Disability In Stroke Patients Research Articles

Arm Ability Training (AAT) Promotes Dexterity Recovery After a Stroke-a Review of Its Design, Clinical Effectiveness, and the Neurobiology of the Actions.

Arm Ability Training (AAT) has been specifically designed to promote manual dexterity recovery for stroke patients who have mild to moderate arm paresis. The motor control problems that these patients suffer from relate to a lack of efficiency in terms of the sensorimotor integration needed for dexterity. Various sensorimotor arm and hand abilities such as speed of selective movements, the capacity to make precise goal-directed arm movements, coordinated visually guided movements, steadiness, and finger dexterity all contribute to our “dexterity” in daily life. All these abilities are deficient in stroke patients who have mild to moderate paresis causing focal disability. The AAT explicitly and repetitively trains all these sensorimotor abilities at the individual's performance limit with eight different tasks; it further implements various task difficulty levels and integrates augmented feedback in the form of intermittent knowledge of results. The evidence from two randomized controlled trials indicates the clinical effectiveness of the AAT with regard to the promotion of “dexterity” recovery and the reduction of focal disability in stroke patients with mild to moderate arm paresis. In addition, the effects have been shown to be superior to time-equivalent “best conventional therapy.” Further, studies in healthy subjects showed that the AAT induced substantial sensorimotor learning. The observed learning dynamics indicate that different underlying sensorimotor arm and hand abilities are trained. Capacities strengthened by the training can, in part, be used by both arms. Non-invasive brain stimulation experiments and functional magnetic resonance imaging data documented that at an early stage in the training cortical sensorimotor network areas are involved in learning induced by the AAT, yet differentially for the tasks trained. With prolonged training over 2 to 3 weeks, subcortical structures seem to take over. While behavioral similarities in training responses have been observed in healthy volunteers and patients, training-induced functional re-organization in survivors of a subcortical stroke uniquely involved the ipsilesional premotor cortex as an adaptive recruitment of this secondary motor area. Thus, training-induced plasticity in healthy and brain-damaged subjects are not necessarily the same.

Neurobehavioral disability in stroke patients during subacute inpatient rehabilitation: prevalence and biopsychosocial associations

ABSTRACTBackground and Objectives: There are scarce data on post-stroke neurobehavioral disability (NBD). The aim of this study was to identify the prevalence of NBD in a subacute inpatient stroke population and examine potential associations with demographic, stroke-related, functional and psychosocial variables.Methods: 82 survivors of stroke were consecutively recruited during their inpatient rehabilitation admission. Nursing staff rated NBD in patients using the St Andrews –Swansea Neurobehavioral Outcome Scale (SASNOS). Measures of patient functional independence (FIM), cognition (MoCA), and mood symptoms (HADS) were collected in addition to nursing reports of whether observed NBD negatively impacted on the patient or those around them.Results: NBD relating to interpersonal relationships (44.4% of participants) and cognition (52.4%) were highly prevalent within the sample while NBD relating to inhibition (1.2%), aggression (3.6%), and communication (2.5%) were relatively rare. Presence of NBD was significantly associated with reduced functional independence (rs=0.39, p < 0.01) and associated with trends in cognitive impairment (rs=0.29, p = 0.03), increased anxiety (rs=-0.43, p = 0.02) and depressive symptoms (rs=-0.43, p = 0.02). Presence of NBD was significantly correlated with negative impact to the patient and those around them across all SASNOS domains (rs range 0.42 - 0.45, all p ≤ 0.01).Conclusions: NBD is common within a subacute stroke inpatient population, particularly interpersonal and cognitive difficulties and preliminary analyses indicate associations with reduced functional ability, cognition and mood. There is a need to provide education and support to clinicians to facilitate routine assessment and management of NBD following stroke.

Onset to hospital admission time and disability in patients with ischemic stroke

The predictive factors of disability in stroke patients are still varied and subject to debate. Lower onset to admission time has been known produces excellent outcomes with significantly lower rates of morbidity and mortality. Previous study about the onset admission time in patients with stroke ischemic in Indonesia is very limited. This was a retrospective cohort study using secondary data from electronic medical record and electronic stroke registry of Bethesda Hospital Yogyakarta Indonesia. A total of 1657 patients with ischemic stroke was admitted between 2015-2017 and 313 patients were included in this study adjusted by inclusion and exclusion criteria. Factors such as age, gender, onset, previous stroke, comorbidities and complications were assessed. Multiple logistic regression analysis showed onset > 6 hour (RR: 4.567; 95% CI: 2.372-8.792;p: 0.000), age (RR: 2.366; 95% CI: 1.357-4.125;p:0.002) and patients with complications (RR: 12.403; 95% CI:2.443-62.968;p:0.002) were independently significant increasing the risk of disability in patient with ischemic stroke. Onset to hospital admission time > 6 hour was significantly increasing disability on ischemic stroke patients. Giving treatment less than 6 hours could save the patient from disability.

