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1.
Neurology ; 97(7): e706-e719, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34400568

RESUMO

OBJECTIVE: To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke. METHOD: In this prospective longitudinal study, 89 patients with first-ever stroke with arm paresis were assessed at 3 weeks and 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), and unimanual motor impairment was assessed with the Fugl-Meyer Assessment (FMA). Candidate predictors included shoulder abduction and finger extension measured by the corresponding FMA items (FMA-SAFE; range 0-4) and sensory and cognitive impairment. MRI was used to measure weighted corticospinal tract lesion load (wCST-LL) and resting-state interhemispheric functional connectivity (FC). RESULTS: Initial Ad-AHA performance was poor but improved over time in all (mild-severe) impairment subgroups. Ad-AHA correlated with FMA at each time point (r > 0.88, p < 0.001), and recovery trajectories were similar. In patients with moderate to severe initial FMA, FMA-SAFE score was the strongest predictor of Ad-AHA outcome (R 2 = 0.81) and degree of recovery (R 2 = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome (R 2 = 0.05). Repeated analyses without FMA-SAFE score identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL >5.5 cm3 strongly predicted low to minimal FMA/Ad-AHA recovery (≤10 and 20 points respectively, specificity = 0.91). FC explained some additional variance to FMA-SAFE score only in unimanual recovery. CONCLUSION: Although recovery of bimanual activity depends on the extent of corticospinal tract injury and initial sensory and cognitive impairments, FMA-SAFE score captures most of the variance explained by these mechanisms. FMA-SAFE score, a straightforward clinical measure, strongly predicts bimanual recovery. CLINICALTRIALSGOV IDENTIFIER: NCT02878304. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that the FMA-SAFE score predicts bimanual recovery after stroke.


Assuntos
Disfunção Cognitiva/fisiopatologia , Conectoma , Mãos/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Paresia/fisiopatologia , Desempenho Psicomotor/fisiologia , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/etiologia , Prognóstico , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
2.
Nutrients ; 13(8)2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34444864

RESUMO

Nutrition and rehabilitation are crucial in post-stroke recovery, especially in the elderly. Since stroke is the leading cause of long-term disability, there is a need to promote special, individually tailored nutrition strategies targeting older patients with low motor ability. Chronic stroke survivors have higher risk of developing nutrition-related chronic diseases, such as sarcopenia, anemia, type 2 diabetes mellitus and osteoporosis. Moreover, reduced motor activity, cognitive impairment and depression might be aggravated by poor malnutrition status. Accumulated data suggest that nutritional supplements and neuroprotective diets can be associated with better effectiveness of post-stroke rehabilitation as well as brain recovery. Therefore, this review focuses on preventive strategies that can improve dietary intake and change dietary patterns. We highlight the importance of neuroprotective diets, the problem of dysphagia and the role of nutrition in rehabilitation. This article focuses on potential nutritional supplements and neuroprotective diets that may have an impact on functional recovery during and after rehabilitation. Moreover, a new approach to post-stroke neuroplasticity including the use of agents from marine sources such as fucoxanthin and tramiprosate as compounds that might be used as potential neuroprotectants with antioxidative and anti-inflammatory properties is introduced.


Assuntos
Dieta/métodos , Suplementos Nutricionais , Desnutrição/prevenção & controle , Terapia Nutricional/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Antioxidantes/administração & dosagem , Ingestão de Alimentos , Feminino , Humanos , Masculino , Desnutrição/etiologia , Neuroproteção , Fármacos Neuroprotetores , Estado Nutricional , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
3.
Prog Cardiovasc Dis ; 66: 92-100, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34332665

RESUMO

Stroke is a major driver of increased morbidity and mortality in patients with non-valvular atrial fibrillation (NVAF). While systemic oral anticoagulation (OAC) continues to be the mainstay for stroke reduction therapy in patients with NVAF, several barriers prevent the sustained long-term use of OAC, including increased risk of bleeding, non-compliance, cost, drug-drug interactions, and the need for ongoing laboratory testing. Given the need for continued stroke reduction therapies in patients who are intolerant of or non-compliant with OAC, percutaneous left atrial appendage (LAA) occlusion (LAAO) has emerged as a nonpharmacologic alternative to OAC. The development of percutaneous LAAO techniques is based on data suggesting that more than 90% of thrombi in patients with NVAF originate in the LAA. Two percutaneous LAAO devices are currently in widespread clinical use: Watchman (United States and Europe) and the Amplatzer type of devices (Europe); randomized trial data exist only for the Watchman device. Multiple randomized and nonrandomized trials and registries have demonstrated the safety and effectiveness of LAAO in patients who are suitable for short-term anticoagulation using a variety of post-procedural antithrombotic strategies. Ongoing randomized clinical trials on LAAO are focused on OAC-ineligible patients to compare efficacy of LAAO devices against a multitude of antithrombotic options. This review aims to discuss the rationale and evidence for LAAO and post procedural antithrombotic strategies and opportunities for research examination. In addition, we discuss the need for continued investigation of LAAO in populations not well represented in clinical trials or registries, including women, older patients, and underrepresented racial and ethnic groups.


