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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.
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
3.
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
4.
J Stroke Cerebrovasc Dis ; 30(6): 105750, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33812174

RESUMO

OBJECTIVE: Vertebral artery compression of the medulla is a rare vascular finding that causes a variety of clinical presentations, from asymptomatic to neurological disability. This article presents the largest literature review to date on medullary compression of the vertebral arteries. METHODS: An English literature search was performed using the PubMed database and the keywords vertebral artery tortuosity, vertebral artery compression, and medullary compression. RESULTS: A comprehensive literature search yielded 68 patients (57% male) with medullary compression by an intracranial vertebral artery (ICVA). The left side of the medulla was compressed in 44, the right side in 19, and bilateral in 7. The most common clinical symptom was weakness - 26 patients (36%) - 6 had quadriparesis and 6 had hemiparesis. 21 patients reported imbalance; 12 various sensory symptoms; 4 patients were asymptomatic. CONCLUSIONS: Understanding the anatomy of the vasculature can help mitigate future debilitating stroke symptoms. Concrete guidelines for revascularization surgery in symptomatic patients may also be effective. Future studies are needed to further clarify the prevalence, natural history, vascular etiology, and treatment of this condition, including asymptomatic patients and the likelihood that they will develop further neurological signs and disability.


Assuntos
Encefalopatias/etiologia , Bulbo/fisiopatologia , Malformações Vasculares/complicações , Artéria Vertebral/anormalidades , Adulto , Idoso , Idoso de 80 Anos ou mais , Encefalopatias/diagnóstico por imagem , Encefalopatias/fisiopatologia , Feminino , Humanos , Masculino , Bulbo/diagnóstico por imagem , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Equilíbrio Postural , Prognóstico , Quadriplegia/etiologia , Quadriplegia/fisiopatologia , Transtornos das Sensações/etiologia , Transtornos das Sensações/fisiopatologia , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Adulto Jovem
5.
J Stroke Cerebrovasc Dis ; 30(6): 105774, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33848906

RESUMO

This blind randomized clinical trial evaluated the effect of CIMT on the functionality and quality of life (QOL) of chronic hemiparetics. Thirty volunteers were divided into two groups: Control (CG) and CIMT (CIMTG); evaluated before and after 12 and 24 intervention sessions. The scales used were: adapted Fugl-Meyer Motor Assessment (FMA), Modified Ashworth, Stroke Specific Quality Of Life (SS-QOL) and the Functional Reach Test (FRT). The scores for all FMA variables in the CIMTG increased until the 24th session, differing from the pre-treatment. In the CG, the scores increased for pain, coordination/ speed and sensitivity. In the FRT there was an increase in the scores in both groups; after the 12th and 24th sessions, the result of the CIMTG was superior to the CG. For the SS-QOL in the CIMTG, the general score and most of the variables increased, as well as in the CG. Muscle tone in CIMTG was lower compared to CG after 24 sessions. Both protocols used in the study were effective, the CIMT protocol showed benefits in recovering the functionality of the paretic upper limb, in the functional range and in reducing muscle tone, with a consequent improvement in quality of life.


Assuntos
Terapia por Exercício , Atividade Motora , Paresia/reabilitação , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Extremidade Superior/inervação , Idoso , Brasil , Feminino , Estado Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/fisiopatologia , Cooperação do Paciente , Estudos Prospectivos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
6.
Arch Phys Med Rehabil ; 102(9): 1755-1763, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33831371

RESUMO

OBJECTIVE: To investigate upper limb (UL) energy demand during unilateral arm crank submaximal exercise testing in individuals with stroke compared with healthy controls and the relationship between UL energy demand and UL activity in individuals with stroke. DESIGN: Cross-sectional, observational study. SETTING: Research laboratory. PARTICIPANTS: Individuals with chronic stroke (n=14) and controls (n=12), matched for age, sex, and body mass index (N=26). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: UL energy demand was measured as peak oxygen consumption (V̇o2)/peak load during unilateral arm crank submaximal exercise testing. UL activity was measured using the Box and Block Test (BBT) and Grooved Pegboard Test (GPT). RESULTS: The energy demand of the paretic side compared with the nonparetic side of the stroke group was 0.43 mL/kg/min/W (95% confidence interval, 0.03-0.83, P=.005) greater than the dominant compared with the nondominant side of the control group. The median difference between sides in peak V̇o2/peak load was 52% for the group with stroke compared with 11% for the control group. Positive correlations between the median percentage difference between the paretic and the nonparetic side of peak V̇o2/peak load and BBT were 0.72 (P=.004) and of V̇o2/peak load and GPT was 0.77 (P=.002). CONCLUSIONS: The higher energy demand of the paretic UL during unilateral arm crank submaximal exercise testing than the nonparetic and both UL of the controls together with the strong relationship between energy demand and UL activity suggest that the energy demand of the paretic UL has the potential to affect real-life UL activity after stroke.


