Problems In Stroke Patients Research Articles

Whole body vibration training for lower limb motor function among stroke patients

Background/aim Motor function impairment is a frequent problem in stroke patients and many questions remain about the application of vibration therapy for neurological patients. This study aims to verify the effects of vibration training on lower limb function in patients affected by stroke. Methods This was a clinical, prospective study. The study's subjects were selected via a convenience sample from Samuel Libanio Hospital's Physical Therapy and Neurology Out-patient clinics in Pouso Alegre, Brazil. The sample comprised of 27 individuals presenting with spastic hemiparesis due to stroke. Participants received whole body vibration training at a frequency of 50 Hz and 2 mm amplitude, for 8 weeks. In the first 4 weeks, participants underwent a series of four 60-second periods of vibration in the following positions: in orthostatic posture, first with the knees semi-flexed at 30°, then with the knees semi-flexed at 90°, and then with the affected knee semi-flexed at 30°, and finally in orthostatic posture again with the knees semi-flexed at 30°. In the last 4 weeks, we doubled the number of series of vibration, but used the same positions. The six minute walking test (6MWT), the stair climbing test (SCT) and the timed get up and go test (TUG) were applied to evaluate the lower members' motor function. The tests were applied before and after the intervention, as well as after a follow-up, which was performed 1 month later. Results This study found statistical differences in the 6MWT (P=0.00), SCT (P=0.00), and TUG (P=0.00), indicating improvement in the participants' lower limbs motor function. Conclusion Vibration therapy can contribute to the improvement of the lower limbs' motor function in patients affected by stroke.

Study of accent-based music speech protocol development for improving voice problems in stroke patients with mixed dysarthria

Based on the anatomical and functional commonality between singing and speech, various types of musical elements have been employed in music therapy research for speech rehabilitation. This study was to develop an accent-based music speech protocol to address voice problems of stroke patients with mixed dysarthria. Subjects were 6 stroke patients with mixed dysarthria and they received individual music therapy sessions. Each session was conducted for 30 minutes and 12 sessions including pre- and post-test were administered for each patient. For examining the protocol efficacy, the measures of maximum phonation time (MPT), fundamental frequency (F0), average intensity (dB), jitter, shimmer, noise to harmonics ratio (NHR), and diadochokinesis (DDK) were compared between pre and post-test and analyzed with a paired sample t-test. The results showed that the measures of MPT, F0, dB, and sequential motion rates (SMR) were significantly increased after administering the protocol. Also, there were statistically significant differences in the measures of shimmer, and alternating motion rates (AMR) of the syllable /K$\inve$/ between pre- and post-test. The results indicated that the accent-based music speech protocol may improve speech motor coordination including respiration, phonation, articulation, resonance, and prosody of patients with dysarthria. This suggests the possibility of utilizing the music speech protocol to maximize immediate treatment effects in the course of a long-term treatment for patients with dysarthria.

The prevalence of visual problems in stroke patients and the effectiveness of the current screening tool used

Aim: To identify the types and prevalence of visual problems in a small series of acute stroke patients and identify the effectiveness of the existing screening tool used by occupational therapists (OTs) at the Royal London Hospital. Strategies will be suggested for improving this screening process and for aiding rehabilitation. Methods: A prospective study is presented comprising a small series of patients referred to the acute stroke unit at the Royal London Hospital with a confirmed diagnosis of stroke. On admission to the ward, all patients underwent an OT screen for visual problems prior to a full orthoptic assessment that included visual fields to confrontation and assessment of visual inattention/neglect. This was performed without the benefit of the OT screen findings to prevent bias. A comparison was made between orthoptic and OT findings to determine the effectiveness of the existing screening tool. Results: Twenty-eight patients were recruited with a mean age of 67 years (range 39–89 years). Orthoptic assessment revealed reduced visual acuity (<0.300 logMAR) in 43% of patients, with most stroke survivors demonstrating good binocular function (94%) and a full range of ocular motility (57%). No patient had visual inattention and 7% were found to have visual field defects. In 68% of stroke survivors the findings of the OT and the orthoptist were comparable. Conclusions: The OT screening tool was found to be effective in this study. Ways to improve the detection of visual deficits in acute stroke patients are discussed.

