Performance In Stroke Patients Research Articles

Relationship of Unaffected Grip Strength and Trunk Function with Toileting Performance in Stroke Patients

Relationship of Unaffected Grip Strength and Trunk Function with Toileting Performance in Stroke Patients

Evolution of short cognitive test performance in stroke patients with vascular cognitive impairment and vascular dementia: Baseline evaluation and follow-up.

ABSTRACT.There is limited evidence about the progression of cognitive performance during the post-stroke stage.Objective:To assess the evolution of cognitive performance in stroke patients without vascular cognitive impairment (VCI), patients with vascular mild cognitive impairment (MCI), and patients with vascular dementia (VD).Methods:A prospective cohort of stroke outpatients from two secondary medical centers in Lima, Peru was studied. We performed standardized evaluations at definitive diagnosis (baseline evaluation), and control follow-ups at 6 and 12 months, including a battery of short cognitive tests: Clinical Dementia Rating (CDR), Addenbrooke's Cognitive Examination (ACE), and INECO Frontal Screening (IFS).Results:152 outpatients completed the follow-up, showing progressive increase in mean score on the CDR(0.34 to 0.46), contrary to the pattern observed on the ACE and IFS (78.18 to 76.48 and 23.63 to 22.24). The box plot for the CDR test showed that VCI patients had progressive worsening (0.79 to 0.16). Conversely, this trend was not observed in subjects without VCI. The box plot for the ACE and IFS showed that, for the majority of the differentiated stroke types, both non-VCI and VCI patients had progressive worsening.Conclusion:According to both ACE and IFS results during a 1-year follow-up, the cognitive performance of stroke patients worsened, a trend which was particularly consistent in infarction-type stroke patients.

A Study on Clinical Determinants and one year Follow-Up of Dementia and Mild Cognitive Impairment Following Ischemic Stroke

Cognitive impairment due to cerebrovascular disease is termed “Vascular Cognitive Impairment” and forms a spectrum that includes Vascular Dementia and milder forms of cognitive impairment referred to as Vascular Mild Cognitive Impairment. While Vascular Dementia is the second most common cause of dementia, the milder form Vascular Mild Cognitive Impairment is much more common. Nearly half of individuals with Vascular Mild Cognitive Impairment convert to dementia after five years. Vascular cognitive disorders are poised to become the silent epidemic of the 21st century and contribute significantly to mortality, disability, and decreased quality of life. It is now clear that Vascular Cognitive Impairment is not a single entity, but represents a complex neurological disorder that occurs as a result of interaction between vascular risk factors and brain parenchymal changes such as macro and micro infarcts, haemorrhages, white matter changes, and brain atrophy occurring in an ageing brain. Factors that determine progression of milder form Vascular Mild Cognitive Impairment to dementia are not well understood. Since Vascular Cognitive Impairment is amenable to prevention and treatment, there is a pressing need to identify factors that protect or predispose to it. Dementia is a common sequelae of stroke with a frequency ranging from 16% to 32%. In a more recent epidemiological study, the 10- year risk of dementia after stroke was estimated at 19.3%, compared to 11.0% in non-stroke controls. This twofold increase in dementia following stroke is in contrast with a nine fold increase reported in some previous studies. The large variation in rates is accounted for by variations in the populations studied as well as the criteria used for the diagnosis of dementia. As the definition of vascular dementia is currently being refined, it is timely that these studies be revisited. One aspect of this reassessment is the consideration of vascular mild cognitive impairment in stroke patients, which has thus far received little attention. 1. This study supports the high prevalence of dementia and mild cognitive impairment following stroke, especially in older individuals, and highlights the importance of cognitive reserve. 2. The contribution of cerebrovascular risk factors is not independent of the stroke risk. 3. Subcortical dementia was the most frequent subtype of Vascular Dementia in our hospital-based series. 4. Stroke volume is a significant determinant of post-stroke dementia. 5. This study suggests that cognitive performance in stroke patients may change over time. It also suggests that progression of cognitive impairment is common after stroke. 6. The cognitive impairment is not only frequent with stroke, but also significantly affects functional adaptation after the acute phase. Efforts to modify the course of acute stroke should also take into account chronic brain failure as an outcome.