Assuntos
Apêndice Atrial/fisiopatologia , Fibrilação Atrial/terapia , Cateterismo Cardíaco/instrumentação , Fibrinolíticos/uso terapêutico , Dispositivo para Oclusão Septal , Acidente Vascular Cerebral/prevenção & controle , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/mortalidade , Tomada de Decisão Clínica , Fibrinolíticos/efeitos adversos , Humanos , Seleção de Pacientes , Desenho de Prótese , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
4.
J Stroke Cerebrovasc Dis ; 30(9): 105961, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34247054

RESUMO

OBJECTIVE: Oral problems affect rehabilitation outcomes. This study aimed to examine the association between improvement in oral health and functional outcomes in patients after stroke. MATERIALS AND METHODS: This retrospective cohort study included post-acute rehabilitation patients who presented with oral problems at admission. Oral problems were assessed using the Revised Oral Assessment Guide (ROAG). The ROAG score change during hospitalization was calculated by subtracting the score at admission from the score at discharge; oral problems were defined as "improved", when the score change value was lower than the median value. Study outcomes were the activities of daily living assessed by the motor domain of the Functional Independence Measure (FIM-motor) scores and dysphagia as assessed by the Food Intake Level Scale (FILS). Multivariate regression analyses were used to determine whether improved oral problems were associated with study outcomes. P-values of <0.05 were considered statistically significant. RESULTS: This study included 300 patients (mean age, 72.0 years; 51.7% men). The median [IQR] baseline ROAG score and its change value during hospitalization were 11 [10, 14] and -1[-3, 0] points, respectively. Multivariate analyses showed that improved oral problems was independently associated with FIM-motor score (ß = 0.144, p = 0.001) and FILS score (ß = 0.227, p < 0.001) at discharge, after adjusting for potential confounders. CONCLUSIONS: Improvement in oral health was positively associated with recovery of the ADL and dysphagia after stroke. Early detection of oral problems and oral treatment should be implemented in these patients to maximize functional recovery.


Assuntos
Atividades Cotidianas , Transtornos de Deglutição/terapia , Deglutição , Saúde Bucal , Higiene Bucal , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Ingestão de Alimentos , Feminino , Estado Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
5.
J Stroke Cerebrovasc Dis ; 30(9): 105989, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34271278

RESUMO

BACKGROUND: Malnutrition is associated with a poor functional outcome in patients with stroke. However, the prevalence of malnutrition diagnosed with the Global Leadership Initiative on Malnutrition (GLIM) criteria or its association with activity of daily living (ADL) in patients with acute stroke have not been reported. OBJECTIVE: To investigate the prevalence of the malnutrition diagnosed with the GLIM criteria and its association with ADL or discharge destination in patients with acute stroke. MATERIALS AND METHODS: In this cross-sectional study, we diagnosed malnutrition with the GLIM criteria and the European Society for Clinical Nutrition and Metabolism (ESPEN) criteria and assessed ADL by functional independence measure motor domain (FIM-M) score in patients with acute stroke. Multivariate regression analysis was used to investigate the relationship between FIM-M score or home discharge and malnutrition defined with GLIM or ESPEN criteria. RESULTS: A total of 115 acute stroke patients (39 females; median age: 72 years) were enrolled in this study. The prevalence of malnutrition according to GLIM-criteria and ESPEN-criteria was 28.7% and 16.5%, respectively. Multivariate analyses for FIM-M score after adjusting for potential confounders showed that GLIM criteria and ESPEN criteria were independently associated with FIM-M score (ß = -0.238, p < 0.001; ß = -0118, p = 0.040, respectively). A multivariate analysis for discharge destination found that only malnutrition from the GLIM criteria was significantly associated with home discharge (OR = 0.08, 95% confidential interval = 0.01-0.69, p = 0.02). CONCLUSIONS: Malnutrition with the GLIM criteria is negatively associated with ADL and is also associated with discharge destination in patients with acute stroke.


