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1.
Rev. neurol. (Ed. impr.) ; 75(9): 283-293, Nov 1, 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-211699

RESUMO

Introducción: La enfermedad cerebrovascular es una de las principales causas de muerte, discapacidad y demencia en el mundo. La forma más frecuente de la enfermedad, el ictus isquémico, sólo tiene un fármaco disponible, el activador tisular del plasminógeno, y pocos pacientes pueden beneficiarse de esta terapia por los estrictos criterios de inclusión establecidos para su uso. Esta circunstancia hace crucial la búsqueda de nuevas formas de tratamiento para combatir las secuelas de la enfermedad, y para ello es necesario el desarrollo de nuevos modelos biomiméticos que permitan conocer mejor su evolución. Desarrollo: En esta revisión, actualizamos las plataformas y modelos más utilizados en los últimos años para estudiar la fisiopatología del ictus isquémico. Por un lado, repasamos las plataformas bi- y tridimensionales sobre las que se llevan a cabo los ensayos in vitro y, por otro lado, describimos los modelos experimentales in vivo más utilizados en la actualidad, así como las técnicas para evaluar el daño isquémico. Conclusiones: El desarrollo de buenos modelos experimentales tiene como fin último encontrar nuevas formas de tratamiento y, de esta manera, mejorar el pronóstico y la calidad de vida de los pacientes; por ello, es importante generar nuevos dispositivos in vitro y refinar más aún los modelos in vivo para hacer posible una buena traslación a la clínica.(AU)


Introduction: Cerebrovascular disease is one of the leading causes of death, disability and dementia around the world. For the most common form of the disease, ischaemic stroke, there is only one drug available, tissue plasminogen activator, and few patients can benefit from this therapy because of the strict inclusion criteria established for its use. This circumstance makes it crucial to search for new forms of treatment to combat the sequelae of the disease, and this requires the development of new biomimetic models that allow for a better understanding of its evolution. Development: In this review, we update the platforms and models most widely used in recent years to study the pathophysiology of ischaemic stroke. On the one hand, we review the two- and three-dimensional platforms on which in vitro assays are carried out and, on the other, we describe the most commonly used in vivo experimental models and techniques for assessing ischaemic damage. Conclusions: The ultimate aim of developing good experimental models is to find new forms of treatment and thus improve patients’ prognosis and quality of life. It is therefore important to generate new in vitro devices and to further refine in vivo models to enable a good clinical translation.(AU)


Assuntos
Humanos , Masculino , Feminino , Acidente Vascular Cerebral , Técnicas In Vitro , Ativador de Plasminogênio Tecidual , Acidente Vascular Cerebral/fisiopatologia , Terapia Baseada em Transplante de Células e Tecidos , Neurologia , Doenças do Sistema Nervoso
3.
Int J Neural Syst ; 32(9): 2250039, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35881016

RESUMO

The motor imagery brain-computer interface (MI-BCI) system is currently one of the most advanced rehabilitation technologies, and it can be used to restore the motor function of stroke patients. The deep learning algorithms in the MI-BCI system require lots of training samples, but the electroencephalogram (EEG) data of stroke patients is quite scarce. Therefore, the expansion of EEG data has become an important part of stroke clinical rehabilitation research. In this paper, a deep convolution generative adversarial network (DCGAN) model is proposed to generate artificial EEG data and further expand the scale of the stroke dataset. First, multichannel one-dimensional EEG data is converted into a two-dimensional EEG spectrogram using EEG2Image based on the modified S-transform. Then, DCGAN is used to artificially generate EEG data based on MI. Finally, the validity of the generated artificial EEG data is proved. This paper preliminarily indicates that generating artificial stroke data is a promising strategy, which contributes to the further development of stroke clinical rehabilitation.


