrovascular/métodos , Electroencefalografía , Femenino , Humanos , Persona de Mediana Edad , Accidente Cerebrovascular/fisiopatología
12.
PLoS One ; 15(10): e0239203, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33112909

RESUMEN

BACKGROUND: There currently is no field test available for measuring maximal exercise capacity in people with stroke. OBJECTIVE: To determine the feasibility, reproducibility and validity of the Shuttle Test (ST) to measure exercise capacity in people with stroke. DESIGN: Longitudinal study design. SETTING: Rehabilitation department, day care centres from a nursing home and private practices specialized in neuro rehabilitation. SUBJECTS: People with subacute or chronic stroke. INTERVENTIONS: A standardized protocol was used to determine feasibility, reproducibility and validity of the 10-meter Shuttle Test (10mST). MAIN MEASURES: Number of shuttles completed, 1stVentilatory Threshold (1stVT). RESULTS: The associations of the number of shuttles completed and cardiopulmonary capacity as measured with a portable gas analyser were r > 0.7, confirming good convergent validity in subacute and chronic people with stroke. Criterion validity, however, indicates it is not a valid test for measuring maximal cardiopulmonary capacity (VO2max). Only 60% of participants were able to reach the 1stVT. Higher cardiopulmonary capacity and a higher total score of the lower extremity Motricity Index contributed significantly to a higher number of shuttles walked (p = 0.001). CONCLUSIONS: The Shuttle Test may be a safe and useful exercise test for people after stroke, but may not be appropriate for use with people who walk slower than 2 km/h or 0.56 m/s.


Asunto(s)
Prueba de Esfuerzo/métodos , Tolerancia al Ejercicio/fisiología , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Umbral Anaerobio , Prueba de Esfuerzo/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Países Bajos , Consumo de Oxígeno , Reproducibilidad de los Resultados , Rehabilitación de Accidente Cerebrovascular , Caminata/fisiología
13.
Nat Commun ; 11(1): 5094, 2020 10 09.
Artículo en Inglés | MEDLINE | ID: mdl-33037225

RESUMEN

Brain lesions do not just disable but also disconnect brain areas, which once deprived of their input or output, can no longer subserve behaviour and cognition. The role of white matter connections has remained an open question for the past 250 years. Based on 1333 stroke lesions, here we reveal the human Disconnectome and demonstrate its relationship to the functional segregation of the human brain. Results indicate that functional territories are not only defined by white matter connections, but also by the highly stereotyped spatial distribution of brain disconnections. While the former has granted us the possibility to map 590 functions on the white matter of the whole brain, the latter compels a revision of the taxonomy of brain functions. Overall, our freely available Atlas of White Matter Function will enable improved clinical-neuroanatomical predictions for brain lesion studies and provide a platform for explorations in the domain of cognition.


Asunto(s)
Encéfalo/patología , Encéfalo/fisiología , Conectoma , Accidente Cerebrovascular/patología , Conducta , Humanos , Neuroimagen , Accidente Cerebrovascular/fisiopatología
14.
Cardiovasc Ther ; 2020: 7172052, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33042224

RESUMEN

Background: We provide an updated meta-analysis with detailed information on a combination of TCM and routine treatment. Methods: Retrieve appropriate articles with no language restrictions on keywords until 8 July 2019 in an electronic database. All trajectories are screened according to certain criteria. The quality of certified research was also evaluated. We made a detailed record of the results of the measurement. Meta-analysis was carried out by using the Revman 5.3 software. Results: Sixty-seven RCTs were included, and 6594 subjects were analyzed. Compared with routine treatment, the total effective rate (TER) of TCM combined with routine treatment was improved, and the recovery of stroke was also significantly accelerated. Regulation of blood lipids by notably shrinking the contents of TC, TG, and LDL and enhancing the levels of HDL. The levels of serum hs-CRP, WHV, and WLV decreased significantly, indicating that the expression of thrombomodulin was decreased after the comprehensive treatment of traditional Chinese medicines (TCMs). The combination of TCM treatment could enhance the protection of neural function by decreasing the NIHSS scoring while increasing the BI scoring. Paeoniae Radix Rubra, Angeticae Sinensis Radix, etc., can effectively improve the clinical symptoms of stroke convalescent patients and promote the recovery of neurological function. ACU of Baihui, Renzhong, etc., can improve the clinical rehabilitation effect of patients. However, our findings must be handled with care because of the small sample size and low quality of clinic trials cited. Other rigorous and large-scale RCTs are in need to confirm these results. Conclusion: A combination of TCM and routine treatment in the treatment of stroke could improve TER, and it is beneficial to the rehabilitation of patients in the recovery period of apoplexy. These effects can be mediated by a combination of several mechanisms. Nevertheless, due to the limitations of this study, these results should be handled with caution.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Medicina China Tradicional , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Medicamentos Herbarios Chinos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular/efectos adversos , Resultado del Tratamiento , Adulto Joven
15.
J Stroke Cerebrovasc Dis ; 29(11): 105213, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066879

