Disability In Stroke Patients Research Articles

A Primeval Mechanism of Tolerance to Desiccation Based on Glycolic Acid Saves Neurons in Mammals from Ischemia by Reducing Intracellular Calcium-Mediated Excitotoxicity.

Stroke is the second leading cause of death and disability worldwide. Current treatments, such as pharmacological thrombolysis or mechanical thrombectomy, reopen occluded arteries but do not protect against ischemia‐induced damage that occurs before reperfusion or neuronal damage induced by ischemia/reperfusion. It has been shown that disrupting the conversion of glyoxal to glycolic acid (GA) results in a decreased tolerance to anhydrobiosis in Caenorhabditis elegans dauer larva and that GA itself can rescue this phenotype. During the process of desiccation/rehydration, a metabolic stop/start similar to the one observed during ischemia/reperfusion occurs. In this study, the protective effect of GA is tested in different ischemia models, i.e., in commonly used stroke models in mice and swine. The results show that GA, given during reperfusion, strongly protects against ischemic damage and improves functional outcome. Evidence that GA exerts its effect by counteracting the glutamate‐dependent increase in intracellular calcium during excitotoxicity is provided. These results suggest that GA treatment has the potential to reduce mortality and disability in stroke patients.

Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China

BackgroundMultiple chronic diseases (MCDs) and social isolation are independent risk factors related to stroke and disability, but it is unknown whether the combination of these two conditions resulted from aging-related to functional disability in stroke patients. This study aimed to probe the relationship between the combination of MCDs, social isolation, and functional disability after stroke in elderly patients.MethodsA multicenter and cross-sectional study was conducted in the Departments of Rehabilitation of 103 hospitals located in 23 cities across China. Stroke patients aged 60–90 years were selected for analysis. Demographic characteristics, lifestyles, and clinical information were investigated by questionnaires and medical records. MCDs (hypertension/ diabetes/ hyperlipidemia/heart disease/kidney disease) were categorized into three levels: 0, 1, and ≥ 2. Functional disability was assessed by the Barthel Index and categorized into four groups: no, mild, moderate, and severe disability. The multi-nominal logistic regression model was used to explore the independent and combined association of MCDs and social isolation with functional disability.ResultsA total of 4046 elderly stroke patients (55 % males) were included in the final analysis. The prevalence of social isolation, MCDs ≥ 2, and severe disability increased with aging. In the fully adjusted model, patients with social isolation or MCDs had a higher risk of functional disability significantly than those without. Patients with social isolation combined MCDs ≥ 2 were 35 times (95 % CI: 18.89–64.69) more likely to suffer severe disability after stroke, and 8 times (95 % CI: 18.89–64.69) for moderate disability than those without social isolation and MCDs.ConclusionsMCDs, social isolation, and their combination were associated with a higher risk of functional disability after stroke in Chinese elderly patients. The elderly population should be encouraged to participate in more social activities, particularly in those with MCDs. Future secondary prevention and rehabilitation treatments to the functional ability of elderly stroke patients should underscore both social activity and the combined treatments of MCDs.Trial registrationNO: ChiCTR2000034067.

The Effectivity of Anodal Transcranial Direct Current Stimulation in Enhancing Wrist Extensor Muscle Activation After Stroke: A Randomized Trial

Background: Disability in stroke patients is frequently due to upper limb motor dysfunction, in which wrist extension control plays a major role. Beneficial effects of anodal transcranial direct current stimulation (tDCS) on motor recovery after stroke have been previously reported, but data regarding its effect on wrist extensor muscle activity is limited. Objective: To investigate whether anodal tDCS has an effect on wrist extensor activation in post-stroke patients. Methods: Ten patients suffering from first ischemic stroke were randomized to either an experimental group (anodal tDCS + occupational therapy) or a control group (occupational therapy only). Anodal tDCS over ipsilesional primary motor cortex (M1) was delivered with 2 mA intensity for 20 minutes. Evaluations of wrist extensor muscle activation during isometric contraction using surface electromyography were performed before and after five days of intervention. Results: Within-group comparison in the experimental and control groups; and between-group comparison showed no significant difference in wrist extension control before and after intervention (p = 0.446, p = 0.764, and p = 0,917, respectively). Conclusions: Five sessions of anodal tDCS showed no significant effect on wrist extensor activation in post-stroke patients. Further studies with a larger sample size and a longer period of intervention are necessary to clarify the effects of tDCS on wrist extension control in stroke patients.