Assuntos
Interfaces Cérebro-Computador , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Algoritmos , Aprendizado Profundo , Eletroencefalografia/métodos , Humanos , Imaginação , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos
4.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 39(3): 498-506, 2022 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-35788519

RESUMO

Transcranial direct current stimulation (tDCS) has become a new method of post-stroke rehabilitation treatment and is gradually accepted by people. However, the neurophysiological mechanism of tDCS in the treatment of stroke still needs further study. In this study, we recruited 30 stroke patients with damage to the left side of the brain and randomly divided them into a real tDCS group (15 cases) and a sham tDCS group (15 cases). The resting EEG signals of the two groups of subjects before and after stimulation were collected, then the difference of power spectral density was analyzed and compared in the band of delta, theta, alpha and beta, and the delta/alpha power ratio (DAR) was calculated. The results showed that after real tDCS, delta band energy decreased significantly in the left temporal lobes, and the difference was statistically significant ( P < 0.05); alpha band energy enhanced significantly in the occipital lobes, and the difference was statistically significant ( P < 0.05); the difference of theta and beta band energy was not statistically significant in the whole brain region ( P > 0.05). Furthermore, the difference of delta, theta, alpha and beta band energy was not statistically significant after sham tDCS ( P > 0.05). On the other hand, the DAR value of stroke patients decreased significantly after real tDCS, and the difference was statistically significant ( P < 0.05), and there was no significant difference in sham tDCS ( P > 0.05). This study reveals to a certain extent the neurophysiological mechanism of tDCS in the treatment of stroke.


Assuntos
Ondas Encefálicas , Encéfalo , Eletroencefalografia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua , Encéfalo/fisiologia , Encéfalo/fisiopatologia , Ondas Encefálicas/fisiologia , Eletroencefalografia/métodos , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Transcraniana por Corrente Contínua/métodos
5.
JAMA ; 327(19): 1899-1909, 2022 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-35506515

RESUMO

Importance: Many patients with severe stroke have impaired airway protective reflexes, resulting in prolonged invasive mechanical ventilation. Objective: To test whether early vs standard tracheostomy improved functional outcome among patients with stroke receiving mechanical ventilation. Design, Setting, and Participants: In this randomized clinical trial, 382 patients with severe acute ischemic or hemorrhagic stroke receiving invasive ventilation were randomly assigned (1:1) to early tracheostomy (≤5 days of intubation) or ongoing ventilator weaning with standard tracheostomy if needed from day 10. Patients were randomized between July 28, 2015, and January 24, 2020, at 26 US and German neurocritical care centers. The final date of follow-up was August 9, 2020. Interventions: Patients were assigned to an early tracheostomy strategy (n = 188) or to a standard tracheostomy (control group) strategy (n = 194). Main Outcomes and Measures: The primary outcome was functional outcome at 6 months, based on the modified Rankin Scale score (range, 0 [best] to 6 [worst]) dichotomized to a score of 0 (no disability) to 4 (moderately severe disability) vs 5 (severe disability) or 6 (death). Results: Among 382 patients randomized (median age, 59 years; 49.8% women), 366 (95.8%) completed the trial with available follow-up data on the primary outcome (177 patients [94.1%] in the early group; 189 patients [97.4%] in the standard group). A tracheostomy (predominantly percutaneously) was performed in 95.2% of the early tracheostomy group in a median of 4 days after intubation (IQR, 3-4 days) and in 67% of the control group in a median of 11 days after intubation (IQR, 10-12 days). The proportion without severe disability (modified Rankin Scale score, 0-4) at 6 months was not significantly different in the early tracheostomy vs the control group (43.5% vs 47.1%; difference, -3.6% [95% CI, -14.3% to 7.2%]; adjusted odds ratio, 0.93 [95% CI, 0.60-1.42]; P = .73). Of the serious adverse events, 5.0% (6 of 121 reported events) in the early tracheostomy group vs 3.4% (4 of 118 reported events) were related to tracheostomy. Conclusions and Relevance: Among patients with severe stroke receiving mechanical ventilation, a strategy of early tracheostomy, compared with a standard approach to tracheostomy, did not significantly improve the rate of survival without severe disability at 6 months. However, the wide confidence intervals around the effect estimate may include a clinically important difference, so a clinically relevant benefit or harm from a strategy of early tracheostomy cannot be excluded. Trial Registration: ClinicalTrials.gov Identifier: NCT02377167.


