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1.
J Nepal Health Res Counc ; 19(1): 218-220, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33934166

RESUMEN

The COVID-19 pandemic has significantly affected health care delivery globally. COVID-19 is associated with varied neurological manifestations including acute ischemic stroke. In densely populated South Asian nations like Nepal that have suboptimal baseline health care systems, we foresee unique challenges during this pandemic to ensure effective stroke management as well as the safety of health care workers involved in the management of stroke patients. Keywords: COVID-19; health care workers; safety; stroke management.


Asunto(s)
/complicaciones , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/virología , Humanos , Nepal/epidemiología , Pandemias
2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(3. Vyp. 2): 53-59, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33908233

RESUMEN

OBJECTIVE: To assess the possibility of using the integral indicators of thrombodynamics to improve the safety of rehabilitation measures in patients in the recovery period of stroke. MATERIAL AND METHODS: A prospective study included 52 patients in the recovery period of stroke. To compare the effect of the intensity of physical activity on the change in the integral indicators of thrombodynamics in accordance with the objectives of the study, the patients were randomized into two groups. In the first group, patients received treatment, including physiotherapy, stabilometric trainings, neuropsychological tasks. Patients of the second group received complex treatment, including more intense physical activity with the use of cyclic exercises, biomechanotherapy. To assess the state of hemostasis, an integral thrombodynamics test was used, and the numerical parameters of the spatial dynamics of the growth of a fibrin clot were calculated. RESULTS: The state of compensated hypercoagulability was revealed in the majority of patients before the start of medical rehabilitation, despite taking antithrombotic therapy, which was evidence of the ineffectiveness of the therapy. At the same time, it was noted that it was its action, probably during the ongoing program of physical rehabilitation, that ensured the stability of the integral indicators of thrombodynamics and the absence of clinically significant unwanted thromboembolic complications. As a result of the analysis of the data in dynamics before and after treatment, a direct relationship was traced between the intensity of physical activity and the tendency to disturb the hemostatic balance. CONCLUSION: The intensity of physical activity during treatment undoubtedly influenced the state of hemostasis. The expediency of monitoring the dynamics of coagulation activity in patients in the recovery period of stroke has been demonstrated.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Trombofilia , Coagulación Sanguínea , Hemostasis , Humanos , Estudios Prospectivos , Accidente Cerebrovascular/terapia
4.
Artículo en Ruso | MEDLINE | ID: mdl-33899446

RESUMEN

The disability of post-stroke patients is one of the most important problems of the modern medical community requiring the improvement of existing rehabilitation technologies through the wider use of non-drug treatment methods among which the most accessible are various modifications of reflexotherapy. OBJECTIVE: To evaluate the effectiveness of the combined reflexology technique, including the combined use of classical acupuncture, su-jok and cranial acupuncture in the early rehabilitation of patients after ischemic stroke. MATERIAL AND METHODS: Examination and course of early neurorehabilitation were carried out in 80 patients aged 47-78 years. Effectiveness evaluation of the different methods of reflexotherapy was carried out in 4 groups (20 patients each) comparable by age, gender and severity of stroke. In the main group the basic rehabilitation complex was supplemented by the combined use of classical, cranial acupuncture (with symmetrical stimulation of 7 main zones) and su-jok. Patients of the 1st comparison group additionally underwent only su-jok-therapy, the 2nd group - corporal acupuncture procedures in combination with cranial acupuncture, the 3rd group - the basic complex of rehabilitation without the inclusion of reflexotherapy. RESULTS: After 2 weeks' treatment in patients of the main group the regression of neurological symptoms according to the NIHSS scale was 5.3 points on average (76%, p<0.001) and the Bartel index increased by 29.8 points (44.9%, p<0.001). An improvement in the psycho-emotional state appeared by decreased depression level on the Beck scale by 6.9 points on average (42%, p<0.05) and reactive anxiety by 12 points (35.7%, p<0.05). The indicators' improvement in the first two comparison groups was also significant across all scales but less pronounced than in the main group. The lowest values of the studied indicators were obtained in the 3rd comparison group. CONCLUSION: Improvement of neurorehabilitation technologies using combined techniques of reflexotherapy in the acute period of ischemic stroke is characterized by high clinical effectiveness that contributing to the regression of neurological symptoms and improvement of the psycho-emotional status of post-stroke patients which has a beneficial effect on their adaptation to the daily life.