Hip abduction with ankle dorsiflexion (HAAD) score and trunk seating control within 72 h after stroke predicts long-term disability: A cohort study

BackgroundThe aim of this study was to determine whether muscle strength of the lower limb and trunk during the acute phase after stroke are predictors of motor function and disability 90 days after hospital discharge. MethodsThis prospective study used a nonconcurrent design to evaluate stroke patients at two time points: a) first 72 h: hip abduction and ankle dorsiflexion (HAAD) score, trunk sitting control, clinical evaluation, demographic profile, and stroke severity using the National Institutes of Health Stroke Scale (NIHSS); b) 90 days after hospital discharge: modified Rankin scale (mRS). The participants were divided into two groups: good outcome (mRS 0–2) and worse outcome (mRS>2), and the differences between them were assessed statistically. Clinical and demographic variables were included in the multiple logistic regression analysis. The ROC curve was used to illustrate the clinical sensitivity and specificity of the HAAD score cutoff for the outcomes. ResultsThirty-seven patients were included: 16 with mRS≤2 and 21 with mRS>2. Patients in the worse outcome group were older (p = 0.02) and presented with higher NIHSS scores (p = 0.002), lower HAAD scores (p < 0.001), higher pain sensation (p = 0.04), greater altered perception (p = 0.008), and no trunk control in the sitting position (p = 0.004). A lower HAAD score (OR = 0.09; 95%CI: 0.14–0.53; p < 0.001) and the absence of trunk control in the sitting position (OR = 0.55; 95%CI:0.54–0.95; p < 0.001) were associated with unsatisfactory outcomes. ConclusionA HAAD score <6 and the absence of trunk control while sitting during the first 72 h are predictors of worse long-term disability in stroke patients.

Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients.

Background: Comorbidity is common and causes poor stroke outcomes. We aimed to examine the modifying impacts of physical activity (PA) and diet quality on the association between comorbidity and disability in stroke patients. Methods: A cross-sectional study was conducted on 951 stable stroke patients in Vietnam from December 2019 to December 2020. The survey questionnaires were administered to assess patients’ characteristics, clinical parameters (e.g., Charlson Comorbidity Index items), health-related behaviors (e.g., PA using the International Physical Activity Questionnaire- short version), health literacy, diet quality (using the Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire), and disability (using the World Health Organization Disability Assessment Schedule II (WHODAS II)). Linear regression models were used to analyze the associations and interactions. Results: The proportion of comorbidity was 49.9% (475/951). The scores of DASH-Q and WHODAS II were 29.2 ± 11.8, 32.3 ± 13.5, respectively. Patients with comorbidity had a higher score of disability (regression coefficient, B, 8.24; 95% confidence interval, 95%CI, 6.66, 9.83; p < 0.001) as compared with those without comorbidity. Patients with comorbidity and higher tertiles of PA (B, −4.65 to −5.48; p < 0.05), and a higher DASH-Q score (B, −0.32; p < 0.001) had a lower disability score, as compared with those without comorbidity and the lowest tertile of PA, and the lowest score of DASH-Q, respectively. Conclusions: Physical activity and diet quality significantly modified the negative impact of comorbidity on disability in stroke patients. Strategic approaches are required to promote physical activity and healthy diet which further improve stroke rehabilitation outcomes.

Abstract P72: The Obesity Paradox: Association Between Body Mass Index (BMI) and Disability After Stroke

