Chronic Ischemic Stroke Patients Research Articles

Mesenchymal Stem Cell Therapy to Reduce the Neurological Deficit of Chronic Ischemic Stroke Patients: A Systematic Review

Current ischemic and hemorrhagic stroke treatments are limited by a narrow golden period and lack of regenerative benefits, so stem cell therapy emerges as an ideal candidate for functional recovery in stroke patients. Stem cell therapy, still being studied, is expected to repair ischemic areas damaged by stroke to restore their physiological functions and reduce neurological deficits in chronic stroke patients. This study aimed to determine the therapeutic efficacy of MSCs in reducing neurological deficits in chronic ischemic stroke patients. We conducted a systematic review. We searched PubMed, Cochrane Library, Science Direct, and Springer Link from inception until December 2022 for cohort studies dealing with mesenchymal stem cell therapy for patients with ischemic stroke. The citation-searching method in this study collected 1,038 articles using the advanced searching method and 8 articles using the citation-searching method, bringing the total number of articles to 1,046. The exclusion criteria used were articles with systematic reviews and meta-analyses and articles that were not accessible in full text. Based on the results of a systematic review study conducted, the conclusion that can be drawn is that MSCs therapy has proven effective in reducing neurological deficits in chronic ischemic stroke patients in terms of the decreased NIHSS score.

Effects of Modified Constraint-Induced Movement Therapy Versus Proprioceptive Neuromuscular Facilitation on Upper Limb Motor Function in Chronic Ischemic Stroke Patients

Effects of Modified Constraint-Induced Movement Therapy Versus Proprioceptive Neuromuscular Facilitation on Upper Limb Motor Function in Chronic Ischemic Stroke Patients

Vagus Nerve Stimulation Paired With Upper Extremity Rehabilitation for Chronic Ischemic Stroke: Contribution of Dosage Parameters

Background Vagus nerve stimulation (VNS) combined with rehabilitation is a Food and Drug Administration approved intervention for moderate to severe upper extremity deficits in chronic ischemic stroke patients. Previous studies demonstrated that VNS improves upper extremity motor impairments, using the Fugl Meyer Assessment of Upper Extremity (FMA-UE); however, delineating where these improvements occur, and the role of VNS dosage parameters were not reported. Objective This study explored the relationship between dosing (time over which task repetitions were executed and number of VNS stimulations) and changes within proximal and distal components of the FMA-UE. Methods Participants underwent VNS implantation, with 1 group receiving VNS paired with rehabilitation (Active VNS) and the other group receiving rehabilitation with sham stimulation (Controls). Both groups received 6 weeks of in-clinic therapy followed by a 90-day at-home, self-rehabilitation program. Participants who completed at least 12 of 18 in-clinic sessions were included in the analyses (n = l06). Pearson correlations and analysis of covariance were used to investigate the relationship between dosing and FMA-UE outcome change along with the effect of covariates including baseline severity, time since stroke, age, and paretic side. Results Compared to Controls, active VNS favorably influenced distal function with sustained improvement after the home program. Significant improvements were observed in only distal components (FMdist) at both post day-1 (1.80 points, 95% Cl [0.85, 2.73], P < .001) and post-day 90 (1.62 points, 95% CI [0.45, 2.80], P < .007). Conclusions VNS paired with rehabilitation resulted in significant improvements in wrist and hand impairment compared to Controls, despite similar in-clinic dosing across both groups. NCT03131960

Effect of adding systematic desensitization to goal-directed paradigm on risk of falling in patients with stroke: a randomized controlled trial.

