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1.

Background

In this study, we investigated the effects of short- and long-term exercise on motor functional recovery following intracerebral hemorrhage (ICH) in rats.

Methods

Male Wistar rats were randomly divided into 5 experimental groups: ICH without training (ICH group), ICH with long-term exercise for 14days from the second day after surgery (ICH?+?LT group), ICH with short-term exercise for 7days from the second day after surgery (ICH?+?EST group), ICH with short-term exercise for 7days from the ninth day after surgery (ICH?+?LST group), and sham operation without training (SHAM group). ICH was induced by collagenase injection into the left striatum. Forelimb sensorimotor function was evaluated using forelimb placing and horizontal ladder tests.

Results

In the behavioral test, the ICH?+?LT and ICH?+?EST groups improved significantly compared with the ICH and ICH?+?LT groups. The ICH?+?LT and ICH?+?EST groups recovered motor function in an almost analogous pattern.

Conclusions

Our results indicated that, when exercise was started from an early phase after ICH, both short- and long-term exercises had similar benefits on motor functional recovery. However, continuous training using simple treadmill running may have limitations to motor functional recovery.  相似文献   

2.

Background

The aim of this study was to systematically assess the effects of exercise rehabilitation program accompanied by experiential music for clinical recovery.

Methods

This was a prospective randomized study with 65 stroke survivor patients. All cases underwent a neuropsychological assessment first as a prescreening test, during the admission at the Rehabilitation center (baseline), and 6 months poststroke. All patients received standard treatment for stroke in terms of medical care and rehabilitation. Additionally, all patients were separated into 2 Groups: a music Group (daily listening to experiential/traditional music), and a control Group (CG) with no experiential/traditional music therapy (standard care only). Computed tomography perfusion and full neurological examination including GCS were assessment. As Recovery was defined the improvement of cognitive and motor skills of the limb in the affected site, with an increase of muscle strength at least by 1/5 and with emotional progress.

Results

Statistically significant differences were found between the Group CG and the rest of the patients in respect of Lesion size (P = .001) and CBF in affected area (P = .001). Μultivariate analysis revealed that only Group and Lesion size were independent predictors for Recovery (odd ratio [OR][95%confidence interval]) .11(.001-.133) and .798(.668-.954) respectively.

Conclusion

The findings of this study suggest that the music-based exercise program has a positive effect on mood profile in stroke patients and Recovery rate is higher when exercise rehabilitation program was accompanied by an enriched sound environment with experiential music.  相似文献   

3.

Background

Poststroke, sensory deficits are not uncommon. In spite of the close association between the sensory and motor recovery, the deficits are usually underemphasized. Mirror therapy (MT), a neural-based approach for the motor deficit has not been explored for the sensory impairment. The objective of the present study was to develop and determine the effect of a MT program for sensori-motor impairment among poststroke subjects.

Methods Design

Randomized controlled trial.

Setting

Functional therapy laboratory of Rehabilitation Institute.

Participants

Thirty-one chronic poststroke subjects (17 experimental and 14 controls), aged between 30 and 60years, with ≤ diminished light touch in the hand.

Outcome Measure

Semmes Weinstein Monofilament (cutaneous threshold), 2-Point discrimination test (touch discrimination) and Fugl-Meyer Assessment (hand motor recovery).

Intervention

The experimental group received sensory stimulus such as tactile perception and motor tasks on the less-affected hand using mirror box. The control counterparts underwent only dose-matched conventional program. 30 sessions with a frequency of 5/week were imparted to the groups.

Results

Post intervention, there was a significant (P < .004) increase up to 30% positive touch-response for the hand quadrants among the experimental group in comparison to only 13.5% rise for the same among the controls. The cutaneous threshold of the less-affected palm also improved significantly among the experimental subjects in comparison to the controls (P = .04).

Conclusion

MT may be considered as a promising regime for enhancing cutaneous sensibility in stroke. The mirror illusion induced by MT may be utilized for sensory and motor deficits as well as for the more-affected and less-affected hands.  相似文献   

4.