Prefrontal cortex activation during a dual task in patients with stroke

Dual tasks destabilize task performance as they involve competing demands for cognitive and physical resources. Several studies have reported that dual-task walking activates the prefrontal cortex (PFC), and recent studies have indicated a relationship between PFC and dual-task deterioration in healthy subjects. However, PFC activity during dual-task walking in stroke patients remains unclear. We investigated the association between PFC activity and dual-task interference on physical and cognitive performance in stroke patients. This study included 14 stroke patients and 14 healthy subjects who performed a calculation task while walking at a comfortable pace on the floor. PFC activity was assessed using wearable near-infrared spectroscopy. The calculation task and trunk linear accelerations were evaluated as measures of cognitive and physical performance. The dual-task deterioration on both physical and cognitive performance of stroke patients was significantly higher than in healthy subjects. PFC activation during dual-task walking was significantly lower in stroke patients. Although right PFC activation was negatively correlated with dual-task deterioration on physical performance in stroke patients, left PFC activation was negatively correlated with the dual-task cost on cognitive performance in healthy subjects. Thus, during dual-task walking, PFC activation might prioritize physical demands in stroke patients, but might prioritize cognitive demands in healthy subjects.

The effects of cognitive versus motor demands on postural performance and weight bearing asymmetry in patients with stroke.

While several studies have investigated the interaction between postural control and secondary cognitive tasks in stroke patients, little is known about the influence of secondary motor task on postural control in these patients. The current research was designed to further examine dual-task performance by comparing the effects of cognitive versus motor dual-tasks on postural performance and weight bearing asymmetry (WBA) in stroke patients (n=23) relative to healthy, matched controls (n=22). All participants stood on dual-force plate under 5 conditions: (1) free standing; (2) simple cognitive task (easy Stroop) while standing; (3) difficult cognitive task (difficult Stroop) while standing; (4) simple motor task (holding a tray while a cylinder lying on its flat side) while standing; and (5) difficult motor task (holding a tray while a cylinder lying on its round side) while standing. The center of pressure (COP) measures was greater in stroke patients than healthy controls. Also, the WBA of the patients was greater than the controls. The COP measures increased when moving from single-task to cognitive dual-task conditions. No significant effect of motor dual-tasking was seen when moving from single-task to motor dual-task conditions. However, in contrast to cognitive dual-tasking, stroke patients and healthy controls employed different strategies during simultaneous performance of postural and motor tasks. It can be suggested that performing a motor task while standing requires greater attentional resources compared to performing a cognitive task while standing and this resulted in greater dual-task interference on motor performance in the stroke patients.

THE RELATIONSHIP OF HYPERTENSION, DIABETES AND OTHER VASCULAR RISK FACTORS WITH POSTSTROKE COGNITIVE FUNCTION: THE STROKOG (STROKE AND COGNITION) CONSORTIUM

While hypertension, diabetes, atrial fibrillation (AF), smoking and past stroke are associated with increased risk of dementia, it is not known whether they contribute to cognitive impairment in patients with recent stroke. This study examines the relationship between vascular risk factors and cognitive function in stroke patients from a combined sample of international cohorts. Eleven studies from the STROKOG consortium provided individual participant data (IPD). Demographic data were harmonised and for each participant, using appropriate normative data from individuals without stroke, z-scores for 5 domains (attention, memory, language, visuospatial and executive function) were calculated from neuropsychological tests completed 3–6 months after index stroke/TIA. Linear mixed effects models in a one-stage IPD meta-analysis were used to examine the association between each cognitive domain z-score and risk factor, adjusting for sex, age and education. Among 2,981 stroke/TIA participants from 9 countries (61% male, mean age 66 years, 94% ischaemic stroke, 4% TIA and 2% haemorrhagic stroke), the mean z-scores in all domains were nearly 1 SD below normal. 70% had a history of hypertension, 30% diabetes, 14% AF, 14% past stroke*and 47% were ex- or current smokers. Diabetes and a history of past stroke were strongly related to poorer cognition in all domains, with global cognition scores (the average of 5 domains) being 0.44 SD less (95%CI: -0.56, -0.31; p-value <0.001) in participants with diabetes and 0.37 SD less (-0.53, -0.22; <0.001) in those with past stroke. Hypertension was associated with poorer cognition in all domains except for memory, with a 0.19 SD ([-0.32, -0.07]; 0.002) lower global cognition score. Smoking contributed negatively to memory and visuospatial domains (-0.14 SD [-0.25,-0.03]; 0.016), (-0.22 SD [-0.35, -0.09]; 0.001), but not the other domains. The relationships between AF and domain scores were not significant (Table 1). Diabetes and history of past stroke are both associated with poorer cognitive performance in stroke patients. Hypertension and smoking are also associated with poorer cognitive function although the effects are smaller and not in all domains. *History of past stroke indicates having one or more strokes prior to the index event.

