Recovery Phase Of Stroke Research Articles

Blood-letting and cupping therapy for upper limb spasticity in recovery phase of stroke

To observe the effect difference between blood-letting and cupping therapy combined with basic treatment and simple basic treatment for upper limb spasticity in the recovery phase of stroke. Sixty patients of upper limb spasticity in the recovery phase of stroke were randomly assigned into an observation group and a control group, 30 cases in each group. In the control group, the basic treatment, including the internal treatment, acupuncture and rehabilitation, was used for 2 weeks, 6 times a week, once a day. Based on the basic treatment, blood-letting, at 3 jing-well points each time, and cupping therapy were used at the most obvious spasm point in the belly of biceps muscle in the observation group for 2 weeks, 3 time a week, once every other day. The spasm score, passive traction value, and moter function score of upper limb were assessed in the two groups before and after treatment. The effects were compared between the two groups. After treatment, the spasm scores and passive traction values were lower than those before treatment in the two groups (all P<0.01), with better score and value as well as different values before and after treatment in the observation group (P<0.05, P<0.01). After treatment, the motor function scores were higher than those before treatment in the two groups (both P<0.01), with better score and different value before and after treatment in the observation group (both P<0.05). The total effective rate was 90.0% (27/30) in the observation group, which was better than 76.7% (23/30) in the control group (P<0.05). Based on the basic treatment, blood-letting combined with cupping therapy are effective for upper limb spasticity in the recovery phase of stroke.

Function in Sitting: Outcomes for Occupational Therapy in the Acute Phase of Stroke Recovery

Abstract Date Presented 4/20/2018 This study assessed the impact of seated bedside activity of daily living interventions in an acute care setting and functional sitting balance for patients with acute stoke. This represents the only evidence available to date and demonstrates clinical significance of this occupation–based treatment. Primary Author and Speaker: Cassie Quinn Contributing Authors: Audrey Butler, Sarah Dean, Joanne Estes, Taylor Miller, Emilee Wilcox

A qualitative exploration of post-acute stroke participants' experiences of a multimodal intervention incorporating horseback riding.

BackgroundMultimodal rehabilitation interventions delivered in late phase of stroke recovery involve physical (motor and sensory), social, and cognitively challenging activities. Horseback riding can be incorporated within such interventions, leading to meaningful long-term improvements when applied to individuals with moderate levels of disability. There is a lack of research illuminating stroke survivors’ experiences and perceptions of horseback riding in the context of multimodal interventions.AimTo explore stroke survivors’ experiences of participation in a multimodal group-based intervention that included horseback riding.MethodsAn explorative interview study was conducted with individual face-to-face interviews performed on a single occasion, utilising a semi-structured interview guide. Eighteen participants were purposively selected from a larger trial (mean age 62, 12 men, 6 women) within four weeks after treatment completion. The interview duration was between 17 and 50 minutes. The data was analysed using a qualitative content analysis method.FindingsFour broad themes were identified from the analysis. These themes were: transformative experiences; human–horse interaction; togetherness and belonging; and the all-in-one solution. Interacting with the horse and peers had a profound emotional impact on the participants. The participants also reported having learned new skills, increased self-efficacy and self-esteem, and improvements in balance and gait, all of which could be transferred to everyday life. The horse itself played a central role, but other components, such as the other group members, the instructors, and the challenging tasks on the horseback, were also important.ConclusionA multimodal rehabilitation intervention that includes horseback riding may provide stroke survivors in a late phase of recovery with rich pleasurable experiences that may have life-changing and profound impacts on their emotional and physical state.

Combined Biomarkers Composed of Environment and Genetic Factors in Stroke.

It was widely accepted that stroke onset was the result of interactions between environment and genetic factors. However, the combined biomarkers covering environment and genetic factors and their interplay information in stroke were still lacking. In this study, we proposed a framework to identify the targeting or indicating role each factor played in the combined stroke biomarkers. A combined set of 36 biomarkers were identified based on evaluation and importance scores. Validations on three independent microarray data sets justified that the obtained markers were pervasively effective in discriminating stroke patients of different stages from healthy people on genetic levels. 8 and 3 genetic factors were identified as biomarkers in the acute and recovery phases of stroke, respectively. For example, the expression changing of SERPINH1 only appeared in the acute phase of stroke showing its targeting role in the combined biomarker. Compared with this, 11 genetic factors such as MMP9 were found to be differentially expressed in both acute and recovery phases of stroke showing their indicating roles in stroke. Functional analyses further revealed that the biomarkers could be grouped into 4 closely related processes of stroke including prevention, occurrence, processing, and recovery, respectively. These results indicated that the adoption of interactions between environment and genetic factors would be helpful in selecting robust and biologically relevant biomarkers, which cast a new insight for stroke biomarker identification.