Asunto(s)
Terapia por Acupuntura , Isquemia Encefálica , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Anciano , Humanos , Persona de Mediana Edad , Accidente Cerebrovascular/terapia , Resultado del Tratamiento
6.
Artículo en Inglés | MEDLINE | ID: mdl-33801969

RESUMEN

OBJECTIVE: To evaluate the influence of conventional rehabilitation combined with virtual reality on improving quality of life related to post-stroke health. DESIGN: Randomized controlled trial. SETTING: Rehabilitation and neurology departments of a general hospital (Talavera de la Reina, Spain). SUBJECTS: A total of 43 participants with subacute stroke. INTERVENTION: Participants were randomized into experimental group (conventional treatment + virtual reality) and control (conventional treatment). MAIN MEASURES: Health-related quality of life as measured by the EuroQoL-5 dimensions instrument (EQ-5D-5L) and EuroQoL visual analog scale (EQ-VAS). RESULTS: A total of 23 patients in the experimental group (62.6 ± 13.5 years) and 20 in the control (63.6 ± 12.2 years) completed the study. In the experimental group, EQ-VAS score was 29.1 ± 12.8 at baseline, 86.5 ± 7.1 post-intervention, and 78.3 ± 10.3 at the three-month follow-up. The control group obtained scores of 25.5 ± 5.1, 57.0 ± 4.7, and 58.5 ± 5.9, respectively. We identified significant differences at the post-intervention and follow-up timepoints (p = 0.000) and a partial η2 of 0.647. In EQ-5D-5L, the severity of issues decreased after intervention in the experimental group, while pain and anxiety dimensions increased between post-intervention and follow-up. CONCLUSIONS: The conventional rehabilitative approach combined with virtual reality appears to be more effective for improving the perceived health-related quality of life in stroke survivors.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Realidad Virtual , Estudios de Seguimiento , Humanos , Calidad de Vida , España , Accidente Cerebrovascular/terapia
7.
Orv Hetil ; 162(17): 668-675, 2021 04 10.
Artículo en Húngaro | MEDLINE | ID: mdl-33838025

RESUMEN

Összefoglaló. Bevezetés: A stroke kezelésének lehetoségei az utóbbi években jelentosen megváltoztak: a thrombolysis után bevezetésre került a mechanikus thrombectomia, és a terápiás idoablak is jelentosen kitágult az utóbbi évek nagy multicentrikus tanulmányai alapján. Ezek a lehetoségek új igényeket fogalmaztak meg a képalkotó diagnosztikával szemben: az ischaemia okozta morfológiai elváltozások mellett az artériás és a kollaterális rendszer állapotát, valamint bizonyos esetekben az agy szöveti perfúzióját is szükséges meghatározni. Ezeket a komplex kiértékelési feladatokat ma már mesterségesintelligencia-algoritmusok támogathatják, melyek a kiértékelést pár perc alatt elvégezve segítenek a terápiás döntés kialakításában. Célkituzés: A Dél- és a Nyugat-dunántúli régióban hat intézmény részvételével egy dedikált stroke teleradiológiai hálózat kialakítása. Módszer: A stroke-CT-kiértékelo szoftver és a képkommunikáció integrációja, a vizsgálati protokollok technikai paramétereinek egységesítése, a kiértékelési eredmények teleradiológiai megjelenítése valósult meg a hálózat kialakítása során. Eredmények: A hálózat egységesítette nemcsak a stroke-CT-protokollok beállításait, de beutalási és értékelési szempontjait is. A stroke-CT-kiértékelések és a mechanikus thrombectomiák száma is emelkedett az elmúlt egy évben. Következtetés: A dedikált teleradiológiai stroke-hálózat segítségével optimalizálni kívánjuk a régió stroke-ellátását: egyrészt lehetoleg ne maradjanak ellátatlanul a thrombectomiából valószínuleg profitáló betegek, másrészt ne terheljük az ellátórendszert olyan esetekkel, melyekrol a teljes dokumentáció ismeretében derül ki, hogy nem javasolt a beavatkozás. Orv Hetil. 2021; 162(17): 668-675. INTRODUCTION: The possibilities of cerebral stroke management have changed substantially during the last few years. Following a few multicentric studies, mechanical thrombectomy became an established method besides thrombolysis. In addition, the therapeutic window for both methods is much wider now than before. These changes described above demanded more information of CT morphological changes due to ischemia, but the condition and functionality of the arterial and collateral system, and occasionally tissue perfusion performance should also be characterized. Recently, evaluation of different computer tomographic (CT) measurements can be done using artificial intelligence based methods, which perform data analysis in a few minutes. OBJECTIVE: To establish a dedicated stroke teleradiology network with artificial intelligence based image analysis in Western and Southern Transdanubia in Hungary that involves six partner institutes. METHOD: Integration of automated image analysis with teleradiology software was established, and the technical parameters of examination protocols were unified. Results of stroke CT image analysis became accessible through the teleradiology network. RESULTS: The daily use of integrated central image analysis and image communication had a positive impact on referrals and therapeutic evaluation of stroke cases. The number of image processing and mechanical thrombectomy increased during the last year. CONCLUSION: With the help of the dedicated teleradiology stroke network, we want to optimize the stroke care in the region: on the one hand, patients who are likely to benefit from thrombectomy should not be left unattended, on the other, the health care system should not be burdened with cases, when intervention is not recommended having the complete clinical data accessed. Orv Hetil. 2021; 162(17): 668-675.