Assuntos
Consumo de Oxigênio/fisiologia , Paresia/fisiopatologia , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Extremidade Superior/fisiopatologia , Adulto , Idoso , Estudos Transversais , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
J Clin Neurosci ; 86: 139-144, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33775318

RESUMO

We report the case of a patient who experienced recurrent ipsilateral hemiparesis in the setting of predominantly-uncrossed corticospinal tracts, with concomitant neuronal reorganization of the cortical motor maps, and the presence of aberrant interhemispheric connections. Their presence was supported by our results from diffusion tensor imaging tractography, functional magnetic resonance imaging, and transcranial magnetic stimulation. To our knowledge, this has never been reported before, and provides valuable insights into the mechanisms behind post-stroke motor recovery.


Assuntos
Córtex Motor/diagnóstico por imagem , Paresia/diagnóstico por imagem , Tratos Piramidais/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Paresia/etiologia , Paresia/fisiopatologia , Tratos Piramidais/fisiopatologia , Recidiva , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
8.
Gait Posture ; 86: 77-82, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33711614

RESUMO

BACKGROUND: Stroke survivors suffer from hemiparesis and somatosensory impairments, which adversely impact walking performance, placing them at higher risks for trips and falls. Post-stroke, somatosensory deficits are commonly observed as impaired interpretation of afferent input and increased threshold. Diminishing or augmenting somatosensory inputs via various techniques have been demonstrated to be able to modify static and dynamic balance, postural and locomotor control in non-neurologically impaired as well as neurologically impaired individuals. RESEARCH QUESTION: We sought to investigate whether enhancing somatosensory input using vibratory insoles, can improve post-stroke gait. We hypothesized that with augmentation of somatosensory input at the soles via vibratory insoles would improve post-stroke gait via increased propulsive forces, decreased braking forces and increased ankle angle movements in the paretic legs of individuals with chronic post-stroke hemiparesis. METHODS: Fifteen individuals with chronic post-stroke hemiparesis and 15 age-similar non-neurologically impaired controls participated in this cross-sectional study. Enhanced somatosensory stimulation was delivered using a pair of tactor-embedded insoles, providing suprathreshold vibratory stimulation to the bottom of the feet. Participants walked over an instrumented treadmill with self-selected speeds, under 5 conditions: no insole in shoe (NT), insoles in shoe with no vibration (BOFF), vibration under both feet (BON), vibration under one foot only (ION, CON). Kinetics and kinematics during walking were recorded and analyzed offline. RESULTS: Suprathreshold vibratory stimulations did not alter gait kinetics under any stimulation conditions. We observed increased paretic ankle dorsiflexions in the paretic legs, when vibratory stimuli were applied unilaterally. SIGNIFICANCE: Vibratory stimulations applied at suprathreshold intensity to the bottom of the feet to augment somatosensory feedback can potentially be used as a low-cost solution to address the inadequate toe clearance during walking in people post-stroke, which is an important goal in post-stroke rehabilitation.