Improvement in rehabilitation outcomes for patients suffering from chronic stroke can be attained through systematic desensitization of their fear of falling, which in turn reduces the risk of falling. This study aimed to examine the effect of adding systematic desensitization to a goal-directed paradigm on functional performance, balance, risk of falling, and fear of falling among chronic ischemic stroke patients. Two equally sized groups, each comprising 40 stroke patients of both sexes, were randomly divided. For 8 weeks, Group A received three sessions per week of combined treatment consisting of systematic desensitization and a goal-directed paradigm, while Group B received only the goal-directed paradigm. The Timed Up and Go (TUG) test and Dynamic Gait Index (DGI) were used to assess function performance; the Berg Balance Scale (BBS) and the Biodex Fall Risk Index (FRI) were used to evaluate balance; and the 16-item Fall Efficacy Scale-International (FES-I) was used to evaluate fear of falling. At baseline and after the treatment, all measurements were obtained. Both groups (A and B) revealed a substantial increase in functional performance through a decrease in TUG scores and an increase in DGI. Additionally, there was a decrease in the risk of falling through an increase in the BBS scores and a decrease in the FRI. Furthermore, there was a decrease in the fear of falling, as measured using the FES-I, after treatment, with superior improvement in Group A with a p-value of <0.001. Systematic desensitization combined with a goal-directed paradigm has a superior effect on improving functional performance and reducing the risk of falling and the fear of falling in patients with stroke compared to a goal-directed paradigm alone.

Abstract TP286: Spatial Transcriptome Profile of Stem Cell-Mediated Recovery in Stroke-Injured Rat Brains

Introduction: Intraparenchymal stem cell transplantation shows therapeutic promise for chronic ischemic stroke patients. Our previous phase 1/2a trial revealed a transient T2-FLAIR (fluid-attenuated inversion recovery) MRI signal in the premotor cortex following intraparenchymal stem cell transplantation, the size of which positively correlated with the extent of clinical recovery. We sought to elucidate the underlying molecular mechanisms in this FLAIR region that may facilitate post-stroke recovery using spatial transcriptomic profiling in stroke-injured rat brains. Methods: Adult male SD rats underwent 30 min transient middle cerebral artery occlusion followed at 1 month by transplantation of human ES-derived neural stem cells (NR1) or buffer into the ipsilesional striatum. Whisker paw test and various MRI sequences (T2, FLAIR, DWI) were performed at multiple time points. The Visium platform (10X Genomics) was used for unbiased spatial transcriptome analysis in two stem-cell and two vehicle-treated brains at the peak of FLAIR. Results: We successfully replicated transplant-induced FLAIR after chronic stroke in rats and found a positive correlation between FLAIR and improved neurological outcomes. Visium identified specific gene clusters for the stroke injury, transplant/needle-track, stem cell graft, and the cortical ‘FLAIR’ region. The latter consisted of a central core containing the gene signature of the needle track and blood, and a wider region around this core which encompassed the FLAIR lesion seen by MRI. This wider FLAIR region displayed a predominantly microglia/inflammation-associated signature and was best characterized by the upregulation of apoptosis-associated genes. Pathway analysis of the differentially-expressed genes in the FLAIR cluster revealed a significant representation of immune cell responses (e.g. phagocytosis, immune cell migration, cytokine signaling), as well as ER stress mechanisms. Conclusion: This pilot study provides initial evidence that altered immune responses in the stem cell transplant-induced FLAIR region may promote recovery after chronic stroke. Further research on the role of microglia/neuroinflammation is needed to understand the mechanisms of stem cell-mediated brain repair.

The Effect of Combination of Calcium Supplement and Physical Exercise on Increasing Muscle Strength in Chronic Ischemic Stroke

Background: Stroke causes muscle weakness which results in limitations in daily activities such as self-care, eating, walking, etc. Objective: This study aims to evaluate the effect of calcium supplement and physical exercise on increasing muscle strength in chronic ischemic stroke patients. Method: This research used a quasi-experimental pretest-posttest with control group design. This research was conducted at Dadi Makassar Hospital and Haji Hospital from March to May 2023. The sample obtained was 37 subjects based purposive sampling with an unpaired numerical comparative formula for two sample groups. Consisting of 18 people in the treatment group who were given calcium supplements at a dose of 500 mg per day and physical exercise (Both training, Proprioceptive Neuromuscular Facilitation (PNF) and strengthening) and 19 people in the control group who were only given physical exercise. The research was carried out for 6 weeks using a Manual Muscle Testing (MMT) measuring instrument for muscle strength. This research used the Wilcoxon and Mann Whitney test. (α&lt;0.05) Results: There is a significant of increasing lower extremity muscle strength between pretest and posttest in treatment group and control group (p=0.001; p=0.014, p&lt;0.05), There is an increasing of the upper extremity muscle strength between pretest and posttest in treatment group and control group (p=0.001; p=0.025). There is no significant difference of increasing muscle strength in the upper and lower limb between two groups (p=0.051). Conclusion: Calcium supplements and physical exercise were no more significant in increasing muscle strength than physical exercise only in chronic ischemic stroke patients.

Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial

Purpose Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles. Methods Twenty-four patients (35–65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor. Results The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01). Conclusions Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1 IMPLICATION FOR REHABILITATION Upper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily living Applying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions

An online method to monitor hand muscle tone during robot-assisted rehabilitation.

Introduction: Robot-assisted neurorehabilitation is becoming an established method to complement conventional therapy after stroke and provide intensive therapy regimes in unsupervised settings (e.g., home rehabilitation). Intensive therapies may temporarily contribute to increasing muscle tone and spasticity, especially in stroke patients presenting tone alterations. If sustained without supervision, such an increase in muscle tone could have negative effects (e.g., functional disability, pain). We propose an online perturbation-based method that monitors finger muscle tone during unsupervised robot-assisted hand therapy exercises. Methods: We used the ReHandyBot, a novel 2 degrees of freedom (DOF) haptic device to perform robot-assisted therapy exercises training hand grasping (i.e., flexion-extension of the fingers) and forearm pronosupination. The tone estimation method consisted of fast (150ms) and slow (250ms) 20mm ramp-and-hold perturbations on the grasping DOF, which were applied during the exercises to stretch the finger flexors. The perturbation-induced peak force at the finger pads was used to compute tone. In this work, we evaluated the method performance in a stiffness identification experiment with springs (0.97 and 1.57N/mm), which simulated the stiffness of a human hand, and in a pilot study with subjects with increased muscle tone after stroke and unimpaired, which performed one active sensorimotor exercise embedding the tone monitoring method. Results: The method accurately estimates forces with root mean square percentage errors of 3.8% and 11.3% for the soft and stiff spring, respectively. In the pilot study, six chronic ischemic stroke patients [141.8 (56.7) months after stroke, 64.3 (9.5) years old, expressed as mean (std)] and ten unimpaired subjects [59.9 (6.1) years old] were tested without adverse events. The average reaction force at the level of the fingertip during slow and fast perturbations in the exercise were respectively 10.7 (5.6) N and 13.7 (5.6) N for the patients and 5.8 (4.2) N and 6.8 (5.1) N for the unimpaired subjects. Discussion: The proposed method estimates reaction forces of physical springs accurately, and captures online increased reaction forces in persons with stroke compared to unimpaired subjects within unsupervised human-robot interactions. In the future, the identified range of muscle tone increase after stroke could be used to customize therapy for each subject and maintain safety during intensive robot-assisted rehabilitation.

Abstract WMP37: Differential Montage Effect On Cortical Excitability In Ischemic Stroke Patients By Single Session Of High Amperage Transcranial Direct Current Stimulation

Background and Objective: We aim to assess the cortical excitability under three montages with single session of transcranial direct current stimulation (tDCS) at 4 mA on ischemic stroke patients. Methods: Adult subjects with first-ever unilateral ischemic stroke ≥6 months and inducible motor evoked potentials (MEP) underwent 3 sessions (washed out ≥2 days apart) of 30 minutes 4 mA tDCS in anodal, cathodal or bihemispheric montage (in pseudorandom order) combined with t upper extremity repetitive task training administered by an Occupational Therapist. We collected MEP responses to transcranial magnetic stimulation (TMS) single pulse, short intracortical inhibition (SICI, 3 ms) and intracortical facilitation (ICF, 15 ms) on bilateral abductor pollicis brevis (APB) muscles at baseline and four post-stimulation timepoints 12 minutes apart. We also monitored safety by recording adverse events, surveying subjects with a questionnaire on tolerability issues and collecting biometric measures (body resistance, skin temperature under the tDCS electrode). Results: Eighteen subjects completed 54 tDCS sessions in total. We observed montage ( P &lt;0.0001) and time ( P &lt;0.01) effects only on the lesioned hemisphere, with bihemispheric tDCS showing relatively higher peak-to-peak MEP. Lack of montage effect in baseline ( P &gt;0.949) suggested sufficient washout interval across the visits. No subjects experienced any adverse events. Biometric measures and tolerability were comparable across the three montages. The most common tolerability issue was transient redness under the tDCS electrodes (70% at anode, 48% at cathode). Conclusions: The bihemispheric montage increased ipsilateral cortical excitability the most in a single session of 4 mA tDCS in chronic ischemic stroke patients. Additionally, a current level of 4 mA is safe and tolerable over multiple sessions.

