Impairment In Post-stroke Patients Research Articles

Efficacy of rTMS in treating functional impairment in post-stroke patients: a systematic review and meta-analysis.

Most stroke patients suffer from an imbalance in blood supply, which causes severe brain damage leading to functional deficits in motor, sensory, swallowing, cognitive, emotional, and speech functions. Repetitive transcranial magnetic stimulation (rTMS) is thought to restore functions impaired during the stroke process and improve the quality of life of stroke patients. However, the efficacy of rTMS in treating post-stroke function impairment varies significantly. Therefore, we conducted a meta-analysis of the number of patients with effective rTMS in treating post-stroke dysfunction. The PubMed, Embase, and Cochrane Library databases were searched. Screening and full-text review were performed by three investigators. Single-group rate meta-analysis was performed on the extracted data using a random variable model. Then subgroup analyses were performed at the levels of stroke acuity (acute, chronic, or subacute); post-stroke symptoms (including upper and lower limb motor function, dysphagia, depression, aphasia); rTMS stimulation site (affected side, unaffected side); and whether or not it was a combination therapy. We obtained 8955 search records, and finally 33 studies (2682 patients) were included in the meta-analysis. The overall analysis found that effective strength (ES) of rTMS was 0.53. In addition, we found that the ES of rTMS from acute/subacute/chronic post-stroke was 0.69, 0.45, and 0.52. We also found that the ES of rTMS using high-frequency stimulation was 0.56, while the ES of rTMS using low-frequency stimulation was 0.53. From post-stroke symptoms, we found that the ES of rTMS in sensory aspects, upper limb functional aspects, swallowing function, and aphasia was 0.50, 0.52, 0.51, and 0.54. And from the site of rTMS stimulation, we found that the ES of rTMS applied to the affected side was 0.51, while the ES applied to the unaffected side was 0.54. What's more, we found that the ES of rTMS applied alone was 0.53, while the ES of rTMS applied in conjunction with other therapeutic modalities was 0.53. By comparing the results of the data, we recommend rTMS as a treatment option for rehabilitation of functional impairment in patients after stroke. We also recommend that rehabilitation physicians or clinicians use combination therapy as one of the options for patients.

Effect of Balance Exercises with Smart Phone Based Virtual Reality Programme on Balance in Stroke Patients

Background and objectives: A stroke is a neurological deficit, caused due to vascular changes. Impaired postural control and balance impairments in post-stroke patients are associated with a high risk of falls among stroke patients. The perturbation-based balance training is mainly used in older adults and balance impairment. Virtual reality (VR) as a novel technology is rapidly becoming a popular intervention for improving balance. VR can visualize computer-generated environments with a full field of view through Head-mounted displays (HMD-VR). This study was conducted to assess and investigate the effect of balance exercises with smartphone-based virtual reality programs on balance in stroke patients. Methods: This was a randomized single-group pre and post-test study design. 30 subjects met the inclusion criteria and were enrolled, assigned, and received intervention. Subjects were given perturbation-based balance exercises and smartphone-based virtual reality along with conventional physiotherapy. The intervention protocol was for 6 days/week for 4 weeks period. Results: Following 4 weeks of intervention showed improvement in postural control and balance which was assessed using BBS, TUG, VR BESS, BESTest, and SIS 3.0. Paired t-test was used to differentiate the mean significance. The mean pre to post-intervention difference is 12.6 with a p - value < 0.05. TUG score improved from pre to post-intervention difference is 1.443 with a p - value < 0.05. VR BESS score improved from pre to post-intervention difference is 10.266 with a p value < 0.05. The mean BESTest pre to post-intervention difference is 11.467 with a p - value < 0.05. SIS 3.0 score improved from a pre to post-intervention difference is 20.33 with p - value < 0.05. The result of this study showed a highly significant difference in pre and post-treatment. Conclusion: The study concludes that perturbation-based balance exercises with smartphone-based virtual reality programs are a useful adjunct to improving balance in stroke patients along with conventional physiotherapy.