Assuntos
Transtornos Neurológicos da Marcha/terapia , Paresia/fisiopatologia , Sapatos , Acidente Vascular Cerebral/complicações , Caminhada/fisiologia , Idoso , Fenômenos Biomecânicos , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Resultado do Tratamento , Vibração
9.
Theranostics ; 11(1): 346-360, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33391479

RESUMO

Rationale: Traumatic brain injury (TBI) leads to neurological impairment, with no satisfactory treatments available. Classical ketogenic diets (KD), which reduce reliance on carbohydrates and provide ketones as fuel, have neuroprotective potential, but their high fat content reduces compliance, and experimental evidence suggests they protect juvenile brain against TBI, but not adult brain, which would strongly limit their applicability in TBI. Methods: We designed a new-KD with a fat to carbohydrate plus protein ratio of 2:1, containing medium chain triglycerides (MCT), docosahexaenoic acid (DHA), low glycaemic index carbohydrates, fibres and the ketogenic amino acid leucine, and evaluated its neuroprotective potential in adult TBI. Adult male C57BL6 mice were injured by controlled cortical impact (CCI) and assessed for 70 days, during which they received a control diet or the new-KD. Results: The new-KD, that markedly increased plasma Beta-hydroxybutyrate (ß-HB), significantly attenuated sensorimotor deficits and corrected spatial memory deficit. The lesion size, perilesional inflammation and oxidation were markedly reduced. Oligodendrocyte loss appeared to be significantly reduced. TBI activated the mTOR pathway and the new-KD enhanced this increase and increased histone acetylation and methylation. Conclusion: The behavioural improvement and tissue protection provide proof of principle that this new formulation has therapeutic potential in adult TBI.


Assuntos
Lesões Encefálicas Traumáticas/dietoterapia , Encéfalo/patologia , Dieta Cetogênica/métodos , Memória Espacial , Ácido 3-Hidroxibutírico/sangue , Acetilação , Animais , Ataxia/fisiopatologia , Encéfalo/metabolismo , Lesões Encefálicas Traumáticas/metabolismo , Lesões Encefálicas Traumáticas/patologia , Lesões Encefálicas Traumáticas/fisiopatologia , Carboidratos da Dieta , Gorduras na Dieta , Fibras na Dieta , Proteínas na Dieta , Modelos Animais de Doenças , Ácidos Docosa-Hexaenoicos , Epigênese Genética , Índice Glicêmico , Código das Histonas , Inflamação/metabolismo , Inflamação/patologia , Coxeadura Animal/fisiopatologia , Leucina , Masculino , Metilação , Camundongos , Teste do Labirinto Aquático de Morris , Oligodendroglia/patologia , Paresia/fisiopatologia , Equilíbrio Postural , Teste de Desempenho do Rota-Rod , Transtornos das Sensações/fisiopatologia , Transdução de Sinais , Serina-Treonina Quinases TOR , Triglicerídeos
10.
J Stroke Cerebrovasc Dis ; 30(3): 105518, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33388631

RESUMO

OBJECTIVES: The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST) proved to be highly efficient in the treatment of emergent large vessel occluding (ELVO) strokes in the anterior circulation. To achieve a timely diagnosis, a robust combination of few and simple signs to identify ELVOs in AIS patients applicable by paramedics in the prehospital triage is worthwhile. MATERIALS AND METHODS: This retrospective single-center study included 904 AIS patients (324 ELVO, 580 non-ELVO) admitted between 2010 and 2015 in a tertiary stroke center. We re-evaluated two symptoms based on NIHSS items, gaze deviation and hemiparesis of the limbs ("Gaze deviation and Paresis Score, GPS") for the pre-hospital prediction of ELVO. RESULTS: A positive GPS AIS in patients predicted ELVO with a sensitivity of 0.89, specificity = 0.97, positive predictive value (PPV) = 0.95, negative predictive value (NPV) = 0.94 and diagnostic odds ratio (DOR) = 34.25 (CI: 20.75-56.53). The positive Likelihood-ratio (LR+) was 29.67, the negative Likelihood ratio (LR-) 0.11. NIHSS of patients with positive GPS (gaze palsy NIHSS ≥ 0, Motor arm NIHSS ≥2 and Motor leg NIHSS ≥2) was markedly higher compared to negative GPS patients (p < 0.001). CONCLUSIONS: The GPS proved to be similarly accurate in detecting ELVO in the anterior circulation of AIS patients and even more specific than other published clinical scores. Its simplicity and clarity might enable non-neurological medical staff to identify ELVO AIS patients with high certainty in a preclinical setting.