Responsiveness of the functioning and disability parts of the International Classification of Functioning, Disability, and Health core sets in postacute stroke patients.

To study the responsiveness of the International Classification of Functioning, Disability, and Health (ICF) core set with respect to human functioning and disability in stroke patients. Postacute stroke patients who were admitted to the convalescent rehabilitation wards were included in this observational cohort study. The comprehensive ICF core set for neurological conditions for postacute care and the ICF rehabilitation set were evaluated at admission and discharge using five-grade qualifiers. Extension indexes were calculated for entire two ICF core sets. Responsiveness was measured as change in the extension indexes in the ICF core sets. The correlation between changes in ICF core sets and improvement in the Functional Independence Measure (FIM) was analyzed using Spearman's correlation coefficient. The study included 108 poststroke patients (49 women, mean age 70.8 years, mean FIM score improvement: 23.0). The mean percentage of categories that showed changes with at least one qualifier level was 19.5% in the comprehensive ICF core set for neurological conditions for postacute care and 35.9% in the ICF rehabilitation set. Effect sizes in each ICF core set were moderate to large (0.79-0.80). Improvement in the two ICF core sets correlated significantly with changes in the FIM score. Our results indicate that functioning and disability parts of these two ICF core sets can detect changes in functioning and disability in patients who receive an inpatient rehabilitation program for postacute stroke.

The impact of lower extremity pain conditions on clinical variables and health-related quality of life in patients with stroke

Background: The presence of lower extremity pain may be associated with poorer motor recovery, impaired activities of daily living (ADL), reduced quality of life, and disability in patients with stroke.Objective: The aims of the study were to describe the characteristics of lower extremity pain conditions and to evaluate the impact of lower extremity pain on clinical variables, and health-related quality of life in patients with stroke.Methods: One hundred and eighty-five patients with stroke who have self-reported pain in the lower extremity were included in the study. Lower extremity pain characteristics of stroke survivors including etiology, intensity, onset time, frequency, aggravating factors, relieving factors, site, and location of pain were evaluated and recorded. The Brunnstrom motor recovery scale, the functional ambulation category, the mini-mental state examination, the star cancellation test, the beck depression inventory, the Barthel Index, and the Short Form-36 Questionnaire (SF-36) were used.Results: The causes of lower extremity pain were diagnosed as osteoarthritis (51.1%), central neuropathic pain (28.7%), mixed pain (10.3%), low back pain associated with leg pain (8.6%), greater trochanteric pain syndrome (5.2%), prior hip fracture (2.4%), heterotopic ossification (2%), developmental hip luxation (1%), hallux valgus (0.5%), and malignancy (0.5%). The intensity of lower extremity pain was a significant predictor of cognitive functions, ADL, depression, and all SF-36 subscales except emotional role and vitality. The duration of lower extremity pain was a significant predictor of depression and lower extremity spasticity.Conclusions: Since lower extremity pain conditions have a significant important influence on clinical variables and health-related quality of life in stroke survivors, early identification and appropriate treatment of the lower extremity pain conditions should be carried out in order to reduce the level of disability in stroke patients.

Health, function and disability in stroke patients in the community.

ABSTRACTBackgroundStroke patients commonly have impairments associated with reduction in functionality. Among these impairments, the motor impairments are the most prevalent. The functional profile of these patients living in the community who are users of the primary health-care services in Brazil has not yet been establishedObjectiveTo describe the functional profile of stroke patients who are users of the primary health-care services in Brazil, looking at one health-care unit in the city of Belo Horizonte, Brazil.MethodFrom medical records and home visits, data were collected regarding health status, assistance received following the stroke, personal and environmental contextual factors, function and disability, organized according to the conceptual framework of the International Classification of Functioning, Disability and Health (ICF). Test and instruments commonly applied in the assessment of stroke patients were used.ResultsDemographic data from all stroke patients who were users of the health-care unit (n=44, age: 69.23±13.12 years and 67±66.52 months since the stroke) participated of this study. Most subjects presented with disabilities, as changes in emotional function, muscle strength, and mobility, risks of falling during functional activities, negative self-perception of quality of life, and perception of the environment factors were perceived as obstacles. The majority of the patients used the health-care unit to renew drug prescriptions, and did not receive any information on stroke from health professionals, even though patients believed it was important for patients to receive information and to provide clarifications.ConclusionStroke patients who used primary health-care services in Brazil have chronic disabilities and health needs that require continuous health attention from rehabilitation professionals. All of these health needs should be considered by health professionals to provide better management as part of the integral care of stroke patients, as recommended by the clinical practice guidelines for stroke rehabilitation.

