Post-ischemic Stroke Patients Research Articles

Visuospatial function impairment in patients with subacute-chronic isolated frontal lobe ischemic stroke: A cross-sectional study using MoCA-Ina in a private hospital

Background. Stroke is one of the leading causes of disability, resulting in both limb disability and also cognitive impairment. Cognitive impairment can occur post-stroke due to lesions in specific cortex areas. Visuospatial function, a domain of cognitive function related to visual imaging, is commonly affected by parietal lobe lesions. However, visuospatial processing also requires sustained attention, planning, and error correction, functions of the frontal lobe. There is a paucity of studies evaluating the relationship between isolated frontal lobe stroke and patients’ visuospatial function. Objective. To analyze the relationship between subacute-chronic frontal lobe ischemic stroke and visuospatial function in post-ischemic stroke patients using the MoCA-Ina. Material and methods. Patients from Siloam Karawaci General Hospital’s neurology outpatient department with ages under 65 years, Glasgow Coma Scale of 15, diagnosis of first-time stroke based on CT scan result, and ischemic lesion confined to one brain lobe were recruited using non-probability consecutive sampling for this cross-sectional study. Patients were divided into frontal lobe and non-frontal lobe stroke subgroups. Visuospatial function was assessed using MoCA-Ina and analyzed using Mann Whitney U test. Outcomes. Fifty patients were included; 25 had frontal lobe stroke, and 25 had non-frontal lobe stroke. The median visuospatial score was lower in the frontal lobe group (2, min/max = 0/4) compared to the non-frontal lobe group (3, min/ max = 0/5), with a p-value of 0.044. There was no significant difference in visuospatial scores between different frontal hemisphere locations. Conclusion. Subacute-chronic frontal lobe ischemic stroke affects visuospatial function in post-ischemic stroke patients.

High prevalence of depression found in post-ischemic stroke patients assessed in routine vascular clinic in a University Hospital from Mexico

High prevalence of depression found in post-ischemic stroke patients assessed in routine vascular clinic in a University Hospital from Mexico

Assessment of nutritional status and dietary protocol in post ischemic stroke patients

Assessment of nutritional status and dietary protocol in post ischemic stroke patients

Efficacy of cerebroxin capsules combined with aspirin in prevention of post-ischemic stroke in patients treated with thrombolysis

Purpose: To analyze the efficacy of Cerebro-Cardiac capsules combined with aspirin for secondary prevention in post-ischemic stroke patients treated with thrombolysis, and also to explore its clinical application value. 
 Methods: 224 ischemic stroke patients in the outpatient clinic of Changsha First Hospital, China from June 2022 to December 2022 were randomly divided into treatment and control groups, with 112 patients per group. Both groups were given oral aspirin (100 mg/daily) but treatment group received cerebroxin capsules (four capsules, three times daily) in addition. The types of recurrent strokes, clinical efficacy, NIHSS score scale, modified Barthel index, levels of fibrinogen and plasma viscosity, total cholesterol and triacylglycerol were assessed and compared between the groups. 
 Results: During the 6-month follow-up, 10 patients in treatment group and 12 patients in control group experienced dislodgment, and 202 cases completed treatment, but the difference was not statistically significant (p > 0.05). Treatment group showed a higher effective rate (92 %) compared to control group (75 %), with a statistically significant difference in clinical symptom efficacy (p < 0.05). Hemodynamic parameters were significantly better in treatment group than in control group (p < 0.05). Both groups exhibited improved total cholesterol levels, triacylglycerol levels and modified Barthel index post-treatment. Treatment group had better NIHSS scores and Barthel index than control group (p < 0.05), while their triacylglycerol levels were lower (p < 0.05). 
 Conclusions: Cerebroxin capsules combined with aspirin improve the symptomatic effect of thrombolytic therapy in patients after ischemic stroke with high safety profile. Analysis of the effect of this combination in an increased sample size and a longer follow-up period will be required in the future.

