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1.
Medicine (Baltimore) ; 99(10): e19121, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150052

RESUMO

About 11% to 13% of patients with acute dysphagia induced by stroke remain chronic dysphagia 6 months after stroke which usually leads to many severe complications and poor quality of life.To investigate the effect of transcranial direct current stimulation (tDCS) on swallowing function in the patients with chronic dysphagia after stroke.26 post-stroke patients with chronic dysphagia who received tDCS were identified by electronic medical records between July 2016 and April 2018. Of which, 13 were treated by unilateral hemispheric anodal tDCS at affected pharyngeal motor cortex. 13 eligible patients only treated by conventional therapies but without tDCS were randomly selected by matching on date of admission (±2 weeks) of the patients receiving unilateral tDCS. The swallowing function and quality of life were evaluated before and 2 weeks after treatment.The patients in three groups were comparable. The swallowing function and quality of life of the patients in all the 3 groups had been improved over time. Comparing to the group without tDCS, both the groups with unilateral or bilateral tDCS had shorter oral transit time (1.69 ±â€Š0.95, 0.97 ±â€Š0.71 seconds, respectively) and higher scores of quality of life (159.76 ±â€Š12.59, 179.69 ±â€Š11.81, respectively) after treatment.Both unilateral and bilateral hemispheric anodal tDCS combined with conventional therapies are helpful for recovery of swallowing function in patients with chronic dysphagia induced by stroke, but bilateral anodal tDCS substantially improve more.


Assuntos
Transtornos de Deglutição/terapia , Córtex Motor/fisiopatologia , Reabilitação do Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua , Estudos de Coortes , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/psicologia , Feminino , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(9): e19386, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118788

RESUMO

Case-control studies have shown that noxious thermal stimulation (TS) can improve arm function in patients with stroke. However, the neural mechanisms underlying this improvement are largely unknown. We explored functional neural activation due to noxious and innocuous TS intervention applied to the paretic arm of patients with stroke. Sixteen participants with unilateral cortical infarctions were allocated to one of two groups: noxious TS (8 patients; temperature combination: hot pain 46°C to 47°C, cold pain 7°C-8°C) or innocuous TS (n = 8; temperature combination: hot 40°C-41°C, cold 20°C-21°C). All subjects underwent fMRI scanning before and after 30 min TS intervention and performed a finger tapping task with the affected hand. Immediate brain activation effects were assessed according to thermal type (noxious vs. innocuous TS) and time (pre-TS vs post-TS). Regions activated by noxious TS relative to innocuous TS (P < .05, adjusted for multiple comparisons) were related to motor performance and sensory function in the bilateral primary somatosensory cortices, anterior cingulate cortex, insula, thalamus, hippocampus and unilateral primary motor cortex, secondary somatosensory cortex at the contralateral side of lesion, and unilateral supplementary motor area at the ipsilateral side of lesion. Greater activation responses were observed in the side contralateral to the lesion, suggesting a significant intervention effect. Our preliminary findings suggest that noxious TS may induce neuroplastic changes unconstrained to the local area.Trial registration: NCT01418404.


Assuntos
Temperatura Alta/uso terapêutico , Estimulação Física/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Adulto , Idoso , Análise de Variância , Estudos de Casos e Controles , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estimulação Física/instrumentação , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/instrumentação
3.
Medicine (Baltimore) ; 99(11): e19512, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176098

RESUMO

To investigate the relationships between grip strengths and self-care activities in stroke patients using a non-linear support vector machine (SVM).Overall, 177 inpatients with poststroke hemiparesis were enrolled. Their grip strengths were measured using the Jamar dynamometer on the first day of rehabilitation training. Self-care activities were assessed by therapists using Functional Independence Measure (FIM), including items for eating, grooming, dressing the upper body, dressing the lower body, and bathing at the time of discharge. When each FIM item score was ≥6 points, the subject was considered independent. One thousand bootstrap grip strength datasets for each independence and dependence in self-care activities were generated from the actual grip strength. Thereafter, we randomly assigned the total bootstrap datasets to 90% training and 10% testing datasets and inputted the bootstrap training data into a non-linear SVM. After training, we used the SVM algorithm to predict a testing dataset for cross-validation. This validation procedure was repeated 10 times.The SVM with grip strengths more accurately predicted independence or dependence in self-care activities than the chance level (mean ±â€Šstandard deviation of accuracy rate: eating, 0.71 ±â€Š0.04, P < .0001; grooming, 0.77 ±â€Š0.03, P < .0001; upper-body dressing, 0.75 ±â€Š0.03, P < .0001; lower-body dressing, 0.72 ±â€Š0.05, P < .0001; bathing, 0.68 ±â€Š0.03, P < .0001).Non-linear SVM based on grip strengths can prospectively predict self-care activities.