Background

We present a single institution registry with the novel feature of 90-day outcome assessments on all hospitalized acute stroke patients, inclusive of every patient with a primary discharge diagnosis of transient ischemic attack (TIA), acute ischemic stroke (AIS), nontraumatic subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH).

Methods

Patient data obtained in the HOPES registry include demographics, comorbid diagnoses, medications, health behaviors, laboratory values, imaging studies, vital signs, and outcome measures, most notably the modified Rankin Scale (mRS) at 90days.

Results

From May 2016 to December 31, 2017, 1607 patients were enrolled in the HOPES registry. 90-day outcome assessments were captured on 1555 patients (97%): 1096 AIS, 230 ICH, 110 SAH, and 119 TIA patients. Mortality rates and 90-day outcomes were most favorable for TIA patients. Mortality and 90-day disability scores were poorest for patients in the ICH group.

Conclusions

The inclusion of 90-day outcomes data will allow HOPES to stand apart among stroke registries as a new standard for stroke outcomes research. The registry will provide the necessary comprehensive data that the field needs as we transition our focus of stroke research to poststroke recovery.  相似文献   

5.
6.

Goal

The main objective was to use the inertial sensor integrated into a smartphone to collect quantitative data on lower limb functioning during execution of the timed up and go test and sit to stand test by people in the acute stage of stroke. The secondary objective was to analyze whether smartphones provide reliable quantitative data on performance of these functional tests.

Material and Methods

Cross-sectional analytical study involving 8 elderly people (M age?=?67.50 years). Both tests were performed to parametrize and analyze the functionality, balance, and strength of lower limbs using an inbuilt inertial sensor of the smartphone. Time, difference in trunk position, angular displacement, angular velocity, and angular acceleration were measured and calculated for each stage at which both functional tests were divided.

Results

The obtained results highlight the similarity in the angular displacement during the 2 stages into which the sitting-standing (flexion: 38.85° and extension: 38.10°) and the standing-sitting (flexion: 36.42° and extension: 36.45°) phases were divided. Mean velocities of .59 m/s and .61 m/s were registered during outward and return walking phases. The intra- and interobserver reliability of variables recorded with the inbuilt inertial sensor ranged from .860 to .897.

Conclusions

Balance and muscle strength problems of stroke patients gave rise to the use of compensatory mechanisms when getting up from or sitting down in a chair and resulted in a reduction in walking speed that is sufficient to make walking in community contexts difficult. Smartphones has excellent reliability when used to quantify lower limb functioning in stroke patients.  相似文献   

7.

Background

The treatment of acute ischemic stroke due to large vessel occlusion (LVO) has revolutionized in the last decade. We sought to compile the most relevant literature published about the evolution in treating this disabling and fatal disease.

Methods

A literature review of recent studies describing early treatment options like intravenous tissue plasminogen activator to the latest mechanical thrombectomy (MT) techniques was performed. We described in a chronological order the evolution of LVO treatment.

Results

Recanalization rates with newer techniques and MT devices approach a 90% of effectiveness. Timely interventions have also resulted in better clinical outcomes with approximately 50% of patient achieving functional independence at 90 days. At least 14 new third generation thrombectomy devices are currently being evaluated in in vitro and clinical studies.

Conclusions

The treatment of LVO with MT is feasible and safe. MT is standard of care in treating acute ischemic stroke due to LVO.  相似文献   

8.

Background

The sudden live changes of stroke survivors may lead to negative psychological and behavioral outcomes, including anxiety and depressive mood, which may compromise the rehabilitation process. Some personality features, such as self-efficacy, could play an important role in mediating the degree of post-stroke depression. Aim of this study is to investigate the possible correlation between specific psychological dimensions, such as poststroke depression and self-efficacy, and rehabilitation outcomes.