Background: Present rise in the incidence of obesity has led to several opposing reports regarding the association between obesity and stroke outcomes. The objective of this study was to investigate a proposed paradoxical relationship between body mass index (BMI) and functional status in ischemic stroke patients at time of hospital discharge. Methods: Saint Francis Hospital Comprehensive Stroke Center patient databases were utilized in identifying 948 patients eligible for retrospective chart review over a period of 15 months. Subjects were divided into 4 groups according to BMI: underweight (BMI &lt; 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25.0-29.9 kg/m 2 ), and obese (BMI ≥ 30.0 kg/m 2 ). Covariates, such as age, gender, prior to event modified Rankin scale (mRS), stroke recurrence, and smoking, were considered. Functional status and disability of stroke patients was scored via mRS at hospital discharge. Ordered logistic regression, Pearson’s chi-squared test, and Pearson’s r correlation were used for analysis to assess the association of BMI and functional status in ischemic strokes. Results: Of 948 eligible subjects, 49.9% were female and mean (SD) age was 69.4 (14.5) years. According to BMI, 22 (2.3%) were underweight, 247 (26.1%) normal weight, 319 (33.7%) overweight, and 360 (37.9%) obese. After adjusting for covariates, ischemic stroke patients with an increased BMI (OR, 0.98; 95% CI, 0.96-0.99) were not associated with increased disability risk upon discharge. Obese (16.2%) and overweight (14.1%) patients discharged with a mRS of 0 (back to baseline) or 1 more frequently compared to normal weight (6.1%) and underweight (0.21%) patients ( P &lt;0.001). Furthermore, an inverse association between BMI status and disability was significantly evident ( r = -0.17, P &lt; 0.001). Conclusion: Obese and overweight stroke patients discharge with a lower risk of disability than normal weight and underweight patients, supporting the existence of the “obesity paradox” in stroke. An inverse association between obesity status and functional outcome was identified and remained significant regardless of covariates.

Abstract P806: Sirtuin1 Plays a Critical Role in Reversing Skeletal Muscle Atrophy in Cerebral Ischemic Stroke

Stroke is a leading cause of mortality and long-term disability in patients worldwide. Skeletal muscle is the primary systemic target organ of stroke that severely induces muscle wasting and weakness, which contributes more to the long-term functional disability in stroke patients than any other disease. Currently, no approved pharmacological drug is available to treat stroke-induced muscle loss. Rehabilitative therapy is the only available option to improve muscle function in stroke patients. However, higher muscle fatigability and lower muscle strength from extensive muscle wasting in post-stroke patients provide poor rehabilitative outcomes. As a result, about two-thirds of stroke survivors persist in a state of insufficient recovery and experience physical disability that drastically reduces their health and quality of life. The major challenge in the drug discovery effort for treating post-stroke muscle wasting is the lack of our understanding of the molecular and/or cellular mechanisms that underlie the muscle wasting in stroke. To understand the molecular origin of stroke-induced muscle atrophy, gene expression profiling and associated biological pathway enrichment studies were performed in a mouse model of cerebral ischemic stroke using high-throughput RNA sequencing and extensive bioinformatic analyses. RNA-seq data revealed that the elevated atrophy in skeletal muscle observed in response to stroke was primairly associated with the altered expression of genes involved in the muscle protein degradation pathway. Further analysis of RNA-seq data identified Sirtuin1 (SirT1) as a critical protein that plays a significant role in regulating post-stroke muscle mass. SirT1 gain-of-function in skeletal muscle significantly reversed stroke-induced muscle atrophy via inhibiting the activation of the ubiquitin proteasomal pathway and restoring autophagy function. Collectively, this study identified suppression of SirT1as a novel mechanism by which stroke induces muscle atrophy.

What can virtual reality offer to stroke patients? A narrative review of the literature.

Studies demonstrated the efficacy of virtual reality (VR) as a method supporting the post-stroke neuro-rehabilitation process by activating motor learning processes. Nevertheless, stroke is frequently accompanied by serious psychological problems including depression, which is associated with an increased risk of mortality, lower post-stroke physical activity, and higher disability in stroke patients. To explore the current use of VR as a method supporting the neuro-rehabilitation process, both in physical and psychological dimensions. An exploratory review was conducted with a narrative synthesis. PubMed was used for literature search. Search includes the use of VR in physical rehabilitation, and as support therapy in psychiatric disorders. Both primary research and systematic reviews were included. In neurological disorders rehabilitation, out of 22 studies, 16 concerned stroke survivors. In psychiatric disorders, 44 literature reviews were included. The studies confirmed the effectiveness of various forms of VR treatment in the alleviation of psychological and behavioral problems and psychiatric disorders. There is a shortage of VR-based technological solutions that would, besides physical rehabilitation, offer stroke patients therapeutic tools to alleviate psychological disturbance and improve the patient's mood and motivation. Such solutions will most likely become a field of intensive research in the coming years.