Recuperation of daily activities and quality of life after stroke: The EAVQ-QdV scale

Stroke is a leading cause of long-term disability in adults. Few studies have investigated the impact of cognitive deficits on health-related quality of life (HRQOL) in patients or caregivers, notably in function of stroke laterality and of lesion volume. This research aims to a better evaluation of HRQOL with a new multi-dimensional scale based on description of the person's present state compared to the pre-stroke state. EAVQ-QdV is an auto-administered questionnaire composed of physical, cognitive, psychic and social domains. For each domain, difficulties and emotional report are evaluated. Patients’ and caregivers’ points of view are collected. Sixty-nine patients filled out the EAVQ-QdV in the chronic phase (46 right stroke, 23 left stroke). Patients also filled out SF36. MRI brain imaging was performed in all patients. Preliminary results show a significant negative correlation between EAVQ-QdV and SF36 (r = −0.54). Age, educational level, delay post-stroke or lesion volume did not correlated with the EAVQ-QdV scores. There was no difference between EAVQ-QdV scores in left-sided vs. right-sided strokes ( P > 0.45). However, right-brain damaged patients, but not left-brain damaged patients, underestimated their difficulties when their scores were compared to the caregivers’ ( P < 0.03). Analysis of the distinct domains of the scale revealed differences in language, attention, executive functions, memory and social relation, with greater severity in patients with left hemisphere strokes, and in the domain of visual neglect for patients with right-sided stroke ( P < 0.02). A single questionnaire exploring different cognitive domains, and comparing patients’ and caregivers’ assessments, with the evaluation of the emotional impact of patients’ and caregivers’ difficulties may permit to obtain a better estimation of residual handicap in stroke patients.

Aerobic, Resistance, and Cognitive Exercise Training Poststroke.

Stroke may cause physical or cognitive impairments. Approximately 50% to 75% of all stroke survivors have residual motor or cognitive disabilities that prevent them from living independently. Muscle weakness is considered a major cause of motor disability in stroke patients.1 Impaired walking occurs in as many as 80% of individuals immediately after stroke,2 with muscle weakness in the paretic limb explaining ≤50% of the variance in gait among individuals with chronic mild-to-moderate poststroke hemiparesis.3 As a result, gait patterns become asymmetrical and gait speed reduced.4 Additionally, impaired walking is commonly observed beyond 6 months after stroke.5 This lack of walking competency can precipitate and exacerbate a sedentary lifestyle and cardiovascular deconditioning. Previous work has shown that maximal oxygen consumption (VO2max), as a measurement of cardiovascular fitness, is reduced to 10 to 17 mL/kg/min within the first month after stroke6 and remains below 20 mL/kg/min beyond 6 months.7 The same values can be 45% lower than in age-matched and healthy individuals.8 The implication of low VO2max becomes even more important knowing that a minimum of 20 mL/kg/min is needed for performing daily activities9 and for independent living among older stroke patients.10 In addition to stroke-related decline in cardiovascular fitness, a natural decline in VO2max occurs after the age of 50, averaging a 5% to 10% (or ≈ 5 mL/kg/min) loss per decade. Therefore, elderly stroke patients may face disease- and age-related declines in cardiorespiratory fitness. In a meta-analysis of 11 studies (n=1105), low physical activity (PA) levels, for example, 4355 daily steps taken, have been observed among stroke patients.11 People with other chronic diseases, such as chronic pulmonary obstructive disease, have reported as few as 2237 steps a day.12 The medical establishment, including …

(568) - Left Ventricular Assist Devices vs. the Total Artificial Heart: Which Causes More Cerebrovascular Accidents?

(568) - Left Ventricular Assist Devices vs. the Total Artificial Heart: Which Causes More Cerebrovascular Accidents?