Assuntos
Reflexo Anormal , Respiração Artificial , Doenças Respiratórias , Acidente Vascular Cerebral , Traqueostomia , Manuseio das Vias Aéreas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Doenças Respiratórias/etiologia , Doenças Respiratórias/fisiopatologia , Doenças Respiratórias/terapia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Traqueostomia/efeitos adversos , Resultado do Tratamento , Desmame do Respirador/métodos
6.
Physiotherapy ; 116: 1-8, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35462214

RESUMO

OBJECTIVE: To investigate the effects of local vibration applied to the plantar region of the foot on static and dynamic balance in stroke patients. DESIGN: Randomised, controlled trial. SETTING: Inpatient. PARTICIPANTS: Thirty patients with stroke were randomised equally to the vibration and control groups. INTERVENTION: The control group underwent conventional physical therapy (CPT) for 4 weeks. The vibration group underwent local vibration therapy at a frequency of 80Hz and CPT for 4 weeks. OUTCOME MEASURES: The primary outcome measure was the Overall Stability Index (OSI). The secondary outcome measures were: the Anteroposterior Stability Index, Mediolateral Stability Index, fall risk, Berg Balance Scale, Functional Reach Test (FRT), and Timed Up and Go Test (TUG) to assess balance; the Trunk Impairment Scale to measure trunk function; and the 10-m Walk Test (10MWT) to measure walking speed. RESULTS: Participants receiving plantar vibration experienced greater improvements in static and dynamic balance assessments compared with participants in the control group. The mean change in OSI score between baseline and 4 weeks was 0.8 [standard deviation (SD) 0.8] for the vibration group and 0.02 (SD 0.6) for the control group [mean difference 0.4, 95% confidence interval (CI) 0.1 to 0.7]. The median change in fall risk score was 0.7 [interquartile range (IQR) 0.4 to 1.4] for the vibration group and 0.1 (IQR -0.1 to 0.6) for the control group (median difference 0.5, 95% CI 0.2 to 0.7). The median change in TUG time was 4 (IQR 1 to 7) seconds for the vibration group and 4 (IQR 0 to 2) seconds for the control group (median difference 2.5, 95% CI 1.5 to 3.5). CONCLUSION: These findings suggest that plantar vibration is useful in stroke patients. Plantar vibration can be applied to support CPT. GOV REGISTRATION NUMBER: NCT03784768.


Assuntos
Pé/fisiologia , Equilíbrio Postural , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Terapia por Exercício , Humanos , Modalidades de Fisioterapia , Vibração/uso terapêutico
7.
Comput Math Methods Med ; 2022: 4581248, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35242206

RESUMO

BACKGROUND: Stroke is a common cerebrovascular disease among the middle-aged and elderly, which can lead to a series of neurological disorders. Acupuncture is an important part of traditional Chinese medicine, with great value in improving the neurological deficits of stroke patients. In addition, rehabilitation therapy is also of great significance for alleviating the neurological deficits of patients and improving their activities of daily living. OBJECTIVE: To explore the effect of acupuncture and moxibustion combined with rehabilitation therapy on the recovery of neurological function and prognosis of stroke patients. METHODS: The case data of 100 stroke patients treated in the Wuhan Hospital of Traditional Chinese Medicine from January 2019 to July 2021 were analyzed retrospectively. According to the treatment plan patients received, they were divided into the following two groups: an observation group (n = 52) treated with acupuncture combined with rehabilitation therapy and a control group (n = 48) treated with rehabilitation therapy alone. The two groups were compared in terms of the following items: therapeutic efficacy, plasma levels of cortisol (Cor) and neuropeptide Y (NPY), nerve function, motor function, balance ability, self-care ability, swallowing function, negative emotions, and quality of life. RESULTS: The therapeutic effect of the observation group was significantly higher than that of the control group (P < 0.05). The levels of Cor and NPY, as well as the neurological function, motor function, balance ability, self-care ability, swallowing function, and negative emotions, were not significantly different between the two groups before treatment (P > 0.05). While after intervention, all the above indexes improved in both groups, with better improvements in the observation group compared with the control group (P < 0.05). And the various dimensions concerning the quality of life of patients were also significantly better in the observation group when compared with the control group. CONCLUSION: Acupuncture of traditional Chinese medicine combined with rehabilitation therapy has outstanding effects in stroke treatment and can effectively improve the neurological function, prognosis, and quality of life of patients, which is worthy of clinical promotion.