White matter fiber integrity and structural brain network topology: implications for balance function in postischemic stroke patients.

Previous studies have suggested that ischemic stroke can result in white matter fiber injury and modifications in the structural brain network. However, the relationship with balance function scores remains insufficiently explored. Therefore, this study aims to explore the alterations in the microstructural properties of brain white matter and the topological characteristics of the structural brain network in postischemic stroke patients and their potential correlations with balance function. We enrolled 21 postischemic stroke patients and 21 age, sex, and education-matched healthy controls (HC). All participants underwent balance function assessment and brain diffusion tensor imaging. Tract-based spatial statistics (TBSS) were used to compare the fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity of white matter fibers between the two groups. The white matter structural brain network was constructed based on the automated anatomical labeling atlas, and we conducted a graph theory-based analysis of its topological properties, including global network properties and local node properties. Additionally, the correlation between the significant structural differences and balance function score was analyzed. The TBSS results showed that in comparison to the HC, postischemic stroke patients exhibited extensive damage to their whole-brain white matter fiber tracts (P < 0.05). Graph theory analysis showed that in comparison to the HC, postischemic stroke patients exhibited statistically significant reductions in the values of global efficiency, local efficiency, and clustering coefficient, as well as an increase in characteristic path length (P < 0.05). In addition, the degree centrality and nodal efficiency of some nodes in postischemic stroke patients were significantly reduced (P < 0.05). The white matter fibers of the entire brain in postischemic stroke patients are extensively damaged, and the topological properties of the structural brain network are altered, which are closely related to balance function. This study is helpful in further understanding the neural mechanism of balance function after ischemic stroke from the white matter fiber and structural brain network topological properties.

Effects of acupoints-based TENS combined with tDCS on spasticity and motor function in ischemic stroke with spastic hemiplegia: study protocol for a randomized controlled trial

BackgroundSpastic hemiplegia following ischemic strokes seriously impedes the recovery of motor function posing a vast rehabilitation challenge. As the uncertain effects of recommended conventional treatments such as botulinum toxin injections on active functional improvement and potential adverse effects cannot be bypassed, there is an increasing need in alternative, more effective and safer modalities. Acupoints-based transcutaneous electrical nerve stimulation (Acu-TENS) and transcranial direct current stimulation (tDCS) are effective non-invasive modalities for stroke rehabilitation, particularly showing anti-spastic effect and functional improvements as well. However, the optimal stimulation frequency of Acu-TENS and whether combination of Acu-TENS and tDCS exert synergistic effect remain to be investigated.ObjectiveTo evaluate the effects of Acu-TENS combined with tDCS on spasticity and motor function in ischemic stroke patients with spastic hemiplegia and screen the optimal frequency of Acu-TENS.MethodsA total of 90 post-ischemic stroke patients with spastic hemiplegia will be intervened for 4 weeks and followed up for 4 weeks. They will be randomly assigned to three groups including two observation groups and a standard care control group in a 1:1:1 ratio. All patients will receive standard care and regular rehabilitation accordingly. In addition, the two observation groups will receive 12 sessions of Acu-TENS at 20 Hz or 100 Hz for 30 min combined with 1 mA tDCS for 20 min, three times a week, for 4 weeks. The primary outcome is the change in total modified Ashworth scale (MAS) score from baseline to week 4. Secondary outcomes include changes in surface electromyography (SEMG), Fugl-Meyer Motor Function Scale, Modified Barthel Index (MBI), and 10-meter walk test from baseline to week 4. MAS score will also be measured after 4 weeks of follow-up. Adverse events throughout the study will be recorded.DiscussionThis trial will evaluate, for the first time, the therapeutic potentials and safety of Acu-TENS combined with tDCS on spasticity and motor function in stroke patients. It will provide evidence for frequency-dependent anti-spastic effect of Acu-TENS, and a reference for rated parameter setting of new mixed transcutaneous and transcranial stimulation system for stroke rehabilitation, thereby promoting proactive healthcare consequently.Trial registration:Chinese Clinical Trials Register ChiCTR2200067186.