Solitaire Stent Reduced Disability in Stroke Patients in the SWIFT PRIME Trial

The SWIFT PRIME study demonstrated that the Solitaire stent was safe and effective at reducing poststroke disability in patients with acute ischemic stroke. Functional independence (mRS of 0 to 2) at 90 days was achieved in 60.2% of patients in the Solitaire plus IV tPA group vs 35.5% in the IV tPA group (P < .0008).

In Landmark Study, Intra-Arterial Treatment Found to Lead to Less Disability in Stroke Patients

In Landmark Study, Intra-Arterial Treatment Found to Lead to Less Disability in Stroke Patients

Assessment of scapular behavior in stroke patients

Background: Stroke is the number two cause of death world-wide and may soon become the leading cause of death worldwide. The occurrence of shoulder pain after stroke is quite common in hemiplegia with an estimated incidence between 16% and 84%.This so-called Post Stroke Shoulder Pain, or PSSP can impede rehabilitation and interfere with both function and quality of life. It may not only interfere with shoulder function, but also with balance, walking, transfers and performance of self-care activities. Alterations in shoulder kinematics could lead to shoulder instabilities which in turn could lead to shoulder pain. Purpose: Assessment of scapular stability, assessment of type of scapular dyskinesia , and assessment of disability in stroke patients with scapular dyskinesia Materials and Methods: Weighing scale, Dumbbells weighing three pounds and five pounds, Ruler to calculate scapular balance angle, Disability assessment scale, Goniometer. Results: Scapular alterations were evident in patients with stroke Conclusion: The scapular stability is affected as evaluated by scapular dyskinesia test and scapular balance angle. Various types of scapular dyskinesia were observed. It was observed that patients with disability have scapular dyskinesia

Communication activity in stroke patients with aphasia

To study communication disability in stroke patients with aphasia. Prospective, multicentric cohort study of patients with aphasia, consecutively included after a first stroke, and examined 1 year later at home. Assessment included a stroke severity scale, the Barthel Index, the boston diagnostic aphasia examination, a communication questionnaire, and the aphasia depression rating scale. A total of 164 patients were included. Among the 100 survivors assessed at follow-up, 24% had severe aphasia, 12% moderate aphasia and 64% mild aphasia according to the Boston diagnostic aphasia examination severity score. Patients mainly reported difficulties in conversation with strangers and/or on abstract topics, using a phone, reading and writing administrative documents, dealing with money and outdoor communication activities. Communication was strongly related to aphasia severity. Age, gender, education level, residence status and type of stroke had no influence on communication activity. On multivariate analysis, severity of stroke and severity of aphasia on inclusion were found to account for 58% of variance and were independent predictors of the communication questionnaire score at follow-up. Documenting the most impaired communication skills may help to set priority goals for speech and language therapy in aphasia.