Assuntos
Terapia por Acupuntura , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/cirurgia , Atividades Cotidianas , Terapia por Acupuntura/estatística & dados numéricos , Idoso , Terapia Combinada , Biologia Computacional , Feminino , Humanos , Masculino , Medicina Tradicional Chinesa , Pessoa de Meia-Idade , Prognóstico , Qualidade de Vida , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Resultado do Tratamento
9.
BMC Cardiovasc Disord ; 22(1): 50, 2022 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-35164696

RESUMO

BACKGROUND: Little is known about the needs of permanent nursing home residents after a stroke; comprehensive descriptions of needs are rare. The Post-Stroke Checklist facilitates the identification of health problems. The study aimed to use the Post-Stroke Checklist to identify the extent of health problems, and how they were addressed, in nursing home residents that experienced strokes in Sweden. We also investigated the feasibility of the Checklist in a nursing home context. METHODS: This is a cross-sectional explorative study. Twenty nursing homes in two regions of Sweden participated. We included residents that had experienced a stroke within approximately 3 years and the responsible staff members were approached. Questionnaires were completed during face-to-face meetings with staff members (n = 45) knowledgeable about the residents. Data collection included the Post-Stroke Checklist, Barthel Index, modified Rankin Scale, resident and staff characteristics, and a satisfaction-questionnaire completed by staff. RESULTS: At the included nursing homes 1061 residents, 22% (n = 239) had a history of stroke, and 6% (n = 65) had experienced strokes during the last 3.5 years. Forty-nine residents were included (41% men, median age, 86 years, range 59-97). Among the health problems identified with the Checklist, activities of daily living (82%) were most common, and spasticity (41%) and pain (29%) were least common. Residents had extensive care needs, with a median of six health problems per resident. The total number of health problems addressed by previous actions i.e., referrals, as suggested in the Checklist, was 124, when recalled by staff. The median Barthel index score was 35. Lack of follow-up after stroke (e.g., by using a checklist) was reported in 17/20 nursing homes. The staff were satisfied with the Post-Stroke Checklist. CONCLUSIONS: We found that more than 1/5 of residents had experienced a stroke; thus, the Post-Stroke Checklist was a useful tool in nursing homes. Half of the residents had more than six health problems, identified with the Post-Stroke Checklist. Extensive needs, combined with a lack of follow-up, indicated a risk of insufficient care. These findings suggested that nursing home routines could be improved with the Post-Stroke Checklist. Trial registration The project is registered in Research web, project number: 256021.


Assuntos
Lista de Checagem , Instituição de Longa Permanência para Idosos , Casas de Saúde , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Estudos Transversais , Estudos de Viabilidade , Feminino , Estado Funcional , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Multimorbidade , Determinação de Necessidades de Cuidados de Saúde , Enfermeiras e Enfermeiros , Assistentes de Enfermagem , Valor Preditivo dos Testes , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Suécia
10.
Circ Res ; 130(4): 512-528, 2022 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-35175851

RESUMO

Women face a disproportionate burden of stroke mortality and disability. Biologic sex and sociocultural gender both contribute to differences in stroke risk factors, assessment, treatment, and outcomes. There are substantial differences in the strength of association of stroke risk factors, as well as female-specific risk factors. Moreover, there are differences in presentation, response to treatment, and stroke outcomes in women. This review outlines current knowledge of impact of sex and gender on stroke, as well as delineates research gaps and areas for future inquiry.


Assuntos
Caracteres Sexuais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/fisiopatologia , Estrogênios/sangue , Feminino , Humanos , Hipertensão/sangue , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/sangue , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/sangue
11.
Sci Rep ; 12(1): 1868, 2022 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-35115543

RESUMO

Many individuals with stroke experience upper-limb motor deficits, and a recent trend is to develop novel devices for enhancing their motor function. This study aimed to develop a new upper-limb rehabilitation system with the integration of two rehabilitation therapies into one system, digital mirror therapy (MT) and action observation therapy (AOT), and to test the usability of this system. In the part I study, the new system was designed to operate in multiple training modes of digital MT (i.e., unilateral and bilateral modes) and AOT (i.e., pre-recorded and self-recorded videos) with self-developed software. In the part II study, 4 certified occupational therapists and 10 stroke patients were recruited for evaluating usability. The System Usability Scale (SUS) (maximum score = 100) and a self-designed questionnaire (maximum score = 50) were used. The mean scores of the SUS were 79.38 and 80.00, and those of the self-designed questionnaire were 41.00 and 42.80, respectively, for the therapists and patients after using this system, which indicated good usability and user experiences. This novel upper-limb rehabilitation system with good usability might be further used to increase the delivery of two emerging rehabilitation therapies, digital AOT and MT, to individuals with stroke.