Assuntos
Atividades Cotidianas , Desnutrição/epidemiologia , Avaliação Nutricional , Estado Nutricional , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Japão/epidemiologia , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Alta do Paciente , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Adulto Jovem
6.
J Stroke Cerebrovasc Dis ; 30(9): 105971, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34280690

RESUMO

PURPOSE: This study aimed to describe recovery of dysphagia after stroke. We determined the proportion of stroke survivors with dysphagia on admission, discharge, and 6 months after stroke. Additionally, the factors affecting oral feeding 6 months after stroke were explored. METHODS: A total of 427 acute stroke patients were recruited prospectively. Presence of dysphagia was evaluated on admission, weekly until recovery was achieved, and at discharge. We compared stroke survivors with dysphagia who had complete recovery, who had dysphagia but achieved oral feeding, and who required tube feeding. Patient-reported eating ability was evaluated at 6 months. Patients who achieved oral feeding by 6 months were compared to those who had persistent tube feeding need. RESULTS: Fifty-five percent of stroke survivors had dysphagia on initial evaluation (3.1 ± 1.4 days after admission) and 37% at discharge (21.1 ± 12.4 days). At 6 months, 5% of patients required tube feeding. Among those who had dysphagia at initial evaluation, 32% had resolution of dysphagia within two weeks, 44% had dysphagia but started oral feeding before discharge, and 23% required alternative means of alimentation (nasogastric tube feeding, percutaneous endoscopic gastrostomy, parental nutrition) throughout hospitalization. At 6 months, 90% of stroke survivors who achieved oral feeding by discharge continued with oral feeding. Patients who achieved oral feeding after discharge had less cognitive impairments on admission and a higher speech therapist intervention rate after discharge. CONCLUSIONS: More than half of stroke survivors had dysphagia but the vast majority were able to return to oral feeding by 6 months. Cognitive function and dysphagia rehabilitation interventions were associated with return to oral feeding after hospital discharge.


Assuntos
Transtornos de Deglutição/reabilitação , Deglutição , Ingestão de Alimentos , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/fisiopatologia , Nutrição Enteral , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Alta do Paciente , Prognóstico , Estudos Prospectivos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
7.
J Stroke Cerebrovasc Dis ; 30(9): 105994, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34284324

RESUMO

OBJECTIVES: To investigate the intensity and effectiveness of rehabilitation in acute stroke patients according to the severity of functional impairments in them. MATERIALS AND METHODS: This retrospective cohort study included 294 patients with acute hemispheric stroke admitted to three acute-care hospitals who subsequently underwent an inpatient rehabilitation program. Stroke severity was classified according to neurological deficits and trunk dysfunction. The following data were obtained from medical records: age, sex, stroke type, lesion side, hospitalization duration, initial functional status determined using the National Institutes of Health Stroke Scale, rehabilitation start date, first day out of bed after admission, total treatment duration, total number of treatment sessions, rehabilitation implementation rate between start of rehabilitation and discharge, trunk control test and Barthel Index score on the first day out of bed after admission and discharge, and post-discharge outcomes. Hierarchical cluster analysis was performed with clusters categorized using the National Institutes of Health Stroke Scale and trunk control test scores. Variables were compared using the Kruskal-Wallis test, and Dunn's nonparametric comparison test was performed for post-hoc analysis to determine differences between clusters. RESULTS: The National Institutes of Health Stroke Scale and trunk control test showed a significant correlation (r = -0.816, p < 0.01) using which cluster analysis identified three clusters. Rehabilitation showed a ceiling effect in patients with mild stroke and a floor effect in patients with severe stroke. CONCLUSION: These results may guide the determination of rehabilitation intensity with reference to the severity of neurological deficits and trunk dysfunction.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Idoso , Avaliação da Deficiência , Feminino , Estado Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Tóquio , Resultado do Tratamento
8.
J Stroke Cerebrovasc Dis ; 30(9): 105995, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34289432