RESUMEN

BACKGROUND: In stroke survivors, post-stroke fatigue predicts dependency in daily living and failure to return to work. Modafinil shows promise as a pharmacotherapy to reduce post-stroke fatigue and related sequelae, e.g., poorer functional and clinical outcomes. AIMS: This study explored the cost-effectiveness of modafinil in treating post-stroke fatigue in the Australian context, by determining its incremental cost-effectiveness ratio (ICER) and by simulating the potential cost-savings on a national scale, through a re-analysis of MIDAS trial data. METHODS: A post hoc cost-effectiveness analysis was undertaken. Part A: patient-level cost and health effect data (Multidimensional Fatigue Inventory (MFI) scores) were derived from the MIDAS trial and analysis undertaken from a health-system perspective. Part B: a secondary analysis simulated the societal impact of modafinil therapy in terms of national productivity costs. RESULTS: Part A: Mean cost of modafinil treatment was AUD$3.60/day/patient for a minimally clinically important change (10 points) in total MFI fatigue score, i.e., AUD$0.36/day/unit change in fatigue score per patient. For the base case scenario, the ICER of using modafinil (versus placebo) was AUD$131.73 ($90.17 - 248.15, for minimum and maximum costs, respectively). Part B: The potential productivity cost-savings to society were calculated as nearly AUD$467 million over 1 year, and up to $383,471,991,248 over 10 years, from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors, representing a significant societal benefit. CONCLUSIONS: Modafinil is a highly cost-effective treatment for post-stroke fatigue, offering significant productivity gains and potential cost-savings to society from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors.


Asunto(s)
Estimulantes del Sistema Nervioso Central/economía , Estimulantes del Sistema Nervioso Central/uso terapéutico , Costos de los Medicamentos , Fatiga/tratamiento farmacológico , Fatiga/economía , Modafinilo/economía , Modafinilo/uso terapéutico , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/terapia , Anciano , Australia , Estimulantes del Sistema Nervioso Central/efectos adversos , Ensayos Clínicos Fase II como Asunto , Ahorro de Costo , Análisis Costo-Beneficio , Fatiga/diagnóstico , Fatiga/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modafinilo/efectos adversos , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Resultado del Tratamiento
16.
J Stroke Cerebrovasc Dis ; 29(11): 105182, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066878

RESUMEN

Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the development of the novel 2019 coronavirus disease (COVID-19) and associated clinical symptoms, which typically presents as an upper respiratory syndrome such as pneumonia. Growing evidence indicates an increased prevalence of neurological involvement (e.g., in the form of stroke) during virus infection. COVID-19 has been suggested to be more than a lung infection because it affects the vasculature of the lungs and other organs and increases the risk of thrombosis. Patients with stroke are vulnerable to secondary events as a result not only of their poor vascular condition but also of their lack of access to rehabilitation resources. Herein, we review current knowledge regarding the pathophysiology of COVID-19, its possible association with neurological involvement, and current drug therapies. Suggestions are also offered regarding the potential for current neurorehabilitation therapies to be taught and practiced at home.


Asunto(s)
Infecciones por Coronavirus/terapia , Modalidades de Fisioterapia , Neumonía Viral/terapia , Prevención Secundaria , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/virología , Interacciones Huésped-Patógeno , Humanos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/virología , Cuarentena , Recuperación de la Función , Recurrencia , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/fisiopatología , Resultado del Tratamiento
17.
J Stroke Cerebrovasc Dis ; 29(11): 105139, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066880
18.
J Stroke Cerebrovasc Dis ; 29(11): 105214, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066892

RESUMEN

BACKGROUND: Patients with post-stroke hemiparesis have poor postural stability; nevertheless, it is unclear whether vestibular rehabilitation affects gait performance after a stroke or not. We performed a systematic review of randomized controlled trials to investigate the effects of vestibular rehabilitation on gait performance in patients with post stroke. METHODS: The Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature databases were comprehensively searched. All literature published from each source's earliest date to June 2019 was included. Study selection and data extraction were performed independently by paired reviewers. Outcomes of gait performance were the 10-Meter Walking Test, Timed Up and Go Test, and Dynamic Gait Index. We applied the Physiotherapy Evidence Database scale to evaluate the risk of bias and the Grading of Recommendations Assessment, Development and Evaluation system to evaluate the quality of a body of evidence. RESULTS: Three studies were included, and two out of three trials showed beneficial effects of vestibular rehabilitation in post-stroke patients. Quality assessment using the Grading of Recommendations Assessment, Development and Evaluation criteria found very low-quality evidence of all included studies due to inadequate allocation concealment, low participant numbers, and lack of blinding. CONCLUSION: This review found beneficial effects of vestibular rehabilitation on gait performance in patients with stroke. However, due to the very low-quality evidence of previous randomized controlled trials as assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria, definitive conclusions on the effectiveness of vestibular rehabilitation cannot be made. Hence, more high-quality and large-scale randomized controlled trials of vestibular rehabilitation after stroke are needed.