Assuntos
Braço/inervação , Mãos/inervação , Atividade Motora , Reabilitação do Acidente Vascular Cerebral/instrumentação , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Comportamento Imitativo , Masculino , Pessoa de Meia-Idade , Neurônios-Espelho , Satisfação do Paciente , Recuperação de Função Fisiológica , Software , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Interface Usuário-Computador , Gravação em Vídeo
12.
PLoS One ; 17(2): e0263662, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35139128

RESUMO

It is known that resistance exercise using one limb can affect motor function of both the exercised limb and the unexercised contralateral limb, a phenomenon termed cross-education. It has been suggested that cross-education has clinical implications, e.g. in rehabilitation for orthopaedic conditions or post-stroke paresis. Much of the research on the contralateral effect of unilateral intervention on motor output is based on voluntary exercise. This scoping review aimed to map the characteristics of current literature on the cross-education caused by three most frequently utilised peripheral neuromuscular stimulation modalities in this context: electrical stimulation, mechanical vibration and percutaneous needling, that may direct future research and translate to clinical practice. A systematic search of relevant databases (Ebsco, ProQuest, PubMed, Scopus, Web of Science) through to the end of 2020 was conducted following the PRISMA Extension for Scoping Review. Empirical studies on human participants that applied a unilateral peripheral neuromuscular stimulation and assessed neuromuscular function of the stimulated and/or the unstimulated side were selected. By reading the full text, the demographic characteristics, context, design, methods and major findings of the studies were synthesised. The results found that 83 studies were eligible for the review, with the majority (53) utilised electrical stimulation whilst those applied vibration (18) or needling (12) were emerging. Although the contralateral effects appeared to be robust, only 31 studies claimed to be in the context of cross-education, and 25 investigated on clinical patients. The underlying mechanism for the contralateral effects induced by unilateral peripheral stimulation remains unclear. The findings suggest a need to enhance the awareness of cross-education caused by peripheral stimulation, to help improve the translation of theoretical concepts to clinical practice, and aid in developing well-designed clinical trials to determine the efficacy of cross-education therapies.


Assuntos
Terapia por Estimulação Elétrica , Fenômenos Fisiológicos Musculoesqueléticos , Reabilitação do Acidente Vascular Cerebral/métodos , Terapia por Estimulação Elétrica/métodos , Humanos , Doenças Neuromusculares/etiologia , Doenças Neuromusculares/fisiopatologia , Doenças Neuromusculares/terapia , Paresia/etiologia , Paresia/fisiopatologia , Paresia/terapia , Nervos Periféricos/fisiopatologia , Modalidades de Fisioterapia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia
13.
PLoS One ; 17(2): e0263613, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35120178

RESUMO

In post-stroke patients, muscle synergy (the coordination of motor modules during walking) is impaired. In some patients, the muscle synergy termed module 1 (hip/knee extensors) is merged with module 2 (ankle plantar flexors), and in other cases, module 1 is merged with module 4 (knee flexors). However, post-stroke individuals with a merging pattern of module 3 (hip flexor and ankle dorsiflexor) and module 4, which is the swing-muscle synergy, have not been reported. This study aimed to determine the muscle-synergy merging subtypes of post-stroke during comfortable walking speed (cws). We also examined the effect of experimental lower-limb angle modulation on the muscle synergy patterns of walking in each subtype. Forty-one participants were assessed under three conditions: cws, long stepping on the paretic side (p-long), and long stepping on the non-paretic side (np-long). Lower-limb flexion and extension angles and the electromyogram were measured during walking. Subtype classification was based on the merging pattern of the muscle synergies, and we examined the effect of different lower-limb angles on the muscle synergies. We identified three merging subtypes: module 1 with module 2 (subtype 1), module 1 with module 4 (subtype 2), and module 3 with module 4 (subtype 3). In the cws condition, the lower-limb flexion angle was reduced in subtype 3, and the lower-limb extension angle was decreased in subtype 1. A more complex muscle synergy was observed only in subtype 3 in the p-long condition versus cws (p = 0.036). This subtype classification of walking impairments based on the merging pattern of the muscle synergies could be useful for the selection of a rehabilitation strategy according to the individual's particular neurological condition. Rehabilitation with increased lower-limb flexion may be effective for the training of patients with merging of modules 3 and 4 in comfortable walking.


