Conditions In Stroke Patients Research Articles

RESULTS OF GLYCEMIC CONTROL AMONG SEVERE STROKE PATIENTS

Background: Hyperglycemia is a relatively common condition in stroke patients, whether they have diabetes or not, and it is associated with adverse outcomes. Achieving target blood glucose levels has a partial impact on the results, but it is not the sole determinant. Objectives: We assessed the result of glycemic control among severe stroke patients. Materials and methods: A prospective study was conducted in the Stroke Department, Can Tho Central General Hospital, from June 2020 to April 2022, with 72 severe stroke patients monitored the capillary blood glucose every 3 hours. Nineteen patients who had persistent hyperglycemia were controlled with continuous intravenous insulin. We determined the average blood glucose level for each patient, the time needed to reach the glycemic target range, the frequency of hypoglycemia, and the glycemic variability from all measured blood glucose concentration. R programming was used to analyze the data. Results: The average age of patients was 65.1±16.1. The percentage of ischemic stroke, accounting for 55.6%, was the highest, followed by cerebral hemorrhage at 34.7%, 1.4% of these patients was attributed to cerebral venous thrombosis. In admission, the median Glasgow score was 8 (IQR: 7-9), and the median modified Rankin score was 5 (IQR: 4-5). Enteral nutrition was the primary nutritional therapy. Among 53 severe strokes without persistent hyperglycemia, blood glucose levels fluctuated around the mean value of 143 mg/dL. In 19 patients with persistently elevated blood glucose concentration, the mean blood glucose levels preinfusion and post-insulin infusion were 299±117mg/dL and 165±43.2mg/dL, respectively; time to glycemic target was 8.25 hours (95% CI: 3.50-14.75 hours), the minimum was 3 hours, and the longest was 189 hours; 5.3% of these patients developed hypoglycemia, and 13.3% of persistent hyperglycemia patients did not obtain the target range. Conclusions: Blood glucose levels fluctuate within the target range among patients with nonhyperglycemia or non-persistent hyperglycemia. In patients with persistent hyperglycemia controlled with intravenous insulin, the mean blood glucose levels were achieved close to the upper limit of the glycemic target.

The Place of Botulinum Toxin in Spastic Hemiplegic Shoulder Pain after Stroke: A Scoping Review

Stroke is a common pathology worldwide, with an age-standardized global rate of new strokes of 150.5 per 100,000 population in 2017. Stroke causes upper motor neuron impairment leading to a spectrum of muscle weakness around the shoulder joint, changes in muscle tone, and subsequent soft tissue changes. Hemiplegic shoulder pain (HSP) is the most common pain condition in stroke patients and one of the four most common medical complications after stroke. The importance of the appropriate positioning and handling of the hemiplegic shoulder for prevention of HSP is therefore of high clinical relevance. Nevertheless, HSP remains a frequent and disabling problem after stroke, with a 1-year prevalence rate up to 39%. Furthermore, the severity of the motor impairment is one of the most important identified risk factors for HSP in literature. Spasticity is one of these motor impairments that is likely to be modifiable. After ruling out or treating other shoulder pathologies, spasticity must be assessed and treated because it could lead to a cascade of unwanted complications, including spastic HSP. In clinical practice, Botulinum toxin A (BTA) is regarded as the first-choice treatment of focal spasticity in the upper limb, as it gives the opportunity to target specifically selected muscles. It thereby provides the possibility of a unique patient tailored focal and reversible treatment for post stroke spasticity. This scoping review aims to summarize the current evidence of BTA treatment for spastic HSP. First, the clinical manifestation and outcome measures of spastic HSP will be addressed, and second the current evidence of BTA treatment of spastic HSP will be reviewed. We also go in-depth into the elements of BTA application that may optimize the therapeutic effect of BTA. Finally, future considerations for the use of BTA for spastic HSP in clinical practice and research settings will be discussed.