Stroke self-management program based on health behavior theory on neurological function and quality of life of post-ischemic stroke patients

Introduction: The two biggest issues for post-ischemic stroke patients are disability and mortality. Patients with post-ischemic stroke have a decline in quality of life due to alterations in neurological function. Additionally, post-stroke patients require ongoing education to improve their independence in completing daily tasks. His research thus sought to examine the impact of stroke self-management on post-ischemic stroke patients' neurological function and quality of life using the framework of health behavior theory. Methods: The sampling method utilized in the study design was successive sampling with a quasi-experimental design to choose the sample following the inclusion and exclusion criteria. 58 intervention and control groups were created from a total sample of 116 respondents. This research used the National Institute of Health Stroke Scale (NIHSS) and Stroke Specific Quality of Life Scale (SS-QoL). Statistical analysis using t-test with p&lt;0.5. Results: According to the findings, the mean neurological function in the intervention group before and after the intervention was 8.259, whereas the mean quality of life before and after the intervention was -20.93. In the control group, the mean neurological function was -0.179 before and after the intervention, whereas the mean quality of life was 0.069. Data analysis revealed a significant difference between health behavior therapy-based stroke self-management programs and neurological function and quality of life in post-ischemic stroke patients with p = 0.00. Conclusion: Stroke self-management based on health behavior theory can be applied over the long term to help patients’ neurological function and quality of life.

Correlation between the degree of leukoaraiosis and hyperlipidemia in post-ischemic stroke patients

Leukoaraiosis is a neurological imaging in the periventricular area and the centrum semiovale. This condition occurs due to abnormalities in the small blood vessels in the brain that lead to hypoxia. It is often observed in patients with ischemic stroke and accompanied by risk factors for hyperlipidemia. This study aimed to evaluate the correlation between the degree of leukoaraiosis and hyperlipidemia in post-ischemic stroke patients. A cross-sectional study retrospectively was conducted on post-ischemic stroke patients who underwent brain MRI (magnetic resonance imaging) on T2 and FLAIR (fluid-attenuated inversion recovery) sequence at the Department of Radiology, Dr. Sardjito General Hospital, Yogyakarta, from January 2021 to March 2022. A total of 36 patients were involved in this study. The leukoaraiosis of patient was examined by brain MRI. Degree of the leukoaraiosis was determined based on Fazekas classification. Serum cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein), and triglyceride levels of patients were then examined. The data obtained were then analyzed using Spearman correlation test. A positive correlation was observed between the degree of leukoaraiosis and triglyceride level (p = 0.042; r = 0.292) and age (p= 0.004; r = 0.464). However, no correlation was observed between the degree of leukoaraiosis and cholesterol, HDL, and LDL (p&gt;0.05). In conclusion, the leukoaraiosis degree is correlated with serum triglyceride levels and age in post-ischemic stroke patients.

Clinical and pharmacotherapeutic factors as survival and death predictors in hospitalized post-stroke patients