Research Roundup

British Journal of Cardiac NursingVol. 7, No. 11 Research RoundupResearch RoundupBelinda LindenBelinda LindenSearch for more papers by this authorBelinda LindenPublished Online:27 Sep 2013https://doi.org/10.12968/bjca.2012.7.11.558AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Coutts SB, Modi J, Patel SK, Aram H, Demchuk AM, Goyal M, Hill MD (2012) What causes disability affer transient ischemic attack and minor stroke?: Results from the CT and MRI in the triage of TIA and minor cerebrovascular events to identify high risk patients (CATCH) Study. Stroke [online ahead of print] doi: 10.1161/STROKEAHA.112.665141 Google ScholarLuengo-Fernandez R, Gray AM, Rothwell PM (2012) Effect of Urgent Treatment for Transient iIchaemic attack and Minor Stroke on Disability and Hospital Costs (EXPRESS study): A Prospective Population-based Sequential Comparison. National Institute for Health Research Economic Evaluation Database (NHS EED) Centre for Reviews and Dissemination, York Google Scholarvan Swieten J, Koudstaal P, Visser M, Schouten H et al. (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19(5): 604–07 Crossref, Google ScholarRychik J, Donaghue DD, Levy S, Fajardo C, Combs J, Zhang X, Szwast A, Diamond GS (2012) Maternal psychological stress affer prenatal diagnosis of congenital heart disease. Journal of Pediatrics (online ahead of print) doi 10.1016/j.jpeds.2012.07.023 Google ScholarWang C, Sen A, Ruffin MT, Nease DE, Gramling R, Acheson LS, O'Neill SM, Rubinstein WS Family Healthware Impact Trial (FHITr) Group (2012) Family history assessment: impact on disease risk perceptions. Am J Preventive Med 43(4): 392–8 Crossref, Google ScholarSchelbert EB, Cao JJ, Sigurdsson S, Aspelund T, Kellman P, Aletras AH, Dyke CK, Torgeirsson G, Eiriksdottir G, Launer LJ, Gudnason V, Harris TB, Arai AE (2012) Prevalence and prognosis of unrecognized myocardial Infarction determined by cardiac magnetic resonance in older adults. JAMA 308(9): 890–6 Crossref, Google ScholarKim HW, Klem I, Shah DJ et al. (2009) Unrecognized Non-Q-Wave myocardial Infarction: prevalence and prognostic significance in patients with suspected coronary disease. PLoS Med 6(4): e1000057. doi: 10.1371/journal.pmed.1000057 Crossref, Google ScholarFriedemann C, Heneghan C, Mahtani K, Thompson M, Perera R, Ward AM (2012) Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ (online ahead of print) 345 doi: 10.1136/bmj.e4759 Crossref, Google ScholarNHS Information Centre for Health and Social Care (2012) Statistics on Obesity, Physical Activity and Diet. London Google ScholarWennberg M, Strömberg U, Bergdahl IA et al. (2012) Myocardial infarction in relation to mercury and fatty acids from fish: a risk-benefit analysis based on pooled Finnish and Swedish data in men. Am J Clin Nutrition 96(4): 706–13 Crossref, Google Scholar FiguresReferencesRelatedDetails 1 November 2012Volume 7Issue 11ISSN (online): 2052-2207 Metrics History Published online 27 September 2013 Published in print 1 November 2012 Information© MA Healthcare LimitedPDF download

Optimizing the management of acute ischaemic stroke: a review of the utilization of intravenous recombinant tissue plasminogen activator (tPA)

Thrombolysis using intravenous tissue plasminogen activator (tPA) is the only available evidence-based treatment for acute ischaemic stroke; however, its current utilization is very low. Therefore, the aim of this article is to review the literature regarding the use of intravenous tPA for the treatment of acute ischaemic stroke. The review will also compare utilization rates of thrombolysis in different centres across the world and identify key reasons for the underutilization of thrombolysis in stroke. MEDLINE, EMBASE, International Pharmaceutical Abstracts (IPA) and Google Scholar were searched for relevant original articles, review papers and other publications over the publication period 1995-2012. The National Institute of Neurological Disorders and Stroke (NINDS) (1995, N = 624 patients) and ECASS III (2008, N = 821 patients) are two pivotal randomized controlled trials providing evidence for the use of intravenous tPA within 3 h or 3-4.5 h from stroke onset, respectively. Both trials have shown that tPA administration decreases disability at 90 days from stroke. Furthermore, a recent pooled analysis of randomized controlled trials (2010, N = 3670 patients) supports these results, highlighting that early stroke treatment is associated with better outcomes, especially when treatment is started within 90 min of stroke onset (but suggesting that the benefit could be afforded within a 4.5-h time window). Three major observational trials, STARS (2000, N = 389 patients), CASES (2005, N = 1135 patients) and SITS-MOST (2007, N = 6483 patients), have reported acceptable safety and efficacy in clinical practice. However, only a small proportion of acute ischaemic stroke patients receive tPA in clinical practice, because of the limited availability of tPA-utilizing sites and suboptimal use of tPA in sites where it is available. tPA reduces disability in stroke patients. Moreover, acceptable safety has been demonstrated in routine clinical practice. However, tPA is significantly underutilized, and specific efforts are needed to encourage appropriate implementation of the stroke treatment guidelines to optimize the use of this important therapy.

The coexistence of heart failure predicts short term mortality, but not disability, in patients with acute ischemic stroke treated with thrombolysis: The Florence area Registry

