Recovery In Post-stroke Patients Research Articles

Acupuncture regulates the glucose metabolism in cerebral functional regions in chronic stage ischemic stroke patients—a PET-CT cerebral functional imaging study

BackgroundAcupuncture has been applied to aid in the recovery of post-stroke patients, but its mechanism is unclear. This study aims to analyze the relationship between acupuncture and glucose metabolism in cerebral functional regions in post-stroke patients using 18 FDG PET-CT techniques. Forty-three ischemic stroke patients were randomly divided into 5 groups: the Waiguan (TE5) needling group, the TE5 sham needling group, the sham point needling group, the sham point sham needling group and the non-needling group. Cerebral functional images of all patients were then acquired using PET-CT scans and processed by SPM2 software.ResultsCompared with the non-needling group, sham needling at TE5 and needling/sham needling at the sham point did not activate cerebral areas. However, needling at TE5 resulted in the activation of Brodmann Area (BA) 30. Needling/sham needling at TE5 and needling at the sham point did not deactivate any cerebral areas, whereas sham needling at the sham point led to deactivation in BA6. Compared with sham needling at TE5, needling at TE5 activated BA13, 19 and 47 and did not deactivate any areas. Compared with needling at the sham point, needling at TE5 had no associated activation but a deactivating effect on BA9.ConclusionNeedling at TE5 had a regulating effect on cerebral functional areas shown by PET-CT, and this may relate to its impact on the recovery of post-stroke patients.

Functional recovery of post stroke patients with hemiparesis after stroke of different aetiology

Medical rehabilitation focuses on improvement of functional recovery in post stroke patients. The aim of the work was to analyze functional recovery in a cohort of post stroke patients with hemiparesis three months after stroke. A prospective, cohort study included 30 patients from the city of Nis aged 40 to 69. The study was conducted at the Department of Physical Medicine and Rehabilitation in Nis. from March 1 to June 30, 2009. The aetiology of stroke was determined by the nuclear magnetic resonance. The average values, standard deviation, and t-test were calculated. Of the total sample of 30 patients, 23 (77%, 16 men and 7 women) had left hemiparesis and 7 (23%, 4 men and 3 women) had right hemiparesis. The average age of the patients was 58.93 +/- 6.86. Fourteen (47%) patients were not able to move, 10 (33%) patients could move when they were assisted by someone and only 6 (20%) patients could move independently. Twenty-six (88%) patients were not able to take care of themselves without assistance and 4 (13%) patients could take care of themselves. The average Barthel Index score on admission to the Department of Physical Medicine and Rehabilitation was 57 and 3 months after discharge it was 79; the determined difference was statistically significant (p < 0.01). At the end of the study, 57% of all the patients could walk without assistance. These results suggest that disabled post stroke patients may attain significant functional improvements in response to early rehabilitation as well as to prolonged rehabilitation therapy.

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AbstractNew Treatment Option for Opioid‐Dependent Patients With Injectable ER NaltrexoneAntidepressants Improve Physical Recovery in Poststroke Patients With or Without DepressionClozapine and PPIs in a Patient With a Respiratory InfectionLower Relapse Rates With Depot vs. Oral AntipsychoticsThe Myth of Medical MarijuanaDronabinol Reduces Trichotillomania SymptomsTakotsubo Cardiomyopathy Induced by Electroconvulsive TherapyDelayed Cognitive Development With Valproate in UteroVarenicline and Cardiovascular RiskSafety Labeling Changes

PO05-MO-19 Efficacy of Relaxin (porcine relaxin) on functional recovery of post stroke patients: a case control study

PO05-MO-19 Efficacy of Relaxin (porcine relaxin) on functional recovery of post stroke patients: a case control study

Factors influencing outcomes in patients with stroke

Outcomes of stroke result in long-term disability in most of the patients. It has been confirmed by scientific studies that rehabilitation can improve functional status and quality of life of poststroke patients. The effectiveness of rehabilitation and the outcomes often differ among patients. For effective utilization of the rehabilitation resources, it is important to prognosticate the possible outcomes of the disorder. Recently, studies are performed with the aim to determine and evaluate factors possibly influencing functional recovery in poststroke patients and helping to distinguish patients with good outcome from those with poor outcome. Age, gender, initial severity of the stroke, functional status at admission to hospital, urinary incontinence, impairment in cognitive function, unilateral neglect syndrome are most often analyzed in scientific studies as factors determining the outcomes of the disorder.