Efficacy and safety of cinepazide maleate injection in patients with acute ischemic stroke: a multicenter, randomized, double-blind, placebo-controlled trial

BackgroundIschemic stroke is a leading cause of morbidity and mortality. Thrombolytic therapy improves disability and survival rates; however, to be effective, it must be given within 4.5 h of onset. Moreover, thrombolytic therapy is frequently contraindicated. Therefore, alternative therapeutic options are required. In China, cinepazide maleate injection has been shown to improve the cerebral collateral circulation and further reduce disability in stroke patients; however, very few studies investigating this therapy have been conducted to date. Therefore, this study aimed to further confirm the efficacy and safety of cinepazide maleate injection in patients with acute ischemic stroke.MethodsPatients with acute ischemic stroke were administered an intravenous infusion of 320 mg cinepazide maleate or placebo once daily for 14 days. All patients were also administered basic therapy (citicoline sodium). The primary efficacy endpoint was the proportion of patients with a modified Rankin scale (mRS) ≤2 on day 90. Secondary efficacy endpoints included Barthel Index ≥95. Safety was evaluated by recording all adverse events (AEs), monitoring laboratory parameters and vital signs, and electrocardiogram.ResultsIn total, 937 patients with an acute ischemic stroke were included, with a mean (standard deviation, SD) National Institutes of Health Stroke Scale score of 8.8 (2.4) and a mean (SD) stroke onset of 30.9 (11.4) hours prior. Following treatment for 90 days, the proportion of patients with an mRS score ≤ 2 was significantly higher in the cinepazide maleate group than in the control group (60.9% vs. 50.1%; p = 0.0004). Moreover, the proportion of patients with a Barthel Index of ≥95 on day 90 was also significantly higher in the cinepazide maleate group than in the control group (53.4% vs. 46.7%; p = 0.0230). There were no statistically significant differences in safety parameters between the cinepazide maleate and control groups.ConclusionsThe results of this study show that cinepazide maleate injection is superior to placebo in improving neurological function and activities of daily living, reducing disability, and promoting functional recovery in patients with acute ischemic stroke. Cinepazide maleate injection was safe and well tolerated with no unexpected AEs reported.Trial registrationChinese Clinical Trial Registry CTR20160292 and ChiCTR1900023827. Retrospectively registered June 13, 2019.

Depression and Functional Disability in Stroke Patients

Background: Stroke patients often suffer from depression, a mental disorder that worsens their condition and slows down the recovery process. Depression is the leading cause of functional disability due to inability to cope with daily stressors and to function independently in their activities. The purpose of this study is to analyze the relationship between depression and functional disability levels in post-stroke patients.Design and Methods: This is an analytic observational research with a cross-sectional approach. The population in exam consisted of all 4-12 week post-stroke patient in the hospital (about 139 patients). The study focused on 104 respondents, who were selected using simple random sampling techniques.Results: The results show that 62.5% stroke patients suffered mild depressive episodes after the stroke while 58.7% experienced mild disabilities. Analysis results using the Pearson Product Moment Test obtained P=0,000. This shows there is a relationship between the level of depression and the degree of functional disability in post-stroke patients.Conclusions: It can be concluded that there is a significant relationship between the levels of post-stroke depression and the functional disability. Families are expected to provide a safe, supportive, and comfortable environment to lessen the level of depression.Significance for public healthPost-stroke depression should be perceived as a psychological reaction to the clinical consequences caused by stroke. This condition can cause functional disability due to inability to cope with daily stressors and to function independently in activities. This study highlights the relationship between depression and functional disability levels in post-stroke patients.

Transcriptome Analysis of Skeletal Muscle Reveals Altered Proteolytic and Neuromuscular Junction Associated Gene Expressions in a Mouse Model of Cerebral Ischemic Stroke.