Assuntos
Avaliação da Deficiência , Serviços Médicos de Emergência , Fixação Ocular , AVC Isquêmico/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Paresia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Procedimentos Endovasculares , Feminino , Humanos , AVC Isquêmico/etiologia , AVC Isquêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia , Paresia/etiologia , Paresia/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Triagem
11.
Phys Ther ; 101(3)2021 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-33444441

RESUMO

OBJECTIVE: This study demonstrated the use of computerized motion analysis to assist in evidence-based clinical decision-making. CASE DESCRIPTION: A 15-year-old girl who had right hemiparesis after a stroke was referred for 3-dimensional computerized motion analysis to determine the effect of 3 devices intended to control her dropfoot and to assist in developing a treatment plan. Four conditions were tested and compared: barefoot, lateral support ankle brace, functional electrical stimulation (FES) device, and dropfoot cuff. RESULTS: Kinematics showed the right ankle had significant dropfoot during swing phase (32.7 degrees of plantarflexion at terminal swing) in barefoot. The lateral support ankle brace, FES device, and dropfoot cuff reduced terminal swing plantarflexion to 27.2 degrees, 17.6 degrees, and 15.3 degrees, respectively, though ankle kinematics remained abnormal because of inadequate dorsiflexion. Improvements in gait variable score with FES (-8.2 degrees) or dropfoot cuff (-8.7 degrees) were significantly more than that with the lateral support brace (-2.2 degrees), and the difference in gait variable score between FES and dropfoot cuff was insignificant. Compared with the barefoot condition, the lateral support brace condition did not show a clinically significant difference in gait profile score; however, the gait profile scores of both FES and dropfoot cuff conditions showed clinically significant improvement (-1.7 degrees and -2.1 degrees, respectively). CONCLUSION: Objective data delineated subtle changes among 3 devices and led to the recommendation to discontinue the lateral support ankle brace, continue using her night ankle-foot orthosis and FES device, with the dropfoot cuff as a backup when she feels leg fatigue or skin irritation, and consider serial casting or surgical calf lengthening. IMPACT: Computerized motion analysis provides quantitative evaluation of subtle differences in the effect of braces with different designs, which are hard for the human eye to discern. The objective data inform and validate treatment decision-making. The recommendations were made as a result of evidence-based practice.


Assuntos
Tomada de Decisão Clínica , Transtornos Neurológicos da Marcha/reabilitação , Aparelhos Ortopédicos , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral , Adolescente , Fenômenos Biomecânicos , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Paresia/fisiopatologia , Estudos de Tempo e Movimento
12.
Am J Phys Med Rehabil ; 100(2): 153-160, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732742

RESUMO

OBJECTIVE: This study aimed to investigate factors related to paretic upper limb use within the first 4 wks after stroke. DESIGN: Sixty inpatients within 4 wks of first-time stroke were stratified by severity defined by Fugl-Meyer Upper Limb scores: severe = 0-22, moderate = 23-50, and mild = 51-66. All wore a wrist accelerometer on the paretic upper limb (24 hrs). Factors investigated were the following measures: upper limb motor impairment; mobility; balance; functional independence; sensory impairment; cognitive function; social factors; environmental restriction; and knowledge. Individual and multivariate quantile regression analyses were performed. RESULTS: Upper limb motor impairment, mobility, balance, functional independence, self-efficacy, and knowing how to use the paretic upper limb were significantly related to upper limb use across the three impairment groups (pseudo R2 = 0.079-0.492, P < 0.02). Multivariate regression showed the only significant factor in moderate and mild group was Fugl-Meyer Upper Limb score (moderate pseudo R2 = 0.55, mild pseudo R2 = 0.54, P < 0.001). For the severe group, Fugl-Meyer upper limb score and step count were significant (severe pseudo R2 = 0.47, P ≤ 0.030). CONCLUSIONS: Upper limb motor impairment is significantly associated with paretic upper limb use across three impairment groups and step count with the severe group. Strategies to improve upper limb motor impairment and increase mobility may be required to increase upper limb use.