The impact of mental practice on stroke patients' postural balance

IntroductionThe most common problem in stroke patients is reduced balance and derangements of postural control that lead to increase the chance of falling and instability during walking. Since physical practice improves balance and postural control, it is assumed also that the application of mental practice would be useful in enhancing such balance. Mental practice is defined as the cognitive rehearsal of a physical skill in the absence of overt physical movements. Factors such as similar time between actual execution and mental performance of a task, the increase of regional cerebral blood flow and also the vegetative activation, all suggest that mental practice imitates physical performance of a task. Thus, the main purpose of this study was to investigate the effect of such mental practice on postural balance among stroke survivors. Method and materialsThis study was implemented as an experimental (interventional), case–control, double blind and randomized trial design. A total of 30 subjects (16 males and 14 females) with necessary arousal, attention and memory functions as their major components of mental practice, participated. Subjects' mean ages were 48.1±10.5years. They were divided randomly in two control and experimental groups. Timed Get up and Go (TUG) test was used to evaluate the balance of all participants. They were assessed before–after treatment and two weeks post-treatment as research's follow up. The two groups received the same method of occupational therapy services, but the experimental group in addition to aforementioned occupational therapy, was requested to participate in mental practice sessions. ResultsMental practice had a significant effect on postural balance in stroke survivors (P=<0.001). ConclusionMental practice may improve postural balance in stroke patients and can be considered for them as a beneficial rehabilitative technique.

Ocular–visual defect and visual neglect in stroke patients – A report from Kathmandu, Nepal

PurposeTo find out the type of visual defects, ocular defects or visual neglect occurring in patients with stroke. MethodsIn this cross-sectional study including 40 subjects diagnosed as stroke, assessment included visual acuity with the Sheridan-Gardner chart, objective and subjective refraction, duction and version eye movement, cover test at distance and near, anterior segment examination with the slit lamp, posterior segment examination after pupil dilatation, color vision test with the Farnsworth D-15 test, diplopia charting, the Hess charting, and visual field examination on Goldmann perimetry. 33 subjects (82.5%) having stroke underwent star cancellation test for visual neglect evaluation. Chi-square test with Yate's correction was performed to evaluate associations between visual neglect and neurological findings. ResultsThe mean age of the subjects was 52.1±15.7 years with male/female ratio of 0.7. Neurological findings included hemiplegia/hemiparesis in 84.8%, ischemic stroke in 80%, left hemisphere involvement in 60%, and cortical area involvement in 65%. Ocular finding included extraocular muscle palsy in 17.5%, exotropia in 12.5%, and ptosis in 7.5%. Co-morbid ocular findings such as cataract, retinopathy, and age-related macular degeneration were also reported. Visual neglect was present in 54.5% subjects predominantly affecting the left side. ConclusionThis study reports the relationship between ocular–visual disorders and stroke. There should be a formal screening for visual problems in stroke patients in hospital and rehabilitation settings.

OC-066 A preliminary study of neurostimulation based interventions in the treatment of chronic dysphagia post-stroke

<h3>Introduction</h3> Oropharyngeal dysphagia after stroke has an incidence up to 45% and when chronic, leads to increased risk of institutionalisation and death in the long term. Pharyngeal electrical stimulation (PES),1 repetitive transcranial magnetic stimulation (rTMS)2 and paired associative stimulation (PAS)3 are three neurostimulation techniques developed to increase cortical excitability of pharyngeal motor cortex, with therapeutic potential. However the effects of these techniques on chronic but stable swallowing problems in stroke patients remain unknown. We therefore investigated the effects of these interventions in stroke patients with dysphagia persisting for &gt;6 weeks. <h3>Methods</h3> In 12 dysphagic stroke patients (69±9 years (mean±SD), 79±25 weeks post-stroke (mean±SD), 6 left, 5 right hemispheric, 1 undetermined) pharyngeal electromyographic responses were recorded using an intraluminal catheter after the application of single TMS pulses over pharyngeal motor cortex, in order to measure cortico-bulbar excitability before, immediately and 30 minutes after real and sham applications of either: a) PES (10 mins of 5 Hz), b) rTMS (250 repeated TMS pulses at 5 Hz), or c) PAS (10 mins of repeated pairs of pharyngeal and TMS pulse every 20 s). In nine subjects, swallowing performance and safety (aspiration-penetration scores, APs) were assessed with videofluoroscopy before and after both real and sham neurostimulation techniques. <h3>Results</h3> Compared to sham, the application of all neurostimulation interventions showed a significant increase in cortical excitability in the unaffected hemisphere by 54%±17% (mean±SEM) immediately post (repeated measures ANOVA p&lt;0.001, Time*Intervention p=0.005), not observed in the affected hemisphere (p=0.12). In addition, after active neurostimulation, APs were reduced by −14%±6% (mean±SEM) compared to sham (Wilcoxon9s test, p=0.05). Moreover, the delay between the oral and pharyngeal phases of swallowing, important for swallowing safety, was shortened by −56%±13% (mean±SEM) after real neurostimulation (Wilcoxon9s test, p=0.01) compared to sham. There was no consistent difference in cortical or swallowing response between the interventions. <h3>Conclusion</h3> These preliminary results show that neurostimulation interventions have beneficial neurophysiological and behavioural effects in chronic stroke patients with dysphagia, increasing cortical excitability and improving swallowing safety. These findings provide support for neurostimulation being a useful adjunct in swallowing rehabilitation, even in chronic neurologic illness, and lay the foundation for further clinical trials of these forms of intervention.