Assuntos
Marcha/fisiologia , Músculo Esquelético/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Caminhada , Idoso , Eletromiografia , Feminino , Transtornos Neurológicos da Marcha , Humanos , Perna (Membro) , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Movimento
14.
Sci Rep ; 12(1): 3163, 2022 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-35210531

RESUMO

Anterior circulation stroke (ACS) differs from posterior circulation stroke (PCS) in many ways, but it remains unclear whether there is any difference in early neurological deterioration (END) in two stroke territories. We compared post-thrombolytic END between ACS and PCS based on the data from INTRECIS. We screened patients receiving intravenous 0.9 mg/kg alteplase within 4.5 h in the INTRECIS cohort. According to stroke territory, patients were divided into ACS and PCS groups. The primary outcome was incidence of END, which was defined as an increase in NIHSS score ≥ 4 or death within 24 h from baseline. The secondary outcomes were associated factors of END and 90-day modified Rankin Scale (mRS) distribution. Overall, 1194 patients were enrolled in this study: 942 in ACS group and 252 in PCS group. There was no significant difference in the incidence of END between two groups (3.8% vs 5.2%, adjusted p = 0.406). Atrial fibrillation (adjusted p = 0.012) and TOAST classification (adjusted p = 0.009) were associated with END in ACS, while hypertension history (adjusted p = 0.046) and baseline NIHSS score (adjusted p = 0.011) with END in PCS. END was associated with worse outcome on 90-day mRS in ACS and PCS (adjusted p < 0.001). Based on a prospective nationwide cohort, we provided first report for similar incidence, but different risk factors of post-thrombolytic END in ACS vs PCS patients.Trial Registration-URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02854592.


Assuntos
Isquemia Encefálica/fisiopatologia , Fibrinólise , Acidente Vascular Cerebral/fisiopatologia , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Isquemia Encefálica/tratamento farmacológico , Circulação Cerebrovascular , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Resultado do Tratamento
15.
J Cardiovasc Pharmacol Ther ; 27: 10742484221078973, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35200057

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia to appear in clinical practice. People with AF have 5 times the risk of stroke compared to the general population. OBJECTIVE: This study aimed to determine the prevalence of AF in people over the age of 50 without known AF, who presented to a community pharmacy to check their cardiovascular risk factors, to identify risk factors associated with AF, and to assess the risk of stroke in people who screened positive for AF. METHODS: A multicenter observational descriptive study of a screening program took place from May to December 2016. A blood pressure monitor (Microlife Watch BP Home) was used to screen for AF, and the CHA2DS2-VASc questionnaire was used to assess stroke risk. RESULTS: The study included 452 adults over the age of 50. The CRIFAFARMA study detected a prevalence of AF of 9.1%. Risk factors for AF were: age of 75 years or older (P = .024), lack of physical activity (P = .043), diabetes (P < .001), dyslipidemia (P = .003), and history of cardiovascular disease (P = .003). Diabetes (OR 2.79, P = .005) and dyslipidemia (OR 2.16, P = .031) had a combined explanatory capacity in the multivariable logistic regression model adjusted for age. 85% were at high risk of stroke according to the CHA2DS2-VASc scale. CONCLUSIONS: AF was detected in more than 9% of the included population. Factors associated with AF were advanced age, lack of physical activity, diabetes, dyslipidemia, and history of cardiovascular disease, with diabetes and dyslipidemia standing out as the factors with independent explanatory capacity.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Determinação da Pressão Arterial , Pressão Sanguínea , Serviços Comunitários de Farmácia , Farmácias , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Comorbidade , Diagnóstico Precoce , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Comportamento Sedentário , Espanha/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Inquéritos e Questionários , Fatores de Tempo
16.
Stroke ; 53(3): 719-727, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35109685