Stroke is a leading cause of mortality and long-term disability in patients worldwide. Skeletal muscle is the primary systemic target organ of stroke that induces muscle wasting and weakness, which predominantly contribute to functional disability in stroke patients. Currently, no pharmacological drug is available to treat post-stroke muscle morbidities as the mechanisms underlying post-stroke muscle wasting remain poorly understood. To understand the stroke-mediated molecular changes occurring at the transcriptional level in skeletal muscle, the gene expression profiles and enrichment pathways were explored in a mouse model of cerebral ischemic stroke via high-throughput RNA sequencing and extensive bioinformatic analyses. RNA-seq revealed that the elevated muscle atrophy observed in response to stroke was associated with the altered expression of genes involved in proteolysis, cell cycle, extracellular matrix remodeling, and the neuromuscular junction (NMJ). These data suggest that stroke primarily targets muscle protein degradation and NMJ pathway proteins to induce muscle atrophy. Collectively, we for the first time have found a novel genome-wide transcriptome signature of post-stroke skeletal muscle in mice. Our study will provide critical information to further elucidate specific gene(s) and pathway(s) that can be targeted to mitigate accountable for post-stroke muscle atrophy and related weakness.

Artesunate promotes the proliferation of neural stem/progenitor cells and alleviates Ischemia-reperfusion Injury through PI3K/Akt/FOXO-3a/p27kip1 signaling pathway.

Stroke is one of the leading causes of death worldwide that also result in long-term disability. Endogenous neural stem/progenitor cells (NSPCs) within subventricular (SVZ) and dentate gyrus (DG) zone, stimulated by cerebral infarction, can promote neural function recovery. However, the proliferation of eNSPCs triggered by ischemia is not enough to induce neural repair, which may contribute to the permanent disability in stroke patients. In this study, our results showed that following the treatment with artesunate (ART, 150 mg/kg), the functional recovery was significantly improved, the infarct volume was notably reduced, and the expression of Nestin, a proliferation marker of NSPCs in the infarcted cortex, was also increased. Additionally, the proliferative activity of NSPCs with or without oxygen-glucose deprivation/reperfusion was significantly promoted by ART treatment, and the therapeutic concentration was 0.8 μmol/L (without OGD/R) or 0.4 μmol/L (with OGD/R) in the in vitro model. Furthermore, the effects of ART can be abolished by the treatment of PI3K inhibitor wortmannin. The expression levels of related molecules in PI3K/Akt/FOXO-3a/p27kip1 signaling pathway (p-AKT, p-FOXO-3a, p27kip1) were examined using western blotting. The results suggested ART could inhibit the transcriptional function of FOXO-3a by inducing its phosphorylation, subsequently downregulating p27kip1 and enhancing neural stem cell proliferation in the infarcted cortex via PI3K/AKT signaling, further alleviating ischemia-reperfusion injury after ischemic stroke.

Molecular Mechanisms of Skeletal Muscle Atrophy in Cerebral Ischemic Stroke

Stroke is the leading cause of death and the top cause of adult disability in patients world‐wide. Skeletal muscle is the main effector organ accounting for disability in stroke patients due to severe muscle atrophy and related weakness. However, the molecular signaling mechanisms that cause post‐stroke muscle atrophy remains elusive. To determine the mechanisms, we used a preclinical model of stroke in which we induced 60 minutes middle cerebral artery occlusion (MCAO) followed by 3 days reperfusion. We found that stroke caused a significant brain lesion and motor deficit. Stroke induced severe skeletal muscle atrophy in the paretic tibialis anterior muscle compared to the corresponding tibialis anterior muscle of sham mice, as evidenced by reduced muscle mass and FCA (fiber cross‐sectional area). Our transcriptome analysis showed that stroke altered mRNA expression profile in skeletal muscle. Some of the genes associated with catabolic pathways are highly dysregulated in post‐stroke muscle. We also found that stroke dramatically repressed the protein deacetylase Sirtuin1 (SirT1) gene expression and its function in skeletal muscle. Interestingly, restoring SirT1 function in post‐stroke muscle notably reversed muscle atrophy, in part, through regulating the key players of autophagy and ubiquitin proteasomal pathway. Collectively, our data uncovered a potential mechanism that causes cerebral ischemic stroke‐induced muscle atrophy and identified SirT1 as a critical regulator of post‐stroke muscle mass.