Asunto(s)
Accidente Cerebrovascular , Telerradiología , Inteligencia Artificial , Humanos , Hungría , Derivación y Consulta , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/terapia
8.
Neurosciences (Riyadh) ; 26(2): 158-162, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33814368

RESUMEN

OBJECTIVES: To assess and quantify the impact COVID-19 has had thus far on ischemic stroke admission rate and severity (National Institutes of Health Stroke Scale (NIHSS) score) at a single tertiary center in Makkah, Saudi Arabia. METHODS: This is a retrospective analysis performed on admitted cases with definitive final diagnoses of transient ischemic attack (TIA) and ischemic stroke at King Abdullah Medical City in Makkah between January 1, 2020 and July 2020. RESULTS: Sixty-nine patients were included in our study, 41 of whom presented at our facility before the pandemic and 29 during the pandemic. No statistical significance was observed between rate of admission, stroke severity, and rate of thrombolysis before the COVID-19 pandemic and after the outbreak. We observed a reduction of mean arrival time after the pandemic began, as well as a reduction of hospital stay days. CONCLUSION: A 29% reduction of admission secondary to acute ischemic stroke was noted during the pandemic. However, COVID-19 did not affect acute stroke care at our institute. The study is limited because of its small sample size, as we assessed just one medical center.


Asunto(s)
Ataque Isquémico Transitorio/epidemiología , /epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Ataque Isquémico Transitorio/terapia , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Arabia Saudita/epidemiología , Índice de Severidad de la Enfermedad , Distribución por Sexo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Centros de Atención Terciaria , Terapia Trombolítica/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Adulto Joven
9.
Mymensingh Med J ; 30(2): 376-386, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33830117

RESUMEN

Significant variations observed in stroke incidence, risk factors and sufferings between high & resource poor countries. Considering lack of study in our country perspective, the study was designed to assess the knowledge of stroke and its risk factors among stroke survivors in Bangladeshi population. This hospital based cross-sectional study was conducted at the Department of Medicine and Department of Neurology in Uttara Adhunik Medical College & Hospital (UAMCH), Dhaka, Bangladesh. Patients aged >18 years who were admitted with stroke (Ischemic and hemorrhagic) were included in the study. Before enrollment informed consent was ensured. Total 50 patients were interviewed and assessed. Separate case record form was used during data collection. Final analysis was done by SPSS 22.00 version software. A 'good' knowledge of stroke was defined by correct answer to ≥4 out of 7 questions about location, cause, risk factor, warning sign, treatment, complication and prevention of stroke. Among 50 stroke survivors, mean age was 58.34±12.90 (SD) years. Male-female ratio was 1.08:1. Overall 78% patients had good knowledge of stroke. Brain was correctly identified as center of stroke by 52% stroke survivors and disturbance of blood supply to brain as a cause of stroke was recognized by 12%. Stress was the most common risk factor identified (50%). At least one warning sign was identified by 76% stroke survivors. Seventy-four percent stroke survivors knew that they have to be taken to nearest health facility and if possible, in hospital where neurological care is available. Only 4% knew about the golden hour of taking the stroke patient. On average knowledge about treatment, complication and prevention of stroke was good. Stroke knowledge was not significantly associated with demographic and socio-economic profile of stroke survivors. More than two thirds of the patients had knowledge regarding stroke and its risk factors but no uniform pattern of knowledge is noticed.