ANALISIS LAJU PERBAIKAN KONDISI KLINIS PASIEN STROKE MENGGUNAKAN REGRESI HAZARD ADITIF LIN-YING (Studi Kasus: Data Pasien Stroke di RSUD Pandan Arang Boyolali Periode Januari 2021 - Agustus 2021)

Additive hazard regression is a survival analysis that is an alternative to Cox proportional hazard regression. The additive hazard models that have been developed include the Aalen additive hazard model and the Lin-Ying. In this study, Lin-Ying additive hazard regression was used as an analytical method to be applied in stroke data that had been hospitalized at Pandan Arang Hospital Boyolali. This method is considered more effective because there is no assumption of proportionality. The purpose of using this method in this study are analyze the characteristics of stroke patients, form a Lin-Ying additive hazard regression model, find out the factors that affect the rate of improvement of the clinical condition of stroke patients, and interpret the model. Based on the analysis that has been done, the average length of hospitalization is 4,471 days ≈ 4 days, and the factors that significantly affect the rate of improvement of clinical conditions in stroke patients at Pandan Arang Hospital Boyolali are blood pressure and blood sugar.

Clinical Evidence Based Nursing (EBNP) Penggunaan Berg Balance Scale Untuk Mengkaji Keseimbangan Pada Pasien Stroke

Stroke can affect balance. Balance is the ability to maintain the body in a balanced position both in static and dynamic conditions. However, the assessment of the existing balance is only done in a static state in stroke patients. The balance assessment describes the balance of stroke patients so that they can be written on asessment form and the transfer record and can determine the need for balance training as one of the rehabilitation of stroke patients. This EBN application aims to find out the use of Berg Balance Scale to assess the balance of both static and dynamic conditions in stroke patients. The method used is conducting PICO analysis, searching database, critical appraisal, and determining relevant journals. EBN implementation was carried out on 10 people who had a stroke in zone A on the 5th floor of Building A RSUPN Dr. Cipto Mangunkusumo. This study uses the Berg Balance Scale scale in Indonesian. The analysis showed that stroke patients who experienced balance disorders were 7 people and did not experience a balance of 3 people BBS can assess the balance of stroke patients in accordance with existing evidence. BBS can be used as a balance assessment in stroke patients.

Effects of Cognitive Sensory Motor Training on Lower Extremity Muscle Strength and Balance in Post Stroke Patients: A Randomized Controlled Study.

Background: Sensory motor impairment, the most common neuromuscular condition in stroke patients, often contributes to muscle weakness and imbalance. Objective: The purpose of this research was to investigate the effects of cognitive sensory-motor training (CSMT) on the muscle strength and balance ability in post-stroke patients. Methods: Thirty-five participants after stroke were randomly assigned to the CSMT (n = 17) or control group (n = 18). All participants received 30 min of training each time, five times per week, for six weeks. Lower extremity muscle strength of tibialis anterior (LEMTA) was evaluated using a digital muscular dynamometer. The Medical Research Council (MRC) scale was used to evaluate muscle strengths of the hip joint, knee joint, and ankle joint. For balance ability test, the center of pressure (COP) movement distance and limited of stability (LOS) were measured using BioRescue. Results: LEMTA, MRC scale, balance ability were significantly more improved in the CSMT group than in the control group (p < 0.05). Conclusions: Our findings indicate that CSMT is beneficial and effective for improving muscle strength of the lower extremity and balance ability of post-stroke patients.

Designing and Analyzing 3D-Printed Personal Steering Controller for Outdoor Electric-Powered Wheelchair Users: A Randomized Controlled Trial on Stroke Patients