Assuntos
Paresia/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Extremidade Superior/fisiopatologia , Acelerometria , Idoso , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Reabilitação do Acidente Vascular Cerebral
14.
Exp Neurol ; 337: 113577, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33359474

RESUMO

Neonatal hypoxic-ischemic encephalopathy (HIE) is a major cause of brain damage in newborns. Although therapeutic hypothermia has been shown to be neuroprotective against neonatal HIE in clinical trials, its effect is not satisfactory. Cell-based therapies have attracted much attention as novel treatments for HIE. Preclinical studies on a variety of human cell transplantation methods have been performed in immunodeficient/immunosuppressed animals, such as severe combined immunodeficient (SCID) mice, which lack functional T and B lymphocytes. The detailed characteristics of neonatal HIE in SCID mice, however, have not been delineated. In preclinical studies, novel therapies for neonatal HIE should be evaluated in combination with hypothermia, which has become a standard treatment for neonatal HIE. However, the effects of hypothermia in SCID mice have not been delineated. In the present study, we compared neonatal hypoxic-ischemic (HI) brain damage in SCID mice and wild-type mice treated with or without hypothermia. Male and female mouse pups were subjected to HI insult induced by unilateral common carotid artery ligation combined with systemic hypoxia on postnatal day 12. In the first 4 h after HI insult, body temperature was maintained at 36 °C for the normothermia groups or 32 °C for the hypothermia groups. The severity of brain damage in SCID mice did not differ from that in wild-type mice based on most evaluations, i.e., cerebral blood flow, hemiparesis, muscle strength, spontaneous activity, cerebral hemispheric volume, neuropathological injury, and serum cytokine levels, although spleen weight, brain weight, leukocyte counts and the levels of some cytokines in the peripheral blood were different between genotypes. The effects of hypothermia in SCID mice were comparable to those in wild-type mice based on most evaluations. Taken together, these findings indicate that SCID mice can be used as an appropriate preclinical model for cell therapies for neonatal HIE.


Assuntos
Dano Encefálico Crônico/patologia , Encéfalo/patologia , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/patologia , Imunodeficiência Combinada Severa/patologia , Animais , Animais Recém-Nascidos , Temperatura Corporal , Dano Encefálico Crônico/etiologia , Circulação Cerebrovascular , Citocinas/sangue , Feminino , Hipóxia-Isquemia Encefálica/psicologia , Hipóxia-Isquemia Encefálica/terapia , Contagem de Leucócitos , Masculino , Camundongos , Camundongos SCID , Atividade Motora , Força Muscular , Tamanho do Órgão , Paresia/etiologia , Paresia/fisiopatologia , Desempenho Psicomotor
15.
J Neuroeng Rehabil ; 17(1): 140, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109225

RESUMO

BACKGROUND: Stroke is a leading cause of disability with associated hemiparesis resulting in difficulty bearing and transferring weight on to the paretic limb. Difficulties in weight bearing and weight transfer may result in impaired mobility and balance, increased fall risk, and decreased community engagement. Despite considerable efforts aimed at improving weight transfer after stroke, impairments in its neuromotor and biomechanical control remain poorly understood. In the present study, a novel experimental paradigm was used to characterize differences in weight transfer biomechanics in individuals with chronic stroke versus able-bodied controls METHODS: Fifteen participants with stroke and fifteen age-matched able-bodied controls participated in the study. Participants stood with one foot on each of two custom built platforms. One of the platforms dropped 4.3 cm vertically to induce lateral weight transfer and weight bearing. Trials involving a drop of the platform beneath the paretic lower extremity (non-dominant limb for control) were included in the analyses. Paretic lower extremity joint kinematics, vertical ground reaction forces, and center of pressure velocity were measured. All participants completed the clinical Step Test and Four-Square Step Test. RESULTS: Reduced paretic ankle, knee, and hip joint angular displacement and velocity, delayed ankle and knee inter-joint timing, increased downward displacement of center of mass, and increased center of pressure (COP) velocity stabilization time were exhibited in the stroke group compared to the control group. In addition, paretic COP velocity stabilization time during induced weight transfer predicted Four-Square Step Test scores in individuals post-stroke. CONCLUSIONS: The induced weight transfer approach identified stroke-related abnormalities in the control of weight transfer towards the paretic limb side compared to controls. Decreased joint flexion of the paretic ankle and knee, altered inter-joint timing, and increased COP stabilization times may reflect difficulties in neuromuscular control during weight transfer following stroke. Future work will investigate the potential of improving functional weight transfer through induced weight transfer training exercise.