СУЧАСНІ ПОГЛЯДИ НА ЗАСТОСУВАННЯ ЗАХОДІВ ФІЗИЧНОЇ ТЕРАПІЇ В ОСІБ З ІНСУЛЬТОМ

Аbstract. The increase in morbidity and mortality in the world due to stroke necessitates the development of rehabilitation of post-stroke patients. Therefore, various specialized associations in developed countries are developing clinical guidelines for the rehabilitation of patients after stroke, which are based on the principles of evidence-based medicine. Objective. Consider modern approaches to the use of physical therapy in individuals after stroke. Methods. Theoretical analysis and generalization of modern scientific and methodological literature data on the use of physical therapy in people with stroke. Results. One of the main causes of disablement, mortality and long-term disability is the consequences of cerebrovascular injuries. Modern views on the recovery of patients after stroke are based on the concept of the International Classification of Functioning (ICF). According to the recommendations of modern clinical guidelines, rehabilitation of patients with stroke should begin from the first days of the patient’s stay in the hospital. It should be a specialized stroke unit with a multidisciplinary team. Provision of evidencebased care reduces mortality and subsequent disability in stroke patients. Methods of intervention with proven effectiveness in stroke include early verticalization of the patient, balance exercises, performing aerobic endurance exercises. It is believed that interventions aimed at reducing spasticity should not be routinely provided to patients with mild to moderate spasticity. If the manifestations of spasticity interfere with exercise and personal hygiene, then you should use proven means to reduce it. Analysis of the works of domestic scientists has shown that for the rehabilitation of stroke victims, it is proposed to use methods with unproven effectiveness, such as massage, acupuncture and reflexology, thermal treatments, cryotherapy, herbal medicine, magnetic therapy, which does not comply with international guidelines. Rehabilitation of patients after stroke is quite relevant and is being studied constantly. New means of physical therapy are constantly offered. They are analyzed by specialized institutions and reduced to systematic reviews, on the basis of which it is already possible to draw a conclusion about their effectiveness. In order to be familiar with current trends in rehabilitation, it is necessary to constantly follow the international guidelines, which are updated almost every year.

ASSESSMENT OF RISK FACTORS AND DRUG UTILIZATION PATTERN OF STROKE PATIENTS IN NEUROLOGY DEPARTMENT

Stroke is the second leading cause of death behind heart diseases in 2013 and a major cause of permanent disability. The burden of stroke in terms of mortality, morbidity and disability is increasing across the world. Neuroprotective drugs has become the core treatment, Due to lack of awareness in people of hospitalization very soon after occurrence of symptoms leading to disability. So this study aimed to discuss in detail on risk factors of stroke and drug utilisation patterns to be followed to achieve rational drug use in effective treating and to prevent disability in stroke patients. The risk factors both modifiable and non modifiable risk factors and standard treatment guidelines for effective treatment in both Ischemic stroke and Hemorrhagic stroke were discussed in detail.Objectives:To study the drug prescribing pattern among stroke patients and the indications for which they have prescribed. To determine the average drug encounter for prescription. To evaluate hazards, then remove or minimise its risk by adding control measures. Materials and Methodology:The current study was a prospective observational study of stroke patients to the department of neurology, Lalitha Super Specialities hospital Pvt Ltd, located in Guntur, Andhra Pradesh. The data collection for the study was conducted between September 2019 to January 2020. Data on demographic parameters, drug prescription pattern and clinical profile was documented.Results: There was high proportion of Ischemic strokes reported 81.61% than hemorrhagic stroke 18.39%. There were about 66.14% males affected when compared to 33.85% females. Mostly age group with 61-70 years were mostly affected in both the genders with 33.89% males and 26.49% females. The risk factor hypertension was reported as most prominent one with 80.26% and diabetes mellitus with 52.01% respectively. There was high proportion of Polypharmacy among the study was reported most of the prescriptions contain 8 drugs 21.28%. The most common category of drugs being consumed were antacids 11.30%, vitamins and supplements 11.28%,Nootropics 9.62%, Antihypertensives 9.52%, antiplatelets 9.305 and statins 8.93%.Conclusion: Prevention is better than cure early identification and management of risk factors like hypertension, diabetes mellitus and change in life style habits like smoking and alcohol consumption may reduce the risk of stroke. Proper prescribing pattern and monitoring the patients may prevent the ADR’s and drug interactions occurring in stroke patients. Follow up of the patient should be taken for the medication adherence and to prevent relapse. The people with good educational background had the awareness on early identification of stroke symptoms and it’s risk factors.