While the physical conditions of stroke patients are diverse, the joystick-type steering controller of the electric-powered wheelchair (EPW) is almost the same, making the user uncomfortable and not fully utilizing the function of the wheelchair. The purpose of this study was to investigate the effects of the EPW steering controller, specifically the so-called joystick type (3DSC; 3D-printed steering controller, conventional steering controllers; CSC), on surface electromyography (sEMG), Wheelchair Skills Test 4.2 (WST), and QUEST 2.0. The participants were 23 hemiplegic stroke patients (14 males and 9 females) (range 40–65 years) recruited from multi-center process. The 3DSC manufacturing process used a scanner (Precision Laser Probe SLP-500) and a modelling program (SOLIDWORKS 2015). The CSC users’ muscle activities were generally higher than those of the 3DSC users in both males and females (p &lt; 0.05). WST total performance score of CSC is statistically significantly lower than those of 3DSC for both males (3DSC = 49.28 ± 2.19; CSC = 42.85 ± 4.31) (z = −3.935; p &lt; 0.05) and females (3DSC = 48.17 ± 0.44; CSC = 41.11 ± 0.78) (z = −1.910; p &lt; 0.05). QUEST 2.0 scores in CSC (male = 2.40 ± 0.70; female = 2.11 ± 0.78) were significantly lower than those of 3DSC (male = 3.50 ± 0.85; female = 2.90 ± 0.51) in effectiveness categories (p &lt; 0.05). We suggest that 3DSC contributes to reducing the user’s muscle activities and raising the scores of WST performance and QUEST.

P2X4R Contributes to Central Disinhibition Via TNF-α/TNFR1/GABAaR Pathway in Post-stroke Pain Rats

Central post-stroke pain (CPSP) is a disabling condition in stroke patients. It is a type of neuropathic pain for which the mechanism and relevant drug pathways remain unknown. Inflammatory response and central disinhibition have been suggested recently. Our previous research has shown targeting P2X4 receptors (P2X4R) may be effective in the treatment of CPSP, but the downstream pathway of the P2X4R has not been studied. In this study, we found the increase in tumor necrosis factor alpha (TNF-α) level and endocytosis of surface gamma-aminobutyric acid a receptors (GABAaR) in CPSP, and these effects were inhibited by blocking P2X4R. Furthermore, antagonizing TNF-α can increase surface GABAaR expression and mechanical pain threshold. Meanwhile, knocking down TNFR1 but not TNFR2 reversed the endocytosis of surface GABAaR and alleviated mechanical allodynia. Thus, the neuropathic pain was mediated, in part, through P2X4R/TNF-α/TNFR1/GABAaR signaling, which was induced after stroke. PerspectiveP2X4R regulates the pathophysiological mechanism of CPSP through central disinhibition mediated by TNF-α/TNFR1. Our results suggest that modulation of P2X4R-TNF-α/TNFR1-GABAaR signaling could provide a new therapeutic strategy to treat CPSP.

Abstract P773: Autotaxin and Lysophosphatidic Acid Impair Blood Brain Barrier and Mitochondria Following Ischemic Stroke

Introduction: Ischemic stroke is a leading cause of death and a serious cause of long-term disability in the US. r-TPA is the only treatment available for stroke. Only 5% of patients receive it, as others have the risk of intracerebral hemorrhage. Ischemic reperfusion (I/R) following stroke exacerbates the condition and initiates various molecular signals, ultimately interrupting blood-brain barrier BBB so, better therapy is in need. Lysophosphatidic acid (LPA) is a bioactive lipid regulating various essential cellular functions such as migration, proliferation, adhesion. Autotaxin (ATX) produces LPA, which then regulates through its six G-protein coupled receptors. Methods: Transient middle cerebral artery occlusion (MCAO) with 90 minutes of ischemia and 24 hours of reperfusion was used as a stroke model in mice. LPA was analyzed in plasma with mass spectrometry and in tissue with immunohistochemistry. AR-2 probe fluorescence measured ATX activity. Seahorse analyzer measured the mitochondrial bioenergetics in brain and mouse brain microvascular endothelial cells (MBMEC). Permeability was studied with Electric Cell Substrate Impedance System. Results: ATX was elevated in mRNA level with 1.7 fold increased activity following I/R. LPA showed a significant (P&lt;0.01) increase in the plasma of MCAO mice. LPA in the brain tissue of MCAO mice revealed an increased synthesis of LPA by ATX following I/R injury. Brain mitochondria isolated following I/R injury had significantly (P&lt;0.01) reduced the mitochondrial oxygen consumption rate (OCR). Permeability measured in MBMECs showed LPA treatment increases the permeability. Also, the protein levels of junctional proteins such as βcatenin, Claudin5, VEcadherin, and Zo1 were significantly (P&lt;0.05) decreased with LPA exposure. LPA, as a negative regulator of the BBB, caused permeability through LPA-LPAR1-ROCK dependent pathway. MBMECs show impaired mitochondrial function with decreased OCR and elevated glycolysis towards LPA treatment (P&lt;0.01). Conclusion: We have shown that LPA and its regulator enzyme ATX play a significant role in ischemic stroke, increasing BBB permeability, and elevating mitochondrial dysfunction. ATX inhibitors as therapy could improve the condition of stroke patients.