Randomized Clinical Stroke Rehabilitation Trials in 2005

This article reviews randomized control trials (RCTs) undertaken in stroke rehabilitation in the year 2005. A Medline search generated 31 RCTs in stroke rehabilitation in the year 2005 in the English language. These trials were primarily efficacy studies of a number of treatments: medications such as folate, vitamin B12 and bisphosphonates in preventing osteoporotic related hip fractures, compression stockings in preventing deep vein thrombosis (DVT), use of mechanical robots and positioning of the upper limb to help improve function; and, transcranial magnetic coil stimulation, acupuncture and neural tissue transplant to enhance motor recovery in post-stroke patients.

Virtual Environment Training Therapy for Arm Motor Rehabilitation

Enhanced feedback provided by a virtual reality system has been shown to promote motor learning in normal subjects. We evaluated whether this approach could be useful for treating patients with motor deficits following brain lesions. Fifty subjects with mild to intermediate arm impairments due to stroke were selected for the study. The patients received treatment daily for one month, consisting of an hour of virtual-environment therapy with enhanced feedback. Before and after the therapy, we assessed the degree of motor impairment and autonomy in daily living activities using the Fugl-Meyer scale for the upper extremities and Functional Independence Measure, respectively. We also analyzed the velocity, duration, and morphology of a sequence of reaching movements, finally comparing the kinematic measures with the scores obtained on the clinical scales. The rehabilitation therapy yielded significant improvements over baseline values in the mean scores on the Fugl-Meyer and Functional Independence Measure scales. The mean Fugl-Meyer score correlated significantly with the duration and velocity of reaching movements. The collated data indicate that motor recovery in post-stroke patients may be promoted by the enhanced feedback provided in a virtual environment and that kinematic analysis of their movements provides reliable measures of motor function changes in response to treatment.

Clinical Correlation Between Motor Evoked Potentials and Gait Recovery in Poststroke Patients

Piron L, Piccione F, Tonin P, Dam M. Clinical correlation between motor evoked potentials and gait recovery in poststroke patients. Objective To evaluate, in patients with a stroke in the area of the middle cerebral artery, whether transcranial magnetic stimulation values from the affected lower limb correlated with the degree of gait recovery. Design The prognostic evaluation in subjects with complete lower-limb palsy, inability to walk, and dependence in the activities of daily living, 1 month after vascular injury. Setting University-affiliated rehabilitation hospital. Participants Twenty consecutive patients (12 women, 8 men) were enrolled 1 month poststroke (30±5d); all patients concluded the rehabilitation program, which lasted 6 months. Intervention Barthel Index score, Hemiplegic Stroke Scale (HSS) score, and motor evoked potentials (MEPs) from the tibialis anterior muscle were performed 1, 4, and 7 months poststroke. The Wilcoxon signed-rank test, Mann-Whitney U test, and Spearman rank-order correlation coefficient were employed. Main Outcome Measures The independence of gait defined as an HSS gait score of 3 or less (ability to walk without assistance apart from a stick or cane). Results Patients with no recordable MEPs 1 month poststroke never regained walking ability; patients with MEPs of 8% or more (13.11±5.95) regained independent gait at discharge. It was not possible to predict walking capacity in patients with MEPs less than 8% (4.0±1.41). Four months postinjury, walking capacity was achieved only by the patients with MEPs of 18% or more (23.1±6.2). Conclusions In the postacute phase of stroke, the lower-limb MEP amplitudes could be a supportive tool for prognosis of lower-limb motor outcome.