Materials and Methods

Thirty-eight patients, affected by stroke, completed a four-hour-daily training lasting up to 8 weeks, including traditional and robotic-assisted physiotherapy. Patients were assessed at admission (T0) and at the end (T1) of the motor training, by means of the Montgomery-Asberg Depression Scale, the General Self-Efficacy Scale, and the Functional Independent Measure.

Results

We observed a significant T0-T1 difference in MADRS scores in patients with a better functional recovery (t?=?5.76; P < .0001) and higher self-efficacy (t?=?4.74; P < .001), but no significant T0-T1 difference in individuals without functional recovery (t?=?1.21; P?=?.239) and low self-efficacy (t?=?1.72; P?=?.103).

Conclusions

Our study shows that rehabilitation outcomes and self-efficacy may influence mood, but not vice versa. Thus, to potentiate self-efficacy in the rehabilitation setting may help clinicians in obtaining better functional outcomes, including depression reduction.  相似文献   

9.

Background

Several studies have reported on predictors for caregiver burden in patients with stroke, but the magnitude of the impact of these variables remains unclear. The aim of the study was to determine the magnitude of relationship between each predictor and caregiver burden.

Methods

Articles related to this filed were search in PUBMED, MEDLINE and Cochrane Library electronic database from the upset to May 2018. Of the 812 articles identified, 22 were included in the final analysis (3025 patients and 2887 caregivers). Weighted correlation coefficient (r-index) was computed as effect size for each predictor.

Results

Of predictor variables of patients, the activity of daily living and anxiety had moderate to large effect sizes; gender, neurological function and depression had the small to moderate effect sizes. Of caregivers’ predictors, depression, anxiety, and sense of coherence had large effect sizes; gender, daughter in law, physical health and employment status had small to moderate effect sizes.

Conclusions

The most powerful predictors of caregiver burden using meta-analysis were identified to direct future research and evidence-based practice.  相似文献   

10.

Objective

Virtual reality game system is one of novel approaches, which can improve hemiplegic extremity functions of stroke patients. We aimed to evaluate the effect of the Microsoft Xbox 360 Kinect video game system on upper limb motor functions for subacute stroke patients.

Methods

The study included 42 stroke patients of which 35 (19 Virtual reality group, 16 control group) completed the study. All patients received 60 minutes of conventional therapy for upper extremity, 5 times per-week for 4 weeks. Virtual reality group additionally received Xbox Kinect game system 30 minutes per-day. Patients were evaluated prior to the rehabilitation and at the end of 4 weeks. Box&Block Test, Functional independence measure self-care score, Brunnstorm stage and Fugl-Meyer upper extremity motor function scale were used as outcome measures.

Results

The Brunnstrom stages and the scores on the Fugl-Meyer upper extremity, Box&Block Test and Functional independence measure improved significantly from baseline to post-treatment in both the experimental and the control groups. The Brunnstrom stage-upper extremity and Box&Block Test gain for the experimental group were significantly higher compared to the control group, while the Brunnstrom stage-hand, the Functional independence measure gain and Fugl-Meyer gain were similar between the groups.

Conclusions

We found evidence that kinect-based game system in addition to conventional therapy may have supplemental benefit for stroke patients. However, for virtual reality game systems to enter the routine practice of stroke rehabilitation, randomized controlled clinical trials with longer follow-up periods and larger sample sizes are needed especially to determine an optimal duration and intensity of the treatment.  相似文献   

11.

Goal

We studied time trends of admission in neurological rehabilitation units (NRU) among patients hospitalised for stroke from 2010 to 2014 and compared prognostic factors of functional gain, home return and inpatient survival.

Methods

Patients hospitalized for Stroke from 2010 to 2014 were selected from the French national hospital databases. Admission in rehabilitation was searched till 3 months. Predictive factors of functional gain, home return, in-patient survival, and the corresponding trends were studied using logistic regression.