An observational study to analyze the risk factors associated with stroke in West Rajasthan, India

Background: The recent years have witnessed a surge in the incidence of stroke cases worldwide. Stroke is the most common neurological emergency. It is the second most known common cause of death and one among the major cause of disability worldwide. Aim and Objectives: The main aim of this study is to analyze the major associated risk factors in stroke and assess the awareness among the survivors for the same. Material and Methods: This was a prospective, cross-sectional, observational study, conducted among 100 patients in both sexes in the age group of 25–75 years admitted in Neurology and General Medicine ward at Mathura Das Mathur Hospital, Dr. Sampurnanand Medical College, Jodhpur. The information was collected by previously designed questionnaire. The data were collected and analyzed using appropriate statistical tests. Results: In our study, 100 patients with stroke were included. Out of these 100 patients, 72% of patients suffered an ischemic stroke and 28% a hemorrhagic stroke. The incidence of stroke was predominant in male with 55% followed by females (45%). With increasing age, the number of stroke patients also increased. Among the 100 selected, 37 patients were below 50 years of age and out of these, 26 showed ischemic and 11 showed hemorrhagic type of stroke. In patients above 50 years, 63 patients were found, in them, 46 showed ischemic and 17 showed hemorrhagic type of stroke. About 63% of stroke patients were found >50 years age group. It was found that the most common comorbid condition in stroke patients was hypertension (47%) followed by diabetes (21%). Family history of stroke was seen in 18% and dyslipidemia in 17%. Fourteen patients have IHD and 10% of patients have a family history of cardiovascular disease. Conclusion: This study concluded that with increasing age, the number of stroke patients also increases and hypertension is the most common cause or risk factor for disease.

Pathophysiology of Central Poststroke Pain: Motor Cortex Disinhibition and Its Clinical and Sensory Correlates.

Background and Purpose- Central poststroke pain (CPSP) is a disabling condition in stroke patients, and evidence suggests that altered corticospinal and motor intracortical excitability occurs in neuropathic pain. The objective of this study was to investigate changes in motor cortex excitability and sensorimotor interaction and their correlates with clinical manifestations and alterations in somatosensory systems in CPSP patients. Methods- Fourteen patients with CPSP but no motor weakness were compared with age- and sex-matched healthy controls for motor cortex excitability and sensorimotor interaction assessed by transcranial magnetic stimulation to measure resting motor thresholds, short-interval intracortical inhibition, intracortical facilitation, and afferent inhibitions. The sensory pathway was evaluated by quantitative sensory testing, contact heat evoked potential, and somatosensory evoked potentials. Clinical pain and quality of life were assessed with validated tools. Results- The duration of CPSP was 3.3±3.0 years (ranging 0.5-10 years), and pain significantly impaired quality of life. Compared with the unaffected hemisphere, the stroke hemisphere had higher thermal thresholds, lower contact heat evoked potential amplitudes, and prolonged cortical somatosensory evoked potential latencies. There was no difference in resting motor thresholds between the stroke and unaffected hemisphere or between patients and controls. CPSP patients had a reduction in short-interval intracortical inhibition in the stroke hemisphere compared with that in the unaffected hemispheres of patients and controls. No changes were noted in afferent inhibitions between the stroke and unaffected hemispheres. The short-interval intracortical inhibition of the stroke hemisphere was negatively correlated with self-rated health on a visual analog scale and positively correlated with cortical somatosensory evoked potential latencies. Conclusions- CPSP patients with intact corticospinal tracts showed reduced motor intracortical inhibition in the stroke hemisphere, suggesting defective gamma-aminobutyric acid-ergic inhibition. This disinhibition was associated with impaired quality of life and was related to dorsal column-medial lemniscus pathway dysfunction.