Assuntos
Avaliação da Deficiência , Força da Mão , Paresia/reabilitação , Autocuidado , Reabilitação do Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Aprendizado de Máquina , Masculino , Paresia/fisiopatologia , Alta do Paciente , Valor Preditivo dos Testes
5.
Am J Occup Ther ; 74(1): 7401205050p1-7401205050p14, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32078516

RESUMO

IMPORTANCE: Despite advancements in stroke rehabilitation research, occupational therapy practitioners still face challenges with implementing research into routine practice. Although the development of evidence-based practices (EBPs) is one critical step along the knowledge translation continuum for the population of people with stroke, research is also needed to identify the most effective strategies for implementing EBPs with stroke survivors who are receiving occupational therapy services. OBJECTIVE: To synthesize research related to occupational therapy practitioners' implementation of EBPs in adult stroke rehabilitation. DATA SOURCES: We searched four electronic databases-CINAHL, MEDLINE, PubMed, and Academic Search Complete-and the peer-reviewed journal Implementation Science to identify relevant research studies. STUDY SELECTION AND DATA COLLECTION: Studies that met the following inclusion criteria were included in the scoping review: published between January 2003 and January 2018, addressed the adult stroke population, and examined the implementation of occupational therapy interventions. Data were abstracted on the basis of recommendations from the seminal review framework established by Arksey and O'Malley (2005). Thematic analysis identified themes that emerged from the included studies. FINDINGS: Twenty-five articles satisfied our inclusion parameters. Our analyses yielded three overarching themes: barriers to implementation, facilitators of implementation, and implementation strategies. Implementation strategies often consisted of multimodal knowledge translation training programs. CONCLUSION AND RELEVANCE: Although the stroke rehabilitation literature appears to have established the barriers to and facilitators of EBP implementation, greater attention to the identification of effective implementation strategies that promote the uptake of EBPs by occupational therapy practitioners is needed. WHAT THIS ARTICLE ADDS: This article summarizes the contextual factors and effective strategies that may influence practitioners' implementation of stroke research findings in real-world practice.


Assuntos
Terapia Ocupacional , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Prática Clínica Baseada em Evidências , Humanos , Acidente Vascular Cerebral/fisiopatologia , Pesquisa Médica Translacional
6.
Medicina (B Aires) ; 80(1): 54-68, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32044742

RESUMO

It is estimated that two thirds of people who have suffered a stroke have sequels that condition their quality of life. The rehabilitation of the stroke is a complex process, which requires the multidisciplinary approach of specialized professionals (doctors, kinesiologists, nurses, occupational therapists, phonoaudiologists, neuropsychologists and nutritionists). Currently, the practices carried out are a consequence of the combination of evidence and consensus, most of them through international stroke rehabilitation guides. The objective of this review is to adjust the international recommendations on stroke rehabilitation to what is applied to daily practice, in order to unify the criteria of the recommendations and to reduce the variability of the practices carried out. This work is a review of the literature on stroke rehabilitation guides developed in the last 10 years. Each section was supervised by different professionals specialized in these areas. We analyze the time and organization necessary to develop rehabilitation, recommendations for motor, cognitive and visual rehabilitation, the management of dysphagia and nutrition, the approach of comorbidities (venous thrombosis, skin ulcers, pain, psychiatric disorders and osteoporosis) and the necessary tasks to favor the return to the activities of daily life.


Assuntos
Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Adulto , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/reabilitação , Humanos , Assistência Centrada no Paciente/métodos , Fatores de Risco
8.
Neuron ; 105(4): 604-620, 2020 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-32078796

RESUMO

Stroke is one of the leading causes of long-term disability. Advanced technological solutions ("neurotechnologies") exploiting robotic systems and electrodes that stimulate the nervous system can increase the efficacy of stroke rehabilitation. Recent studies on these approaches have shown promising results. However, a paradigm shift in the development of new approaches must be made to significantly improve the clinical outcomes of neurotechnologies compared with those of traditional therapies. An "evolutionary" change can occur only by understanding in great detail the basic mechanisms of natural stroke recovery and technology-assisted neurorehabilitation. In this review, we first describe the results achieved by existing neurotechnologies and highlight their current limitations. In parallel, we summarize the data available on the mechanisms of recovery from electrophysiological, behavioral, and anatomical studies in humans and rodent models. Finally, we propose new approaches for the effective use of neurotechnologies in stroke survivors, as well as in people with other neurological disorders.