Stroke is a neurological disease. High mortality and sequelae that cause physical or psychological disability demand greater efforts for adequate therapeutic management. The present study aimed to identify signs, symptoms, comorbidities, and therapeutic agents associated with decreased survival time and increased death risk in hospitalized stroke patients. Medical records of stroke patients hospitalized in 2016 at a Peruvian hospital were included. Post-stroke survival time was determined using the Kaplan-Meier method. A comparison of the mean survival time of ischemic and hemorrhagic stroke patients was carried out with the Mantel-Cox test. In addition, the death risk or hazard ratio (HR) was determined using Cox proportional hazards model. The mean survival time was 34.37 (95% CI, 31.89-36.85) and 16.96 (95% CI, 12.35-21.56) days in post-ischemic and hemorrhagic stroke patients, respectively. Dyspnea, peripheral edema, sensory disorder, diffuse cerebral edema and previous stroke are associated with a decrease in survival time. In addition, multivariate analysis revealed that chronic kidney failure (HR=11.98; 95% CI, 2.33-61.68; p=0,003), dyslipidemia (HR=5.19; 95% CI, 1.65-16.32; p=0.005), previous stroke (HR=1.51; 95% CI, 0.41-5.63; p=0.043), and use of antihemorrhagic (HR=1.12; 95% CI, 0.79-1.59; p=0.002) or antiepileptic drugs (HR=1.08; 95% CI, 0.70-1.68; p=0.016) could be considered as death predictors. Clinical and pharmacotherapeutic factors associated with a decrease in mean survival time and increased death risk in hospitalized stroke patients were identified. These factors should be an alarm sign to provide special and timely medical care that reduces the risk of death in patients.

Phytochemical screening, stability test formulation and physical gel ethanol extract of Jatropha leaves (Jatropha curcas L.) as a gel compress preparation for post-ischemic stroke patients

Introduction: Stroke is one of the diseases that cause death and impact serious health problems. The inflammatory response that appears in ischemic stroke will affect the progression of the stroke. This study examines the ethanol extract of Jatropha leaves (Jatropha curcas L.) as a gel compress preparation in post-ischemic stroke patients. Methods: The research design was experimental with a randomized post-test-only control group design. The sample was extracted with 96 % ethanol as solvent. Jatropha leaf samples (Jathropa curcas L.) were blended until smooth and weighed as much as 500 g in a 1 000 mL glass beaker. After that, 96 % ethanol was added to the procedure and poured into the extraction vessel. This study used a phytochemical screening test.

Searching for underlying atrial fibrillation using artificial intelligence-assisted MRI images from ischemic stroke patients

Abstract Background Nearly 30% of ischemic strokes are attributed to atrial fibrillation (AF) related cardiac thromboembolism. This subset of strokes are associated with higher recurrence rate, morbidity and mortality. As a result, current recommendation suggests a cardiac monitoring of variable intensity and duration to search for unknown AF after a stroke so that optimal secondary prevention could be administered. Unfortunately, it is reported that 24h Holter ECG monitoring for underlying AF is completed routinely in only a minority of stroke centers, making a huge gap between AF detection rate in clinical practice and estimated actual data (2–3% vs 23–30%). So, it is obvious that paroxysmal AF remains undetected in a significant proportion of patients after a stroke and an early and effective identification approach of cardiac disturbances is needed. Purpose We aim to develop an innovative end-to-end artificial intelligence model to rapidly search for atrial fibrillation in post ischemic stroke patients using MRI imaging data. Methods 489 patients diagnosed with ischemic stroke, 174 of which had a prior known history of AF or new AF detected by intensive ECG monitoring poststroke, from January 2018 to October 2021 were enrolled in this study. The MRI images obtained after their admission in the stroke unit were meticulously evaluated and acute ischemic stroke lesions on DWI sequences were segmented and confirmed by two senior neuroradiologists independently. These processed images were randomly split into training (n=315) and testing set (n=174) for the implementation and validation of our AI screening model. And the algorithm was based on the combination of radiomic features and semantic features extracted from convolutional neural network (CNN). The model performance was evaluated by accuracy, recall, precision, F-Measure and AUC. Also, heatmaps which indicate the attention mechanism of the model were generated for interpreting underlying patterns. Results The AUC of our model (COM) reached 0.8 (Figure 1A). Also, the algorithm yielded values for the accuracy, recall, precision and F-Measure of 70%, 92.5%, 63.8% and 75.5%, respectively, which showed satisfactory classification results. As to the interpretability of the AI model, we found that more “attention” was paid to the main lesions (Figure 1B) and radiomic features which indicated the minimum gray level intensity and the sphericity of the lesions (Figure 1C, D) were crucial to the classifier. Conclusions Our work revealed a potential correlation between brain ischemic lesion pattern on DWI images and underlying etiology of AF. Moreover, the AI model we developed may serve as a rapid screening tool for AF in clinical practice of stroke units. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China