Quality of Life and Disability in Stroke Survivors

Background: With advancing treatment of stroke patients, their mortality has decreased but morbidity and disability has increased. Hence, it becomes increasingly important to find the measures to improve these areas. The study aims to assess the quality of life (QOL) and disability in stroke survivors at least six months post stroke.&#x0D; Methods: Descriptive, cross sectional design was used to assess the QOL and disability in stroke patients attending Neuromedicine and Neurosurgery out-patient departments of Kathmandu Medical College. Data was collected purposively using interview from 155 respondents. QOL was assessed using Health Related Quality of Life in Stroke Patients (HRQOLISP-40) and disability was measured by using World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Analysis was done using Pearson’s correlation and Mann Whitney U test.&#x0D; Results: The QOL was found to be best in the ‘ecosocial’ and worst in the ‘soul’ domain. In disability, patients scored the best in ‘Getting along with people’ and ‘self-care’ domains and worst in the ‘life activities: school/ work’ domain. Respondents with hemorrhagic stroke, only one admission and those who did not exercise had better QOL. Patients with less than 10 years of formal education, those not earning and those with comorbidities had more disability. Correlation analysis showed better QOL with lesser age, higher monthly family income and higher Barthel index whereas higher disability was found in respondents with higher age and lower Barthel index.&#x0D; Conclusions: Disability in stroke patients needs to be addressed inorder to improve their QOL. The domains affected should be given attention during rehabilitation of stroke patients.

Robot-Assisted Stair Climbing Training on Postural Control and Sensory Integration Processes in Chronic Post-stroke Patients: A Randomized Controlled Clinical Trial.

BackgroundPostural control disturbances are one of the important causes of disability in stroke patients affecting balance and mobility. The impairment of sensory input integration from visual, somatosensory and vestibular systems contributes to postural control disorders in post-stroke patients. Robot-assisted gait training may be considered a valuable tool in improving gait and postural control abnormalities.ObjectiveThe primary aim of the study was to compare the effects of robot-assisted stair climbing training against sensory integration balance training on static and dynamic balance in chronic stroke patients. The secondary aims were to compare the training effects on sensory integration processes and mobility.MethodsThis single-blind, randomized, controlled trial involved 32 chronic stroke outpatients with postural instability. The experimental group (EG, n = 16) received robot-assisted stair climbing training. The control group (n = 16) received sensory integration balance training. Training protocols lasted for 5 weeks (50 min/session, two sessions/week). Before, after, and at 1-month follow-up, a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Berg Balance Scale (BBS). Secondary outcomes:10-meter walking test, 6-min walking test, Dynamic gait index (DGI), stair climbing test (SCT) up and down, the Time Up and Go, and length of sway and sway area of the Center of Pressure (CoP) assessed using the stabilometric assessment.ResultsThere was a non-significant main effect of group on primary and secondary outcomes. A significant Time × Group interaction was measured on 6-min walking test (p = 0.013) and on posturographic outcomes (p = 0.005). Post hoc within-group analysis showed only in the EG a significant reduction of sway area and the CoP length on compliant surface in the eyes-closed and dome conditions.ConclusionPostural control disorders in patients with chronic stroke may be ameliorated by robot-assisted stair climbing training and sensory integration balance training. The robot-assisted stair climbing training contributed to improving sensorimotor integration processes on compliant surfaces. Clinical trial registration (NCT03566901).

Enlarged Perivascular Spaces and Cerebral Small Vessel Disease in Spontaneous Intracerebral Hemorrhage Patients.