Effect of Balance Exercises with Smart Phone Based Virtual Reality Programme on Balance in Stroke Patients

BACKGROUND AND OBJECTIVES: Stroke is a neurological deficit, caused due to vascular changes. Impaired postural control and balance impairments in post stroke patients, associated with high risk of fall among the stroke patients. The perturbation - based balance training mainly used in older adults and balance impairment. Virtual reality (VR) as a novel technology is rapidly becoming a popular intervention for improving balance. VR can visualize the computer - generated environments with full field of view by Head mounted displays (HMD-VR) .This study was conducted to assess and investigate the effect of balance exercises with smart phone based virtual reality programme on balance in stroke patients. METHOD: This was a randomized single-group pre and post test study design. 30 subjects met the inclusion criteria and were enrolled, assigned and received intervention. Subjects were given perturbation based balance exercise and smart phone based virtual reality along with conventional physiotherapy. Intervention protocol was for 6 days/week for 4 weeks period. RESULTS: Following 4 weeks of intervention showed improvement in postural control and balance which was assessed using BBS, TUG, VR BESS, BESTest, SIS 3.0. Paired t test was used to differentiate the mean significance. The mean pre to post intervention difference is 12.6 with P value < 0.05. TUG score improved from pre to post intervention difference is 1.443 with P value < 0.05. VR BESS score improved from pre to post intervention difference is 10.266 with P value < 0.05. The mean BESTest pre to post intervention difference is 11.467 with P value < 0.05. SIS 3.0 score improved from pre to post intervention difference is 20.33 with P value < 0.05. The result of this study showed highly significant difference in pre and post treatment. CONCLUSION: The study concludes that perturbation based balance exercises with smart phone based virtual reality programme is a useful adjunct on improving balance in stroke patients along with conventional physiotherapy.

Emerging Validation for the Adapted Chinese Version of Quick Aphasia Battery.

The quick aphasia battery (QAB) was designed to evaluate language disorder from multi-dimension efficiently, which had been translated into several languages but lacked in Chinese. This study conducted cross-cultural adaption for the Chinese version and verified its psychometric properties. First, the Chinese Version of quick aphasia battery (CQAB) was adapted following WHO literature guidelines with steps of forward translation, expert panel, back-translation, pre-test, and interview, then develop the final version. Second, the psychometric properties tests were conducted in 128 post-stroke patients to identify if aphasia happens and verify the validity and reliability of CQAB. The Cronbach's alpha coefficient of the CQAB is 0.962, test-retest reliability 0.849, and inter-rater reliability 0.998. Content validity 0.917, KMO 0.861, exploratory factor analysis extracted 2 factors named "language understanding" and "language program", cumulative variance contribution rate is 91.588% >50%. Calibration association validity 0.977. Sensitivity 0.977, specificity 0.932, with the optimal cutoff point is 8.86. The study supported CQAB, which adapted following standardized guidelines, is reliable and effective to assess language impairment in post-stroke patients.

Rehabilitation of somatic sensation and related deficit of motor control by Mirror Box Therapy: a case report

ABSTRACT Somatosensory disorders are often present after cerebral stroke. These deficits are associated with patients’ disability. Therefore, their rehabilitation takes an importance in recovery program. However, the treatment of sensation remains poorly considered during neurorehabilitation and evidence for active sensory training is limited. Mirror Box Therapy is a simple training used to treat upper extremity motor deficits and pain also in patients with stroke. However, the effects of Mirror Box Therapy on somatosensory impairments in post-stroke patients are not deeply investigated and often exclusively motor exercises are provided during therapy. The aim of the present study was to investigate the effects of Mirror Box Therapy sensory training on somatosensory deficits in a stroke patient presenting upper limb impairment. The patient underwent to four weeks of training, five days a week. Before, during and after the Mirror Box Therapy treatment, the patient was assessed by Rivermead Assessment of Somatosensory Performance. Before and after training also upper limb motor function and performance in activities of daily living were assessed. After training patient showed an improvement in somatosensory performance. The gain was maintained at follow-up. This case report shows the effects of Mirror Box Therapy sensory training on the upper extremity for the improvement of sensation and movement in a patient with a thalamo-capsular hemorrhagic stroke during the subacute phase.