Erectile dysfunction: a warning sign of silent vascular disease

Erectile dysfunction (ED) is the inability to achieveand/or maintain an erection sufficient to permitsatisfactory sexual intercourse [1]. ED is nowadaysa common condition affecting approximately 5–20%of adult men; ED has a considerable effect on thequality of life not only of the patients themselves, butalso of their spouses/family [2–4]. This Editorialdiscusses ED as a manifestation/warning sign ofclinically silent cardiovascular disease. It does notdiscuss ED due to other causes (for instance drugs,depression, etc).A direct association between ED with cardiovas-cular disease has been supported [2–6]. For example,almost one in two stroke patients report some degreeof ED, which is demonstrated as a diminished post-stroke libido and sexual dysfunction compared withbefore the episode [3, 7]. A recent study showed thatstroke patients had a [3-fold increased risk ofreporting ED compared with nonstroke patients (oddsratio [OR], 3.30; 95% confidence interval [CI], 1.22–8.88) [8]. ED is thus an important problem in strokepatients with considerable psychosocial conse-quences [9].Another study including 690 male patients whohad been referred for stress testing, without diag-nosed peripheral arterial disease (PAD) showed thatED is a marker of previously undiagnosed PAD [10].ED was present in 45%, while PAD was present in23% of the patient group. More men with ED hadconcomitant PAD compared with patients withoutED (32 vs. 16%, respectively; P\0.01). On multi-variate logistic regression analysis, ED was anindependent predictor of PAD (OR, 1.97; 95% CI,1.32–2.94; P = 0.002). Therefore, ED may identifymen who would benefit from screening using theankle–brachial pressure index [10].The prevalence of carotid and/or lower limb arteryatherosclerosis was investigated in patients with ED[11]. The incidence of simultaneous penile arterialinsufficiency and carotid and/or lower limb arteryabnormalities was higher compared with that foundin patients with ED of nonarterial organic or

The symptomatology of post‐stroke depression: comparison of stroke and myocardial infarction patients

Depression is a frequent problem in stroke patients but, all too often, the problem goes unrecognized. How depression-like symptoms in post-stroke depression (PSD) should be interpreted is still subject to debate. If PSD has a distinct symptom profile of depression accompanying other chronic vascular somatic conditions then this could imply that PSD is a specific disease entity. To study whether depressed stroke patients exhibit other signs and symptoms than patients suffering from depression after myocardial infarction (MI). Depressive signs and symptoms were measured using the Hospital Anxiety and Depression Scale and the 17-item Hamilton Depression Rating Scale. The results of 190 stroke patients were compared with the results of 198 MI patients every 3 months during the first year after the event. Depressed stroke patients exhibited more loss of interest, psychomotor retardation, and gastro-intestinal complaints as compared to depressed MI patients. However, in multivariate analyses including both depressed and non-depressed stroke and MI patients, no specific symptom profile was found to differentiate between the two depressive syndromes by looking at the modifying effect of stroke vs MI on the occurrence of specific symptoms in depression. Although in their clinical presentation, depressed stroke patients exhibit a symptom profile different from depressed MI patients, this is not due to differences in the depressive syndrome in these two patient groups but it reflects differences between stroke and MI patients in general.

Sight/stroke meeting.