The effect of aquatic training on static and semi-dynamic balance of patients with chronic ischemic stroke: A randomized clinical trial.

Objectives This study aims to investigate the effect of six-week aquatic exercise on the static and semi-dynamic balance of male patients with chronic ischemic stroke (CIS). Patients and methods This randomized clinical trial (RCT) included a total of 36 male CIS patients (mean age 60.2±6.7 years; range, 40 to 70 years) between January 2015 and January 2017. The patients were randomly divided into three groups consisting of 12 patients in each group: (i) exercising in shallow water, (ii) exercising in deep water, and (iii) control group. Training sessions were held three days a week for six weeks, and the control group did not participate in these sessions. The balance of the patients was checked using the Biodex balance system in two stages. Results There was no significant difference between the two intervention groups (shallow and deep) in terms of the balance assessment post-test (p>0.05), yet there was a statistically significant difference between the two intervention groups (shallow and deep) with the control group in terms of the semi-dynamic balance (total) score, (p<0.05); the semi-dynamic balance (total) of the two intervention groups (shallow and deep) was higher than that of the control group (p<0.05). Conclusion Our study results indicate that exercise in both depths is a suitable solution to improve balance, particularly semi-dynamic balance (total) in male CIS patients. Accordingly, aquatic training has a positive effect on balance in male stroke patients and we can prescribe this protocol as a useful remedy for these patients.

Effect of RehaCom cognitive rehabilitation software on working memory and processing speed in chronic ischemic stroke patients

ABSTRACT Stroke survivors need assistance to overcome cognitive impairments. Working memory (WM) and processing speed (PS) as two critical cognitive functions are disrupted by stroke. The goal of this study was to investigate the effect of RehaCom rehabilitation software on WM and PS in participants with chronic ischemic stroke with hemiplegia (right/left side). Participants were selected among stroke patients who were referred to our special rehabilitation clinic. Fifty participants were assigned to control (n = 25) and experimental (n = 25) groups. The results of the experimental group were compared with the control group before and after the treatment with RehaCom (ten 45-min sessions across five weeks, two sessions per week). The results showed a significant improvement in WM and PS in the experimental group in comparison with the control group after a 5-week training with RehaCom. In conclusion, our findings indicate that treatment with RehaCom software improves WM and PS in chronic ischemic stroke participants with hemiplegia. The exact mechanism of RehaCom is largely unknown and further studies are needed, but its effects on the function of brain regions involved in modulating cognitive functions such as the prefrontal cortex, cingulate cortex, and parietal cortex may be mechanisms of interest.

The Effect of Sham Controlled Continuous Theta Burst Stimulation and Low Frequency Repetitive Transcranial Magnetic Stimulation on Upper Extremity Spasticity and Functional Recovery in Chronic Ischemic Stroke Patients

ObjectiveThis randomized controlled study examined the effect of continuous theta burst stimulation (cTBS) and low frequency repetitive transcranial magnetic stimulation (rTMS) on upper extremity spasticity and functional recovery in chronic ischemic stroke patients. Materials and MethodsTwenty chronic ischemic stroke patients were randomized into three groups as real rTMS group (n = 7), real cTBS group (n = 7) and sham cTBS group (n = 6), in which real rTMS with physical therapy (PT), real cTBS with PT and sham cTBS with PT were applied in 10 sessions, respectively. The evaluation parameters were assessed at pre-treatment, post-treatment and follow up at 4 weeks. ResultsTen sessions of real rTMS or real cTBS combined with PT were found beneficial in motor functional recovery and daily living activities both at post-treatment and follow up at 4 weeks (p ˂ 0.05). In the sham cTBS group, functional improvement was not significant (p > 0.05). In addition, in the real rTMS group, elbow flexor, pronator, wrist flexor and finger flexor spasticity were significantly decreased; in the real cTBS group, significant decrease was observed in the elbow flexor and wrist flexor spasticity (p ˂ 0.05). In comparison with sham cTBS group, only in the real cTBS group, significant improvement was observed in the level of wrist flexor spasticity at follow up at 4 weeks (p ˂ 0.017). ConclusionsIn this study, it was observed that real cTBS or real rTMS combined with PT provided improvement on upper extremity motor functions and daily living activities in chronic ischemic stroke patients, but improvement in spasticity was limited.