Results

In 2014, global rehabilitation rate was 36.3% with 15.8 discharged in a NRU. The rate of patients managed in NRU rose between 2010 and 2014. An increase in the proportion of home return (+4%) and inpatient survival rate (+7%) were observed between 2010 and 2014. Almost 40% of patients with severe functional deficits benefited of a partial or complete recovery after their rehabilitation stay. NRU admission was associated with higher probability of functional gain (OR [odds ratio] =1.76 [confidence interval {CI} 95% 1.67-1.85]), home return (OR?=?1.38 [CI 95% 1.29-1.47]) and inpatient survival (OR?=?3.15 [CI 95% 2.83-3.52]).

Conclusions

A greater proportion of patients were admitted in NRU along with an increase of home return and in-patient survival, but too many patients remained excluded.  相似文献   

12.

Background

Acute-stroke prognostic indicators remain controversial including relationship of urinary incontinence with outcomes in cognition, transfers, and discharge destination.

Objective

To examine if urinary incontinence is associated with inpatient-rehabilitation (IR) outcomes in cognition, transfers, and discharge destinations.

Design

Retrospective observational study of 303 of 579(52%) acute-stroke patients admitted to IR 2012-2015 with complete urinary incontinence (total assistance for bladder management). Discharge Functional Independence Measure (FIM) scores were correlated for continence, cognition, transfers-(bed/chair/wheelchair), and discharge destination.

Results

Patients were admitted to IR on average 7.4 days after acute stroke. Average length-of-stay in IR was 14 days. At discharge 118 of 303(39%) remained urinary incontinent (total assistance). Continence/bladder-management FIM scores at discharge were associated with cognition FIM scores at discharge (chi square =105.8; P < .0001), and associated with transfer FIM scores at discharge (chi square?=?153.1; P < .0001). Patients total to moderate assistance for continence at discharge included greater percentage that were dependent to moderate assistance for cognition and transfers than those minimal assistance to independent for continence. Continence/bladder-management FIM scores at discharge were associated with discharge disposition destinations (chi square?=?29.98; P < .002). Patients total to moderate assistance for continence at discharge included greater percentage of acute care transfers, and skilled-nursing-facility dispositions, than patients that recovered to minimal assist to independent for continence. Urinary-incontinence recovery to minimal assistance to independent was associated with a home/community disposition rate of 82%.

Conclusions

52% stroke patients were total assistance with bladder management for urinary incontinence on IR admission. Partial to complete continence recovery occurred in 61%. Continence/bladder-management FIM scores at discharge were associated with cognition and transfer FIM scores, and discharge destinations.  相似文献   

13.

Objective

This study aims to observe the clinical effect of upper limb ischemic postconditioning (LIPostC) as an adjunct to treatment with acute stroke patients, possibly due to increased cerebral perfusion.

Methods

We perform a randomized blinded placebo controlled trial in nonthrombolysis patients with acute ischemic stroke, within 72hours of ictus, divided into the LIPostC group and control group. The LIPostC group is induced by 4 cycles of intermittent repeated limb ischemia: alternating 5 minutes inflation (20mm Hg above systolic blood pressure) and 5 minutes deflation performed manually using a standard upper arm blood pressure cuff in the nonparetic arm. The control group receives a sham procedure (cuff inflation to 30mm Hg). Patients underwent the intervention from the time of enrollment to Day 14. Comparison of National Institutes of Health Stroke Scale (NIHSS) score, cerebral infarction volume, relative Perfusion weighted imaging (PWI) parameters (regional relative cerebral blood flow, regional relative mean transit time; preintervention [day 0], day 14, day 90), modified Rankin Scale (mRS; the preintervention score [day 0], the curative ratio at day 90 [we define 0-1 score as close to recovery or full recovery]).

Results

Sixty eligible patients with acute stroke (29 LIPostC and 31 control) are recruited age 65years (SD 12.22), blood pressure 156/74mm Hg (SD 14/10), and NIHSS score 5.98 (SD 3.35), mRS score 2.25 (SD .79). Only 1 in the LIPostC group is intolerant the first cycle to give up. All patients tolerate the sham procedure. Two patients experience recurrent stroke versus none in the LIPostC group. Day 90, compared with the control group, there is a significant decrease the NIHSS score, regional relative mean transit time (P < .05) and increase the curative ratio of mRS, regional relative cerebral blood flow(P < .05) in the LIPostC group, which infarct volume decreased by 31.3% (P < .05).