RESUMO

OBJECTIVES: To investigate if the distance covered in the Six-Minute Walk Test (6MWT) and in the Incremental Shuttle Walk Test (ISWT) is most strongly explained by walking capacity or cardiorespiratory fitness (CRF) measures in individuals after chronic stroke. MATERIALS AND METHODS: This is a cross-sectional study. Individuals after chronic stroke aged at least 20 years old and able to walk at least 10 minutes independently were included. The distance covered (meters) in the 6 MWT and ISWT (dependent variables), comfortable and fast gait speed obtained by the 10 m walk test (10 mWT) (walking capacity measures; independent variables) and peak oxygen consumption (VO2peak; CRF measure; independent variable) (ml.kg-1.min-1) obtained by the cardiopulmonary exercise test (CPET) were obtained. Linear regression analyses were performed (α = 5%). RESULTS: Fifty individuals (mean age of 55±12 years and mean time after stroke of 67±74 months) were included. Comfortable and fast gait speeds were the variables that most strongly explained the distance covered in the field tests: 6MWT (R² = 0.614, ß = 0.784, p < 0.001 and R² = 0.615, ß = 0.778, p < 0.001, respectively) and ISWT (R² = 0.450, ß = 0.671, p < 0.001 and R² = 0.456, ß = 0.746, p < 0.001, respectively). On the other hand, for the VO2peak, the following models were generated: 6MWT (R² = 0.280, ß = 0.530, p < 0.001) and ISWT (R² = 0.154, ß = 0.393, p = 0.005). CONCLUSIONS: The distance covered in the field tests (6MWT and ISWT) is more suitable to support inferences about the walking capacity than about the CRF of individuals after chronic stroke.


Assuntos
Aptidão Cardiorrespiratória , Tolerância ao Exercício , Acidente Vascular Cerebral/diagnóstico , Teste de Caminhada , Caminhada , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Consumo de Oxigênio , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Velocidade de Caminhada
9.
J Stroke Cerebrovasc Dis ; 30(9): 105958, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34303088

RESUMO

BACKGROUND: Loss of skeletal muscle is a critical health issue that frequently occurs due to aging and various pathologies. No studies have reported increases in appendicular skeletal muscle mass among elderly patients after stroke. Our hypothesis was that even older individuals after stroke could increase skeletal muscle mass by rehabilitation. OBJECTIVES: This study aimed to evaluate changes to skeletal muscle mass in elderly patients after stroke rehabilitation and to assess factors associated with skeletal muscle mass increases. MATERIALS AND METHODS: Participants in this case-control study were 159 patients ≥ 80 years old in rehabilitation wards after stroke. Body mass index (BMI), appendicular skeletal muscle index (SMI), Functional Independence Measure (FIM), interval from onset to transfer, presence of hemiplegia, National Institutes of Health Stroke Scale (NIHSS), length of hospital stay for rehabilitation, period of exercise therapy per day, and protein intake were examined. Multivariate logistic regression analysis was performed to identify association between these values and SMI increases. RESULTS: SMI at discharge was significantly increased (5.30 kg/m2) compared to baseline (5.20kg/m2; p = 0.002). Multiple logistic regression analysis showed that length of hospital stay and protein intake were significantly associated with SMI increases, with odds ratios of 1.013 (95% confidence interval, 1.005-1.022) and 3.746 (95% confidence interval, 1.077-13.028), respectively. CONCLUSIONS: The SMI of patients ≥ 80 years old increased significantly with rehabilitation after stroke. In addition, length of hospital stay and protein intake were independently associated with increases in SMI.


Assuntos
Composição Corporal , Terapia por Exercício , Fragilidade/terapia , Músculo Esquelético/fisiopatologia , Sarcopenia/terapia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Proteínas na Dieta/administração & dosagem , Impedância Elétrica , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Hospitalização , Humanos , Pacientes Internados , Tempo de Internação , Masculino , Tamanho do Órgão , Sarcopenia/diagnóstico , Sarcopenia/fisiopatologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
10.
J Stroke Cerebrovasc Dis ; 30(9): 105984, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34311419

RESUMO

BACKGROUND: Arm reaching training in standing for several weeks affects the postural control of individuals recovering from cerebrovascular accident (CVA). Whether these effects differ with the side of the brain lesion are unknown. OBJECTIVES: To examine the immediate effects of a training session of arm reaching movements on the balance and trunk motion of individuals who suffered a right or left CVA. MATERIALS AND METHODS: Thirty-six adults divided into four groups (i.e., right CVA, left CVA, right control, and left control) performed 120 reaches in a standing position toward one of three target heights. Before and after the reaching trials, participants stood as quiet as possible on two force plates and had their postural sway, trunk motion, and body weight distribution assessed. RESULTS: CVA groups showed greater postural sway regardless of the brain lesion's side compared to the control groups. After the session of reaching movements, the left stroke group reduced the postural sway and trunk displacements. Larger ranges of weight-bearing asymmetry were more frequent after the training session, mainly for the right stroke group. CONCLUSIONS: A single session training of reaching movements affects mostly the postural control of left stroke survivors. More training sessions may be needed for individuals after right stroke to show balance improvements. The current findings support the hemispheric specialization for postural control and suggest that the training involving arm movements in standing can benefit the motor rehabilitation of stroke individuals.