Нейропластичность и постинсультные когнитивные нарушения (терапевтические возможности)

В статье представлена частота встречаемости, факторы риска, патогенетические механизмы развития когнитивных нарушений у пациентов, которые перенесли мозговой инсульт. Показана роль ней­ротрофических факторов в формировании когнитивного дефицита у постинсультных больных. На основании экспериментальных и клинических исследований показаны возможности влияния Hericium erinaceus на когнитивные функции у пациентов с цереброваскулярными и нейродегенеративными заболеваниями.

Effect of acupuncture combined with rehabilitation on cognitive and motor functions in poststroke patients.

The aim of the study was to explore the effect of acupuncture combined with rehabilitation on cognitive and motor functions in poststroke patients. All patients were divided into Group A and Group B based on different interventions (Group A: acupuncture + conventional rehabilitation, Group B: conventional rehabilitation alone). Acupuncture was conducted once a day, five times a week for 8 weeks, and rehabilitation (including physical therapy and occupational therapy) was conducted for 2 hr per session, once a day, five times a week for 8 weeks. Mini-mental State Examination (MMSE) and Fugl-Meyer Assessment (FMA) were used to assess the motor and cognitive functions at baseline and the end of 8 weeks. After the intervention, FMA and MMSE scores were improved significantly in the two groups (p <.05), compared with the scores prior to intervention. After 8 weeks of intervention, a statistically significant difference in the FMA and MMSE scores was observed between the Group A and the Group B. The results suggested that the combined intervention is more effective than the conventional rehabilitation alone in improving cognitive and motor functions in poststroke patients.

ВЛИЯНИЕ РИТМИЧЕСКОЙ ТРАНСКРАНИАЛЬНОЙ И МНОГОУРОВНЕВОЙ МАГНИТНОЙ СТИМУЛЯЦИИ НА КОГНИТИВНЫЕ НАРУШЕНИЯ У ПОСТИНСУЛЬТНЫХ БОЛЬНЫХ

Cognitive impairment in post-stroke patients is often a major cause of social limitations. They seem insignificant and are masked by prominent post-stroke motor disorders, but negatively affect rehabilitation outcomes with loss of learning skills. Application of transcranial magnetic stimulation using multiple variations of schemes, its feature of noninvasive influence on the central and peripheral nervous system and modification of plasticity processes, appears effective for therapy in post-stroke patients, both in the acute and recovery periods.

Stress and Relationship with Cognitive Disorders of Post-Stroke Patients

Cognitive disorders will greatly interfere with activity in patients with a history of stroke. This will be exacerbated by chronic stress conditions. The design of this study is descriptive analytic with cross sectional approach with 75 post-stroke patients as outpatients at X Hospital. The instruments used in this study are standard instruments, DASS for stress questionnaires and MMSE for cognitive impairment. The results obtained are based on characteristic data, namely age over 46 years (98.7%), female gender (52%), high school graduate education (40%), not working (54.7%) and bivariate test results obtained p value 0.020. the conclusion of this study is that there is a close relationship between stress and cognitive impairment in post-stroke patients. The expectation of this research is to be an important illustration that stress theory and cognitive function can be a reference in the process of solving problems that occur in post-stroke patients

Association of plasma trimethylamine-N-oxide levels with post-stroke cognitive impairment: a 1-year longitudinal study