Correlation between vitamin D levels and cognitive impairment on 90 days post ischemic stroke patients

The prevalence of ischemic stroke based on the American Heart Association (AHA) data in 2019 reached 77.2 million people. As much as 72% of post ischemic stroke patients got cognitive impairment. Vitamin D deficiency is often found in post-stroke patients and causes functional decline. This study aims to assess the relationship between vitamin D levels and cognitive impairment in 90 days post ischemic stroke patients. This study is a cross-sectional study using secondary data from medical records at Bethesda Hospital Yogyakarta taken from January to March 2021. Cognitive impairment in 90 days post ischemic stroke patients were assessed using MMSE (Mini-Mental State Examination) and CDT (Clock Drawing Test). This study was analyzed through univariate tests and bivariate tests using Spearman correlation. This proves a correlation between vitamin D levels and cognitive impairment which is formulated by the value of MMSE (p=0.000) and CDT (p=0.031). The mean of vitamin D levels was 13.53±3.625. The proportion of hypovitaminosis D was divided into 5.7% of insufficiency patients and 94.3% patients stated as deficiency. The lower the vitamin D levels, the lower the MMSE and CDT values accordingly. In conclusion, there is a relationship between vitamin D levels and cognitive impairment in 90 days post ischemic stroke patients. Low levels of vitamin D result in more frequent and more severe cognitive impairments.

Effect of Adding Physical Exercises to Cognitive Rehabilitation in Post-Ischemic Stroke Patients

Effect of Adding Physical Exercises to Cognitive Rehabilitation in Post-Ischemic Stroke Patients

Apolipoprotein E Polymorphism and Carotid Intima Medial Thickness Progression in Post Ischemic Stroke Patient

Background : Apolipoprotein E (APOE) gene is believed to associate with cholesterol level, a risk factor of ischemic stroke. CIMT (carotid intima-media thickness) can be used to determine the degree of atherosclerosis. Increased CIMT may predict ischemic stroke recurrence. This study aimed to determine association between increased CIMT in post ischemic stroke patients and APOE genotype. Methods : This was an epidemiological prospective study involving 71 post ischemic stroke patients (1 month from onset), admitted from 2012 to 2013. CIMT was examined with carotid duplex ultrasound at 1st, 6th, and 12nd month after stroke onset. APOE gene polymorphism was examined using HRM (high-resolution melting) which is a simple method, accurate, and sensitive for genotyping. Results : We found 5 APOE gene variation categories, i.e. E2E3, E2E4, E3E3, E3E4, and E4E4. The most common allele was E3 and genotype groups E3E3 was the majority of the population. E2E4 allele had the highest CIMT level among others, in the 1st month, 6th month, and 12nd month after stroke, with no association with hypertension, diabetes, and hypercholesterolemia. E3E3 allele was most often associated with hypertension, diabetes mellitus, dyslipidemia, and hyperhomocysteinemia. Conclusion : The results showed that APOE genotype E2E4 may independently constitute risk factor for atherosclerosis progression (CIMT) in post ischemic stroke patients. While the E3E3 genotype was often associated with hypertension, diabetes mellitus, dyslipidemia, and hyperhomocysteinemia. Our results suggest that APOE E4 was not an important risk factor for carotid atherosclerosis in post ischemic stroke patient.

Implementation of an Advanced Practice Registered Nurse-Led Clinic to Improve Follow-up Care for Post-Ischemic Stroke Patients.