Background: Cerebral small vessel disease (SVD) is associated with cognitive decline, depression, increased mortality, and disability in stroke patients. MRI-visible perivascular spaces (PVS) are a sensitive neuroimaging marker of SVD. We aimed to explore the risk factors and associations with other SVD markers of PVS in two topographical regions (in the basal ganglia [BG] and centrum semiovale [CS]) in a cohort of spontaneous intracerebral hemorrhage (ICH) patients.Method: We included 306 consecutive patients from a prospective spontaneous ICH cohort. We rated PVS, white matter hyperintensities (WMH), cerebral microbleeds (CMB), and lacunes with validated visual rating scale. We collected clinical information using standardized forms. We predefined severe PVS as score > 2 and examined associations between PVS in both BG and CS regions and clinical and imaging markers of SVD by logistic regression.Results: In the multivariable logistic regression, increasing age (OR = 1.075; 95% CI = 1.038–1.113, p < 0.001), high CS PVS degrees (OR = 6.906; 95% CI = 3.024–15.774, p < 0.001), extensive periventricular WMH (OR = 2.878; 95% CI = 1.298–6.379, p = 0.009), and the presence of CMB (OR = 4.073, 95% CI = 1.869–8.877, p < 0.001) were independently associated with BG PVS severity. Alcohol-drinking habit (OR = 2.805; 95% CI = 1.451–5.422, p = 0.002), hyperlipidemia history (OR = 3.782; 95% CI = 1.582–8.783, p = 0.003), high BG PVS degrees (OR = 6.293; 95% CI = 2.755–14.371, p < 0.001) and the presence of strictly lobar CMB (OR = 2.556, 95% CI = 1.285–5.085, p = 0.008) were independent predictors of increased CS PVS severity.Conclusion: MRI-visible PVS in BG and CS regions are inter-related and have different risk factors in spontaneous ICH patients. Further studies are needed to explore the mechanism and clinical importance of PVS, with possible implications for cerebrovascular disease prevention and effective treatments.

Role of citicoline in improvement of cognition, memory and post stroke disability in stroke patients

Background: Citicoline has emerged as a potential neuroprotectant in experimental models in stroke patients. Citicoline has shown some beneficial effects in human ischaemic stroke and with an excellent safety profile while in haemorrhagic stroke data is limited. Authors conducted this study to test role of citicoline in stroke patients in terms of cognition, memory and post stroke disability.Methods: In this prospective study, patients had to be previously independent, aged &gt;18 years of age, presented within 24 hours of onset of symptoms of stroke diagnosed by neuroimaging (CT or MRI). Patients received either a placebo or 500 mg/12 h citicoline for 12 weeks (orally or intravenously). The primary aim was to evaluate improvement in cognition, memory and post stroke disability after 12 weeks. The efficacy endpoint was the percentage of subjects with MMSE and DRS at 12 weeks.Results: Total 75 stroke patients were enrolled, 40 in control group and 35 in citicoline group were allotted randomly. Patients in citicoline group were given intravenous citicoline 500 mg/12 hour during hospital stay and orally 500 mg/12 hour after discharge for up to 12 weeks. Control Group was given Placebo. cognition, memory and post stroke disability show positive improvement in citicoline group.Conclusions: Citicoline shows beneficial effects in stroke in terms of cognition, memory and post stroke disability.

Clinical Profile of Stroke Patients with Vertigo in Hasan Sadikin General Hospital Bandung Neurology Ward

Vertigo often occurs from the ages of 18 to 79 years with a prevalence of 7.4%. Central vertigo is less common than peripheral vertigo, but it can worsen disability in stroke patients. This study aims to determine the profile of stroke patients with vertigo in Hasan Sadikin General Hospital Bandung Neurology Ward. This is a retrospective descriptive study, using medical record data from 2013 to 2017, and collected 173 medical record data. The results showed that most stroke patients with vertigo were women (59%), the most age group was 55-64 years (34.1%), the most common type of stroke was ischemic stroke (75.7%), the most disturbance regarding the vertebrobasilar system was (72.8%), the most patients got the first stroke was (52.6%), 60.7% of patients suffered from hypertension, 23.1% of patients suffered from hyperlipidemia 40 (23.1%), and 22% of patients suffered from diabetes mellitus type 2. This study concludes that stroke patients who experience vertigo are more common in women, and in the 55-64 year age group. The most common stroke is ischemic in the vertebrobasilar system. Most symptoms in stroke patients with vertigo are dizziness not affected by position, vomiting and nystagmus. Hypertension, hyperlipidemia and diabetes mellitus play an important role in the incidence of stroke in patients.&#x0D; &#x0D; Keywords: vertigo, risk factor, stroke, vertebrobasilar