Assuntos
Estimulação Encefálica Profunda/métodos , Destreza Motora/fisiologia , Plasticidade Neuronal/fisiologia , Recuperação de Função Fisiológica/fisiologia , Córtex Sensório-Motor/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Encefálica Profunda/instrumentação , Humanos , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/fisiopatologia , Doenças do Sistema Nervoso/reabilitação , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Córtex Sensório-Motor/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/instrumentação
9.
Nihon Ronen Igakkai Zasshi ; 57(1): 45-52, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32074560

RESUMO

AIM: To clarify risk factors for aspiration pneumonia and the effects of aspiration pneumonia on the recovery after stroke in elderly stroke patients in a convalescent rehabilitation ward. METHODS: We conducted a retrospective study of 463 stroke patients with dysphagia who were ≥65 years of age (mean age, 80.2±8.1 years) who were admitted to our convalescent rehabilitation ward. Information was obtained from medical charts. A multivariate analysis was performed to clarify risk factors for aspiration pneumonia and the association between aspiration pneumonia and increased functional oral intake scale and functional independence measure motor scores. For the increase in functional independence measure motor score, values of ≥16 points and ≤15 points were coded as 1 and 0, respectively. RESULTS: Aspiration pneumonia developed in 52 patients. The multivariate analysis revealed that male sex (odds ratio [OR] 3.07, 95% confidence interval [CI] 1.59-5.95, p<0.001), geriatric nutritional risk index (OR for one unit increase 0.94, 95% CI 0.90-0.97, p<0.001) and tube feeding (OR 3.89, 95% CI 1.71-8.83, p=0.001) on admission were significant predictors of aspiration pneumonia. Aspiration pneumonia was associated with increased functional oral intake scale scores (OR 0.29, 95% CI 0.12-0.66, P=0.003) and increased functional independence measure motor scores (OR 0.23, 95% CI 0.09-0.55, P=0.001). CONCLUSIONS: Male sex, undernutrition and tube feeding on admission are risk factors for aspiration pneumonia. Aspiration pneumonia is suggested to be associated with recovery of the oral intake of food and activities of daily living.


Assuntos
Pneumonia Aspirativa , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pneumonia Aspirativa/etiologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações
10.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 37(1): 129-135, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32096386

RESUMO

In order to stimulate the patients' active participation in the process of robot-assisted rehabilitation training of stroke patients, the rehabilitation robots should provide assistant torque to patients according to their rehabilitation needs. This paper proposed an assist-as-needed control strategy for wrist rehabilitation robots. Firstly, the ability evaluation rules were formulated and the patient's ability was evaluated according to the rules. Then the controller was designed. Based on the evaluation results, the controller can calculate the assistant torque needed by the patient to complete the rehabilitation training task and send commands to motor. Finally, the motor is controlled to output the commanded value, which assists the patient to complete the rehabilitation training task. The control strategy was implemented to the wrist function rehabilitation robot, which could achieve the training effect of assist-as-needed and could avoid the surge of assistance torque. In addition, therapists can adjust multiple parameters in the ability evaluation rules online to customize the difficulty of tasks for patients with different rehabilitation status. The method proposed in this paper does not rely on the information from force sensor, which reduces development costs and is easy to implement.


Assuntos
Robótica , Reabilitação do Acidente Vascular Cerebral/instrumentação , Punho/fisiologia , Humanos , Modalidades de Fisioterapia
11.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 37(1): 169-173, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32096391

RESUMO

Neurological damage caused by stroke is one of the main causes of motor dysfunction in patients, which brings great spiritual and economic burdens for society and families. Motor imagery is an important assisting method for the rehabilitation of patients after stroke, which is easy to learn with low cost and has great significance in improving the motor function and the quality of patient's life. This paper mainly summarizes the positive effects of motor imagery on post-stroke rehabilitation, outlines the physiological performance and theoretical model of motor imagery, the influencing factors of motor imagery, the scoring criteria of motor imagery and analyzes the shortcomings such as the few kinds of experimental subject, the subjective evaluation method and the low resolution of the experimental equipment in the process of rehabilitation of motor function in post-stroke patients. It is hopeful that patients with stroke will be more scientifically and effectively using motor imagery therapy.