Post-stroke cognitive impairment (PSCI) is a clinical condition arising from stroke and causes significant changes to memory, thinking, and behavior. Trimethylamine-N-oxide (TMAO), the metabolite produced by gut microbiota, has mechanistic relevance to atherosclerotic diseases. This study aimed to investigate whether an association existed between elevated plasma TMAO levels and PSCI. Consecutive patients with acute ischemic stroke were prospectively enrolled during Jan. 2017 to Dec. 2017. TMAO concentration was measured within 24h after admission. PSCI was assessed using the Mini-Mental State Examination (MMSE) score after 1year and defined as MMSE score ≤ 26. Binary logistic regression analysis was used to determine the contribution of TMAO level in the prediction of PSCI. Of the 256 patients studied (age, 67.1 ± 11.0years; male, 54.3%), 86 (33.6%) patients were diagnosed as PSCI. The mean TMAO level was 5.6 ± 2.4μM, with quartile level as follows: < 3.9μM (first quartile), 3.9-5.1μM (second quartile), 5.2-7.4μM (third quartile), and > 7.4μM (fourth quartile). After controlling for potential confounders, multivariable logistic analysis showed that higher level of plasma TMAO was an independent predictor for cognitive impairment in post-stroke patients (the quartile 1 was used as reference, the quartile 4 odds ratio, 3.304; 95% confidence intervals, 1.335-8.178; P = 0.010). This study demonstrated that increasing plasma level of TMAO may be associated with PSCI.

Development and Validation of an Exercise Programme for Recovery Balance Impairments in Poststroke Patients

Background: Deterioration of balance is one of the most common and disabling physical-motor deficits in patients after a stroke that have a negative impact on quality of life and increase the risk of falls. Previous studies have evaluated the effectiveness of the exercises on specific aspects of balance. However, there is no structured exercise program divided by levels for balance impairment in poststroke patients. Methods: Delphi method was used to design the exercise programme, and then a pilot study was performed. For the pilot study, we included 14 poststroke adults patients (n = 7 in each group), with balance impairment, without previous severe functional dependence, sensorial deficit or dementia. Our 4 weeks intervention (5 times/week) is based on 9 exercise of progressive difficulty, offering a multidimensional approach training (biomechanical constraints, stability limits, anticipatory, postural responses, and sensory orientation). Patients in the intervention arm received 45 minutes of usual rehabilitation plus 15 minutes of the intervention proposed. The usual-care arm received 60 minutes of usual rehabilitation. Balance impairment (Mini BESTest) was assessed at the baseline and at 4 weeks. Differences between groups were analysed using Mann-Whitney U test. Results: The agreement for the intervention designed was reached after 2 rounds. Participants in pilot study were 69 (SD = 9.7) years, 21.4% females. Post-treatment, median improvements in Mini BESTest were 20 (SD = 8) and 11 (SD = 10) points, P < .01 for intervention and control group respectively. Conclusion: A multidimensional approach of balance impairments in poststroke patients through the validated exercise programme proposed, may improve balance deficits.

Structural brain network measures are superior to vascular burden scores in predicting early cognitive impairment in post stroke patients with small vessel disease.

ObjectivesIn this cross-sectional study, we aimed to explore the mechanisms of early cognitive impairment in a post stroke non-dementia cerebral small vessel disease (SVD) cohort by comparing the SVD score with the structural brain network measures.Method127 SVD patients were recruited consecutively from a stroke clinic, comprising 76 individuals with mild cognitive impairment (MCI) and 51 with no cognitive impairment (NCI). Detailed neuropsychological assessments and multimodal MRI were performed. SVD scores were calculated on a standard scale, and structural brain network measures were analyzed by diffusion tensor imaging (DTI). Between-group differences were analyzed, and logistic regression was applied to determine the predictive value of SVD and network measures for cognitive status. Mediation analysis with structural equation modeling (SEM) was used to better understand the interactions of SVD burden, brain networks and cognitive deficits.ResultsGroup difference was found on all global brain network measures. After adjustment for age, gender, education and depression, significant correlations were found between global brain network measures and diverse neuropsychological tests, including TMT-B (r = −0.209, p < .05), DSST (r = 0.206, p < .05), AVLT short term free recall (r = 0.233, p < .05), AVLT long term free recall (r = 0.264, p < .05) and Rey-O copy (r = 0.272, p < .05). SVD score showed no group difference and was not correlated with cognition tests. Network global efficiency (EGlobal) was significantly related to cognitive state (p < .01) but not the SVD score. Mediation analysis showed that the standardized total effect (p = .013) and the standardized indirect effect (p = .016) of SVD score on cognition was significant, but the direct effect was not.ConclusionsBrain network measures, but not the SVD score, are significantly correlated with cognition in post-stroke SVD patients. Mediation analysis showed that the cerebral vascular lesions produce cognitive dysfunction by interfering with the structural brain network in SVD patients. The brain network measures may be regarded as direct and independent surrogate markers of cognitive impairment in SVD.