BackgroundThrombolysis in ischemic stroke reduces disability but not mortality. Our aim was to evaluate the predictivity of heart failure (HF) diagnosis on 90-day mortality and disability in stroke patients undergoing thrombolysis. Material and methodsHospital records of all consecutive stroke patients treated with thrombolysis at our University Hospital were reviewed. Clinical assessment for HF and echocardiogram were available for all patients according to the thrombolysis institutional protocol. History of HF, LVEF <40%, or BOSTON score ≥5 were tested as predictors. ResultsOf 130 patients (age 66±14years, 64.6% males, baseline NIHSS 15.6±8.8), 17 (13.1%) had a history of HF, 16 (12.7%) a BOSTON score ≥5, 13 (10.9%) a LVEF <40% and 24 (19.0%) met clinical criteria for HF diagnosis. Ninety-day mortality and incidence of disability were 16.1% and 36.1%, respectively. After adjustment for age, sex, baseline stroke severity and pre-stroke disability, LVEF <40% and clinical diagnosis of HF were predictors of 90-day mortality, (p=0.007 and p=0.037, respectively). ConclusionClinical diagnosis of HF predicts mortality, but not disability, in acute stroke patients undergoing thrombolysis. Unlike anamnestic record of HF, clinical evaluation of cardiac function, with estimation of LVEF, predicts mortality.

PO01-MO-11 Prevalence of stroke, stroke risk factors, post stroke depression and the development of local wisdoms in improving of disability in stroke patients in a province of southern Thailand

PO01-MO-11 Prevalence of stroke, stroke risk factors, post stroke depression and the development of local wisdoms in improving of disability in stroke patients in a province of southern Thailand

Predictors of functional outcome in first-ever ischemic stroke: A special interest to ischemic subtypes, comorbidity and age

Most cardiovascular abnormalities are associated not only with increased risk of certain ischemic stroke subtypes but also with markedly greater disability in stroke patients. We aimed to investigate the associations between age, comorbidity, cardiovascular problems, site and size of ischemic lesions and functional outcome in inpatient first-ever ischemic stroke patients. A total of 129 first-ever ischemic stroke admissions to a university affiliated rehabilitation centre were involved. Demographic data, brain computerized tomography or magnetic resonance imaging reports of the patients were recorded. Cardiovascular parameters consisted of electrocardiographic, echocardiographic and carotid Doppler ultrasonographic findings. Location and size of ischemic lesions was determined by using the Oxfordshire Community Stroke Project classification. Charlson Comorbidity index adjusted for ischemic stroke was used to assess associated health problems. Functional recovery was defined as the improvements made on Functional Independence Measure. Our data indicated that the presence of chronic atrial fibrillation and carotid stenosis had significant associations with total anterior circulation infarcts. Multivariate analyses revealed that age, Charlson Comorbidity index adjusted for ischemic stroke, total anterior circulation infarcts, Functional Independence Measure on admission were associated with rehabilitation outcomes. Advanced age, high comorbidity, large anterior circulation infarcts and poor functional level on admission were independent indicators of unfavorable functional outcome. Hemodynamic comorbidities had significant impact on localization and extend of ischemic lesions.

Akuttherapie des Schlaganfalls - Stroke Units ermöglichen die Implementierung von Qualitätsstandards

The acute therapy of stroke has changed essentially in the last years. The two most important factors are the efficient and structured therapy of stroke victims in stroke units, and the use of thrombolysis in acute ischemic stroke. Stroke units establish an efficient basis therapy and contribute to the implementation of quality standards. The systemic thrombolysis will be performed within the three-hours time-window” after symptom onset. However, the sticking to the strict inclusion and exclusion criteria must be ensured by experienced physicians. Neuroprotective strategies are not available yet. The surgically performed decompressive hemicraniectomy is able to reduce mortality and disability in stroke patients suffering from malignant hemispheric infarcts. The optimal treatment of intracerebral hemorrhages, surgery versus conservative treatment, is still controversial and the decision must be made in each patient individually. A procoagulatoric therapy with recombinant factor VII for prevention of hemorrhage growth has been shown as non-effective, and can therefore not be recommended to be used outside clinical studies.

The Treatment of Spastic Equinovarus Foot after Stroke

Spastic equinovarus foot (SEF) is a major cause of disability in stroke patients. Treatments are multimodal and include rehabilitation, orthosis, botulinum toxin injections, alcohol and phenol nerve blocks, functional neurosurgery (neurotomy and intrathecal baclofen) and orthopedic surgery (tendon transfer or lengthening). Precise knowledge of the cause of the equinovarus deformity (muscle spasticity, shortening, and/or weakness) with clinical examination, diagnostic nerve blocks with anesthetics, and gait analysis may help to determine the most appropriate treatment for each patient. This article summarizes current approaches to the assessment and treatment of SEF. In contrast with the number of treatments available, there are a lack of comparative studies to guide therapeutic decisions, which actually depend more on personal experience than on scientific guidelines.