BACKGROUND: Ischemic stroke continues to be a leading cause of serious disability within the United States, affecting 795 000 people annually. Approximately 12% to 21% of post-ischemic stroke patients will be readmitted to the hospital within 30 days of discharge. Studies suggest that implementation of a follow-up appointment within 7 to 14 days of discharge improves 30-day readmission rates; however, implementation of these guidelines is uncommon, and follow-up visits within the recommended window are not often achieved. The purpose of this project was to evaluate the impact of an advanced practice registered nurse (APRN)-led stroke clinic on follow-up care for post-ischemic stroke patients. The aims were to improve time to follow-up visit and reduce 30-day unplanned readmissions. METHODS: A pre/post intervention design was used to evaluate the impact of a process to access the APRN-led stroke clinic. The intervention included a scheduling process redesign, and subsequent APRN and scheduler education. RESULTS: The time to clinic follow-up preintervention averaged 116.9 days, which significantly reduced to 33.6 days post intervention, P = .0001. Unplanned readmissions within 30 days declined from 11.5% to 9.9%; however, it was not statistically significant, P = .149. Age was not statistically different between preintervention and postintervention groups, P = .092, and other demographics were similar between the groups. CONCLUSION: An APRN-led clinic can improve follow-up care and may reduce unplanned 30-day readmissions for post-ischemic stroke patients. Further work is needed to determine the impact of alternative approaches such as telehealth.

Factors Related to Depression among Caregivers Attending Post-Ischemic Stroke Patients

BACKGROUND: Stroke is known as chronic disease, leading to disability which makes help from caregivers become necessary. Attending stroke patients possess certain challenges and burdens toward the caregivers. AIM: We aim to investigate risk factors related to depression among caregivers attending post-ischemic stroke. METHODS: Eighty-three caregivers and post-ischemic stroke patients were collected consecutively from the Neurology Department of Universitas Sumatera Utara Hospital, Medan, Indonesia. Linear regression was used to analyze the data. RESULTS: Our multivariate study shows that patient’s age, caregiver’s gender, patient’s gender, and modified Barthel Index are associated with depression with adjusted R2 of 59.3%. CONCLUSION: Early detection and intervention should be addressed regularly for caregivers attending post-stroke patients.

Assessment of CVD Risk Factors in Secondary Prevention after Ischemic Stroke Using the ICF.

Background: Patients after undergoing ischemic stroke have a high risk of further cardiovascular disease (CVD) incidents. Monitoring risk factors is critical to prevent the recurrence of CVD. Objective: The aim of the study was to determine differences in the incidence of risk factors for CVD in a post-ischemic stroke patient group (SG) compared to the control group, which had not undergone ischemic stroke (CG), and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 55 patients in SG and 55 patients in CG. The results were translated into categories from the ICF classification system. Results: Atrial fibrillation (p = 0.013), carotid artery stenosis > 50% (p < 0.001), LDL > 71 mg/dL (p < 0.001), heart rate > 80/min (p = 0.007), taking NOAC (p = 0.008) and NSAIDs (p < 0.001) as well as nicotinism (p = 0.001) were significantly more common in SG compared to CG. The value of the distribution of the total incidence of CVD risk factors were observed to be higher for SG than for CG. In SG, both for males (p < 0.001) and females (p < 0.001) more risk factors for recurrent CVD incidents were observed compared to CG. Conclusions: Patients in SG differ in the occurrence of risk factors for CVD event compared to CG. The use of a single tool, such as the ICF assessment sheet, can be useful in assessing and analyzing risk factors for recurrent CVD events. This may help to reduce the risk of subsequent CVD events in secondary prevention.

The Combination of Sensor Digital Kariasa Early Detection Prototype and Health Education for Self-Management in Preventing Recurrent Ischemic Stroke.