Effect of long-time needle retaining at Baihui (GV 20) on cognitive impairment in post-stroke patients

To observe the clinical efficacy of long-time needle retaining at Baihui (GV 20) in treating post-stroke cognitive impairment. A total of 60 eligible patients with post-stroke cognitive impairment were randomized into a treatment group and a control group by random digital table, 30 cases in each group. The control group was intervened by basic treatment including routine therapy in Neurology department and Western medicine rehabilitation therapy, while the treatment group was intervened by same treatment in the control group combined with long-time needle retaining at Baihui (GV 20). Mental state of patients was evaluated by National Institute of Health stroke scale (NIHSS) and mini-mental state examination (MMSE) after 4 weeks of treatment. After 4-week treatment, the NIHSS score dropped in both groups, and intra-group comparisons showed statistical significances (both P<0.05), and the score in the treatment group was statistically lower than that in the control group (P<0.01); the MMSE score in the treatment group was significantly higher than that in the control group, there was a statistical inter-group difference (P<0.01); the total effective rate was 93.3%, and the marked effective rate was 50.0% in the treatment group, versus 76.7% and 20.0% in the control group, there were significant differences in the total effective rate and the marked effective rate between the two groups (all P<0.05). Long-time needle retaining at Baihui (GV 20) can produce a safe valid therapeutic efficacy in treating post-stroke cognitive impairment.

Comparison between mini mental state examination (MMSE) and Montreal cognitive assessment Indonesian version (MoCA-Ina) as an early detection of cognitive impairments in post-stroke patients

Mild cognitive impairment (MCI) is defined as cognitive impairment that may never develop into dementia. Cognitive impairment is one long-term complication of a stroke. The Mini Mental State Examination (MMSE), which is commonly used as a screening tool for cognitive impairment, has a low sensitivity to detect cognitive impairment, especially MCI. Alternatively, the Montreal Cognitive Assessment Indonesian version (MoCA-Ina) has been reported to have a higher sensitivity than the MMSE. The aim of this study was to compare the proportion of MCI identified between the MMSE and MoCA-Ina in stroke patients. This was a cross-sectional study of stroke outpatients who attended the Polyclinic Neuromuscular Division, Rehabilitation Department, and Polyclinic Stroke, Neurology Department Cipto Mangunkusumo General Hospital, Jakarta. The proportion of MCI identified using the MMSE was 31.03% compared to 72.41% when using the MoCA-Ina. This difference was statistically significant (Fisher’s exact test, p = 0.033). The proportion of MCI in stroke patients was higher when using the MoCA-Ina compared to the MMSE. The MoCA-Ina should be used as an alternative in the early detection of MCI in stroke patients, especially those undergoing rehabilitation.

Model-based variables for the kinematic assessment of upper-extremity impairments in post-stroke patients

BackgroundCommon scales for clinical evaluation of post-stroke upper-limb motor recovery are often complemented with kinematic parameters extracted from movement trajectories. However, there is no a general consensus on which parameters to use. Moreover, the selected variables may be redundant and highly correlated or, conversely, may incompletely sample the kinematic information from the trajectories. Here we sought to identify a set of clinically useful variables for an exhaustive but yet economical kinematic characterization of upper limb movements performed by post-stroke hemiparetic subjects.MethodsFor this purpose, we pursued a top-down model-driven approach, seeking which kinematic parameters were pivotal for a computational model to generate trajectories of point-to-point planar movements similar to those made by post-stroke subjects at different levels of impairment.ResultsThe set of kinematic variables used in the model allowed for the generation of trajectories significantly similar to those of either sub-acute or chronic post-stroke patients at different time points during the therapy. Simulated trajectories also correctly reproduced many kinematic features of real movements, as assessed by an extensive set of kinematic metrics computed on both real and simulated curves. When inspected for redundancy, we found that variations in the variables used in the model were explained by three different underlying and unobserved factors related to movement efficiency, speed, and accuracy, possibly revealing different working mechanisms of recovery.ConclusionThis study identified a set of measures capable of extensively characterizing the kinematics of upper limb movements performed by post-stroke subjects and of tracking changes of different motor improvement aspects throughout the rehabilitation process.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-016-0187-9) contains supplementary material, which is available to authorized users.