Effects of home-based physical activity incitation and education program in subacute phase of stroke recovery after 6 months of monitoring

The aim of the study was to evaluate the effect of physical activity incitation and education program at home on functional capacity, fatigue and depression levels in subacute phase of stroke recovery. Eighty-four volunteers post-stroke patients participated in this randomized clinical trial (Mean ± SD; Age: 62 ± 13 years; Barthel Index: 95.4 ± 9.1; Weight: 76.8 ± 15 Kg; Stroke delay: 77.6 ± 45.7 days). Participants were divided into a Home-based Physical Activity Incitation group (HBPAI, n = 42) and Control group (CG, n = 42). HBPAI follow the physical activity incitation program during six months. The 6 minutes walking test (6MWT), Functional Ambulation Classification (FAC), Hospital Anxiety Depression Scale (HADS) and Multidimensional Fatigue Inventory questionnaire (MFI-20) were measured at baseline (T0), after 6 months (T1) and 12 months (T2). 6MWT (m) performed by HBPAI and CG group at T0, T1 and T2 was (374 ± 141.1; 454 ± 134.8; 437.8 ± 146.4) and (372.5 ± 149.4; 385 ± 157.8; 400.1 ± 153) respectively. Distance walked during 6MWT significantly increased in HBPAI than CG ( P < 0.05) at T1, but not at T2. Score of general fatigue significantly decreased between T0 and T1 (11.9 ± 3.1 and 10.5 ± 2.9; P < 0.004) and T2 (9.6 ± 4.1; P < 0.001) in HBPAI. Depression score significantly decreased between T0 and T2 (8.6 ± 3.2 and 6.5 ± 3.7; P < 0.01) in HBPAI. Increasing physical activity after stroke could improve post-stroke common functional problems. However, the efficacy of physical activity programs at home is still unknown (Jones et al., 2015). Furthermore, there is limited information about the effects of PA on fatigue levels after stroke (Duncan et al., 2012). HBPAI program could be a good strategy to improve the walking distance and decrease fatigue and depression scores in subacute phase of stroke recovery.

Sensorimotor integration in chronic stroke: Baseline differences and response to sensory training.

The integration of somatosensory information from the environment into the motor cortex to inform movement is essential for motor function. As motor deficits commonly persist into the chronic phase of stroke recovery, it is important to understand potential contributing factors to these deficits, as well as their relationship with motor function. To date the impact of chronic stroke on sensorimotor integration has not been thoroughly investigated. The current study aimed to comprehensively examine the influence of chronic stroke on sensorimotor integration, and determine whether sensorimotor integration can be modified with an intervention. Further, it determined the relationship between neurophysiological measures of sensorimotor integration and motor deficits post-stroke. Fourteen individuals with chronic stroke and twelve older healthy controls participated. Motor impairment and function were quantified in individuals with chronic stroke. Baseline neurophysiology was assessed using nerve-based measures (short- and long-latency afferent inhibition, afferent facilitation) and vibration-based measures of sensorimotor integration, which paired vibration with single and paired-pulse TMS techniques. Neurophysiological assessment was performed before and after a vibration-based sensory training paradigm to assess changes within these circuits. Vibration-based, but not nerve-based measures of sensorimotor integration were different in individuals with chronic stroke, as compared to older healthy controls, suggesting that stroke differentially impacts integration of specific types of somatosensory information. Sensorimotor integration was behaviourally relevant in that it related to both motor function and impairment post-stroke. Finally, sensory training modulated sensorimotor integration in individuals with chronic stroke and controls. Sensorimotor integration is differentially impacted by chronic stroke based on the type of afferent feedback. However, both nerve-based and vibration-based measures relate to motor impairment and function in individuals with chronic stroke.

Home-based physical activity incentive and education program in subacute phase of stroke recovery (Ticaa\u2019dom): study protocol for a randomized controlled trial

BackgroundStroke causes functional decline, psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Although physical activity (PA) is beneficial in stroke recovery, PA recommendations are rarely met after hospital discharge. There is presently no standard strategy for monitoring and inciting PA at home during the subacute phase of stroke recovery. The main aim of this study is to evaluate the effects of a home-based physical activity incentive and education program (Ticaa’dom) on functional capacity in subacute stroke patients.MethodsThis study is a comparative prospective, observer-blinded, monocentric, parallel, randomized controlled clinical trial. This study will include 84 patients: 42 patients in the home-based physical activity incentive group (HB-PAI) and 42 in the control group (CG). The intervention group will follow the HB-PAI program over 6 months: their PA will be monitored with an accelerometer during the day at home while they record their subjective perception of PA on a chart; they will observe a weekly telephone call and a home visit every three weeks. The CG will receive traditional medical care over 12 months. The main study outcome will be the distance on a 6-minute walk test. Secondary outcomes will include measurements of lower limb strength, independence level, body composition, cardiac analysis, fatigue and depression state.DiscussionThe results of this trial will demonstrate the value of implementing the Ticaa’dom program during the subacute phase of stroke recovery.Trial registrationClinicalTrials.gov, NCT01822938. Registered on 25 March 2013.