The Stroke Association together with the Royal National Institute of the Blind is holding a one-day conference on Monday 3rd March in Devon on stroke related eye conditions, assessment of vision, and advances in rehabilitation. Each year an estimated 150,000 people in the UK have a stroke ( page 14 ). Of these, about a third is likely to die in the first ten days, a third is likely to make a recovery in one month and a third is likely to be left disabled and needing rehabilitation. Sight problems in stroke are associated with reduced activities of daily living and with falls. Because many visual problems are easily corrected or improve with intervention, formal screening for visual problems in stroke patients in a rehabilitation setting may be beneficial. Conference details are available on 0117 935 7750 or Rnibsouthwest@rnib.org.uk.

Improving outcome in stroke patients with visual problems

stroke is a common condition, frequently with significant effects on a patient's ability to live an active and independent life. Anything that may potentially have a beneficial effect on the rehabilitation of such patients should therefore be explored, and as ocular and visual problems are common in patients with stroke, it is important that their implications are understood. this article aims at providing a broad overview of the literature relating to visual problems in stroke patients, looking particularly at the impact on, and the potential for, recovery and rehabilitation. the online database PubMed was searched for literature relating to visual and ocular problems in stroke. The resulting abstracts and articles were then reviewed to extract clinically relevant information. Findings are summarised and discussed. visual problems in stroke are associated with problems with activities of daily living (ADL), falls and rehabilitation. Because many visual problems are easily corrected or improve with intervention, there may be a role for formal screening for visual problems in stroke patients in a rehabilitation setting. The orthoptist has an important role to play in stroke rehabilitation, and links between the stroke and orthoptic departments should be established in all units.

Sleep problems in stroke patients: relationship with shoulder pain

This study was designed to document the occurrence and the type of sleep problems in stroke patients and to examine the importance of shoulder pain in stroke in relation to sleep disturbances. Forty-six stroke patients were evaluated for the presence of sleep disturbances, general health problems (Nottingham Health Profile) and anxiety-depression (Hospital Anxiety Depression Scale) and compared with 47 age- and sex-matched subjects who had not had strokes. A four-item sleep questionnaire was used to assess different components of insomnia disorders through the previous month. The results showed that stroke patients had significantly more problems in initiating sleep than controls (p &lt; 0.01). Other components of insomnia, difficulty in maintaining sleep or nonrestorative sleep did not differ between the two groups (p &lt; 0.05). Factors found to be associated with poor sleep such as pain (p &lt; 0.01), anxiety (p &lt; 0.01) and depression (p &lt; 0.01) were more common in the patient group but these did not otherwise result in a significant increase in all components of insomnia, probably because of the high level of benzodiazepine and tricyclic antidepressant intake amongst patients. Stroke patients with shoulder pain showed significantly more sleep disturbances (p &lt; 0.01 ) and less general well-being ( p &lt; 0.05) than patients without shoulder pain. It is concluded that attention must be paid to shoulder pain and to ensuing sleep disturbances among stroke patients.

The recovery of perceptual problems after stroke and the impact on daily life

The frequency of perceptual problems in stroke patients and the impact of daily life, were assessed at one month and two years after onset of the stroke. Ninety patients were assessed on the Rivermead Perceptual Assessment Battery (RPAB) and an Activities of Daily Living (ADL) scale. Perceptual problems were identified in 69% of patients on the one month assessment and in 74% of patients on the two-year assessment. There was no significant difference in the frequency or severity of perceptual problems, between the two assessments. Significant improvement occurred in activities such as mobility, preparing a hot drink and crossing a road. There remained a significantly high correlation between perceptual problems and independence in activities of daily living.

Development of a questionnaire for detecting everyday problems in stroke patients with unilateral visual neglect

Unilateral Visual Neglect can affect everyday behaviours such as reading, but there have been few attempts at measuring subjective accounts of these difficulties. The present study reports on the reliability and validity of a questionnaire designed to detect the problems experienced by patients with visual neglect. Sixty-four right hemisphere lesioned stroke patients and 49 of their relatives completed a questionnaire concerning problems in everyday life. The neglect subjects did not report significantly more problems than the non-neglect subjects. However, on the relative's questionnaire, neglect subjects were seen as having significantly more difficulties. The most frequently reported problems were similar for both subject groups. Scores on the neglect questionnaire were correlated with performance on a star cancellation test, indicating the validity of the questionnaire. The possible application of this type of questionnaire is discussed.