Recurrent stroke is one of the concerns that not only causes functional disability but also economic and psychosocial problems. Self-management is one of the indicators to predict recurrent stroke. Field observations indicate there is currently no tool to increase the survivors' self-awareness. The study aimed to investigate if an early detection tool and health education can improve patient self-awareness toward self-management in ischemic stroke patients in order to prevent recurrent ischemic stroke. This study consisted of two stages. In the first stage, the study used research and development methods to develop a digital sensor tool named Sensor Digital Kariasa (SenDiKa). In the second stage, the study used a quasi-experimental design with a pretest-posttest control group involving 44 postischemic stroke patients who were selected by using consecutive sampling. The subjects were divided into intervention and control groups, and the length of the intervention was 12 weeks. This study found a significant difference between the two groups (P < .001). The intervention group who used the early detection tool and received health education showed better self-management compared to the control group. The use of SenDiKa early detection prototype and health education for self-management was perceived useful and gave positive effect to the improvement of self-management in poststroke patients to prevent recurrent stroke. The combination of SenDiKa early detection prototype and health education for self-management can be used for patients to identify the major risk factors of recurrent stroke, such as blood pressure, blood sugar, and cholesterol.

Rehabilitation-related knowledge correlate to visit compliance in post-ischemic stroke patients in an outpatient rehabilitation clinic

Background: Stroke is a serious medical condition potential that affects humans and requires special attention. The treatment of stroke is highly dependent on patients' knowledge and adherence in undergoing rehabilitation. Knowledge about medical rehabilitation will determine the level of patients' adherence undergo medical rehabilitation. The study aimed to find the correlation between patients' knowledge and adherence to chronic stroke patients undergoing medical rehabilitation.Methods: This is an observational analytic study conducted in the executive medical rehabilitation policlinic at dr. Zainoel Abidin Hospital. Seventy-four respondents were selected by the non-probability sampling technique and accidental sampling method. Two questionnaires were used, namely the "Overview of Familial Behaviour towards Stroke Patients in Rehabilitation Efforts" questionnaire and the "Correlation of Family Support with Stroke Patients Rehabilitation Adherence" questionnaire. Data were analyzed using Chi-Square statistical test.Results: 45.9% of respondents had good knowledge and compliance, 23% of respondents had average knowledge and compliance, and 9.5% of the respondents had poor knowledge and compliance. Data analysis showed a significant correlation between patients' knowledge and level of adherence in undergoing medical rehabilitation.Conclusion: Increasing patients' knowledge about medical rehabilitation is crucial to improve patient's adherence in undergoing medical rehabilitation.

Gambaran Gangguan Tidur pada Pasien Pasca Stroke Iskemik

Background : Sleep disorder is common to be the complication in stroke patients and can be a risk factor for stroke. Sleep disorder in stroke patients decrease the quality of life. &#x0D; Objective : The purpose of this study was to find out the prevalence of sleep disorders in a post-ischemic stroke patient and the association between sleep disorders and stroke risk factors.&#x0D; Methods: A cross-sectional study was conducted on post-ischemic stroke at the neurology outpatient clinic of Ibnu Sina Islamic Hospital Padang. Information about stroke risk factors is obtained through patient data and guided questionnaires. Types of sleep disorders were assessed through the 2005 Specialized Center of Research Sleep Questionnaire. &#x0D; Results: We found out there were 57 post-ischemic stroke patients, in which 37 post-ischemic stroke patients (64.9%) had sleep disorder incidences, such as apnea, restless legs syndrome, insomnia, and narcolepsy (38.6%, 36.8%, 35.1%, and 15.8%; respectively). There was an association between age and insomnia (p = 0.034,CI = 95%). On the other hand, there was no association between other risk factors (gender, diabetes mellitus, dyslipidemia, heart disease, obesity, smoking, and alcohol consumption) and insomnia, apnea, narcolepsy, and restless legs syndrome.&#x0D; Conclusions : The conclusion of this study was more than half post-ischemic stroke patients have sleep disorder with the most common were apnea. There was an association between age and insomnia.&#x0D; Keywords: sleep disorder, apnea, ischemic stroke