Asunto(s)
Accidente Cerebrovascular , Anciano , Bangladesh/epidemiología , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Sobrevivientes
10.
Zhongguo Zhen Jiu ; 41(4): 421-3, 2021 Apr 12.
Artículo en Chino | MEDLINE | ID: mdl-33909364

RESUMEN

Professor WANG Lin-peng's clinical experience in treatment of stroke by acupuncture based on Zhuxie (clearing away pathogenic factors) theory is summarized. According to the pathogens nature of stroke patients (wind, fire, phlegm, blood stasis, asthenia) and the relationship between pathogenic qi and the antipathogenic qi, distinguishing the relationship between the main and secondary pathogenic factors, different acupuncture programs are determined. The filiform needle acupuncture, fire needle acupuncture, bloodletting therapy and other acupuncture methods are used to achieve the treatment objectives of clearing wind, fire, phlegm, blood stasis and strengthening the body.


Asunto(s)
Terapia por Acupuntura , Acupuntura , Accidente Cerebrovascular , Puntos de Acupuntura , Venodisección , Humanos , Agujas , Accidente Cerebrovascular/terapia
11.
BMC Health Serv Res ; 21(1): 288, 2021 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789627

RESUMEN

BACKGROUND: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the stroke care systems have been seriously affected because of social restrictions and other reasons. As the pandemic continues to spread globally, it is of great significance to understand how COVID-19 affects the stroke care systems in mainland China. METHODS: We retrospectively studied the real-world data of one comprehensive stroke center in mainland China from January to February 2020 and compared it with the data collected during the same period in 2019. We analyzed DTN time, onset-to-door time, severity, effects after treatment, the hospital length of stays, costs of hospitalization, etc., and the correlation between medical burden and prognosis of acute ischemic stroke (AIS) patients. RESULTS: The COVID-19 pandemic was most severe in mainland China in January and February 2020. During the pandemic, there were no differences in pre-hospital or in-hospital workflow metrics (all p>0.05), while the degree of neurological deficit on admission and at discharge, the effects after treatment, and the long-term prognosis were all worse (all p<0.05). The severity and prognosis of AIS patients were positively correlated with the hospital length of stays and total costs of hospitalization (all p<0.05). CONCLUSIONS: COVID-19 pandemic is threatening the stroke care systems. Measures must be taken to minimize the collateral damage caused by COVID-19.


Asunto(s)
Isquemia Encefálica , Prestación de Atención de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Accidente Cerebrovascular , Tiempo de Tratamiento , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Isquemia Encefálica/terapia , China/epidemiología , Servicios Médicos de Urgencia , Humanos , Pandemias , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia
12.
Medicine (Baltimore) ; 100(14): e25480, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832167

RESUMEN

BACKGROUND: Ischemic stroke is a major chronic noninfectious disease that seriously endangers health. Acupuncture is effective for ischemic stroke and less adverse reactions. However, there is not enough clinical trial data and solid evidence could confirm how acupuncture work to cerebral functional connectivity changes, and whether the changes is related to the different stimulation quantity. DESIGN: This is a multicenter, central-randomized, controlled, double-blind, noninferiority, 2 factors and 3 levels orthogonal clinical trial. A total of 100 participants with ischemic stroke aged from 40 to 80 were randomized into experimental group and control group, the experimental group was divided into 9 groups (A1-A9) according to different factors or levels, and each group have 10 participants. The whole study period is 17 days, including 1 week for baseline observation, 3 days treatment and observation, and 1 week follow-up. Primary outcome is the fMRI based on blood oxygenation level dependent. Secondary outcomes included National Institute of Health Stroke Scale, Modified Barthel Index, Brunnstrom stroke recovery, stroke Chinese medicine symptom. Clinical assessments will be evaluated at before and the 0 hour, 24 hours, 36 hours after treatment, and 1 week follow-up. The primary outcome of the postacupuncture effect were investigated by paired T-test, and the continuous outcome variables will be analyzed with univariate repetitive measurement deviation analysis. Adverse events will be noted and recorded for the safety evaluation. CONCLUSION: The purpose of this study was to evaluate the central mechanism of acupuncture stimulation quantity using time and frequency as control conditions. This study will provide reasonable stimulation parameters and strong mechanism evidence of cerebral central network for the use of acupuncture for ischemic stroke. CHICTR REGISTRATION NUMBER: ChiCTR1900023169. Registered 15 May 2019.


Asunto(s)
Terapia por Acupuntura/métodos , Encéfalo/diagnóstico por imagen , Neuroimagen Funcional , Imagen por Resonancia Magnética , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/irrigación sanguínea , Encéfalo/fisiopatología , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/fisiopatología , Resultado del Tratamiento
13.
Artículo en Inglés | MEDLINE | ID: mdl-33800902

RESUMEN

BACKGROUND: The major endovascular mechanic thrombectomy (MT) techniques are: Stent-Retriever (SR), aspiration first pass technique (ADAPT) and Solumbra (Aspiration + SR), which are interchangeable (defined as switching strategy (SS)). The purpose of this study is to report the added value of switching from ADAPT to Solumbra in unsuccessful revascularization stroke patients. METHODS: This is a retrospective, single center, pragmatic, cohort study. From December 2017 to November 2019, 935 consecutive patients were admitted to the Stroke Unit and 176/935 (18.8%) were eligible for MT. In 135/176 (76.7%) patients, ADAPT was used as the first-line strategy. SS was defined as the difference between first technique adopted and the final technique. Revascularization was evaluated with modified Thrombolysis In Cerebral Infarction (TICI) with success defined as mTICI ≥ 2b. Procedural time (PT) and time to reperfusion (TTR) were recorded. RESULTS: Stroke involved: Anterior circulation in 121/135 (89.6%) patients and posterior circulation in 14/135 (10.4%) patients. ADAPT was the most common first-line technique vs. both SR and Solumbra (135/176 (76.7%) vs. 10/176 (5.7%) vs. 31/176 (17.6%), respectively). In 28/135 (20.7%) patients, the mTICI was ≤ 2a requiring switch to Solumbra. The vessel's diameter positively predicted SS result (odd ratio (OR) 1.12, confidence of interval (CI) 95% 1.03-1.22; p = 0.006). The mean number of passes before SS was 2.0 ± 1.2. ADAPT to Solumbra improved successful revascularization by 13.3% (107/135 (79.3%) vs. 125/135 (92.6%)). PT was superior for SS comparing with ADAPT (71.1 min (CI 95% 53.2-109.0) vs. 40.0 min (CI 95% 35.0-45.2); p = 0.0004), although, TTR was similar (324.1 min (CI 95% 311.4-387.0) vs. 311.4 min (CI 95% 285.5-338.7); p = 0.23). CONCLUSION: Successful revascularization was improved by 13.3% after switching form ADAPT to Solumbra (final mTICI ≥ 2b was 92.6%). Vessel's diameter positively predicted recourse to SS.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Estudios de Cohortes , Humanos , Estudios Retrospectivos , Accidente Cerebrovascular/terapia , Resultado del Tratamiento
14.
Int J Mol Sci ; 22(6)2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33809413

RESUMEN

Stroke-induced cognitive impairments affect the long-term quality of life. High-intensity interval training (HIIT) is now considered a promising strategy to enhance cognitive functions. This review is designed to examine the role of HIIT in promoting neuroplasticity processes and/or cognitive functions after stroke. The various methodological limitations related to the clinical relevance of studies on the exercise recommendations in individuals with stroke are first discussed. Then, the relevance of HIIT in improving neurotrophic factors expression, neurogenesis and synaptic plasticity is debated in both stroke and healthy individuals (humans and rodents). Moreover, HIIT may have a preventive role on stroke severity, as found in rodents. The potential role of HIIT in stroke rehabilitation is reinforced by findings showing its powerful neurogenic effect that might potentiate cognitive benefits induced by cognitive tasks. In addition, the clinical role of neuroplasticity observed in each hemisphere needs to be clarified by coupling more frequently to cellular/molecular measurements and behavioral testing.


Asunto(s)
Cognición/fisiología , Entrenamiento de Intervalos de Alta Intensidad , Plasticidad Neuronal/fisiología , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Humanos , Resistencia Física , Recuperación de la Función
15.
Neurosciences (Riyadh) ; 26(2): 199-206, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33814374

RESUMEN

OBJECTIVES: To present the experience on stroke thrombolysis of a tertiary care center in Riyadh, KSA. METHODS: Cross-sectional, observational study of patients thrombolyzed between January 2012 and December 2018. RESULTS: Thrombolysis was performed in 148 patients (mean age: 58.2±14.5 years), 94 (63.5%) of them were men. The median onset-to-door time was 81 minutes, and 25% of the patients arrived within 1 hour. The median National Institute of Health Stroke Scale score upon admission was 13. Hypertension (68.9%), diabetes (56.1%), and dyslipidemia (40.5%) were the most common risk factors for stroke. The most common mechanism of stroke was cardioembolism (43.2%), which was associated with a more severe presentation (p=0.031). Intravenous thrombolysis alone was given to 98 patients (66.2%); the rest received intravenous tissue plasminogen activator plus endovascular therapy or endovascular therapy alone. The median door-to-needle (DTN) time was 70.5 min, with a significant improvement from 2012 (111.6 minutes) to 2018 (69.9 minutes) (p<0.001). Among the patients, 53 (35.8%) showed a good outcome (with a modified Rankin score of 0-2) whereas 14 (9.5%) died. Symptomatic intracranial hemorrhage (sICH) was seen in 8.1%. All vascular risk factors were more common in patients aged >60 years, except smoking, which was more common in the younger age group (p=0.007). CONCLUSION: In our cohort, the utilization of thrombolysis and the DTN time improved over time. One-thirds of the patients received endovascular treatment. Moreover, the frequency of the vascular risk factors was high. Compared with the published findings, our results showed that cardioembolic strokes were the most frequent and had severe presentation and were likely the cause of the slight increase in mortality and sICH.


Asunto(s)
Procedimientos Endovasculares , Fibrinolíticos/uso terapéutico , Trombolisis Mecánica/métodos , Accidente Cerebrovascular/terapia , Activador de Tejido Plasminógeno/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Arabia Saudita , Accidente Cerebrovascular/tratamiento farmacológico , Centros de Atención Terciaria , Resultado del Tratamiento , Adulto Joven
16.
J Stroke Cerebrovasc Dis ; 30(5): 105710, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33690029

RESUMEN

BACKGROUND: Faster treatment times are associated with improved outcomes in patients with acute ischemic stroke. In this prospective pilot study, we assess the feasibility of initiating telestroke consultation in emergency medical services unit (TEMS). METHODS: Patients with stroke symptoms were evaluated via TEMS using a video-call with a stroke provider. After TEMS evaluation, patients were transferred to the nearest stroke center (NSC) or thrombectomy capable center (TCS) depending on stroke severity and symptom onset time. We compared time metrics between patients evaluated via TEMS to those via standard telestroke (STS) consultation. RESULTS: 49 patients were evaluated via TEMS between May 2017 and March 2020. Median age was 66, 24 (49%) were females, 15 (30.6%) received intravenous alteplase (tPA) after arrival to a local hospital, and 3 (6.1%) underwent mechanical thrombectomy (MT) after bypassing the NSC. Compared to 52 tPA patients treated through STS consultation, TEMS patients had shorter door to needle (DTN) time (21 vs. 38 min, p < 0.001). In addition, patients who received MT after bypassing the NSC had shorter onset to groin time compared to those transferred from NSC (216 vs. 293 min, P = 0.04). CONCLUSION: Prehospital stroke triaging using TEMS is feasible, and could result in shorter DTN and onset to groin times.