Cough reflex attenuation and swallowing dysfunction in sub-acute post-stroke patients: prevalence, risk factors, and clinical outcome.

Cough and swallowing impairments in post-stroke patients (PSP) have been associated with increased risk for respiratory complications. To assess the prevalence of alterations in protective cough responses in subacute PSP and its association with oropharyngeal dysphagia (OD), clinical, and neurotopographic stroke factors and clinical outcomes. Three months after stroke, the cough reflex test (CRT) was performed by nebulizing incremental citric acid concentrations (7.8-1000mmolL-1 ) to determine the concentration that elicited two and five coughs; OD was assessed by the volume-viscosity swallow test. Clinical and neurotopographic stroke risk factors and complications (readmissions, respiratory infections, institutionalization, and mortality) were recorded from 3 to 12months post-stroke. We included 225 PSP. Prevalence of impaired CRT was 5.8%, that of OD was 40.4% (20.4% with impaired safety of swallow), and of both impairments was, 1.8%. No specific risk factors associated with impaired CRT were found; however, hemorrhagic, wide circulation infarction (TACI), and brainstem strokes delayed the cough response. OD was associated with age, TACI and poor functional and nutritional status. Outcome of PSPs was unaffected by impaired CRT but OD and impaired safety of swallow increased institutionalization, respiratory infections, and mortality with the poorest outcome for those with both impairments. Prevalence of subacute post-stroke OD and swallow safety impairments was much higher than CRT attenuation, and risk factors strongly differed suggesting that the swallow response receives a stronger cortical control than the cough reflex. OD has a greater impact on PSP clinical outcome than impaired cough, the poorest prognosis being for patients with both airway protective dysfunctions.

Does kinematics add meaningful information to clinical assessment in upper limb rehabilitation after stroke?

Researchquestion:The aimsof this studywere: (a) quantify the upper limb impairments in post-stroke patients; (b) quantitatively evaluate the effectiveness of an upper limb rehabilitation program; (c) gain more clinically meaningful information using kinematic analysis in addition to clinical assessment. Introduction: The motor functions and the effects of rehabilitative treatments are measured using clinical tests and semi-quantitative scale. The samemotor behavior can be analyzed using instrumental kinematic tools that provide qualitative and quantitative information. Materials and methods: A group of 10 post-stroke patients was treated with an integrated rehabilitative program (including upper limb training); a second group of 5 post-stroke patients was treated with conventional physiotherapy. Treatment for both groups includes ten session lasting an hour and a half a day. Kinematic analysis was performed by an optoelectronic system (Vicon, UK). The subjects were asked to reach an object in a standardized setting. The task was repeated 12 times (six movements, right and left). Kinematic analysis was conducted identifying and computing specific parameters of movement duration, velocity, smoothness and upper limbs angles [1,2]. The clinical scales were Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), Nine HolePegTest (NHPT) andHandGripDynamometer test. All patients were assessed PRE and POST treatment. The comparison between the two sessions was done using non parametric tests (p<0.05). Results: The upper limb kinematics evaluation showed that in PRE session the most of parameters of both groups were different from the normality ranges, with no differences between the two groups. In particular, they executed the movement slower, with higher movement duration, and with lower precision. After the treatment in the first group we found significant improvements in terms of movement duration, in particular during going phase (1.3 vs. 1.0 s; p<0.05; controls: 0.8 s) and total duration (3.6 vs. 2.5 s; p<0.05; controls: 1.9 s), and number of unit movements (15.2 vs. 7.5; p<0.05; controls: 2.8); our data showed higher mean velocity (0.3 vs. 0.5m/s; p<0.05; controls: 0.6m/s) and an increased ROM of shoulder flex-extension (32.9 vs. 36.9 degrees; p<0.05; controls: 43.9 degrees). On the contrary, the group treated with conventional physiotherapy showed no statistically changes. Some significant correlations were found between the clinical outcomes and kinematic evaluation. Discussion: Our data show that integration of clinical assessment with kinematic evaluation is useful to detect quantitative and qualitative changes in performance. The latter are meaningful signsof rehabilitationprogrameffectiveness. Theoptoelectronic system resulted reliable for studyingupper limbs patterns ofmovement (bymeans of integration of speed, coordination and precision indexes).