Assuntos
Terapia por Exercício , Lateralidade Funcional , Atividade Motora , Equilíbrio Postural , Posição Ortostática , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Extremidade Superior/inervação , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Suporte de Carga
11.
J Stroke Cerebrovasc Dis ; 30(9): 105991, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34293643

RESUMO

OBJECTIVES: Computer game assisted task specific exercises (CGATSE) are rehabilitation gaming systems (RGS) used in stroke rehabilitation to facilitate patient performance of high intensity, task based, repetitive exercises aiming to enhance neuroplasticity. CGATSE maybe an appealing option in home based rehabilitation of stroke patients, especially during the COVID-19 pandemic. This study aimed to determine the effects of CGATSE on hemiplegic arm-hand function, cognitive function and quality of life in stroke. MATERIALS AND METHODS: Thirty stroke patients were randomized into two groups. All participants received twenty sessions of physical therapy. In addition, the therapy group undertook thirty minutes of CGATSE using the Rejoyce gaming system; while the control group undertook thirty minutes of occupational therapy (OT). Motor function was evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), Brunnstrom stages of stroke recovery (BSSR) arm and hand. The CGATSE group also completed the Rejoyce arm hand function test (RAHFT). Cognitive function was evaluated using the mini mental state examination, Montreal Cognitive Assessment (MoCA) and Stroke Specific Quality of Life (SS-QOL) scale. RESULTS: The FMUE, BSSR arm and SSQOL improved in both groups (p < 0.05). BSSR of the hand improved only in the CGATSE group (p = 0.024). RAHFT scores improved in the CGATSE group (p = 0.008). MoCA scores significantly improved in the control group (p = 0.008). CONCLUSIONS: CGATSE may be beneficial in providing continuation of care after stroke, especially during the Covid-19 pandemic when home based rehabilitation options are becoming increasingly important. Benefits of CGATSE in improving cognitive function is less clear. RGS aimed at improving motor function may be compared to gaming systems designed to target cognitive development and more detailed higher cortical function deficit tests can be used as outcome measures.


Assuntos
Cognição , Terapia por Exercício , Atividade Motora , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Telerreabilitação , Extremidade Superior/inervação , Jogos de Vídeo , Idoso , Avaliação da Deficiência , Feminino , Estado Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do Tratamento , Turquia
12.
Nutrients ; 13(6)2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34201106

RESUMO

Ischemic stroke (IS) is still among the leading causes of death and disability worldwide. The pathogenic mechanisms beyond its development are several and are complex and this is the main reason why a functional therapy is still missed. The beneficial effects of natural compounds against cardiovascular diseases and IS have been investigated for a long time. In this article, we reviewed the association between the most studied polyphenols and stroke protection in terms of prevention, effect on acute phase, and rehabilitation. We described experimental and epidemiological studies reporting the role of flavonols, phenolic acid, and stilbens on ischemic mechanisms leading to stroke. We analyzed the principal animal models used to evaluate the impact of these micronutrients to cerebral blood flow and to molecular pathways involved in oxidative stress and inflammation modulation, such as sirtuins. We reported the most significant clinical trials demonstrated as the persistent use of polyphenols is clinically relevant in terms of the reduction of vascular risk factors for IS, such as Atrial Fibrillation. Interestingly, different kinds of polyphenols provide brain protection by activating different pathways and mechanisms, like inducing antithrombotic effect, such as Honokiol. For this reason, we discussed an appropriate integrative use of them as a possible therapeutic alternative against stroke.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/prevenção & controle , Polifenóis/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controle , Animais , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Modelos Animais de Doenças , Humanos , Estresse Oxidativo/efeitos dos fármacos , Polifenóis/farmacologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral
13.
Nutrients ; 13(7)2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34202303

RESUMO

This cross-sectional study investigated the proportion of patients' recovery from sarcopenia status and the relationship between improvement in sarcopenia (IS) and function and discharge outcome in hospitalized patients with stroke. This study included patients with stroke, aged 65 years or more, with a diagnosis of sarcopenia, who were admitted to a convalescent rehabilitation ward. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Patients were divided according to the presence or absence of sarcopenia at discharge: IS group and non-improvement in sarcopenia (NIS) group. Among the 227 participants (mean age: 80.5 years; 125 females), 30% (69/227) of the patients were in the IS group, while 70% (158/227) were in the NIS group. The IS group showed a higher Functional Independence Measure (FIM) than the NIS group (median 112 vs. 101, p = 0.003). The results demonstrated that IS was independently associated with higher FIM (partial regression coefficient, 5.378; 95% confidence interval (CI), 0.709-10.047). The IS group had higher odds of home discharge than the NIS group (odds ratio, 2.560; 95% CI, 0.912-7.170). In conclusion, recovery from sarcopenia may be associated with better function in patients with stroke.