Effects of Task-Oriented Robot-Assisted Therapy for Motor Function of Upper Extremities and ADL Performance of Stroke Patients: A Systematic Review and Meta-Analysis

Effects of Task-Oriented Robot-Assisted Therapy for Motor Function of Upper Extremities and ADL Performance of Stroke Patients: A Systematic Review and Meta-Analysis

Effects of rTMS based on brain activation during language performance in stroke patients with non-fluent Aphasia (Pilot Study)

Effects of rTMS based on brain activation during language performance in stroke patients with non-fluent Aphasia (Pilot Study)

The effects of combined repetitive transcranial magnetic stimulation and transcranial direct current stimulation on motor function in patients with stroke.

Both transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), when provided to stroke patients in combination with motor training, enhance therapeutic efficacy and motor function. However, the majority of previous studies have only examined a single treatment modality. The authors investigated the modulating influence of combination dual-mode brain stimulation upon bihemispheric stimulation with motor training in stroke patients. Twenty stroke patients with hemiparesis underwent five randomly arranged sessions of diverse combinations of rTMS and tDCS. We applied cathodal or anodal tDCS over the contralesional primary motor cortex (cM1) and 10 Hz rTMS over the ipsilesional primary motor cortex (iM1) in a simultaneous or preconditioning method including sham stimulation. Immediately after dual-mode stimulation, sequential hand motor training was performed for 5 minutes. The total pulses of rTMS and the duration of tDCS and motor training were the same for all sessions. Cortical excitability and sequential motor performance were evaluated before and after each session. Motor function and corticomotor excitability following simultaneous stimulation via cathodal tDCS over the cM1 combined with 10 Hz rTMS over the iM1 were significantly increased after the intervention, with significantly greater motor improvement than seen with other treatment conditions (P < 0.05). For the combination of bihemispheric rTMS and tDCS, simultaneous stimulation of cathodal tDCS and 10 Hz rTMS results in better motor performance in stroke patients than other combination methods. This result seemed to be related to effective modulation of interhemispheric imbalance of cortical excitability by dual-mode stimulation.

Pulsed Light Stimulation Increases Boundary Preference and Periodicity of Episodic Motor Activity in Drosophila melanogaster.

There is considerable interest in the therapeutic benefits of long-term sensory stimulation for improving cognitive abilities and motor performance of stroke patients. The rationale is that such stimulation would activate mechanisms of neural plasticity to promote enhanced coordination and associated circuit functions. Experimental approaches to characterize such mechanisms are needed. Drosophila melanogaster is one of the most attractive model organisms to investigate neural mechanisms responsible for stimulation-induced behaviors with its powerful accessibility to genetic analysis. In this study, the effect of chronic sensory stimulation (pulsed light stimulation) on motor activity in w1118 flies was investigated. Flies were exposed to a chronic pulsed light stimulation protocol prior to testing their performance in a standard locomotion assay. Flies responded to pulsed light stimulation with increased boundary preference and travel distance in a circular arena. In addition, pulsed light stimulation increased the power of extracellular electrical activity, leading to the enhancement of periodic electrical activity which was associated with a centrally-generated motor pattern (struggling behavior). In contrast, such periodic events were largely missing in w1118 flies without pulsed light treatment. These data suggest that the sensory stimulation induced a response in motor activity associated with the modifications of electrical activity in the central nervous system (CNS). Finally, without pulsed light treatment, the wild-type genetic background was associated with the occurrence of the periodic activity in wild-type Canton S (CS) flies, and w+ modulated the consistency of periodicity. We conclude that pulsed light stimulation modifies behavioral and electrophysiological activities in w1118 flies. These data provide a foundation for future research on the genetic mechanisms of neural plasticity underlying such behavioral modification.