The Efficiency of Spa Rehabilitation in Chronic Ischemic Stroke Patients-Preliminary Reports.

Background: Rehabilitation-oriented therapy after a stroke must continue in various forms as a life-long effort. Aim: The study investigated the impact of spa rehabilitation on the quality of life and functional efficiency in patients after an ischemic stroke at a chronic stage of recovery. Methods: The assessment was carried out in a spa resort in southeastern Poland. It involved 32 patients with strokes who participated in a three-week rehabilitation program. Three examinations were performed: upon admission, on the day of discharge and at a two-month follow-up. The quality of life and functional efficiency were assessed with the WHOQOL-BREF and Barthel Index. Results: The quality of life was significantly higher in Exam II compared with Exam I (p < 0.001), and improvement was retained at the follow-up. The Barthel scores were higher in Exam II compared with Exam I (79.84 vs. 68.59), while the differences between the scores in Exams II and III were small (p = 0.039). Conclusions: Three-week spa rehabilitation seems to favorably affect the functional efficiency and quality of life after a stroke. The effects appear to be long-term. The gender, age and time from stroke onset do not seem to impact short-term effects. However, long-term effects are related to the time from stroke onset.

Multimodal Assessment of the Motor System in Patients With Chronic Ischemic Stroke.

Despite continuing efforts in the multimodal assessment of the motor system after stroke, conclusive findings on the complementarity of functional and structural metrics of the ipsilesional corticospinal tract integrity and the role of the contralesional hemisphere are still lacking. This research aimed to find the best combination of motor system metrics, allowing the classification of patients into 3 predefined groups of upper limb motor recovery. We enrolled 35 chronic ischemic stroke patients (mean 47 [26-66] years old, 29 [6-58] months poststroke) with a single supratentorial lesion and unilateral upper extremity weakness. Patients were divided into 3 groups, depending on upper limb motor recovery: good, moderate, and bad. Nonparametric statistical tests and regression analysis were used to investigate the relationships among microstructural (fractional anisotropy (FA) ratio of the corticospinal tracts at the internal capsule (IC) level (classic method) and along the length of the tracts (Fréchet distance), and of the corpus callosum) and functional (motor evoked potentials [MEPs] for 2 hand muscles) motor system metrics. Stratification rules were also tested using a decision tree classifier. IC FA ratio in the IC and MEP absence were both equally discriminative of the bad motor outcome (96% accuracy). For the 3 recovery groups' classification, the best parameter combination was IC FA ratio and the Fréchet distance between the contralesional and ipsilesional corticospinal tract FA profiles (91% accuracy). No other metrics had any additional value for patients' classification. MEP presence differed for 2 investigated muscles. This study demonstrates that better separation between 3 motor recovery groups may be achieved when considering the similarity between corticospinal tract FA profiles along its length in addition to region of interest-based assessment and lesion load calculation. Additionally, IC FA ratio and MEP absence are equally important markers for poor recovery, while for MEP probing it may be important to investigate more than one hand muscle.

Effect of mirror therapy on hand functions in Egyptian chronic stroke patients

BackgroundMost stroke survivors (more than 60%) suffer from persistent neurological impairments that significantly affect activities of daily living. Hand functions are essential for doing daily living and working activities. Mirror therapy is shown to be effective in improving hand functional recovery in stroke patients.ObjectiveThis study aimed to determine the effect of mirror therapy on improving hand functions in Egyptian chronic stroke patients.Subjects and methodsThirty chronic ischemic stroke patients from both sexes participated in the study. Their ages ranged from 45 to 65 years. They were randomly assigned into two equal groups: the study group that received a selected physical therapy program in addition to the mirror therapy and the control group that received the same selected physical therapy program but without a mirror therapy. Treatment sessions were conducted three times per week for 8 weeks. Range of motion (ROM) of the wrist extension and forearm supination, hand grip strength, and the time of Jebson Hand Function Test (JHFT) were measured before and after the treatment program.ResultsThere were statistically significant increases in the range of motion of the wrist extension and forearm supination and hand grip strength with a decrease in the time of Jebson Hand Function Test in both groups post-treatment. Post-treatment improvement was more significant in the study group compared to the control group.ConclusionMirror therapy had a positive effect on improving hand motor functional skills in a sample of Egyptian chronic stroke patients.