RESUMO

BACKGROUND AND PURPOSE: To assess the association between systolic blood pressure change (ΔSBP) at different time intervals after successful reperfusion with radiographic and clinical outcomes. METHODS: This is a post hoc analysis of the BP-TARGET multicenter trial (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy). ΔSBP was defined as end of procedure SBP minus mean SBP at different time intervals (15-60 minutes, 1-6 hours, and 6-24 hours postprocedure). The primary outcome was the poor functional outcome (90-day modified Rankin Scale score 3-6). RESULTS: We included a total of 267 patients (130 in the intensive treatment group). Compared with patients with favorable outcome, patients with poor outcome had lower ΔSBP (less SBP reduction) at all times intervals. After adjusting for potential confounders including baseline SBP, both ΔSBP15-60M and ΔSBP6-24H were associated with lower odds of poor outcome (adjusted odds ratio per 5 mm Hg SBP reduction, 0.89 [95% CI, 0.81-0.99], and adjusted odds ratio 0.82 [95% CI, 0.73-0.92], respectively). Concerning safety outcomes, patients with intraparenchymal hemorrhage had lower ΔSBP at all time intervals. ΔSBP15-60M was associated with lower odds of any intraparenchymal hemorrhage (adjusted odds ratio per 5 mm Hg SBP reduction 0.91 [95% CI, 0.83-0.99]). Conversely, ΔSBP was not associated with mortality or neurological deterioration at any time interval. CONCLUSIONS: After successful reperfusion, ΔSBP had a linear relationship with poor outcome and the risk of poor outcome was higher with less reduction from the baseline SBP. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03160677.


Assuntos
Pressão Sanguínea , Hemorragia Cerebral , Procedimentos Endovasculares , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/genética , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/prevenção & controle , Feminino , Humanos , Masculino , Reperfusão , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia
17.
Neural Plast ; 2022: 7399995, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35111219

RESUMO

Background: Impaired cognitive ability to anticipate the required control for an upcoming task in patients with stroke may affect rehabilitation outcome. The cortical excitability of task-related motor anticipation for upper limb movement induced by virtual reality (VR) training remains unclear. Aims: To investigate the effect of VR training on the cortical excitability of motor anticipation when executing upper limb movement in patients with subacute stroke. Methods: A total of thirty-six stroke survivors with upper limb hemiparesis resulting from the first occurrence of stroke within 1 to 3 months were recruited. Participants were randomly allocated to the VR intervention group or conventional therapy group. Event-related potentials (ERPs) and electromyography (EMG) were used to simultaneously record the cortical excitability and muscle activities during palmar grasp motion. Outcome measures of the contingent negative variation (CNV) latency and amplitude, EMG reaction time, Upper Limb Fugl-Meyer Assessment (UL-FMA), Action Research Arm Test (ARAT), and National Institutes of Health Stroke Scale (NIHSS) were recorded pre- and postintervention. The between-group difference was analysed by mixed model ANOVA. Results: The EMG onset time of the paretic hand in the VR group was earlier than that observed in the control group (t = 2.174, p = 0.039) postintervention. CNV latency reduction postintervention was larger in the VR group than in the control group (t = 2.411, p = 0.021) during paretic hand movement. The reduction in CNV amplitude in the VR group was larger in the VR group than in the control group (p < 0.001 for all electrodes except for C3) when executing paretic hand movement. ARAT and UL-FMA scores were significantly higher in the VR group than in the control group (p = 0.019 and p = 0.037, respectively) postintervention. No significant difference in the reduction in NIHSS was found between the VR and control groups (p = 0.072). Conclusions: VR intervention is superior to conventional therapy to improve the cognitive neural process of motor anticipation and reduce the excessive compensatory activation of the contralesional hemisphere. The improvements observed in the cognitive neural process corroborated with the improvements in hand function.


Assuntos
Potenciais Evocados/fisiologia , Mãos/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Realidade Virtual , Idoso , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Reabilitação do Acidente Vascular Cerebral/métodos , Resultado do Tratamento , Extremidade Superior/fisiopatologia
18.
Neural Plast ; 2022: 9662630, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35126507

RESUMO

An improvement in the activities of daily living (ADLs) is significantly related to the quality of life and prognoses of patients with stroke. However, the factors predicting significant improvement in ADL (SI-ADL) have not yet been clarified. Therefore, we sought to identify the key factors affecting SI-ADL in patients with stroke after rehabilitation therapy using both logistic regression modeling and decision tree modeling. We retrospectively collected and analyzed the clinical data of 190 patients with stroke who underwent rehabilitation therapy at our hospital between January 2020 and July 2020. General and rehabilitation therapy data were extracted, and the Barthel index (BI) score was used for outcome assessment. We defined SI-ADL as an improvement in the BI score by 15 points or more during hospitalization. Logistic regression and decision tree models were established to explore the SI-ADL predictors. We then used receiver operating characteristic (ROC) curves to compare the logistic regression and decision tree models. Univariate analysis revealed that compared with the non-SI-ADL group, the SI-ADL group showed a significantly shorter course of stroke, longer hospital stay, and higher rate of receiving occupational and speech therapies (all P < 0.05). Binary logistic regression analysis revealed the course of stroke at admission (odds ratio (OR) = 0.986, 95%confidence interval (CI) = 0.979-0.993; P < 0.001) and the length of hospital stay (OR = 1.030, 95%CI = 1.013-1.047; P =0.001) as the independent predictors of SI-ADL. ROC comparisons revealed no significant differences in the areas under the curves for the logistic regression and decision tree models (0.808 vs. 0.831; z = 0.977, P = 0.329). Both models identified the course of disease at admission and the length of hospital stay as key factors affecting SI-ADL. Early initiation of rehabilitation therapy is of immense importance for improving the ADLs in patients with stroke.