Assuntos
Extremidade Inferior/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Suporte de Carga/fisiologia , Idoso , Fenômenos Biomecânicos , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral
16.
J Stroke Cerebrovasc Dis ; 29(11): 105202, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066924

RESUMO

INTRODUCTION AND OBJECTIVES: Motor evoked potentials (MEPs) have been postulated to be useful in predicting recovery in patients with motor impairment. We aimed to investigate whether MEPs elicited by transcranial magnetic stimulation (TMS), serum brain derived neurotrophic factor (BDNF) and its genotype have prognostic value on stroke recovery in patients with hand paresis due to stroke. METHODS: This was an observational cohort study. Patients underwent TMS with MEPs from abductor digiti minimi evaluation between 2-14 (D0) and 30 days (D30) after stroke and their impact on motor function of the upper limb and general outcome was assessed after 3 months (D90). The presence of a BDNF gene polymorphism was determined and serum BDNF concentrations were measured at D0, D30 and D90. RESULTS: The presence of MEPs and their amplitude at rest and in effort significantly correlated with improvement of upper-limb paresis and general outcome after 3 months. Resting motor threshold did not have prognostic value. Central motor conduction time and MEP latency less consistently predicted stroke outcome or motor deficit improvement. Neither BDNF polymorphisms nor BDNF concentration at D0, D30 and D90 corresponded with the degree of paresis or the independence of patients 3 months after stroke. CONCLUSIONS: The presence of MEPs and their amplitude are useful predictors of upper-limb motor function recovery and general outcome after stroke. BDNF concentration and its genotype had no prognostic value. Further studies conducted on large cohorts are necessary to determine the usefulness of these methods in motor recovery and stroke outcome prediction.


Assuntos
Fator Neurotrófico Derivado do Encéfalo/sangue , Potencial Evocado Motor , Mãos/inervação , Paresia/terapia , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Fator Neurotrófico Derivado do Encéfalo/genética , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Paresia/diagnóstico , Paresia/fisiopatologia , Polimorfismo Genético , Valor Preditivo dos Testes , Tempo de Reação , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
17.
J Stroke Cerebrovasc Dis ; 29(12): 105377, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33091753

RESUMO

OBJECTIVE: Although studies on the efficacy of the rehabilitation robot are increasing, there are few reports using the robot for gait training in the actual clinical setting. This study aimed to investigate the effectiveness of gait training using Welwalk in hemiparetic stroke patients in a real clinical setting. MATERIALS AND METHODS: This prospective study included 36 hemiparetic stroke patients who underwent gait training using Welwalk. We examined the walking ability improvement efficiency using Functional Independence Measure (FIM)-walk as the primary outcome, which was compared with that of 36 patients (matched control group) who underwent conventional rehabilitation. Other outcomes were the actual gait training period using Welwalk, raw FIM-walk score, lower extremity motor functions score in Stroke Impairment Assessment Set at discharge, and duration from stroke onset until discharge. RESULTS: The improvement efficiency of the FIM-walk was significantly higher in the Welwalk group than in the matched control group (control 0.48 ± 0.31, Welwalk 0.80 ± 0.38, p-value < 0.001). The mean gait training period using Welwalk was 5 weeks. No significant differences were found in other outcomes between the Welwalk group and the matched control group. CONCLUSION: This study demonstrated the effectiveness of gait training using Welwalk on the improvement efficiency of the FIM-walk in hemiparetic stroke patients in an actual clinical setting.


Assuntos
Marcha , Atividade Motora , Paresia/reabilitação , Robótica/instrumentação , Reabilitação do Acidente Vascular Cerebral/instrumentação , Acidente Vascular Cerebral/terapia , Idoso , Avaliação da Deficiência , Exoesqueleto Energizado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
18.
J Neuroeng Rehabil ; 17(1): 139, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087137

RESUMO

Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration.