Conclusions

LIPostC after acute stroke is well tolerated and appears safe and feasible. LIPostC may improve neurological outcome, and protective mechanisms may be increased cerebral blood flow to improve cerebral perfusion. A larger trial is warranted.  相似文献   

14.

Introduction

Capsular warning syndrome (CWS) is characterized by recurrent conventional episodes of motor and/or sensory deficits without cortical symptoms. The purpose of this case series study was to evaluate the safety and appropriate treatment for CWS to prevent the development of complete stroke.

Methods

We reviewed our hospital records and previous reports to find patients with neurologically fluctuating profiles, and excluded those with unknown details of initial treatment/final treatment of antiplatelet therapy or radiological findings.

Results

We retrieved two cases of CWS from our hospital, which presented motor and/or sensory symptoms followed by complete resolution without complete ischemia. The recurring episodes in both were unable to be stabilized by single antiplatelet therapy but were successfully managed using two or more antiplatelet drugs. In 11 previously reported cases of CWS, the recurring episode was frequency stabilized with plural antiplatelet therapy.

Conclusion

Multiplicate antiplatelet therapy is important for treatment of CWS, and caution is needed regarding hemorrhagic complications.  相似文献   

15.

Background

The incidence and predictors for in-stent restenosis (ISR) was not fully explored. We aim to investigate the incidence and predictors of ISR after stenting at the origin of vertebral artery.

Materials and Methods

Two hundred and six patients with 229 stents implantation between July 1, 2005 and July 31, 2015 were included in the study. All patients underwent conventional clinical and angiographic (digital subtraction angiography) follow-up at around 6 months post procedure. ISR was defined as greater than 50% stenosis within or immediately (within 5 mm) adjacent to the stent. Multivariate Cox regression analyses were utilized to investigate the predictors for ISR.

Results

The ISR was found in 30 patients (30/206, 14.6%) with 31 lesions (31/229, 13.5%) with the mean follow-up duration of 11.1-month (range: 3 - 92 months). Stent diameter (hazard ratio 0.504, 95% confidence interval 0.294 - 0.864) was an independent predictor for ISR.

Conclusion

ISR rate after Vertebral artery ostium stent placement is acceptable, which was conversely associated with the stent diameter.  相似文献   

16.

Objectives

To describe the neurological manifestations of invasive aspergillosis presenting with a focal neurological deficit compatible with an acute stroke.

Materials and Methods

Retrospective analysis of a clinical series of patients between 2011 and 2017 with invasive aspergillosis and neurological symptoms compatible with an acute brain stroke. Clinical and epidemiological data, microbiological results, radiological findings, treatment, and course were recorded.

Results

Five patients were selected with a mean age of 55.4years. All patients were immunosuppressed. In 4, systemic infection was unknown. In every case, neurology on call was alerted because of acute focal neurological symptoms. None of the patients received revascularization procedures. Galactomannan antigen was positive in all of the patients and culture was positive in 3. Mortality was 100% despite specific antifungal treatment.

Conclusions

Acute stroke can be the first manifestation of disseminated aspergillosis. This form of presentation was frequent in our series and should be suspected in immunocompromised patients with acute neurological deficits.  相似文献   

17.

Objective

To compare the effects of Transcranial Direct Current Stimulation (tDCS) versus Galvanic Vestibular Stimulation (GVS) on Lateropulsion following stroke.