Assuntos
Atividades Cotidianas , Árvores de Decisões , Qualidade de Vida , Recuperação de Função Fisiológica/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Sci Rep ; 12(1): 690, 2022 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-35027612

RESUMO

Stroke individuals' daily function has been demonstrated to be influenced by their somatosensory capability, cognitive capability, and upper extremity (UE) motor abilities. However, the structural relationships among these abilities on stroke individuals' independence in daily function remain unclear. We analyzed the pretest measures of 153 stroke individuals in outpatient rehabilitation settings by structural equation modeling to determine the structural relationship among somatosensory capability, UE muscle strength, UE motor function, and cognitive capability that influences independence in daily function. The standardized results indicated somatosensory capability negatively influenced UE muscle strength, but positively influenced UE muscle strength mediated by UE motor function. UE muscle strength, then, positively influenced individuals' independence in daily function. On the other hand, somatosensory capability positively influenced cognitive capability, which marginally and positively affected the performance of independence in daily function. To the best of our knowledge, this is the first study to demonstrate the influence of somatosensory capability on the daily function is mediated mainly by motor functions and marginally by cognitive capability. This structural model may allow future clinical therapists to design more effective task-related training protocols to promote the independence in daily function for stroke individuals.


Assuntos
Atividades Cotidianas , Cognição/fisiologia , Atividade Motora/fisiologia , Córtex Somatossensorial/fisiopatologia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Extremidade Superior/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular
20.
Med Sci Monit ; 28: e934100, 2022 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-35013090

RESUMO

BACKGROUND Hyperhomocysteinemia (HHcy) and metabolic syndrome (MS) are established cardiovascular risk factors of stroke and are frequently associated with hypertension. However, studies on the association between HHcy combined with MS and stroke risk in hypertensive patients were absent. MATERIAL AND METHODS In 14 059 selected participants with elevated blood pressure, we assessed the prevalence of the MS and stroke. We defined HHcy as plasma total homocysteine >15 µmol/L. MS was defined according to the Chinese Diabetes Society (CDS) criterion. Multivariable analysis was used to examine the association of HHcy or (and) MS with stroke risk in different models. RESULTS The prevalence rates of HHcy and MS were 49.96% and 42.21%, respectively. Patients with stroke had higher plasma total homocysteine levels and a higher prevalence of MS (P<0.001). Multivariable analyses indicated that HHcy and MS are independently associated with higher prevalence of stroke (adjusted-odds ratio (OR): 1.36, 95% CI 1.17 to 1.58, P<0.001; adjusted-OR: 1.68, 95% CI 1.44 to 1.96, P<0.001, respectively). Those with combined HHcy and MS had higher odds of stroke than those with isolated HHcy or MS (adjusted-OR: 1.78, 95% CI 1.47 to 2.15, P<0.001; adjusted-OR: 1.39, 95% CI 1.13 to 1.70, P=0.002, respectively). CONCLUSIONS HHcy combined with MS was associated with higher prevalence of stroke in Chinese adults with elevated blood pressure.


Assuntos
Homocisteína/sangue , Hiper-Homocisteinemia , Hipertensão , Síndrome Metabólica , Acidente Vascular Cerebral , Idoso , Biomarcadores/sangue , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/estatística & dados numéricos , China/epidemiologia , Comorbidade , Correlação de Dados , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Hiper-Homocisteinemia/sangue , Hiper-Homocisteinemia/diagnóstico , Hiper-Homocisteinemia/epidemiologia , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/metabolismo , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Prevalência , Medição de Risco/métodos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/metabolismo , Acidente Vascular Cerebral/fisiopatologia
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