Assuntos
Estado Funcional , Estado Nutricional , Sarcopenia/reabilitação , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Razão de Chances , Alta do Paciente , Recuperação de Função Fisiológica , Sarcopenia/complicações , Sarcopenia/fisiopatologia , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos , Resultado do Tratamento
14.
Cardiovasc Ther ; 2021: 6622651, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34257706

RESUMO

Objectives: To assess mean systolic and diastolic blood pressure (SBP and DBP) levels in patients ≥50 years with uncontrolled hypertension (HTN) and evaluate the correlation between BP and stroke risk. It also assessed therapeutic drug classes prescribed in these patients. Methods: A cross-sectional, observational study was conducted at 176 outpatient centers across India, including patients aged ≥50 years with elevated SBP (≥140 mmHg). The relationship between stroke risk, calculated using Stroke Riskometer™, and mean SBP, mean DBP, and other risk factors was evaluated using Pearson correlation coefficient and logistic regression analysis. Results: The study included 3791 patients (men, 60.0%; mean age: 62.1 ± 8.3 years; mean BMI: 27 kg/m2) with mean SBP 157.3 ± 12.8 mmHg and mean DBP 89.8 ± 9.7 mmHg. Five-year stroke risk in 33.9% and 10-year stroke risk in 70% patients were moderate to severe. A ~4% increase in both 5- and 10-year stroke risk with each 1 mmHg increase in mean SBP (p < 0.0001) was seen. However, mean DBP did not exhibit any significant correlation with 5-year (p = 0.242) or 10-year (p = 0.8038) stroke risk. There was a positive correlation between mean SBP and patient age, comorbid diabetes, and smoking and alcohol habits (p < 0.0001). Comorbid diabetes and smoking increased 5- and 10-year stroke risk by 2- to 5-fold. Irrespective of the risk category, most patients received antihypertensive therapy with an angiotensin receptor blocker. Conclusion: Findings corroborate an association between stroke risk and mean SBP. These real-world clinical findings indicate that efforts are required to improve primary prevention of stroke and reduce the prevalence of recurrent stroke in India.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
15.
J Stroke Cerebrovasc Dis ; 30(9): 105941, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34217068

RESUMO

OBJECTIVE: Phase angle, an assessment of muscle quality, might be a possible predictor of physical function in patients with an acute stroke; however, the evidence for the same is limited. Therefore, this study aimed to investigate whether phase angle is associated with improved physical function at discharge. METHODS: In this observational cohort study, we determined the phase angle in patients with an acute stroke using a portable, noninvasive multifrequency bio-impedance device. The primary objective was the assessment of physical function using the Functional Independence Measure motor (FIM-motor) at discharge in the acute phase. The secondary outcome was home discharge. Multiple regression analysis was used to determine the association between phase angle, FIM-motor score, and home discharge. RESULTS: The study included 129 patients (78 men; mean age 75.2 years). Multiple linear regression analysis showed that the phase angle was independently associated with FIM-motor score at discharge in all models (Model 1: ß= 0.27, p < 0.001; Model 2: ß = 0.234, p < 0.001; Model 3: ß = 0.201, p = 0.017). However, multiple logistic regression analysis showed that the phase angle was not associated with home discharge (p = 0.464). CONCLUSIONS: The phase angle at the onset of a stroke, is an independent predictor of physical function at discharge in the acute phase. Our findings highlight the importance of determining the phase angle in patients with an acute stroke.