Is isolated hand weakness associated with subtypes of stroke?

Isolated hand weakness is an uncommon condition in stroke patients. It is frequently confused with peripheral nerve system (PNS) pathologies; misdiagnosis may delay identification of the etiology and treatment of stroke. Herein, we aimed to underline the necessity of keeping the diagnosis of stroke in mind in case of patients with isolated hand weakness and to assess the etiology of stroke. A total of eight patients (four females and four males), who are presented with isolated hand weakness and had acute cortical infarction documented via cranial MRI, were enrolled in the study. Demographic characteristics, physical and radiological findings of the patients, as well as the lateralization and etiology of infarction were evaluated. The mean age of the patients was 61.8 ± 12 years. Isolated hand weakness was in the dominant hand in four patients. According to the etiology and clinical signs, the stroke was cardioembolic in three patients and they had predominant radial-side (thumb and index) finger weakness. Large vessel atherosclerosis was present in three patients; two patients with predominant ulnar-side (little and ring) finger weakness and one patient with uniform finger weakness; there were two patients with stroke of undetermined etiology and they had uniform finger weakness. Keeping stroke in mind together with PNS pathologies in case of isolated hand weakness is critical for early diagnosis and treatment of the patients. In addition, cardioembolic focus should be considered in case of predominant radial-side finger weakness, whereas particular attention should be paid to carotid artery diseases in case of predominant ulnar-side finger weakness.

Obstructive sleep apnea and stroke

Obstructive Sleep Apnea (OSA) is a common co-morbid condition in stroke patients. It represents a very important risk factor for stroke in addition to the other established ones such as hypertension, cardiovascular disease (CVD), hyperlipidemia, atrial fibrillation (AF), type 2 diabetes mellitus (T2DM), stress, smoking, and heavy drinking. Although in the United States the prevalence of OSA has somewhat decreased from the previous years, globally its prevalence remains constant, or in some cases, is on the rise. In this review we present the epidemiology for OSA in stroke populations and discuss the risk factors for stroke as well as the underlying pathogenetic mechanisms linking OSA, stroke and CVD. We also emphasize the more thorough evaluation and control of OSA in order to prevent the disabling side effects of a stroke, which not only compromises the physical and mental health of a person and increases the burden on families, but also adds a severe burden to national health economics. OSA should always be considered when assessing a patient with transient ischemic attacks (TIA). Work up and treatment for OSA will not only help prevent stroke with its devastating consequences, but will also help prevent CVD, and ameliorate co-morbid conditions such as diabetes and hypertension in these vulnerable populations.

Using functional near-infrared spectroscopy (fNIRS) in the assessment of cognitive motor interference in post-stroke patients

Pre-frontal cortex (PFC) activity during dual task (DT) condition in stroke patients remains unclear. Functional near-infrared spectroscopy (fNIRS) is a functional neuroimaging technique for studying cortical activity. The purpose of this study was to evaluate the hemodynamic activity of the PFC in two DT conditions in post-stroke patients. Stroke patients were instructed to perform a cognitive task (n-back test) while continuously walking. They were evaluated in DT low (n-1 back) and high (n-2 back) cognitive load. fNIRS recorded bilateral PFC activity and GAITRite measured gait parameters in these two DT conditions. Cognitive performance was evaluated by the number of answers, the number of correct answers and the error percentage. The main endpoint was the DT cost, and we compared the change in oxygenated hemoglobin (an indicator of the changes in PFC activation) between the DT high and DT low. Eleven stroke patients (8 men and 3 women; mean age, 64.2 ± 19.5 years; range, 28–87 years) were included in the study. The DT cost was higher in DT n-2 (82.1% ± 15.6) compared with DT n-1 (61.2% ± 38.6), P = 0.007. There was no decline of spatiotemporal gait parameters with the increasing of cognitive load ( P > 0.05) and no difference for the number of answers in DT high versus low cognitive load ( P > 0.05). The number of correct answers was lower during DT high (3 ± 2.4) versus DT low (7.8 ± 3.6), P = 0.0015; and the error percentage was higher during DT high (62.3 ± 23.2) versus low condition (24.4 ± 12.9), P = 0.0001. There was a greater increase bilateral PFC activity during DT high versus DT low. The increasing DT cost allowed to maintain spatiotemporal gait parameters in DT high and led to a degradation of the cognitive performance. During DT, PFC activation might prioritize gait performances in stroke patients when the cognitive load is high.