Implantation of the clinical-grade human neural stem cell line, CTX0E03, rescues the behavioral and pathological deficits in the quinolinic acid-lesioned rodent model of Huntington's disease

Huntington's disease (HD) is a devastating, autosomal‐dominant neurodegenerative disease, for which there are currently no disease‐modifying therapies. Clinical trials to replace the damaged striatal medium spiny neurons (MSNs) have been attempted in the past two decades but have met with only limited success. In this study, we investigated whether a clonal, conditionally immortalized neural stem cell line (CTX0E03), which has already shown safety and signals of efficacy in chronic ischemic stroke patients, could rescue deficits seen in an animal model of HD. After CTX0E03 transplantation into the quinolinic acid‐lesioned rat model of HD, behavioral changes were measured using the rotarod, stepping, and staircase tests. In vivo differentiation and neuronal connections of the transplanted CTX0E03 cells were evaluated with immunohistochemical staining and retrograde tracing with Fluoro‐Gold. We found that transplantation of CTX0E03 gave rise to a significant behavioral improvement compared with the sham‐ or fibroblast‐transplanted group. Transplanted CTX0E03 formed MSNs (DARPP‐32) and GABAergic neurons (GABA, GAD65/67) with BDNF expression in the striatum, while cortically transplanted cells formed Tbr1‐positive neurons. Using a retrograde label, we also found stable engraftment and connection of the transplanted cells with host brain tissues. CTX0E03 transplantation also reduced glial scar formation and inflammation, as well as increasing endogenous neurogenesis and angiogenesis. Overall, our results demonstrate that CTX0E03, a clinical‐grade neural stem cell line, is effective for preclinical test in HD, and, therefore, will be useful for clinical development in the treatment of HD patients.

Relation between Cardiorespiratory Fitness Measured with Six-Minute Walk Test and Walking Speed Measured with 1— Meter Walk Test in Patients of Post-Subacute and Chronic Ischemic Stroke

Background: Cardiorespiratory fitness measurement using 6MWT (Six Minute Walking Test) and walking speed measurement using 10MWT (Ten Minute Walking Test) in post-stroke patients are measurement to assess post-ischemic stroke patients in subacute or chronic phase. This study is to assess cardiorespiratory fitness and to measure walking speed of post-stroke patients in subacute and chronic. We also aim to observe the relation between cardiorespiratory fitness and walking speed in post-stroke patients. Method: This study involved 38 subjects as samples. 6MWT assessment was conducted by measuring the mileage in six minutes. Walking speed was conducted afterwards with self-speed and fast-speed which were respectively assessed through three repetitions. Results: We found string correlation in 6MWT assessment results with mileage in meter and VO2 max (r = 0.680 and p = 0.000). The result of 6MWT measured with VO2 max (ml/kg/minute) indicated strong correlation with 10MWT both with self-speed (r = 0.715, p = 0.000) and fast-speed (r = 0.687 p = 0.000). Conclusions: We concluded that there was a relation between cardiorespiratory fitness and walking speed in post-subacute and chronic ischemic stroke patients.

Comparison of long-term efficacy and safety between cilostazol and clopidogrel in chronic ischemic stroke: a nationwide cohort study.