Assuntos
Composição Corporal , Músculo Esquelético/fisiopatologia , Sarcopenia/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Impedância Elétrica , Feminino , Estado Funcional , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Atividade Motora , Tamanho do Órgão , Valor Preditivo dos Testes , Prognóstico , Recuperação de Função Fisiológica , Sarcopenia/fisiopatologia , Sarcopenia/terapia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral , Fatores de Tempo
16.
J Stroke Cerebrovasc Dis ; 30(9): 105895, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34242857

RESUMO

OBJECTIVES: The subjective nature of fatigue may contribute to inconsistencies in prevalence rates for post-stroke fatigue. More objective performance fatigue measures may offer a more reliable construct of fatigue. Our goal was to establish test-retest reliability of fatigability in stroke during 6-minute walk (6MW) testing. Relationships between post-stoke fatigability and other constructs were assessed. MATERIALS AND METHODS: Twenty-three hemiparetic stroke survivors underwent two 6MW tests with portable metabolic monitoring performed at least 48 hours apart. Fatigability was defined as ratio of change in walking speed to distance covered during the 6MW. 6MW oxygen consumption (VO2), peak aerobic capacity (VO2peak), walking speed over-ground, dynamic gait index, fatigue, falls efficacy, and BMI were measured. RESULTS: Fatigability was highly correlated between both 6MW trials (ICC = 0.99, p < 0.001) with no significant difference between trials (0.08, p = 0.48). The strongest correlation was between fatigability and 6MW VO2 trial 1 and 2 (r = 0.92, p < 0.001 and r = 0.95, p < 0.001, respectively). Moderate-to-strong relationships were observed between fatigability for 6MW and fastest-comfortable walking speed (r = -0.82 and -0.77), self-selected walking speed (r = -7.8 and -0.78), 6MW walking speed (r = -0.80 and 0.80, VO2peak (r = -0.47 and -0.48) (p < 0.001), and DGI (r = -0.70 and -0.68, p < 0.001). CONCLUSION: This study establishes test-retest reliability for an objective measure of fatigue in stroke-related disability. The strong correlations between fatigability and other functional measures also provides insight into the contributors underlying fatigability in this population. REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01322607.


Assuntos
Tolerância ao Exercício , Fadiga/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Teste de Caminhada , Caminhada , Adulto , Idoso , Idoso de 80 Anos ou mais , Aptidão Cardiorrespiratória , Doença Crônica , Estudos Transversais , Fadiga/etiologia , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Paresia/diagnóstico , Paresia/etiologia , Paresia/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
17.
J Stroke Cerebrovasc Dis ; 30(9): 105928, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34256199

RESUMO

BACKGROUND: Dual transcranial direct current stimulation (dual tDCS) can be combined with stroke rehabilitation interventions to promote excitatory changes in the cerebral cortex. OBJECTIVE: To investigate how the combined intervention of dual tDCS and modified constraint-induced movement therapy (mCIMT) using both anodal and cathodal stimulation affects on the recovery of upper limb function in chronic stroke patients. METHODS: This study was a double-blind randomized controlled trial. A total of 30 patients were randomly assigned to the experimental group (dual tDCS and mCIMT) or control group (sham dual tDCS and mCIMT). The experimental and control group performed mCIMT immediately after applying dual tDCS for 20 min, but the control group also performed mCIMT after applying sham tDCS for 20 min in a state where no current flows. The total intervention period was performed 5 times a week for 4 weeks. The outcome was assessed using Fugle-Meyer Assessment (FMA) Motor Activity Log (MAL) Accelerometer. RESULTS: There was a significant improvement in AOU of MAL and usage of unaffected side in the experimental group compared to the control group, and the experimental group showed more than a small effect difference compared to the control group in the effect size of all evaluations. CONCLUSIONS: This study has clinical significance in that it presents the possibility of convergence intervention that considers the therapeutic efficiency in clinical practice.


Assuntos
Terapia por Exercício , Atividade Motora , Córtex Motor/fisiopatologia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua , Extremidade Superior/inervação , Idoso , Terapia Combinada , Avaliação da Deficiência , Método Duplo-Cego , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Recuperação de Função Fisiológica , República da Coreia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Fatores de Tempo , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Resultado do Tratamento
18.
BMC Neurol ; 21(1): 280, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271872