Lasting effect of an oral hygiene care program for patients with stroke during in-hospital rehabilitation: a randomized single-center clinical trial

Purpose: Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge.Method: In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at three- to four-day intervals five times during the hospitalization period.Results: After OHCP, oral hygiene status including the plaque index, calculus index, and O’Leary plaque index improved significantly in the intervention group, compared to the control group (p < 0.05). In the intervention group, after administration of the OHCP for the fourth time, the O’Leary index improved significantly, and remained high when checked three months after discharge (p < 0.001).Conclusions: An OHCP conducted during in-hospital rehabilitation was effective in improving oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital.Implications for RehabilitationInitial oral hygiene status and plaque control performance were poor in stroke patients who were in rehabilitation center.An oral hygiene care program during in-hospital rehabilitation was effective in improving oral hygiene status and plaque control performance among stroke patients at three months after discharge.Repeated tooth brushing education and professional tooth cleaning were necessary to improve plaque control performance of stroke patients.

Analysis of muscle synergy for evaluation of task-specific performance in stroke patients.

Muscle synergy represents a central neural module that organizes and activates a group of muscles when performing a certain task. However, whether muscle synergy is a good physiological indicator of motor ability in task performance for patients suffering stroke is not clear. The purpose of this study is to understand how information of task-specific muscle synergy in healthy subjects and patients post stroke can be used to evaluate their motor ability, and further to assist motor rehabilitation for stroke patients. Electromyography (EMG) signals and movement kinematics in reaching tasks were recorded in 5 healthy subjects and 4 stroke patients. Muscle synergies were extracted from EMGs and compared cross healthy and stroke subjects. Normal synergies displayed a characteristic pattern common in healthy subjects. But pathological synergies in stroke subjects lacked the characteristics of normal synergy without a common component, implicating varying extent of damage to the motor module due to lesion in cerebral circuits. Further analysis in stroke subjects showed that pathological patterns of synergy in stroke subjects corresponded to the abnormality in their movement control compared with healthy subjects. Data showed that task-specific muscle synergy did reveal a positive correlation to the ability of neural control of tasks. It was further observed that task-specific synergy was changed towards the normal pattern after intervention with functional electrical stimulation in patients post stroke.

Effects of A Combined Functional Electrical Stimulation with Action Observation Training for Balance and Gait Performance in Stroke Patients

PURPOSE: The purpose of this study is to evaluate the functional effects of action observation plus functional electrical stimulation (FES) treatment on the weight distribution indexes (heel and toe; right and left), stability indexes, gait velocities, and stride lengths of stroke patients. METHODS: The subjects, who were all more than six months post stroke, were randomly divided into two groups of ten each: an experimental group and a control group. TETRAX (Tetrax Interactive Balance System) and GAITRite (GAITRite computerized gait analysis system) were measured at baseline, six weeks after treatment. Participants in both the groups received functional electrical stimulation treatment, but the experimental group was provided with additional action observation. Independent t-tests were used to compare the differences between the groups, and repeated measured two-way ANOVA was used to compare the interaction between the groups. RESULTS: The result of the interactions between the groups and the periods showed significant increases in the weight distribution indexes (heel and toe; right and left), stability indexes, gait velocities and stride lengths (p0.05). CONCLUSION: Action observation plus functional electrical stimulation treatment should be considered as a therapeutic method for physical therapy for stroke patients to improve the weight distribution indexes, stability indexes, gait velocities, and stride lengths.