User Experience Design of Stroke Patient Communications Using Mobile Finger (MOFI) Communication Board With User Center Design Approach

&lt;p class="0abstract"&gt;Stroke has become a phenomenon in Indonesia. From 2014 to mid-2015, the disease is the first cause of death in Indonesia. This is of particular concern to the Ministry of Health so that the prevention, treatment, and prevention of stroke is further enhanced. The condition of stroke patients whose movements are limited is exacerbated by the psychic condition of patients who are unable to communicate pressure will cause obstacles to the healing process of the patient. This research proposes a stroke patient communication media by applying the technology of Mobile Finger Communication Board and user center design approach (UCD). This communication board is operated using the patient's fingers so that it is comfortable for everyday activities. Mobile Finger Communication Board Design based on five planes of user experience. The result of Mobile Finger Communication Board implementation shows that application usability level seen from perception and ergonomic point of view shows satisfaction index of the user at the satisfactory level so that it can be said that the system works with the satisfactory result of the users. It is expected that with a convenient Mobile Finger Communication Board can support the healing process of stroke so that the healing rate of stroke is increasing.&lt;/p&gt;&lt;p class="0keywords"&gt; &lt;em&gt;&lt;/em&gt;&lt;/p&gt;

Design of Mobile Finger Communications Board for Stroke Patient Using The Five Planes of User Experience

Stroke, in 2014 to mid-2015 is the first cause of death in Indonesia. The condition of stroke patients whose movements are limited is exacerbated by the psychic condition of patients who are unable to communicate pressure will cause obstacles to the healing process of the patient. This research is designed based on the five planes of user experience which are divided into five areas: strategy, scope, structure, skeleton, and surface. This communication board is operated using the patient's fingers so that it is comfortable for everyday activities. The result of Mobile Finger Communication Board implementation shows that application usability level seen from perception and ergonomic point of view shows satisfaction index of the user at the satisfactory level so that it can be said that the system works with the satisfactory result of the users. It is expected that with the Mobile Finger Communication Board which will be used daily to support the healing process of stroke so that the healing rate of stroke is increasing.

Emotional and social characteristics of stroke patients with low verbal memory.

Cognitive deficits, especially problems with memory observed after stroke often coexist with patients' experience of difficulties in everyday life situations. The purposes of the study were to explore the relationships between verbal memory, emotional functioning and social competence in stroke patients, and to examine the emotional and social condition of stroke patients with low verbal memory. Ninety-five participants were assessed with the Rey Auditory Verbal Learning Test, the Neuropsychology Behavior and Affect Profile, and the Social Competency Questionnaire. The participants' relatives (N = 95) also took part in the study evaluating patients' emotional and social functioning. Stroke patients with low verbal memory had higher scores in depression, indifference, and inappropriateness than the patients with normal memory. They also obtained higher scores in the self-reported intimacy and lower scores in objectively assessed social exposition than controls. It is worth considering patients' relationships with relatives that evolve after stroke, especially when the patients experience cognitive difficulties in gaining new information. Collecting verbal information seems to be important for the feeling of effectiveness in some dimensions of elders' social functioning. Because the social engagement may be treated as protective factor in the course of recovery we would recommend that during rehabilitation more attention should be paid to emotional and social functioning of stroke patients with low verbal memory.