The Frequency of Perceptual Deficits after Stroke

The frequency of perceptual problems in stroke patients was assessed using a standardised assessment, the Rivermead Perceptual Assessment Battery.1 One hundred and fifty stroke patients (75 right hemiplegic and 75 left hemiplegic), admitted consecutively to two general hospitals, were assessed one month after stroke, to identify the proportion with perceptual difficulties. Perceptual difficulties were identified in 71% of right hemiplegic stroke patients and 81% of left hemiplegic patients. They were identified in 97% of dysphasic right hemiplegic patients, compared to 47% of nondysphasic right hemiplegic patients, and 84% of female hemiplegic patients, compared to 67% of male hemiplegic patients. Unilateral neglect was identified in both right and left hemiplegic patients. The proportion of patients with neglect varied according to the measure chosen. The results indicate that perceptual problems are common following both right and left hemiplegic stroke, with unilateral neglect accounting for a relatively small proportion of the problems.

The frequency of perceptual deficits after stroke

The frequency of perceptual problems in stroke patients was assessed using a standardised assessment, The Rivermead Perceptual Assessment Battery.1 One hundred and fifty stroke patients (75 right hemiplegic and 75 left hemiplegic), admitted consecutively to two general hospitals, were assessed one month after stroke, to identify the proportion with perceptual difficulties. Perceptual difficulties were identified in 71 % of right hemiplegic stroke patients and 81 % of left hemiplegic patients. They were identified in 97% of dysphasic right hemiplegic patients, compared to 47% of nondysphasic right hemiplegic patients and 84% of female hemiplegic patients, compared to 67% of male hemiplegic patients. Unilateral neglect was identified in both right and left hemiplegic patients. The proportion of patients with neglect varied according to the measure chosen. The results indicate that perceptual problems are common following both right and left hemiplegic stroke, with unilateral neglect accounting for a relatively small proportion of the problems.

Eating after a stroke—Towards an integrated view

Good nursing is of paramount importance for the clinical outcome in patients who have had a stroke. We have experiences from a non-intensive stroke unit where a strategy involving improved nursing care, very early rehabilitation and extensive psychosocial support to the patient and his/her family in combination with structured medical treatment has been adopted. This approach is successful in reducing the need for long-term hospitalization after a stroke. Thus, in a controlled study, we found that 39% of the surviving patients remained hospitalized three months after the stroke if they had initially been admitted to general medical wards, while only 15% remained in hospital if they had been treated in the stroke unit (Strand et al., 1983). It appears that determined efforts to improve patient care-in its broadest sense-during the critical first weeks after stroke are highly productive. One of the most critical factors in the care of stroke patients is eating. This applies to the early as well as the late phase of the syndrome. Stroke sequelae are the second most common cause for permanent spoonfeeding in nursing homes in our hospital region (Norberg and Backstrom, in preparation). It is conceivable that a determined approach to manage eating problems during the acute phase may prevent some of the detrimental long-term effects of a stroke on eating. The total care of a stroke patient is multifarious (O’Brien and Pallett, 1978; Hamrin, 1981; Sjogren, 1982) but detailed studies of eating and feeding in this condition have not been performed. In this overview, we outline some common eating problems in stroke patients and we suggest an integrated theoretical model as a guide to further structured studies on this subject. Patients and methods A theoretical model of eating problems after a stroke was developed based on observations made at our stroke unit and on others’ experiences reported in the literature.

Volunteer scheme for dysphasia and allied problems in stroke patients.

With nearly 100 000 heavily handicapped hemiplegics in Great Britain' stroke is a major medical problem. Though most stroke patients benefit from their period of rehabilitation there inevitably comes a time when, with many problems remaining, they are discharged home to their families. The despair felt by the patient and his relatives may be overwhelming, and in most cases little support is available. The problem is particularly acute when speech is affected since there is a national shortage in some areas a total absence-of speech therapists. One source of help which has not been fully explored is the use of volunteer helpers working within a responsible organization and co operating with doctors, speech therapists, and other professional workers. Such a project has been sponsored by the Chest and Heart Association and financed by the Clarkson Foundation. This report describes the pilot scheme and records some observations made after 16 months' work in two areas, the Chilterns and Oxford city.