Assuntos
Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Perna (Membro)/fisiopatologia , Locomoção/fisiologia , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Paresia/reabilitação , Acidente Vascular Cerebral/complicações , Caminhada/fisiologia
19.
J Neurol Neurosurg Psychiatry ; 91(12): 1261-1269, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33087421

RESUMO

Functional movement disorders (FMD) are proposed to reflect a specific problem with voluntary control of movement, despite normal intent to move and an intact neural capacity for movement. In many cases, a positive diagnosis of FMD can be established on clinical grounds. However, the diagnosis remains challenging in certain scenarios, and there is a need for predictors of treatment response and long-term prognosis.In this context, we performed a systematic review of biomarkers in FMD. Eighty-six studies met our predefined criteria and were included.We found fairly reliable electroencephalography and electromyography-based diagnostic biomarkers for functional myoclonus and tremor. Promising biomarkers have also been described for functional paresis, gait and balance disorders. In contrast, there is still a lack of diagnostic biomarkers of functional dystonia and tics, where clinical diagnosis is often also more challenging. Importantly, many promising findings focus on pathophysiology and reflect group-level comparisons, but cannot differentiate on an individual basis. Some biomarkers also require access to time-consuming and resource-consuming techniques such as functional MRI.In conclusion, there are important gaps in diagnostic biomarkers in FMD in the areas of most clinical uncertainty. There is also is a lack of treatment response and prognostic biomarkers to aid in the selection of patients who would benefit from rehabilitation and other forms of treatment.


Assuntos
Encéfalo/diagnóstico por imagem , Transtorno Conversivo/diagnóstico , Eletroencefalografia , Eletromiografia , Neuroimagem Funcional , Transtornos dos Movimentos/diagnóstico , Biomarcadores , Encéfalo/fisiopatologia , Transtorno Conversivo/fisiopatologia , Distonia/diagnóstico , Distonia/fisiopatologia , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Transtornos dos Movimentos/fisiopatologia , Mioclonia/diagnóstico , Mioclonia/fisiopatologia , Plasticidade Neuronal , Paresia/diagnóstico , Paresia/fisiopatologia , Tomografia por Emissão de Pósitrons , Tempo de Reação , Tiques/diagnóstico , Tiques/fisiopatologia , Tremor/diagnóstico , Tremor/fisiopatologia
20.
J Stroke Cerebrovasc Dis ; 29(10): 105107, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912556

RESUMO

BACKGROUND: Peak neurologic recovery from acute stroke occurs within the first 3 months, and continues at a slower pace for 6 months. OBJECTIVE/HYPOTHESIS: The aim of this pilot study is to clarify the safety and feasibility of multiple diagonal-transcranial direct current stimulation (d-tDCS) sessions up to 3 months with electrodes placed diagonally over the lesional dorsolateral prefrontal cortex and contralesional primary motor cortex for upper limb hemiparesis in acute stroke. METHODS: Five patients with acute stroke (2 with intracerebral hemorrhage and 3 with cerebral infarction) with upper limb paresis participated. d-tDCS (1 mA, 20 min per day) combined with conventional rehabilitation was given starting 7-21 days after stroke onset. Each session consisted of 10 d-tDCS over 2 weeks and patients received 2 sessions in the acute phase and 2 sessions in the subacute phase for a total 40 treatments. Motor function was assessed using Fugl-Meyer Assessment for upper extremity (FMA-UE) before and after each session, and the period to achieve 70% of maximal potential recovery in FMA-UE was evaluated. RESULTS: All 5 patients completed the intervention and showed no adverse effects throughout the protocol. Of these, 3 (60%) achieved 70% predicted scores within 2 months. Regarding therapeutic gains of FMA-UE in each of the 10 sessions in the acute phase, 4 sessions showed great recovery, 3 sessions showed moderate recovery, and 3 sessions showed poor recovery. CONCLUSION: These findings suggest that d-tDCS over 3 months may be safe and feasible for acute stroke patients in the acute to subacute phases and have therapeutic potential to promote recovery of upper limb function, although further randomized, double-blind, sham-controlled trial is warranted with larger sample size.


Assuntos
Atividade Motora , Córtex Motor/fisiopatologia , Paresia/terapia , Córtex Pré-Frontal/fisiopatologia , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua , Extremidade Superior/inervação , Idoso , Avaliação da Deficiência , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/fisiopatologia , Projetos Piloto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Resultado do Tratamento
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