Assuntos
Reabilitação do Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Humanos , Recuperação de Função Fisiológica
13.
Med Clin North Am ; 104(2): 199-211, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32035564

RESUMO

This article summarizes stroke rehabilitation, with a particular focus on rehabilitation from acute diagnosis to chronic impairments of stroke. The emphasis is on both pharmacologic and nonpharmacologic intervention and interdisciplinary collaboration.


Assuntos
Comunicação Interdisciplinar , Administração dos Cuidados ao Paciente/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Humanos
14.
Medicine (Baltimore) ; 99(6): e19062, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028426

RESUMO

BACKGROUND: The efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) for functional independence and depression prevention in early stage of post-stroke (within 1 month after stroke onset) are still unclear. METHODS: Relevant randomized controlled trials (RCTs) comparing early SSRIs therapy with placebo were sought from PubMed, Cochrane Library, Medline, and Embase. Primary outcomes were functional independence and depression occurrence. Secondary outcomes contained the improvement of Fugl-Meyer motor scale (FMMS) score and adverse events. We used fixed or random effects model to pooled effect estimates. And we chose risk ratio (RR) or mean differences (MDs) with the 95% confidence intervals (CIs) for data analysis. RESULTS: We included 10 RCTs with total 5370 patients. The outcome of functional independence showed no significant difference between SSRIs and placebo group (RR, 1.28; 95% CI, 0.96-1.72; P = .10; I = 92%). However, depression occurrence differed significantly between these 2 groups, which favored SSRIs group (RR, 0.78; 95% CI, 0.67-0.90; P = .001; I = 23%). In addition, we observed that the side effects of SSRIs were seizure and nausea. Except psychiatric disorders/insanity rate was less in SSRIs group than placebo group (RR, 0.66; 95% CI, 0.48-0.90; P = .009) (I = 0%), other adverse events were revealed non-significant in our meta-analysis. CONCLUSIONS: Our meta-analysis revealed that early SSRIs therapy were effective to prevent post-stroke depression. However, SSRIs did not improve patient's post-stroke functional independence. In addition to increase the occurrence of seizure and nausea, SSRIs were relatively safe.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Depressão/prevenção & controle , Inibidores de Captação de Serotonina/uso terapêutico , Acidente Vascular Cerebral/psicologia , Atividades Cotidianas/psicologia , Humanos , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos
15.
Hu Li Za Zhi ; 67(1): 81-88, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960399

RESUMO

BACKGROUND & PROBLEMS: Early rehabilitation after stroke is important for the recovery of bodily functions in stroke patients. However, the percentage of completion of early limb rehabilitation among stroke patients is only 16%. PURPOSE: Raise the early rehabilitation intervention rate to 88% for patients with stroke within 24 hours of hospitalization. RESOLUTION: We developed an education course on post-stroke rehabilitation and a related e-Learning course as well as organized an 'alliance for recovery' team. In addition, we established a standard for post-stroke relay rehabilitation and designed rehabilitation relay cards, Xbox rehabilitation games, and nine squares challenge for brain stroke care. RESULTS: The accuracy of the knowledge of nursing staff related to physical rehabilitation improved from 72.4% to 100%; the accuracy of their perceptions regarding early limb rehabilitation increased from 16% to 100%; and patient satisfaction increased from 68% to 98%. CONCLUSIONS: We deployed diverse and innovative strategies to assist limb rehabilitation in patients with stroke. Patients and caregivers should be encouraged to participate in early rehabilitation and related programs and should apply the skills and rehabilitation activities learned to daily life.


Assuntos
Extremidades/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/fisiopatologia , Difusão de Inovações , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital/educação , Recursos Humanos de Enfermagem no Hospital/psicologia , Satisfação do Paciente/estatística & dados numéricos , Desenvolvimento de Programas
16.
Zhongguo Zhen Jiu ; 40(1): 21-5, 2020 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-31930894