Transcranial Direct Current Stimulation Technique: A Need of Bangladesh for Stroke Management

Stroke has been considered as one of the leading cause of death worldwide. It results in reduced excitability, deregulated plastic modifications, and formation of aberrant connections and, these factors hinder recovery from stroke. Transcranial direct current stimulation (tDCS) is a promising technique for the treatment of a wide range of neurological disorders including stroke. Its application could improve the condition of patients having neurological disorders by making functional connections and maintaining existing pathways. In Bangladesh, stroke remains the third leading cause of death with 0.3% prevalence. The number of disability-adjusted life years lost for stroke is 485 per 10000 people, which depicts great economic burden of this disease in the future. Thus, introduction of new technologies such as tDCS in the treatment of stroke will not only improve conditions of stroke patients but also reduce economic burden of this disease in Bangladesh.

The effects of an 8-week computer-based brain training programme on cognitive functioning, QoL and self-efficacy after stroke

ABSTRACTCognitive impairment after stroke has a direct impact on daily functioning and quality of life (QoL) of patients and is associated with higher mortality and healthcare costs. The aim of this study was to determine the effect of a computer-based brain training programme on cognitive functioning, QoL and self-efficacy compared to a control condition in stroke patients. Stroke patients with self-perceived cognitive impairment were randomly allocated to the intervention or control group. The intervention consisted of an 8-week brain training programme (Lumosity Inc.®). The control group received general information about the brain weekly. Assessments consisted of a set of neuropsychological tests and questionnaires. In addition, adherence with trained computer tasks was recorded. No effect of the training was found on cognitive functioning, QoL or self-efficacy when compared to the control condition, except for very limited effects on working memory and speed. This study found very limited effects on neuropsychological tests that were closely related to trained computer tasks, but no transfers to other tests or self-perceived cognitive failures, QoL or self-efficacy. These findings warrant the need for further research into the value of computer-based brain training to improve cognitive functioning in the chronic phase after stroke.

Prefrontal Cortex Activation While Walking Under Dual-Task Conditions in Stroke

Background. Walking while performing another task (eg, talking) is challenging for many stroke survivors, yet its neural basis are not fully understood. Objective. To investigate prefrontal cortex activation and its relationship to gait measures while walking under single-task (ST) and dual-task (DT) conditions (ie, walking while simultaneously performing a cognitive task) in stroke survivors. Methods. We acquired near-infrared spectroscopy (NIRS) data from the prefrontal cortex during treadmill walking in ST and DT conditions in chronic stroke survivors and healthy controls. We also acquired functional magnetic resonance imaging (fMRI) and NIRS during simulated walking under these conditions. Results. NIRS revealed increased oxygenated hemoglobin concentration in DT-walking compared with ST-walking for both groups. For simulated walking, NIRS showed a significant effect of group and group × task, being greater on both occasions, in stroke survivors. A greater increase in brain activation observed from ST to DT walking/ simulated walking was related to a greater change in motor performance in stroke survivors. fMRI revealed increased activity during DT relative to ST conditions in stroke patients in areas including the inferior temporal gyri, superior frontal gyri and cingulate gyri bilaterally, and the right precentral gyrus. The DT-related increase in fMRI activity correlated with DT-related change in behavior in stroke participants in the bilateral inferior temporal gyrus, left cingulate gyrus, and left frontal pole. Conclusion. Our results provide novel evidence that enhanced brain activity changes relate to dual task motor decrements.

The use of orthoses in stroke rehabilitation

Orthotics is the field of splinting and bracing. This article sets outlines what orthotics are, how they can be used and the underlying biomechanical principles and key areas where orthotic intervention can complement stroke rehabilitation. A common condition in stroke patients is dropped foot; the article explains and illustrates the three-point force system used to correct it. While emphasising the specialist work of the orthotist in helping patients recover from stroke, the role of the whole multidisciplinary team in supplementing that specialist work is stressed. Teaching the patient how to stand and then to walk are dealt with. The article concludes with sections on tuning and problem-solving in orthotics and how they can help with spasticity.