RESUMO

BACKGROUND: Motor impairment after stroke is due not only to direct tissue loss but also to disrupted connectivity within the motor network. Mixed results from studies attempting to enhance motor recovery with Transcranial Magnetic Stimulation (TMS) highlight the need for a better understanding of both connectivity after stroke and the impact of TMS on this connectivity. This study used TMS-EEG to map the causal information flow in the motor network of healthy adult subjects and define how stroke alters these circuits. METHODS: Fourteen stroke patients and 12 controls received TMS to two sites (bilateral primary motor cortices) during two motor tasks (paretic/dominant hand movement vs. rest) while EEG measured the cortical response to TMS pulses. TMS-EEG based connectivity measurements were derived for each hemisphere and the change in connectivity (ΔC) between the two motor tasks was calculated. We analyzed if ΔC for each hemisphere differed between the stroke and control groups or across TMS sites, and whether ΔC correlated with arm function in stroke patients. RESULTS: Right hand movement increased connectivity in the left compared to the right hemisphere in controls, while hand movement did not significantly change connectivity in either hemisphere in stroke. Stroke patients with the largest increase in healthy hemisphere connectivity during paretic hand movement had the best arm function. CONCLUSIONS: TMS-EEG measurements are sensitive to movement-induced changes in brain connectivity. These measurements may characterize clinically meaningful changes in circuit dynamics after stroke, thus providing specific targets for trials of TMS in post-stroke rehabilitation.


Assuntos
Mapeamento Encefálico , Eletroencefalografia , Acidente Vascular Cerebral/fisiopatologia , Estimulação Magnética Transcraniana , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Paresia/fisiopatologia
19.
Medicine (Baltimore) ; 100(24): e26275, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128859

RESUMO

ABSTRACT: This study was conducted to investigate the effects of the degree of dual-task (DT) interference on gait, dual-task cost (DTC), cognitive ability, balance, and fall efficacy in people with stroke.In this cross-sectional study, people with chronic stroke (N = 36) performed a DT gait assessment (gait and cognitive task). During the evaluation, DT interference in motor and cognition was evaluated simultaneously. Thus, the group with severe interference in both tasks (mutual interference) was compared with the group with mild interference in either.The main effects for the degree of motor interference were observed on gait performance, DTC in motor, time up and go, and trail-making test B. In the cognitive interference, the main effects were observed on correct response rate, DTC in cognition, time up and go, and trail-making test B. An interaction effect was observed in the trail-making test B.The degree of motor interference affected gait, balance ability, and executive function (EF), and the degree of cognitive interference influenced the correct response rate in the DT condition, balance ability, and EF. Furthermore, mutual interference led to a significant reduction in EF in people with stroke.


Assuntos
Cognição/fisiologia , Marcha/fisiologia , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Acidentes por Quedas , Idoso , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Desempenho Psicomotor/fisiologia , Reabilitação do Acidente Vascular Cerebral , Análise e Desempenho de Tarefas
20.
Medicine (Baltimore) ; 100(24): e26339, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128880

RESUMO

ABSTRACT: The clinical presentation of stroke is usually more severe in patients with intracerebral hemorrhage (ICH) than in those with cerebral infarction (CI); recovery of stroke-related muscle paralysis is influenced and limited by the type of stroke. To date, many patients have been treated by neurorehabilitation; however, the changes in the recovery of motor paralysis depending on the type of stroke, ICH or CI, have not been established. This study aimed to determine this difference in improvement of upper extremity paralysis using 2-week in-hospital NovEl intervention Using Repetitive transcranial magnetic stimulation combined with Occupational therapy (NEURO).We scrutinized the medical records of all patients with poststroke (ICH or CI) upper extremity muscle paralysis using Fugl-Meyer assessments (FMAs) who had been admitted to 6 hospitals between March 2010 and December 2018 for rehabilitation treatment. This was a multiinstitutional, open-label, retrospective cohort study without control patients. We evaluated the effects of NEURO on patients with CI and ICH by dividing them into 2 groups according to the type of stroke, after adjustment for age, sex, dominant hand, affected hand side, time since stroke, and prediction of recovery capacity in the upper extremity.The study included 1716 (CI [n = 876] and ICH [n = 840]) patients who had undergone at least 2 FMAs and had experienced stroke at least 6 months before. The type of stroke had no effect on the outcomes (changes in the FMA-upper extremity score, F[4,14.0] = 2.05, P = .09, partial η2 = 0.01). Patients from all 5 groups equally benefited from the treatment (improvement in FMA scores) according to the sensitivity analysis-stratified analysis (F = 0.08 to 1.94, P > .16, partial η2 < 0.001).We conclude that NEURO can be recommended for chronic stroke patients irrespective of the type of stroke.


Assuntos
Terapia Ocupacional/métodos , Paralisia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Estimulação Magnética Transcraniana/métodos , Idoso , Hemorragia Cerebral/complicações , Infarto Cerebral/complicações , Doença Crônica , Terapia Combinada , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Paralisia/etiologia , Paralisia/fisiopatologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Resultado do Tratamento , Extremidade Superior/fisiopatologia
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