Methods

Patients with Stroke and Burke Lateropulsion Scale (BLS) scores greater than or equal to 2 gave informed consent to receive sinusoidal 1 Hz DC (0-2 mA) anodal stimulation over the affected parietal cortex versus similar GVS with ipsilesional mastoidal anode. Seated haptic center of pressure (COP-X) was measured using an AMTI analog-to-digital forceplate. An inclinometer (Biopac ) measured lateral thoracic tilt. COP-X Power Spectra were analyzed over 3 frequency intervals: 0-.3 Hz, .3-1 Hz, and 1-3 Hz.

Results

Six males/4 females age 66 ± 9.5 standard deviation with admission BLS scores of 5.4 ± 3.7 within 8.6 ± 8.1 days poststroke were enrolled. COP-X medial-lateral speed increased for both the tDCS and the GVS protocols compared to sham condition. Fourier Analysis of COP-X velocity for 0-.3 Hz responses showed a significant increase for tDCS stimulation. The .3-1 Hz responses for the tDCS condition were decreased from baseline. Lateral thoracic tilt showed significant improvement for tDCS compared to Sham stimulation at 10 minutes and for GVS versus Sham at 15 minutes.

Discussion

Anodal tDCS over the ipsilesional PIVC increases low frequency postural responses usually attributed to visual control with down regulation of median frequency vestibular responses, biasing postural control toward more dependence on visual as opposed to vestibular control.

Conclusions

2 mA sinusoidal 1 Hz anodal tDCS over the ipsi-lesional PIVC or similar ipsi-lesional anodal GVS improve Lateropulsion following stroke.  相似文献   

18.

Background

To validate iScore and PLAN score in acute anterior circulation large vessel occlusion stroke patients undergoing thrombectomy.

Methods

iScore and PLAN score were calculated for consecutive acute ischemic stroke undergoing thrombectomy were included and death at 1 month and death at 3 months were recorded. The area under the receiver operating characteristic curve was used to assess the discrimination ability of the scales for death.

Results

Two hundred and twenty-nine patients were included, 25.3% (58 of 229) of patient died at 1 month after thrombectomy and 25.8% (59 of 229) of them died at 3 months after thrombectomy. The receiver operator curve analysis found that iScore (area under the curve [AUC] = .76, 95% confidence interval [CI] .69-.83) was numerically better than PLAN score (AUC?=?.73, 95% CI .66-.81) for predicting death at day 90. The cut-off for iScore is 193, with sensitivity 64%, specificity 79%, positive predictive value 75% and negative predictive value 69%.

Conclusions

The iScore scale is a valid predictive tool for death in anterior circulation large vessel occlusions undergoing thrombectomy.  相似文献   

19.

Background

Poststroke balance impairment adversely affects stroke outcomes and addressing the impairment is expected to constitute an important focus of neurorehabilitation.

Aims

To examine the prevalence and factors associated with balance impairment after stroke.

Methods

Ninety-five stroke survivors undergoing neurorehabilitation at 2 government hospitals in Northern Nigeria participated in this cross-sectional study. Berg Balance Scale (BBS) was used to assess the presence of balance impairment (BBS score of 0-20). Prevalence of balance impairment was presented as frequency and percentage while demographic and stroke-related determinants of balance impairments were identified using logistic regression analysis.

Results

Thirty-five (36.8%) stroke survivors had balance impairment, and age, gender, and poststroke duration were statistically significant determinants. Stroke survivors aged less than 40 years (odds ratio [OR]?=?.14 [confidence interval [CI]?=?.20-.94]) and 40-59 years (OR?=?.23 [CI?=?.06-.81]) had a lower likelihood of having balance impairment compared to stroke survivors aged 60 years and above. Similarly, males had a lower likelihood of having balance impairment (OR?=?1.60 [CI?=?.05-.55]) compared to females while those in the acute/subacute phase of stroke had a 7-fold likelihood of having balance impairment (OR?=?7.74 [CI?=?2.63-22.79]) compared to those with chronic stroke.

Conclusions

Poststroke balance impairment appears to be significantly influenced by stroke survivors’ age, gender, and poststroke duration. Hence, these variables should be considered when planning rehabilitation strategies for improving balance after stroke.  相似文献   

20.
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