Asunto(s)
Marcha , Equilibrio Postural , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Vestíbulo del Laberinto/fisiopatología , Anciano , Femenino , Análisis de la Marcha , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Resultado del Tratamiento
19.
J Stroke Cerebrovasc Dis ; 29(11): 105211, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066897

RESUMEN

INTRODUCTION: Acute management of blood pressure in ischemic stroke treated with reperfusion therapy remains uncertain. We evaluated blood pressures during the first 24-hours after reperfusion therapy in relation to in-hospital outcomes. METHODS: We conducted a single-center retrospective study of blood pressure in the first 24 hours among ischemic stroke patients who underwent reperfusion therapy with intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) at a tertiary referral center. Blood pressure variability was expressed as the range between the highest and the lowest pressures. Outcomes of interest were discharge disposition and in-hospital mortality. Favorable outcome was defined as a discharge destination to home or inpatient rehabilitation facility (IRF). Multivariable logistic regression analysis was performed with adjustment for age, National Institutes of Health Stroke Scale score, and patients receiving reperfusion therapy. RESULTS: Among the 140 ischemic stroke patients (117 IVT, 84 MT and 61 both), 95 (67.8%) had favorable discharge disposition and 24 (17.1%) died. Higher 24-hour peak systolic blood pressures (SBPs) and peak mean arterial pressures (MAPs) were independently associated with a lower likelihood of favorable discharge disposition, with an adjusted odds ratio (aOR) 0.868, 95 % CI 0.760 - 0.990 per 10 mm Hg for SBP and aOR 0.710, 95% CI 0.515 - 0.980 for MAP, and with increased odds of death aOR 1.244, 95% CI 1.056-1.467 and aOR 1.760, 95% CI 1.119 - 2.769 respectively. Greater variability of SBP and MAP was also associated with odds of death aOR 1.327, 95% CI 1.104 - 1.595 and aOR 1.577, 95% CI 1.060- 2.345 respectively, without a significant effect on discharge disposition. CONCLUSION: In the first 24 hours after reperfusion therapy, higher peak and variable blood pressures are associated with unfavorable discharge outcomes and increased in-hospital mortality. Further studies in stroke patients undergoing reperfusion therapy might target blood pressure reduction and variability to improve patient outcomes.


Asunto(s)
Presión Arterial , Isquemia Encefálica/terapia , Alta del Paciente , Accidente Cerebrovascular/terapia , Trombectomía , Terapia Trombolítica , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Isquemia Encefálica/fisiopatología , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Trombectomía/efectos adversos , Trombectomía/mortalidad , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/mortalidad , Factores de Tiempo , Resultado del Tratamiento
20.
J Stroke Cerebrovasc Dis ; 29(11): 105206, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066902

RESUMEN

BACKGROUND: Arterial stiffness is an independent determinant of cardiovascular and cerebrovascular risks. The relationship between the increase in arterial stiffness parameters and the severity of stroke has been shown in previous studies. We aimed to investigate the association between clinical improvement and changes in arterial stiffness parameters in patients presenting acute ischemic stroke. METHODS: A total of 107 patients were enrolled in this study. On the first and seventh day of the hospitalization, 24 h non-invasive blood pressure was monitored and arterial stiffness parameters were measured. The National Institutes of Health Stroke Scale (NIHSS) was used to determine the severity of stroke, and the Modified Rankin Scale was used to determine dependency and to evaluate functional improvements. RESULTS: Arterial stiffness parameters of augmentation index (AIx@75) and pulse wave velocity (PWV) were significantly higher in patients who died during hospitalization than patients who were discharged (respectively p <0.001, p = 0.04). In the group with clinical improvement, PWV values measured on the seventh day were significantly lower than PWV values measured on the first day (p = 0.032). When the changes in PWV value measured on the first and seventh day for both groups were analyzed using mixed ANOVA test, p value were significant (p = 0.033). Multivariate binary logistic regression analyses showed that negatively change in PWV and CDBP independently predicts the clinical improvement. CONCLUSIONS: Increased AIx@75 and PWV appear to be associated with higher in-hospital mortality rates in patients with acute ischemic stroke. Additionally, clinical improvement in patients with ischemic stroke is associated with a decrease in PWV .


Asunto(s)
Isquemia Encefálica/diagnóstico , Análisis de la Onda del Pulso , Accidente Cerebrovascular/diagnóstico , Rigidez Vascular , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/mortalidad , Isquemia Encefálica/fisiopatología , Isquemia Encefálica/terapia , Femenino , Mortalidad Hospitalaria , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Alta del Paciente , Valor Predictivo de las Pruebas , Estudios Prospectivos , Recuperación de la Función , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Factores de Tiempo , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA