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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3860-3863, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018843

RESUMO

Spasticity is a common ailment following stroke, which can cause pain, contracture, abnormal limb posture and functional limitation. Early management of post-stroke spasticity is vital to reduce these complications, and improve function and help patients become independent. We propose a therapeutic program based on applying a series of vibrations to the ankle joints at specific ankle position as well as over the range of motion using a rehabilitation robotic system to reduce the neural and muscular abnormalities associated with spasticity. We provided a 30-minute perturbation training, 3 times a week for 10 sessions for 8 stroke survivor subjects. Ankle stiffness was calculated using the hysteresis curves. Other kinematic and kinetic parameters were also used to evaluate the mechanical abnormalities. We evaluated participants before starting the therapeutic program, immediately after first session of training and after 10 sessions of training.Our results showed that all subjects had substantial improvements in stiffness, max voluntary contraction, energy loss, passive range of motion, and voluntary movement after both short- and long-term therapeutic program. Surprisingly, for most of these measures the maximum improvement obtained at short-term training. Interestingly, these improvements became persistent over the long-term training. These findings suggest that vibration therapy can be considered as an effective rehabilitation intervention to reduce neuromuscular abnormalities associated with the spasticity in stroke.


Assuntos
Procedimentos Cirúrgicos Robóticos , Acidente Vascular Cerebral , Tornozelo , Articulação do Tornozelo , Humanos , Espasticidade Muscular/etiologia , Acidente Vascular Cerebral/complicações , Sobreviventes
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 264-267, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33017979

RESUMO

Spatial neglect (SN) is a neurological syndrome in stroke patients, commonly due to unilateral brain injury. It results in inattention to stimuli in the contralesional visual field. The current gold standard for SN assessment is the behavioral inattention test (BIT). BIT includes a series of penand-paper tests. These tests can be unreliable due to high variablility in subtest performances; they are limited in their ability to measure the extent of neglect, and they do not assess the patients in a realistic and dynamic environment. In this paper, we present an electroencephalography (EEG)-based brain-computer interface (BCI) that utilizes the Starry Night Test to overcome the limitations of the traditional SN assessment tests. Our overall goal with the implementation of this EEG-based Starry Night neglect detection system is to provide a more detailed assessment of SN. Specifically, to detect the presence of SN and its severity. To achieve this goal, as an initial step, we utilize a convolutional neural network (CNN) based model to analyze EEG data and accordingly propose a neglect detection method to distinguish between stroke patients without neglect and stroke patients with neglect.Clinical relevance-The proposed EEG-based BCI can be used to detect neglect in stroke patients with high accuracy, specificity and sensitivity. Further research will additionally allow for an estimation of a patient's field of view (FOV) for more detailed assessment of neglect.


Assuntos
Lesões Encefálicas , Transtornos da Percepção , Acidente Vascular Cerebral , Eletroencefalografia , Humanos , Redes Neurais de Computação , Transtornos da Percepção/diagnóstico , Acidente Vascular Cerebral/complicações
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 588-591, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018057

RESUMO

Stroke survivors are often characterized by hemiparesis, i.e., paralysis in one half of the body, that severely affects upper limb movements. Continuous monitoring of the progression of hemiparesis requires manual observation of the limb movements at regular intervals and hence is a labour intensive process. In this work, we use wrist-worn accelerometers for automated assessment of hemiparetic severity in acute stroke patients through bivariate Poincaré analysis between accelerometer data from the two hands during spontaneous and instructed movements. Experiments show that while the bivariate Poincaré descriptors CSD1 and CSD2 can identify hemiparetic patients from control subjects, a novel descriptor called Complex Cross-Correlation Measure (C3M) can distinguish between moderate and severe hemiparesis. Further, we justify the use of C3M by showing that it is described by multiple-lag cross-correlations, representing the co-ordination of activity between two hands. The descriptors are compared against the National Institutes of Health Stroke Scale (NIHSS), the clinical gold standard for evaluation of hemiparetic severity, and studied using statistical tests for developing supervised models for hemiparesis classification.Clinical relevance-This study establishes the suitability of wrist-worn accelerometers in identifying hemiparetic severity in stroke patients through novel descriptors of hand co-ordination.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Dispositivos Eletrônicos Vestíveis , Acelerometria , Humanos , Paresia/diagnóstico , Acidente Vascular Cerebral/complicações , Estados Unidos
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3735-3738, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018813

RESUMO

Stroke survivors are often characterized by upper limb hemiparesis due to which activities in one of the hands is significantly restricted. Manual evaluation of the progression of hemiparesis in acute stroke patients involves 24x7 medical supervision, which is prone to inter-rater variability, is labor-intensive and consequently expensive in public hospitals. In this paper, we investigate the use of wrist-worn accelerometers for automated identification of upper limb hemiparesis in acute stroke. We propose a set of spontaneous and instructed movements in order to estimate two-hand activity correlation using accelerometry data. We use this information to determine the weak hand and further investigate an Activity Based Distance (ABD) measure to quantify this correlation. We compare ABD with standard time-series distance measures such as Lp norms and Dynamic Time Warping (DTW) for hemiparetic severity estimation. We study these distance measures with respect to the National Institutes of Health Stroke Scale (NIHSS), the clinical gold standard to determine hemiparetic severity, and demonstrate their suitability for developing a wearable based automated hemiparesis detection and monitoring system.Clinical relevance-This study presents a novel experimental paradigm for identifying upper limb hemiparesis in acute stroke patients using measures of two-hand activity correlation.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Mãos , Humanos , Paresia/diagnóstico , Acidente Vascular Cerebral/complicações , Estados Unidos , Extremidade Superior
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3743-3746, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018815

RESUMO

After a hemiparetic stroke, the contralesional upper limb is left with significant motor impairments including: weakness, spasticity, and abnormal joint torque patterns resulting in the flexion synergy (i.e. abnormal coupling between shoulder abduction and elbow/wrist and finger flexion). These impairments, and in particular the flexion synergy, limit ability to reach to the full extent of their limb workspace. Motor control of the trunk is also altered post stroke, with compromised ability to stabilize the trunk and excessive trunk movement during reaching, abnormal isometric torque coupling patterns in the transverse and sagittal planes and weakness. These motor impairments in both trunk and arm limit their ability to perform activities of daily living. While the effect of stroke on reaching has been studied extensively, less is known about the impact of deficits in trunk motor control on reaching ability and the impact of the flexion synergy on trunk postural control. Methods for investigating altered trunk control, specifically during a reach when concurrent loads that elicit the flexion synergy are imposed on the limb and trunk, are limited. Specifically, trunk deficits have yet to be studied in the context of the flexion synergy whereby loads imposed on the arm to elicit shoulder abduction have a negative impact on reaching and potentially on trunk posture. In order to address this gap, we developed a system that integrates a robotic device to simulate varied reaching environments, surface electromyography to measure primary trunk and arm muscle activity, and a two-camera motion capture system that uses reflective markers to measure trunk and arm movement. Feasibility and usability of the system was established during evaluation of reaching ability with varying levels of shoulder abduction loads while the trunk is either restrained or unrestrained in two participants with stroke and a healthy control.Clinical Relevance- The system presented here is capable of monitoring changes in trunk postural control after a hemiparetic stroke during a reaching task as a first step in furthering our understanding of changes in trunk motor control during reaching with the goal of developing more targeted and effective interventions for stroke rehabilitation.


Assuntos
Atividades Cotidianas , Acidente Vascular Cerebral , Humanos , Paresia , Amplitude de Movimento Articular , Acidente Vascular Cerebral/complicações , Tronco
6.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 5-9, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016670

RESUMO

OBJECTIVE: The timely diagnosis of atrial fibrillation (AF) in patients with cardiac embolism with implantable loop recorders (ILR). MATERIAL AND METHODS: Twenty-nine patients, hospitalized within 6 months after stroke (n=19) or transient ischemic attack (n=10), were included in the study. ILR were implanted in all cases. The mean time of follow-up was one year. RESULTS: Five hundred and thirteen transmissions were detected during the whole follow-up period. Symptomatic episodes were recorded in 165 cases. Such episodes as bradycardia, asystole, AF, atrial tachycardia and ventricular tachycardia were recorded in 98 cases out of 348 planned transmissions. All transmissions were analyzed by an operator. However, 70 cases were false-positive because of ILR over-sensing. In total, arrhythmias were detected in 5 patients, including sick sinus syndrome (1), supraventricular tachycardia (1), ventricular tachycardia (1) and atrial fibrillation (3). Anticoagulant therapy was started immediately after the diagnosis of AF. CONCLUSION: Loop recording monitoring is an effective strategy in patients with cardiac embolism for timely diagnosis and further treatment of arrhythmia.


Assuntos
Fibrilação Atrial , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Anticoagulantes , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Eletrocardiografia Ambulatorial , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
7.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 24-29, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016673

RESUMO

OBJECTIVE: To identify the likelihood of developing systemic inflammation (SI) as a general pathological process in severe haemorrhagic intracerebral stroke with and without the phenomenon of ineffective cerebral blood flow. MATERIAL AND METHOD: Three groups were examined: 1) 89 blood donors (controls), 2) 15 patients with severe haemorrhagic stroke without the phenomenon of ineffective brain blood flow; 3) 26 patients with severe haemorrhagic stroke with ineffective cerebral blood flow. Ineffective cerebral blood circulation was recorded on the basis of transcranial Doppler ultrasound data; 87% of patients had clinical signs of brain death. All patients in the groups with haemorrhagic stroke had signs of multiple organ dysfunction according to the Sepsis-related Organ Failure scale, all of them received intensive care. An integrated scale based on the determination of plasma concentrations of cytokines (IL-6, IL-8, IL-10, TNF-α), procalcitonin, cortisol, D-dimers, myoglobin, troponin I was used to verify systemic inflammation. RESULTS AND CONCLUSION: Systemic inflammation or borderline state (pre-SI) was identified in all patients of the second group both on 1-3 days from the onset of haemorrhagic stroke, and on 5-8 days. On the contrary, in the third group, there were no signs of SI on 1-3 days. On 5-8 days, signs of SI and pre-SI were recorded only in 18.2% of patients. Apparently, the reason for these differences is the blockade of the passage of tissue decay products and other pro-inflammatory factors into the bloodstream from the damaged brain in the third group.


Assuntos
Circulação Cerebrovascular , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Encéfalo/diagnóstico por imagem , Humanos , Inflamação
8.
Medicine (Baltimore) ; 99(37): e22165, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925781

RESUMO

Aphasia shows high incidence in stroke patients and seriously impairs language comprehension, verbal communication, and social activities. Therefore, screening aphasic patients during the acute phase of stroke is crucial for language recovery and rehabilitation. The present study developed a Chinese version of the Language Screening Test (CLAST) and validated it in post-stroke patients.The CLAST was adapted from the Language Screening Test developed by Constance et al to incorporate Chinese cultural and linguistic specificities, and administered to 207 acute stroke patients and 89 stabilized aphasic or non-aphasic patients. Based on the Western Aphasia Battery (WAB) test, its reliability and validity were assessed. A cut-off for the CLAST in Chinese patients was determined by ROC curve analysis.The CLAST comprised 5 subtests and 15 items, including 2 subscores, namely expression (8 points, assessing naming, repetition, and automatic speech) and receptive (7 points maximum, evaluating picture recognition, and verbal instructions) indexes. Analysis of the alternate-form reliability of the questionnaire showed a retest correlation coefficient of 0.945 (P < .001). Intraclass correlation coefficients of three rating teams were >0.98 (P < .001). Internal consistency analysis showed a Cronbach's alpha coefficient of 0.909 (P < .001). The non-aphasia group showed higher scores than the aphasia group (14.2 ±â€Š1.3 vs 10.6 ±â€Š3.8) (P < .01). The questionnaire showed good construct validity by factor analysis. ROC curve analysis showed high sensitivity and specificity for the CLAST, with a cut-off of 13.5.The CLAST is suitable for Chinese post-stroke patients during the acute phase, with high reliability, validity, sensitivity, and specificity.


Assuntos
Afasia/diagnóstico , Afasia/etiologia , Testes de Linguagem/normas , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
9.
J Comput Assist Tomogr ; 44(5): 708-713, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936578

RESUMO

OBJECTIVE: Assessing collateral status is important in acute ischemic stroke (AIS). The purpose of this study was to establish an easy and rapid method for evaluating collateral flow. METHODS: A total of 60 patients with AIS were enrolled. The patients were aged 18 to 85 years with endovascular therapy treatment within 10 hours after the appearance of stroke symptoms, prestroke modified Rankin Scale ≤1, Alberta Stroke Program Early CT Score ≥6, and the occlusion of large vessels in anterior circulation. We reformed imaging strategies by conducting a small-dose group-injection test before normal computed tomography angiography (CTA) scanning and selected the visual collateral score and the regional leptomeningeal score scales as the single-phase CTA collateral flow assessment scales with the replacement of the parasagittal anterior cerebral artery territory by anterior cerebral artery regions adjacent to the longitudinal fissure and then verified, respectively, the consistencies between the 2 single-phase CTA-based collateral scales and the digital subtraction angiography (DSA)-based American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale and compared the prognosis of endovascular therapy between the AIS patients in the poor-collateral-flow group and the other patients' group assessed by 2 single-phase CTA-based collateral scales. RESULTS: There was a high consistency between the 2 single-phase CTA-based collateral flow scales with DSA-based American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale. The assessment by using CTA-based collateral flow assessment methods generated consistent results. CONCLUSION: The single-phase CTA-based visual collateral score scale and regional leptomeningeal score scale can be used as the imaging evidence for the evaluation of collateral flow in AIS patients in the majority of grassroots hospitals where DSA is difficult to carry out.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Angiografia Cerebral/métodos , Circulação Colateral/fisiologia , Angiografia por Tomografia Computadorizada/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Angiografia Digital/métodos , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
10.
Medicine (Baltimore) ; 99(38): e22313, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957396

RESUMO

INTRODUCTION: About 66% of stroke survivors present with cognitive or physical consequences, which are often complicated by emotional instability. Alexithymia is defined as "a difficulty in identifying and describing feelings", although there is no consensus on the exact diagnosis and treatment. PATIENT CONCERNS: A 36-year-old right-handed man, affected by ischemic stroke (which occurred about 3 months before admission) involving the right hemisphere (ie, the fronto-parieto-temporal region) with left hemiparesis and behavioral abnormalities, came to our observation for intensive rehabilitation. He was treated unsuccessfully with a traditional and behavioral training. DIAGNOSIS: Alexithymia due to ischemic stroke. INTERVENTIONS: Then, a specific combined protocol using computerized emotional and virtual emotional training was applied in a semi-immersive virtual reality environment using the BTS-Nirvana device. OUTCOMES: At the end of this novel rehabilitation approach, the patient showed a significant improvement in emotional skills, cognitive performances, and coping strategies. CONCLUSIONS: Virtual reality, in addition to standard therapy, may be a valuable tool in improving emotional abnormalities due to brain lesions, such as alexithymia.


Assuntos
Sintomas Afetivos/terapia , Reabilitação do Acidente Vascular Cerebral/instrumentação , Terapia de Exposição à Realidade Virtual/métodos , Adulto , Sintomas Afetivos/etiologia , Humanos , Masculino , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia
11.
Medicine (Baltimore) ; 99(38): e22360, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957409

RESUMO

BACKGROUND: Post-stroke dysphagia (PSD) requires effective treatment as it may cause aspiration pneumonia, dehydration, or malnutritution, which can increase the length of hospital stay as well as mortality. In the field of stroke, electroacupuncture (EA) has been widely used, and a number of clinical research papers have been published regarding its effects. This systematic review aims to evaluate the effectiveness of EA for the treatment of PSD. METHODS: Randomized controlled trials evaluating the use of EA in PSD will be included in this meta-analysis. The following electronic databases will be searched from inception to July 31, 2020, using terms relating to EA and PSD: PubMed, the Cochrane Library, the Excerpta Medica Database, China National Knowledge Infrastructure, the Korean Medical Database, KoreaMed, the National Digital Science Library, and the Oriental Medicine Advanced Searching Integrated System. Two reviewers will independently search these databases, select studies for inclusion, and evaluate the quality of the studies. Methodological quality will be assessed using the Cochrane Handbook for Systematic Reviews of Interventions (version 6.0). The primary outcome will be the total effective rate; secondary outcomes will include results of other assessments of dysphagia such as the water drinking test scale and videofluoroscopic swallowing study. We will also investigate the number and severity of adverse events. The Cochrane Review Manager (RevMan) software (version 5.3.5) will be employed to assess bias risk, data integration risk, and meta-analysis risk. Mean difference and standardized mean difference will be used to represent continuous data, while risk ratios will be used for pooled binary data. RESULTS: This study will provide a comprehensive review and evaluation of the available evidence regarding the efficacy and safety of EA as a treatment for PSD. CONCLUSION: This study will clarify whether EA could be an effective and safe treatment for PSD.


Assuntos
Transtornos de Deglutição/terapia , Eletroacupuntura/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Transtornos de Deglutição/etiologia , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto
12.
Nat Commun ; 11(1): 4592, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32929089

RESUMO

Prediabetes is a state of glycaemic dysregulation below the diagnostic threshold of type 2 diabetes (T2D). Globally, ~352 million people have prediabetes, of which 35-50% develop full-blown diabetes within five years. T2D and its complications are costly to treat, causing considerable morbidity and early mortality. Whether prediabetes is causally related to diabetes complications is unclear. Here we report a causal inference analysis investigating the effects of prediabetes in coronary artery disease, stroke and chronic kidney disease, complemented by a systematic review of relevant observational studies. Although the observational studies suggest that prediabetes is broadly associated with diabetes complications, the causal inference analysis revealed that prediabetes is only causally related with coronary artery disease, with no evidence of causal effects on other diabetes complications. In conclusion, prediabetes likely causes coronary artery disease and its prevention is likely to be most effective if initiated prior to the onset of diabetes.


Assuntos
Doenças Cardiovasculares/complicações , Estado Pré-Diabético/complicações , Glicemia/metabolismo , Doenças Cardiovasculares/genética , Intervalos de Confiança , Doença da Artéria Coronariana/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Jejum/sangue , Humanos , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Razão de Chances , Estado Pré-Diabético/sangue , Estado Pré-Diabético/genética , Insuficiência Renal Crônica/complicações , Fatores de Risco , Acidente Vascular Cerebral/complicações
13.
Medicine (Baltimore) ; 99(38): e22243, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957370

RESUMO

Although obesity is an established risk factor of primary stroke, the association between obesity and post-stroke mortality remains unclear. The aim of this study was to investigate the association between dynamic obesity status and mortality in survivors of their first stroke in China.Of 775 patients with first-ever ischemic stroke included in a longitudinal study, 754 patients were included in this study and categorized into 4 categories of body mass index (BMI) (underweight, normal weight, overweight, and obese) and 2 categories of waist circumference (WC) (normal WC and abdominal obesity) according to standard Chinese criteria. The mortality information and obesity status were obtained via telephone follow-up every 3 months, beginning in 2010 through 2016. Time-dependent Cox proportional hazards models were used to estimate the unadjusted and adjusted hazard ratios (HRs) for the relationship between all-cause mortality and dynamic obesity status.Of 754 patients, 60.87% were male, and the overall mean age was 61.45 years. After adjusting for possible confounders, significant inverse associations were identified between BMI and WC and all-cause mortality. Compared with those with normal BMI or WC, those with abdominal obesity or overweight had a significantly lower risk of all-cause mortality (HR and 95% confidence intervals [CIs]: .521 [.303-.897] and 0.545 [.352-.845], respectively), whereas patients with underweight had the highest risk and those with obesity had lower risk of mortality, though it was not statistically significant (1.241 [.691-2.226] and .486 [.192-1.231], respectively).Overweight and abdominal obesity were paradoxically associated with reduced risk of mortality in patients who survived their first-ever ischemic stroke in China. Future prospective studies must look at evaluating the role of obesity in different stroke subtypes and devise appropriate weight-management strategies for optimal prognoses in secondary prevention in these survivors.


Assuntos
Isquemia Encefálica/mortalidade , Obesidade/epidemiologia , Acidente Vascular Cerebral/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/prevenção & controle , China/epidemiologia , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/terapia , Prevalência , Estudos Prospectivos , Fatores de Risco , Prevenção Secundária , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/prevenção & controle , Sobreviventes , Circunferência da Cintura , Adulto Jovem
14.
Medicine (Baltimore) ; 99(38): e22275, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957379

RESUMO

BACKGROUND: Urinary incontinence (UI) is still a persistent challenge in many stroke survivors, affecting the quality of life and emotional being of these individuals. Numerous studies have demonstrated the curative effect of electroacupuncture on post-stroke incontinence, however they were mired with questionable quality and inconsistencies in safety and efficacy. Therefore, the main objective of this meta-analysis is to provide a comprehensive evaluation of the efficacy and safety of electroacupuncture against urinary incontinence after stroke, with a view of providing more reliable evidence-based solutions for UI. METHODS: A systematic literature search will be conducted using PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and 4 Chinese databases from inception to June 2020 to identify randomized control trials that report on electroacupuncture against urinary incontinence after stroke. Two reviewers will independently identify eligible studies and extract data. The risk of bias of the included randomized control trials will be evaluated according to the Cochrane tool. Risk ratio and 95% confidence intervals will be used to estimate the efficacy of treatment,. and the grading of recommendations, assessment, development, and evaluation approach to rate the certainty of evidence. The statistical heterogeneity will be evaluated by Cochran's Q and the I. Data will be analyzed using Stata software (Version 13.0, Stata Corp, College Station, TX, USA). RESULTS: This study will provide a comprehensive evaluation of the efficacy and safety of electroacupuncture against UI after stroke, with a view of providing more reliable evidence-based solutions for UI. ETHICS AND DISSEMINATION: This work synthesises evidence from previously published studies and does not require ethics review or approval. A manuscript describing the findings will be submitted for publication in a peer-reviewed scientific journal. INPLASY REGISTRATION NUMBER: INPLASY202050073.


Assuntos
Eletroacupuntura/efeitos adversos , Metanálise como Assunto , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto , Incontinência Urinária/terapia , Humanos , Qualidade de Vida , Incontinência Urinária/etiologia
15.
BMC Neurol ; 20(1): 358, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32972381

RESUMO

BACKGROUND: The novel coronavirus (COVID-19) global pandemic is associated with an increased incidence of acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). The treatment of these patients poses unique and significant challenges to health care providers requiring changes in existing protocols. CASE PRESENTATION: A 54-year-old COVID-19 positive patient developed sudden onset left hemiparesis secondary to an acute right middle cerebral artery occlusion (National Institutes of Health Stroke Scale (NIHSS) score = 11). Mechanical thrombectomy (MT) was performed under a new protocol specifically designed to maximize protective measures for the team involved in the care of the patient. Mechanical Thrombectomy was performed successfully under general anesthesia resulting in TICI 3 recanalization. With regards to time metrics, time from door to reperfusion was 60 mins. The 24-h NIHSS score decreased to 2. Patient was discharged after 19 days after improvement of her pulmonary status with modified Rankin Scale = 1. CONCLUSION: Patients infected by COVID-19 can develop LVO that is multifactorial in etiology. Mechanical thrombectomy in a COVID-19 confirmed patient presenting with AIS due to LVO is feasible with current mechanical thrombectomy devices. A change in stroke workflow and protocols is now necessary in order to deliver the appropriate life-saving therapy for COVID-19 positive patients while protecting medical providers.


Assuntos
Infecções por Coronavirus/complicações , Procedimentos Endovasculares/métodos , Infarto da Artéria Cerebral Média/cirurgia , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Trombectomia/métodos , Betacoronavirus , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Serviços Médicos de Emergência , Feminino , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Intubação Intratraqueal , Pessoa de Meia-Idade , Pandemias , Reperfusão , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Tempo para o Tratamento , Resultado do Tratamento
16.
J Neurovirol ; 26(5): 631-641, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32876900

RESUMO

A subset of patients with coronavirus 2 disease (COVID-19) experience neurological complications. These complications include loss of sense of taste and smell, stroke, delirium, and neuromuscular signs and symptoms. The etiological agent of COVID-19 is SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), an RNA virus with a glycoprotein-studded viral envelope that uses ACE2 (angiotensin-converting enzyme 2) as a functional receptor for infecting the host cells. Thus, the interaction of the envelope spike proteins with ACE2 on host cells determines the tropism and virulence of SARS-CoV-2. Loss of sense of taste and smell is an initial symptom of COVID-19 because the virus enters the nasal and oral cavities first and the epithelial cells are the receptors for these senses. Stroke in COVID-19 patients is likely a consequence of coagulopathy and injury to cerebral vascular endothelial cells that cause thrombo-embolism and stroke. Delirium and encephalopathy in acute and post COVID-19 patients are likely multifactorial and secondary to hypoxia, metabolic abnormalities, and immunological abnormalities. Thus far, there is no clear evidence that coronaviruses cause inflammatory neuromuscular diseases via direct invasion of peripheral nerves or muscles or via molecular mimicry. It appears that most of neurologic complications in COVID-19 patients are indirect and as a result of a bystander injury to neurons.


Assuntos
Betacoronavirus/patogenicidade , Encefalopatias/complicações , Infecções por Coronavirus/complicações , Transtornos do Olfato/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/complicações , Acidente Vascular Cerebral/complicações , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Encéfalo/virologia , Encefalopatias/imunologia , Encefalopatias/patologia , Encefalopatias/virologia , Efeito Espectador , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Células Epiteliais/patologia , Células Epiteliais/virologia , Regulação da Expressão Gênica , Interações Hospedeiro-Patógeno/genética , Interações Hospedeiro-Patógeno/imunologia , Humanos , Pulmão/irrigação sanguínea , Pulmão/patologia , Pulmão/virologia , Neurônios/patologia , Neurônios/virologia , Transtornos do Olfato/imunologia , Transtornos do Olfato/patologia , Transtornos do Olfato/virologia , Pandemias , Peptidil Dipeptidase A/genética , Peptidil Dipeptidase A/imunologia , Pneumonia Viral/imunologia , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Embolia Pulmonar/imunologia , Embolia Pulmonar/patologia , Embolia Pulmonar/virologia , Transdução de Sinais/genética , Transdução de Sinais/imunologia , Glicoproteína da Espícula de Coronavírus/genética , Glicoproteína da Espícula de Coronavírus/imunologia , Acidente Vascular Cerebral/imunologia , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/virologia
17.
J Neurointerv Surg ; 12(11): 1045-1048, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32989032

RESUMO

BACKGROUND: We aimed to compare the outcome of acute ischemic stroke (AIS) patients who received endovascular thrombectomy (EVT) with confirmed COVID-19 to those without. METHODS: We performed a retrospective analysis using the Vizient Clinical Data Base and included hospital discharges from April 1 to July 31 2020 with ICD-10 codes for AIS and EVT. The primary outcome was in-hospital death and the secondary outcome was favorable discharge, defined as discharge home or to acute rehabilitation. We compared patients with laboratory-confirmed COVID-19 to those without. As a sensitivity analysis, we compared COVID-19 AIS patients who did not undergo EVT to those who did, to balance potential adverse events inherent to COVID-19 infection. RESULTS: We identified 3165 AIS patients who received EVT during April to July 2020, in which COVID-19 was confirmed in 104 (3.3%). Comorbid COVID-19 infection was associated with younger age, male sex, diabetes, black race, Hispanic ethnicity, intubation, acute coronary syndrome, acute renal failure, and longer hospital and intensive care unit length of stay. The rate of in-hospital death was 12.4% without COVID-19 vs 29.8% with COVID-19 (P<0.001). In mixed-effects logistic regression that accounted for patient clustering by hospital, comorbid COVID-19 increased the odds of in-hospital death over four-fold (OR 4.48, 95% CI 3.02 to 6.165). Comorbid COVID-19 was also associated with lower odds of a favorable discharge (OR 0.43, 95% CI 0.30 to 0.61). In the sensitivity analysis, comparing AIS patients with COVID-19 who did not undergo EVT (n=2139) to the AIS EVT patients with COVID-19, there was no difference in the rate of in-hospital death (30.6% vs 29.8%, P=0.868), and AIS EVT patients had a higher rate of favorable discharge (32.4% vs 47.1%, P=0.002). CONCLUSION: In AIS patients treated with EVT, comorbid COVID-19 infection was associated with in-hospital death and a lower odds of favorable discharge compared with patients without COVID-19, but not compared with AIS patients with COVID-19 who did not undergo EVT. AIS EVT patients with COVID-19 were younger, more likely to be male, have systemic complications, and almost twice as likely to be black and over three times as likely to be Hispanic.


Assuntos
Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Infecções por Coronavirus/complicações , Procedimentos Endovasculares/estatística & dados numéricos , Pneumonia Viral/complicações , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Trombectomia/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Procedimentos Endovasculares/métodos , Grupos Étnicos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Trombectomia/métodos , Resultado do Tratamento , Adulto Jovem
18.
Cochrane Database Syst Rev ; 9: CD013019, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32970328