Asunto(s)
Servicios Médicos de Urgencia , Procedimientos Endovasculares , Fibrinolíticos/administración & dosificación , Consulta Remota , Accidente Cerebrovascular/terapia , Trombectomía , Terapia Trombolítica , Tiempo de Tratamiento , Activador de Tejido Plasminógeno/administración & dosificación , Transporte de Pacientes , Triaje , Anciano , Anciano de 80 o más Años , Toma de Decisiones Clínicas , Procedimientos Endovasculares/efectos adversos , Estudios de Factibilidad , Femenino , Fibrinolíticos/efectos adversos , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Trombectomía/efectos adversos , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento , Comunicación por Videocoferencia
17.
J Stroke Cerebrovasc Dis ; 30(5): 105707, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33735667

RESUMEN

INTRODUCTION: Stroke affects all ages. Despite increased incidence in those <65 years, little is known about age-based differences in inpatient rehabilitation management and outcomes. OBJECTIVES: To investigate management and outcomes, comparing younger (<65 years) and older (≥65 years) patients with stroke, who received inpatient rehabilitation. METHODS: Multicentre, cross-sectional study using data from Australian hospitals who participated in the Stroke Foundation national stroke rehabilitation audit (2016-2018). Chi-square tests compared characteristics and care by age. Multivariable regression models were used to compare outcomes by age (e.g. length of stay). Models were adjusted for sex, stroke type and severity factors. RESULTS: 7,165 audited cases from 127 hospitals; 23% <65 years (66% male; 72% ischaemic stroke). When compared to older patients, younger patients were more likely male (66% vs 52%); identify as Aboriginal or Torres Strait Islander (6% vs 1%); be less disabled on admission; receive psychology (46% vs 34%) input, and community reintegration support, including return to work (OR 1.47, 95% CI 1.03, 2.11), sexuality (OR 1.60, 95% CI 1.39, 1.84) and self-management (OR 1.39, 95% CI 1.23, 1.57) advice. Following adjustment, younger patients had longer lengths of stay (coeff 3.54, 95% CI 2.27, 4.81); were more likely to be independent on discharge (aOR 1.96, 95% CI 1.68, 2.28); be discharged to previous residences (aOR 1.64, 95% CI 1.41, 1.91) and receive community rehabilitation (aOR: 2.27, 95% CI 1.91, 2.70). CONCLUSIONS: Age-related differences exist in characteristics, management and outcomes for inpatients with stroke accessing rehabilitation in Australia.


Asunto(s)
Disparidades en Atención de Salud/tendencias , Hospitales de Rehabilitación/tendencias , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Indicadores de Calidad de la Atención de Salud/tendencias , Rehabilitación de Accidente Cerebrovascular/tendencias , Accidente Cerebrovascular/terapia , Adolescente , Adulto , Factores de Edad , Anciano , Australia/epidemiología , Estudios Transversales , Femenino , Disparidades en Atención de Salud/etnología , Humanos , Pacientes Internos , Masculino , Auditoría Médica , Persona de Mediana Edad , Factores Raciales , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etnología , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
18.
Artículo en Inglés | MEDLINE | ID: mdl-33669715

RESUMEN

Gait and balance impairments are common after stroke. This study aimed to evaluate the effect of a music-based rhythmic auditory stimulation (RAS) in combination with conventional physiotherapy on gait parameters and walking ability in subacute stroke. This single-blind, historical controlled trial, included 55 patients who had suffered a stroke within the three weeks prior to enrolment. Patients from 2018 (n = 27) were assigned as the historical control group whereas 2019 patients (n = 28) received music-based RAS three times a week. Both groups received 11 h of conventional physiotherapy per week during hospitalization. Primary outcomes were gait and balance parameters (Tinetti test and Timed Up&Go test) and walking ability (Functional Ambulation Category scale). Secondary outcomes were trunk control, assistive devices, functional independence (Functional Independence Measure, Barthel index), and stroke severity and disability (modified Rankin scale, National Institutes of Health Stroke Scale). Results: No between-group differences were identified for gait and balance parameters nor for secondary outcomes. Significant between-group differences were observed in the Functional Ambulation Category: the intervention group (Δmean ± SD; 3.43 ± 1.17) showed greater improvement (p = 0.002) than the control group (Δmean ± SD; 2.48 ± 1.09). Compared with conventional physiotherapy alone, our results suggest that the walking ability of subacute stroke patients might be improved with music-based RAS combined with conventional physiotherapy, but this treatment is not more effective than conventional physiotherapy in obtaining gait and balance gains.