A Single Dose of the Serotonin Neurotransmission Agonist Paroxetine Enhances Motor Output: Double-Blind, Placebo-Controlled, fMRI Study in Healthy Subjects

Since serotonin (5-HT) stimulates motor function, pharmacological potentiation of 5-HT neurotransmission may improve motor function in healthy subjects and, possibly, recovery in poststroke patients. Indeed, fluoxetine, a selective serotonin reuptake inhibitor (SSRI), increased activation in executive motor areas of healthy subjects as fenozolone, a releaser of monoamines (including noradrenaline, dopamine, and serotonin) from intracellular stores. This study is intended to test the hypothesis that paroxetine can likewise modulate brain motor activity in a dose-dependent manner in healthy subjects. In a double-blind counterbalanced study, six subjects underwent functional MRI examinations on three sessions 1 week apart (E1, E2, and E3) at the time of peak plasma concentrations (5 h after drug intake, i.e., either 20 or 60 mg of paroxetine or placebo) with a complex sequential opposition task. Rest and activation alternated in a block design. During activation, subjects performed, with the right hand, a 1-Hz-paced task that alternated two fist closings with a sequential opposition task. Paroxetine elicited effects similar to those reported for fluoxetine; notable changes were hyperactivation in the contralateral S1/M1, and posterior SMA and widespread hypoactivation of basal ganglia and cerebellum. There was an inverse correlation between dose and effect: significantly greater effects were observed with the 20-mg dose compared with 60 mg. Paroxetine dose-dependently modulates activation of the entire motor pathway in a way that favors motor output. Thus, a single dose of the SSRI paroxetine reorganized motor processing.

The effects of atrial fibrillation on functional recovery in post-stroke patients

Purpose : This study evaluates the negative effects of atrial fibrillation (AF) on after stroke recovery and its relationship with age and other concomitant diseases. Method : One hundred and ninety-nine consecutive inpatients, after their first stroke, were enrolled and entered a rehabilitation program lasting 60 days. The mean interval since the stroke was 19 days. The disability, both at admission and at discharge, was assessed by Functional Independence Measure (FIM). Atrial fibrillation was diagnosed at admission on the basis of electrocardiographic recordings. Gender, age, blood pressure and blood sugar level were also taken into account. Results : Stroke patients suffering from AF, when compared to those lacking AF, have higher disability at admission as well as at discharge and had a lesser gain in functional recovery. No statistical difference of the AF occurrence was found between male and female patients. The negative correlation between age and functional gain was found only in AF patients. There was also a significant association between AF and hypertension, but not between AF and diabetes. At the beginning and at the end of the study, the median FIM scores of all the patients with AF were quite similar irrespective of manifesting hypertension, diabetes or neither of these two. Conclusions : The presence of AF has a negative prognostic value on post stroke outcome, particularly in the elderly patients. The pattern of recovery of stroke subjects having AF is not influenced by concomitant diseases like hypertension or diabetes.

Effects of Fluoxetine and Maprotiline on Functional Recovery in Poststroke Hemiplegic Patients Undergoing Rehabilitation Therapy

In animals, drugs that increase brain amine concentrations influence the rate and degree of recovery from cortical lesions. It is therefore conceivable that antidepressants may influence outcome after ischemic brain injury in humans. We evaluated the effects of the norepinephrine reuptake blocker maprotiline and the serotonin reuptake blocker fluoxetine on the motor/functional capacities of poststroke patients undergoing physical therapy. Fifty-two severely disabled hemiplegic subjects were randomly assigned to three treatment groups; during 3 months of physical therapy, patients were treated with placebo, maprotiline (150 mg/d), or fluoxetine (20 mg/d). Before and at the end of the observation period, we assessed activities of daily living by the Barthel Index, degree of neurological deficit by a neurological scale for hemiplegic subjects, and depressive symptomatology by the Hamilton Depression Rating Scale. The diverse treatments ameliorated walking and activities of daily living capacities to different extents. The greatest improvements were observed in the fluoxetine-treated group and the lowest in the maprotiline-treated group. Furthermore, fluoxetine yielded a significantly larger number of patients with good recovery compared with maprotiline or placebo. These effects of the drugs were not related to their efficacy in treating depressive symptoms. Fluoxetine may facilitate or, alternatively, maprotiline may hinder recovery in poststroke patients undergoing rehabilitation. The effects of fluoxetine as an adjunct to physical therapy warrant further investigation, since treatment with fluoxetine may result in a better functional outcome from stroke than physical therapy alone.