RESUMO

BACKGROUND: Motor imagery (MI) is defined as a mentally rehearsed task in which movement is imagined but is not performed. The approach includes repetitive imagined body movements or rehearsing imagined acts to improve motor performance. OBJECTIVES: To assess the treatment effects of MI for enhancing ability to walk among people following stroke. SEARCH METHODS: We searched the Cochrane Stroke Group registry, CENTRAL, MEDLINE, Embase and seven other databases. We also searched trial registries and reference lists. The last searches were conducted on 24 February 2020. SELECTION CRITERIA: Randomized controlled trials (RCTs) using MI alone or associated with action observation or physical practice to improve gait in individuals after stroke. The critical outcome was the ability to walk, assessed using either a continuous variable (walking speed) or a dichotomous variable (dependence on personal assistance). Important outcomes included walking endurance, motor function, functional mobility, and adverse events. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the trials according to pre-defined inclusion criteria, extracted the data, assessed the risk of bias, and applied the GRADE approach to evaluate the certainty of the evidence. The review authors contacted the study authors for clarification and missing data. MAIN RESULTS: We included 21 studies, involving a total of 762 participants. Participants were in the acute, subacute, or chronic stages of stroke, and had a mean age ranging from 50 to 78 years. All participants presented at least some gait deficit. All studies compared MI training versus other therapies. Most of the included studies used MI associated with physical practice in the experimental groups. The treatment time for the experimental groups ranged from two to eight weeks. There was a high risk of bias for at least one assessed domain in 20 of the 21 included studies. Regarding our critical outcome, there was very low-certainty evidence that MI was more beneficial for improving gait (walking speed) compared to other therapies at the end of the treatment (pooled standardized mean difference (SMD) 0.44; 95% confidence interval (CI) 0.06 to 0.81; P = 0.02; six studies; 191 participants; I² = 38%). We did not include the outcome of dependence on personal assistance in the meta-analysis, because only one study provided information regarding the number of participants that became dependent or independent after interventions. For our important outcomes, there was very low-certainty evidence that MI was no more beneficial than other interventions for improving motor function (pooled mean difference (MD) 2.24, 95% CI -1.20 to 5.69; P = 0.20; three studies; 130 participants; I² = 87%) and functional mobility at the end of the treatment (pooled SMD 0.55, 95% CI -0.45 to 1.56; P = 0.09; four studies; 116 participants; I² = 64.2%). No adverse events were observed in those studies that reported this outcome (seven studies). We were unable to pool data regarding walking endurance and all other outcomes at follow-up. AUTHORS' CONCLUSIONS: We found very low-certainty evidence regarding the short-term benefits of MI on walking speed in individuals who have had a stroke, compared to other therapies. Evidence was insufficient to estimate the effect of MI on the dependence on personal assistance and walking endurance. Compared with other therapies, the evidence indicates that MI does not improve motor function and functional mobility after stroke (very low-certainty evidence). Evidence was also insufficient to estimate the effect of MI on gait, motor function, and functional mobility after stroke compared to placebo or no intervention. Motor Imagery and other therapies used for gait rehabilitation after stroke do not appear to cause significant adverse events.


Assuntos
Transtornos Neurológicos da Marcha/reabilitação , Imagens, Psicoterapia/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Idoso , Viés , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Velocidade de Caminhada
19.
Medicine (Baltimore) ; 99(39): e22025, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991405

RESUMO

BACKGROUND: This study will assess the efficacy and safety of arthroscopic capsular release (ACR) for the treatment of post-stroke frozen shoulder (PSFS). METHODS: We will carry out a systematic study of randomized controlled trials that assess the efficacy and safety of ACR for PSFS. We will search all potential records for any eligible trials from selected electronic databases (MEDLINE, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, WANGFANG, and China National Knowledge Infrastructure) and grey literature sources from inception to the present. Two authors will independently perform study selection, data extraction, and study quality assessment. Any disagreement will be solved by a third author via consultation. Statistical analysis will be carried out by RevMan 5.3 software. RESULTS: This study will comprehensively summarize current eligible studies to systematically assess the efficacy and safety of ACR for PSFS. CONCLUSION: This study will provide evidence to determine whether ACR is an effective management for patients with PSFS.


Assuntos
Bursite/cirurgia , Liberação da Cápsula Articular/métodos , Bursite/etiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto
20.
Medicine (Baltimore) ; 99(39): e22236, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991418

RESUMO

Articulation disorder is associated with impaired control of respiration and speech organ movement. There are many cases of dysarthria and dysphonia in stroke patients. Dysphonia adversely affects communication and social activities, and it can interfere with everyday life. The purpose of this study is to assess the association between phonation abilities and the vowel quadrilateral in stroke patients.The subjects were stroke patients with pronunciation and phonation disorders. The resonance frequency was measured for the 4 corner vowels to measure the vowel space area (VSA) and formant centralization ratio (FCR). Phonation ability was evaluated by the Dysphonia Severity Index (DSI) and maximal phonation time (MPT) through acoustic evaluation for each vowel. Pearsons correlation analysis was performed to confirm the association, and multiple linear regression analysis was performed between variables.The correlation coefficients of VSA and MPT/u/ were 0.420, VSA and MPT/i/ were 0.536, VSA and DSI/u/ were 0.392, VSA and DSI /i/ were 0.364, and FCR and DSI /i/ were -0.448. Multiple linear regression analysis showed that VSA was a factor significantly influencing MPT/u/ (ß = 0.420, P = .021, R = 0.147), MPT/i/ (ß = 0.536, P = .002, R = 0.262), DSI/u/ (ß = 0.564, P = .045, R = 0.256), and DSI/i/ (ß = 0.600, P = .03, R = 0.302).The vowel quadrilateral can be a useful tool for evaluating the phonation function of stroke patients.


Assuntos
Disfonia/terapia , Fonação , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , Disfonia/etiologia , Disfonia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações
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