RESUMO

OBJECTIVE: To compare the differences in the clinical effect on post-stroke hand spasm among the combined treatment of penetrating acupuncture and kinesiotherapy, the simple application of penetrating acupuncture and the simple application of kinesiotherapy. METHODS: A total of 105 patients with post-stroke hand spasm were randomized into a penetrating acupuncture group, a kinesiotherapy group and a combined treatment group, 35 cases in each one, of which, 2 cases were dropped out in either the combined treatment group and the penetrating acupuncture group, and 1 case dropped out in the kinesiotherapy group. The routine rehabilitation training, e.g. occupational therapy and Bobath exercise and medication were adopted in all of the three groups. In the penetrating acupuncture group, the penetrating needling technique was exerted from Hegu (LI 4) to Houxi (SI 3) and from Waiguan (TE 5) to Sidu (TE 9) on the affected side. In the kinesiotherapy group, the persistent movement or passive movement was exerted on the wrist joint, the metacarpophalangeal joints and the interphalangeal joints. In the combined treatment group, the penetrating acupuncture (the same as the penetrating acupuncture group) was exerted combined with kinesiotherapy (the same as the kinesiotherapy group). In each group, the treatment was given once a day, 30 min in each time, 6 treatments a week in total, with the interval of 1 day between the courses. The treatment for 2 weeks was as one course and 2 courses were required totally. Before and after treatment, the scores of hand spasm index, hand-wrist motor function and the activity of daily living (ADL) were compared in each group. RESULTS: After treatment, the scores of hand spasm index were reduced as compared with those before treatment in each group (P<0.05) and the scores of hand-wrist motor function and ADL were increased significantly as compared with those before treatment in each group (P<0.05). After treatment, the reducing degree of the score of hand spasm index in the combined treatment group was greater than the penetrating acupuncture group and the kinesiotherapy group (P<0.01), and the increasing degree of the scores of hand-wrist motor function and ADL were higher than either the penetrating acupuncture group or the kinesiotherapy group (P<0.01). The improvements in each index were not different statistically between the kinesiotherapy group and the penetrating acupuncture group (P>0.05). CONCLUSION: Compared with the simple application of either penetrating acupuncture or kinesiotherapy, the combined treatment of them achieves the significant improvements in hand spasm degree, hand wrist motor function and ADL in patients with stroke.


Assuntos
Terapia por Acupuntura , Espasmo/terapia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Pontos de Acupuntura , Humanos , Cinese , Espasmo/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
17.
Zhongguo Zhen Jiu ; 40(1): 26-9, 2020 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-31930895

RESUMO

OBJECTIVE: To compare the therapeutic effect of plum-blossom needle tapping at three yin meridians of wrist combined with rehabilitation training and simple rehabilitation training on wrist joint contracture after stroke. METHODS: A total of 72 patients with wrist joint contracture after stroke were randomized into an observation group and a control group, 36 cases in each one. In the control group, simple rehabilitation training was applied, 5 times a week, 3 weeks as one course and totally 3 courses were required. On the basis of the treatment in the control group, plum-blossom needle tapping at three yin meridians of wrist was adopted in the observation group. The tapping regions were wrist traveling parts of three yin meridians of hand, ranging from up 3 cun to below 1 cun of wrist crease, 3 times a week, 3 weeks as one course and totally 3 courses were required. The active range of motion (AROM) of active wrist extension, Fugl-Meyer score (FMA) and Barthel index (BI) score were observed before and after treatment in the two groups. RESULTS: The AROM, FMA scores and BI scores after treatment in the two groups were superior to before treatment (P<0.05), and the improvements of 3 indexes in the observation group were superior to the control group (P<0.05). CONCLUSION: The therapeutic effect of plum-blossom needle tapping at three yin meridians of wrist combined with rehabilitation training is superior to simple rehabilitation training on wrist joint contracture after stroke.


Assuntos
Terapia por Acupuntura , Contratura , Meridianos , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Contratura/etiologia , Contratura/terapia , Humanos , Acidente Vascular Cerebral/complicações , Resultado do Tratamento , Punho , Articulação do Punho
18.
J Stroke Cerebrovasc Dis ; 29(1): 104454, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31699572