Transcranial Direct Current Stimulation Over the Primary and Secondary Somatosensory Cortices Transiently Improves Tactile Spatial Discrimination in Stroke Patients.

In healthy subjects, dual hemisphere transcranial direct current stimulation (tDCS) over the primary (S1) and secondary somatosensory cortices (S2) has been found to transiently enhance tactile performance. However, the effect of dual hemisphere tDCS on tactile performance in stroke patients with sensory deficits remains unknown. The purpose of this study was to investigate whether dual hemisphere tDCS over S1 and S2 could enhance tactile discrimination in stroke patients. We employed a double-blind, crossover, sham-controlled experimental design. Eight chronic stroke patients with sensory deficits participated in this study. We used a grating orientation task (GOT) to measure the tactile discriminative threshold of the affected and non-affected index fingers before, during, and 10 min after four tDCS conditions. For both the S1 and S2 conditions, we placed an anodal electrode over the lesioned hemisphere and a cathodal electrode over the opposite hemisphere. We applied tDCS at an intensity of 2 mA for 15 min in both S1 and S2 conditions. We included two sham conditions in which the positions of the electrodes and the current intensity were identical to that in the S1 and S2 conditions except that current was delivered for the initial 15 s only. We found that GOT thresholds for the affected index finger during and 10 min after the S1 and S2 conditions were significantly lower compared with each sham condition. GOT thresholds were not significantly different between the S1 and S2 conditions at any time point. We concluded that dual-hemisphere tDCS over S1 and S2 can transiently enhance tactile discriminative task performance in chronic stroke patients with sensory dysfunction.

A Direct Comparison of Real-World and Virtual Navigation Performance in Chronic Stroke Patients

An increasing number of studies have presented evidence that various patient groups with acquired brain injury suffer from navigation problems in daily life. This skill is, however, scarcely addressed in current clinical neuropsychological practice and suitable diagnostic instruments are lacking. Real-world navigation tests are limited by geographical location and associated with practical constraints. It was, therefore, investigated whether virtual navigation might serve as a useful alternative. To investigate the convergent validity of virtual navigation testing, performance on the Virtual Tubingen test was compared to that on an analogous real-world navigation test in 68 chronic stroke patients. The same eight subtasks, addressing route and survey knowledge aspects, were assessed in both tests. In addition, navigation performance of stroke patients was compared to that of 44 healthy controls. A correlation analysis showed moderate overlap (r = .535) between composite scores of overall real-world and virtual navigation performance in stroke patients. Route knowledge composite scores correlated somewhat stronger (r = .523) than survey knowledge composite scores (r = .442). When comparing group performances, patients obtained lower scores than controls on seven subtasks. Whereas the real-world test was found to be easier than its virtual counterpart, no significant interaction-effects were found between group and environment. Given moderate overlap of the total scores between the two navigation tests, we conclude that virtual testing of navigation ability is a valid alternative to navigation tests that rely on real-world route exposure.

Hierarchy of Dysfunction Related to Dressing Performance in Stroke Patients: A Path Analysis Study.

Previous reports indicated that various dysfunctions caused by stroke affect the level of independence in dressing. These dysfunctions can be hierarchical, and these effects on dressing performance can be complicated in stroke patients. However, there are no published reports focusing on the hierarchical structure of the relationships between the activities of daily living and balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits. The purpose of this study was to elucidate the hierarchical and causal relationships between dressing performance and these dysfunctions in stroke patients. This retrospective study included 104 first-time stroke patients. The causal relationship between the dressing performance and age, time post stroke, balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits were examined using path analysis. A hypothetical path model was created based on previous studies, and the goodness of fit between the data and model were verified. A modified path model was created that achieved an almost perfect fit to the data. Balance function and abdominal muscle strength have direct effects on dressing performance, with standardized direct effect estimates of 0.78 and 0.15, respectively. Age, motor and sensory functions of the affected lower limb, and strength of abdominal muscle and knee extension on the unaffected side have indirect effects on dressing by influencing balance function. Our results suggest that dressing performance depends strongly on balance function, and it is mainly influenced by the motor function of the affected lower limb.