Improvement of memory impairments in poststroke patients by hyperbaric oxygen therapy.

Several recent studies have shown that hyperbaric oxygen (HBO₂) therapy carry cognitive and motor therapeutic effects for patients with acquired brain injuries. The goal of this study was to address the specific effects of HBO₂ on memory impairments after stroke at late chronic stages. A retrospective analysis was conducted on data of 91 stroke patients 18 years or older (mean age ∼60 years) who had either ischemic or hemorrhagic stroke 3-180 months before HBO₂ therapy (M = 30-35 months). The HBO₂ protocol included 40 to 60 daily sessions, 5 days per week, 90 min each, 100% oxygen at 2ATA, and memory tests were administered before and after HBO₂ therapy using NeuroTrax's computerized testing battery. Assessments were based on verbal or nonverbal, immediate or delayed memory measures. The cognitive tests were compared with changes in the brain metabolic state measured by single-photon emission computed tomography. Results revealed statistically significant improvements (p < .0005, effect sizes medium to large) in all memory measures after HBO₂ treatments. The clinical improvements were well correlated with improvement in brain metabolism, mainly in temporal areas. Although further research is needed, the results illustrate the potential of HBO₂ for improving memory impairments in poststroke patients, even years after the acute event.

Validation of the Brazilian-Portuguese version of the Modified Telephone Interview for cognitive status among stroke patients.

To examine the psychometric properties of the Brazilian version of the Modified Telephone Interview for Cognitive Status (TICS-M) for cognitive impairment in post-stroke patients from the Stroke Mortality and Morbidity Study. The original version of the TICS-M was translated and adapted into Brazilian-Portuguese language in 30 non-clinical subjects. After that, two trained researchers applied the TICS-M in 73 stroke participants from the Stroke Mortality and Morbidity Study; however, 12 carried out only the first evaluation and 61 participants completed the follow up: (i) personal interview 6 months after stroke; (ii) telephone interview 1 week after the first evaluation; and (iii) telephone interview 2 weeks after the first evaluation. The reliability of the TICS-M was calculated by test-retest Pearson's correlation, intraclass correlation and Cronbach's alpha coefficient in 61 participants. Also, using data from the same participants, we carried out the analysis of the receiver operating characteristics curve using the Mini-Mental State Examination as a comparison. The structural validity of the TICS-M was assessed through principal components analysis in 103 individuals (30 non-clinical and 73 stroke patients). Test-retest reliability and intraclass correlation ranged from 0.87 to 0.97 across the evaluations. The Cronbach's alpha was 0.96. Principal components analysis extracted three meaningful domains: working memory, recall memory and orientation. The best cut-off point to screen cognitive impairment was 14 out of 15 (91.5% sensitivity, 71.4% specificity). The area under the curve was 0.89. The Brazilian version of the TICS-M has been found to be a reliable, stable and homogeneous instrument to screen cognitive impairment in stroke patients.

Supplemental Material for Improvement of Memory Impairments in Poststroke Patients by Hyperbaric Oxygen Therapy

Supplemental Material for Improvement of Memory Impairments in Poststroke Patients by Hyperbaric Oxygen Therapy