RESUMO

BACKGROUND AND PURPOSE: Transcranial direct current stimulation (tDCS) is a treatment used in the rehabilitation of stroke patients aiming to improve functionality of the plegic upper extremity. Currently, tDCS is not routinely used in post stroke rehabilitation. The aim of this study was to establish the effects of bihemspheric tDCS combined with physical therapy (PT) and occupational therapy (OT) on upper extremity motor function. METHODS: Thirty-two stroke inpatients were randomised into 2 groups. All patients received 15 sessions of conventional upper extremity PT and OT over 3 weeks. The tDCS group (n = 16) also received 30 minutes of bihemispheric tDCS and the sham group (n = 16) 30 minutes of sham bihemispheric tDCS simultaneously to OT. Patients were evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), functional independence measure (FIM), and Brunnstrom stages of stroke recovery (BSSR) by a physiatrist blind to the treatment group RESULTS: The improvement in FIM was higher in the tDCS group compared to the sham group (P = .001). There was a significant within group improvement in FMUE, FIM and BSSR in those receiving tDCS (P = .001). There was a significant improvement in FIM in the chronic (> 6months) stroke sufferers who received tDCS when compared to those who received sham tDCS and when compared to subacute stroke (3-6 months) sufferers who received tDCS/sham. CONCLUSIONS: Upper extremity motor function in hemiplegic stroke patients improves when bihemispheric tDCS is used alongside conventional PT and OT. The improvement in functionality is greater in chronic stroke patients.


Assuntos
Cérebro/fisiopatologia , Atividade Motora , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua , Extremidade Superior/inervação , Atividades Cotidianas , Adolescente , Adulto , Idoso , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional , Modalidades de Fisioterapia , Estudos Prospectivos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Turquia , Adulto Jovem
19.
J Stroke Cerebrovasc Dis ; 29(1): 104463, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31740027

RESUMO

BACKGROUND: Stroke often results in motor impairment and limited functional capacity. This study aimed to verify the relationship between widely used clinical scales and instrumented measurements to evaluate poststroke individuals with mild, moderate, and severe motor impairment. METHODS: This cross-sectional study included 34 participants with chronic hemiparesis after stroke. Fugl-Meyer Assessment and Modified Ashworth Scale were used to quantify upper and lower limb motor impairment and the resistance to passive movement (i.e., spasticity), respectively. Upper limb Motor performance (movement time and velocities) and movement quality (range of motion, smoothness and trunk displacement) were analyzed during a reaching forward task using an optoelectronic system (instrumented measurement). Lower limb motor performance (gait and functional mobility parameters) was assessed by using an inertial measurement unit system. FINDINGS: Fugl-Meyer Assessment correlated with motor performance (upper and lower limbs) and with movement quality (upper limb). Modified Ashworth scale correlated with movement quality (upper limb). Cutoff values of 9.0 cm in trunk anterior displacement and .57 m/s in gait velocity were estimated to differentiate participants with mild/moderate and severe compromise according to the Fugl-Meyer Assessment. CONCLUSIONS: These results suggest that the Fugl-Meyer Assessment can be used to infer about motor performance and movement quality in chronic poststroke individuals with different levels of impairment.


Assuntos
Avaliação da Deficiência , Atividade Motora , Paresia/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Atividades Cotidianas , Idoso , Fenômenos Biomecânicos , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Paresia/reabilitação , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral , Resultado do Tratamento
20.
J Stroke Cerebrovasc Dis ; 29(2): 104516, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31791651

RESUMO

BACKGROUND AND PURPOSE: ASPECTS (Alberta Stroke Program Early CT Score) is a 10-point topographic CT scan score that has been shown to be a strong prognostic factor in acute ischemic stroke. We investigated whether all ASPECTS regions have the same prognostic value. METHODS: Clinical characteristics, ASPECTS, and 3-month modified Rankin Scale (mRS) data were retrospectively collected in 350 patients who were diagnosed with middle cerebral artery (MCA) territory stroke. To describe the 3-month mRS data, an ordered categorical approach was applied using a proportional odds model. Furthermore, external validation was performed using additional data from 30 patients. RESULTS: As expected, ASPECTS was an independently important predictor. However, when 10 regions were analyzed separately, the M1, M2, and M3 regions, related to MCA cortex, were not found to predict 3-month mRS scores in the final model. The odds ratios for ischemic change in other regions (except M1, M2, and M3) ranged from 2.6 to 3.8. Moreover, among clinical characteristics, only age was identified as a significant predictor. The sensitivity and specificity of the final model in the external validation were 91% and 88%, respectively. CONCLUSIONS: All ASPECTS regions did not have the same predictive power for functional outcomes, defined as the 3-month mRS. The implementation of a proportional odds model allowed a proper description of the ordered categorical nature of the mRS and the identification of relevant predictors.


Assuntos
Infarto da Artéria Cerebral Média/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Infarto da Artéria Cerebral Média/fisiopatologia , Infarto da Artéria Cerebral Média/reabilitação , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Estudos Retrospectivos , Reabilitação do Acidente Vascular Cerebral , Fatores de Tempo
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