Influence of essential amino acids on muscle mass and muscle strength in patients with cerebral stroke during early rehabilitation: protocol and rationale of a randomized clinical trial (AMINO-Stroke Study).

BackgroundPatients with stroke are at a high risk for long-term handicap and disability. In the first weeks after stroke muscle wasting is observed frequently. Early post-stroke rehabilitation programs are directed to improve functional independence and physical performance. Supplementation with essential amino acids (EAAs) might prevent muscle wasting and improve rehabilitation outcome by augmenting muscle mass and muscle strength. We aim to examine this in a double blinded, randomized placebo-controlled clinical trial.MethodsPatients with ischemic or haemorrhagic stroke will be enrolled at begin of the early post-stroke rehabilitation in a parallel group interventional trial. Oral supplementation of EAAs or placebo will be given for 12 weeks in a double blinded manner. Physical and functional performance will be assessed by exercise testing before supplementation of EAAs as well as at discharge from the in-patient rehabilitation, at 12 weeks and 1 year afterwards.DiscussionThis is the first randomized double-blinded placebo-controlled clinical study aiming to assess the effect of the EAAs supplementation on muscle strength, muscle function and physical performance in stroke patients during early post-stroke rehabilitation. Supplementation of EAAs could prevent muscle mass wasting and improve functional independence after stroke.Trial registrationThe study is registered at the German registry for clinical trials as well as at World Health Organization (WHO; number DRKS00005577).

Investigating the effects of visual biofeedback therapy on recovery of postural balance in stroke patients using a complexity measure

Background and purpose: Postural balance deficit is one of the common post-stroke disabilities. Providing visual biofeedback while balance activities are performed is a way to improve postural balance disorders following stroke. But among the research publications, there is incoherency about the positive effects of visual biofeedback therapy. The purpose of this study was to investigate the effects of using visual biofeedback as an adjunct to physical therapy exercises on recovery of postural balance of stroke patients. Materials and methods: A total of 31 hemiplegic stroke patients were recruited in this study and randomly assigned into case and control groups. Both groups received conventional physical therapy interventions and balance training exercises. During balance training, the case group received visual biofeedback, whereas the control group did not receive visual information. Balance performance of stroke patients were examined quantitatively using the EquiTest testing system. Center of pressure data were collected before starting, during, and after completion of the rehabilitation program and a nonlinear complexity measure, approximate entropy (ApEn), calculated and used for the analysis. Results: No significant between-group differences were detected after completion of the program. Noticeable increase was found in ApEn values of both groups along anterior–posterior direction, whereas no statistically significant improvement was found along mediolateral direction after rehabilitation. Conclusion: Both rehabilitation routines created advances in the postural control system of stroke patients. Visual biofeedback balance training did not produce extra advantage for balance ability of participants who received this treatment program in comparison with those who were treated without visual biofeedback.

Short-Term Effect of Prosthesis Transforming Sensory Modalities on Walking in Stroke Patients with Hemiparesis.

Sensory impairments caused by neurological or physical disorders hamper kinesthesia, making rehabilitation difficult. In order to overcome this problem, we proposed and developed a novel biofeedback prosthesis called Auditory Foot for transforming sensory modalities, in which the sensor prosthesis transforms plantar sensations to auditory feedback signals. This study investigated the short-term effect of the auditory feedback prosthesis on walking in stroke patients with hemiparesis. To evaluate the effect, we compared four conditions of auditory feedback from plantar sensors at the heel and fifth metatarsal. We found significant differences in the maximum hip extension angle and ankle plantar flexor moment on the affected side during the stance phase, between conditions with and without auditory feedback signals. These results indicate that our sensory prosthesis could enhance walking performance in stroke patients with hemiparesis, resulting in effective short-term rehabilitation.

CO-OP접근법이 뇌졸중 환자의 작업수행에 미치는 효과: 예비연구

CO-OP접근법이 뇌졸중 환자의 작업수행에 미치는 효과: 예비연구