Asunto(s)
Música , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Estimulación Acústica , Marcha , Humanos , Equilibrio Postural , Método Simple Ciego , Accidente Cerebrovascular/terapia , Resultado del Tratamiento , Caminata
19.
Complement Ther Clin Pract ; 43: 101343, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33714169

RESUMEN

OBJECTIVE: To observe the improvement of stroke patients' ability to participate in daily activities by using Scalp acupuncture therapy combined with exercise. METHODS: According to random number table, patients were divided into a treatment group, which received rehabilitation training and scalp acupuncture to retain needles at different times, and a control group, which received rehabilitation training alone. The Barthel index was used to evaluate the activities of daily living before and after treatment. RESULTS: The scores of Barthel index of all groups were higher than those before treatment, and the scalp acupuncture for 2 h combined with rehabilitation training group had the highest score. There was significant difference compared with pre-treatment and other treatment groups. CONCLUSION: Scalp acupuncture therapy combined with exercise therapy can significantly improve the ability of stroke patients to participate in daily activities; 2 h of scalp acupuncture combined with exercise therapy had the most significant effect.


Asunto(s)
Terapia por Acupuntura , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Actividades Cotidianas , Humanos , Cuero Cabelludo , Accidente Cerebrovascular/terapia , Resultado del Tratamiento
20.
NeuroRehabilitation ; 48(2): 195-208, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33664157

RESUMEN

BACKGROUND: The burden of post-stroke cognitive impairment, as well as affective disorders, remains persistently high. With improved stroke survival rates and increasing life expectancy, there is a need for effective interventions to facilitate remediation of neurocognitive impairments and post-stroke mood disorders. OBJECTIVE: To investigate the effects of Therapeutic Instrumental Music Performance (TIMP) training with and without Motor Imagery on cognitive functioning and affective responding in chronic post-stroke individuals. METHODS: Thirty chronic post-stroke, community-dwelling participants were randomized to one of three experimental arms: (1) 45 minutes of active TIMP, (2) 30 minutes of active TIMP followed by 15 minutes of metronome-cued motor imagery (TIMP+cMI), (3) 30 minutes of active TIMP followed by 15 minutes of motor imagery without cues (TIMP+MI). Training took place three times a week for three weeks, using a selection of acoustic and electronic instruments. Assessments, administered at two baselines and post-training, included the Trail Making Test (TMT) - Part B to assess mental flexibility, the Digit Span Test (DST) to determine short-term memory capacity, the Multiple Affect Adjective Checklist - Revised (MAACL-R) to ascertain current affective state, and the General Self-Efficacy Scale (GSE) to assess perceived self-efficacy. The Self-Assessment Maniqin (SAM) was also administered prior to and following each training session. RESULTS: Thirty participants completed the protocol, ten per arm [14 women; mean age = 55.9; mean time post-stroke = 66.9 months]. There were no statistically significant differences between pooled group baseline measures. The TIMP+MI group showed a statistically significant decrease in time from pre-test 2 to post-test on the TMT. The TIMP group showed a significant increase on MAACL sensation seeking scores, as well as on the Valence and Dominance portions of the SAM; TIMP+cMI showed respective increases and decreases in positive and negative affect on the MAACL, and increases on the Valence, Dominance, and Arousal portions of the SAM. No statistically significant association between cognitive and affective measures was obtained. CONCLUSIONS: The mental flexibility aspect of executive functioning appears to be enhanced by therapeutic instrumental music training in conjunction with motor imagery, possibly due to multisensory integration and consolidation of representations through motor imagery rehearsal following active practice. Active training using musical instruments appears to have a positive impact on affective responding; however, these changes occurred independently of improvements to cognition.


Asunto(s)
Cognición/fisiología , Imágenes en Psicoterapia/métodos , Musicoterapia/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Adulto , Anciano , Señales (Psicología) , Función Ejecutiva/fisiología , Femenino , Humanos , Imágenes en Psicoterapia/tendencias , Masculino , Persona de Mediana Edad , Música/psicología , Musicoterapia/tendencias , Accidente Cerebrovascular/psicología , Rehabilitación de Accidente Cerebrovascular/psicología , Prueba de Secuencia Alfanumérica , Resultado del Tratamiento
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