Background:Previous clinical trials showed a significant difference in efficacy and safety among antiplatelets in acute ischemic stroke (IS). The present study wished to compare the efficacy and safety head-to-head between cilostazol and clopidogrel in chronic IS.Methods:This open prospective cohort study recruited chronic IS patients with an index hospitalization between 2001 and 2013 from Taiwan National Health Insurance Research Database. In the 504,191 hospitalized patients, patients who had missing information and history of atrial fibrillation or rheumatic heart disease, received mechanical valve replacement or anticoagulants, expired during the index hospitalization, received follow-up ⩽6 months, or had recurrent stroke within 6 months after index stroke were excluded.Results:Among the 15,968 eligible patients, 502 patients who consistently received either cilostazol or clopidogrel from the 7th month after the index stroke were included for analysis after propensity score matching. The 3-year primary outcomes showed similar frequency of recurrent IS, all-cause mortality, and acute myocardial infarction (AMI), and similar frequency of intracerebral hemorrhage, gastrointestinal bleeding, and major bleeding between the cilostazol and clopidogrel groups. Subgroup analysis revealed that patients with a history of hypertension or gastrointestinal bleeding had a trend of having lower frequency of recurrent IS or major bleeding, respectively, in the cilostazol group.Conclusion:The present real-world study demonstrated no significant difference in efficacy and safety between cilostazol and clopidogrel in chronic IS. However, cilostazol might be better than clopidogrel in patients with a history of hypertension or gastrointestinal bleeding.

Automatic post-stroke lesion segmentation on MR images using 3D residual convolutional neural network.

In this paper, we demonstrate the feasibility and performance of deep residual neural networks for volumetric segmentation of irreversibly damaged brain tissue lesions on T1-weighted MRI scans for chronic stroke patients. A total of 239 T1-weighted MRI scans of chronic ischemic stroke patients from a public dataset were retrospectively analyzed by 3D deep convolutional segmentation models with residual learning, using a novel zoom-in&out strategy. Dice similarity coefficient (DSC), average symmetric surface distance (ASSD), and Hausdorff distance (HD) of the identified lesions were measured by using manual tracing of lesions as the reference standard. Bootstrapping was employed for all metrics to estimate 95% confidence intervals. The models were assessed on a test set of 31 scans. The average DSC was 0.64 (0.51-0.76) with a median of 0.78. ASSD and HD were 3.6mm (1.7-6.2mm) and 20.4mm (10.0-33.3mm), respectively. The latest deep learning architecture and techniques were applied with 3D segmentation on MRI scans and demonstrated effectiveness for volumetric segmentation of chronic ischemic stroke lesions.

Clinical improvement with intensive robot-assisted arm training in chronic stroke is unchanged by supplementary tDCS.

Intensive robot-assisted arm training in the chronic phase of stroke recovery can lead to clinical improvement. Combinatorial therapeutic approaches are sought to further optimize stroke recovery. Transcranial direct current stimulation (tDCS) is one candidate to combine with robotic training, as transient increases in excitability and improvements in motor behavior have separately been reported. To determine whether tDCS, delivered prior to robotic training, could augment clinical improvement. We conducted a dual-site, randomized controlled trial in 82 chronic ischemic stroke patients (inclusion > 6 m post-injury, dominant hemisphere, first stroke; residual hemiparesis) who were split into two groups to receive tDCS (M1-SO montage, anode ipsilesional, 5×7 cm electrodes, 2 mA, 20 mins) or sham tDCS, prior to robotic upper-limb training (12 weeks; 36 sessions; shoulder-elbow robot or wrist robot on alternating sessions). The primary end-point was taken after 12 weeks of training, and assessed with the Upper Extremity Fugl-Meyer impairment scale (FM). Corticomotor conduction was assessed with transcranial magnetic stimulation (TMS). For the combined group (n = 82; post-training) robotic training increased the FM by 7.36 points compared to baseline (p < 0.0001). There was no difference in the FM increase between the tDCS and sham groups (6.97 and 7.73 respectively, p = 0.46). In both groups, clinically meaningful improvement (≥5 points) from baseline was evident in the majority of patients (56/77), was sustained six months later (54/72), and could be attained in severe, moderate and mild baseline hemiparesis. Clinical improvement was associated with increased excitability in the affected hemisphere as assessed by resting motor threshold (pre-post p = 0.029; pre-post 6 months p = 0.029), but not with threshold-adjusted assessment of MEP amplitude (pre-post p = 0.09; pre-post 6 months p = 0.15). Participants with motor evoked potentials were more likely to improve clinically than those without (17/18, 94%, versus 39/59, 66%, p = 0.018). Our study confirms the benefit of intensive robot-assisted training in stroke recovery, and indicates that conventional tDCS does not confer further advantage to robotic training. We also showed that corticospinal integrity, as assessed by TMS, is a predictor of clinically meaningful response to intensive arm therapy in chronic stroke.