Abstract WP103: Exogenous Growth Differentiation Factor 11 Reduces Atrophy and Decreases Gliosis After Stroke in Aged Mice

Introduction: Drugs and mechanical devices for retrieving blood clot are effective; however, they must be used within few hours of stroke onset. No pharmacological therapy has been shown to be effective in the recovery phase of stroke, which occurs days after the initial insult. Growth differentiation factor (GDF) 11, a member of transforming growth factor beta superfamily, has been effective in ameliorating age associated cardiac hypertrophy, skeletal muscle dysfunction and decreased neurogenesis in older mice. Therefore, we hypothesized ; exogenous GDF11 will improve tissue loss and functional outcomes in old mice. Methods: Middle cerebral artery occlusion (MCAo) (n=32) or sham surgery (n=12) was induced in old male mice (19-20 months). Five days after MCAo, GDF11 (0.1mg/kg) and BrdU (75 mg/kg) was administered for 5 days. Y maze, Barnes maze was performed on day 14, 21 and 28-post ischemia. Tail suspension and open field was performed on day 29 and day 30 respectively. The mice were euthanized on day 30-post stroke for assessment of tissue loss, gliosis and neurogenesis. Results: Cerebral atrophy was significantly lower in the MCAo GDF11 (13.1 ± 1.62) vs MCAo vehicle treated group (22 ± 2.06) (p&lt;0.05). Additionally, a reduced mortality was observed in MCAo GDF11 group (p=0.09). Exogenous GDF11 resulted in reduced GFAP + cells (p&lt;0.05) and Iba-1 + cells (p=0.17) in the peri-infarct cortex of MCAo GDF11 group. Moreover, an increase in CD31 + cells was seen in the MCAo GDF11 group, though this did not reach significance (p=0.12). On behavior task, there was no difference in spontaneous alterations and escape latency between MCAo GDF11 vs MCAo vehicle treated groups as assessed on Y and Barnes maze respectively. Additionally, no effect of GDF11 was seen on motor function or immobility when assessed on open field and tail suspension test respectively. Five days of exogenous GDF11 did not increase neurogenesis in the MCAo GDF11 group. Conclusion: Exogenous GDF11 reduced tissue damage, decreased gliosis and enhanced angiogenesis in old mice. However, no benefit of GDF11 treatment was observed on long-term functional outcomes.

Patient Engagement Is Related to Impairment Reduction During Digital Game-Based Therapy in Stroke.

Upper limb impairment in the chronic phase of stroke recovery is persistent, disabling, and difficult to treat. The objectives of this study were to determine whether therapeutic enjoyment is related to clinical improvement after upper limb rehabilitation and to assess the feasibility of a therapy gaming system. Ten chronic stroke survivors with persistent upper limb impairment were enrolled in the study. Upper limb impairment was evaluated by using the Fugl-Meyer Assessment of Upper Extremity Function (FMA-UE). The Physical Activity Enjoyment Scale (PACES) assessed the level of therapy enjoyment, and the System Usability Scale (SUS) measured the ease of operation of the game. Upper limb therapy involved 30 minutes of novel digital gaming therapy, three times per week, for 6 weeks. The average improvement in the FMA-UE after the digital gaming therapy was 2.8 (±2.1) points. Participants scored the digital gaming system as having good usability (SUS: 72 ± 7.9), and the physical activity as enjoyable (PACES: 65.8 ± 10.6). There was a strong positive correlation between improvement in the FMA-UE score and the PACES (Spearman's Rho = 0.84; P < 0.002). This pilot study demonstrates the feasibility and potential for improvements in upper limb motor function by using digital gaming in the chronic stroke patient population. The positive correlation found between therapy enjoyment and clinical gains highlights the importance of engagement in therapy to optimize outcomes in chronic stroke survivors.

A qualitative study exploring patients', with mild to moderate stroke, and their carers' perceptions of healthy lifestyles

Background/Aims: To explore patients', with mild to moderate stroke, and their carers' experiences after a stroke and to explore their perceptions of healthy lifestyles. Methods: A qualitative study using semi-structured interviews was undertaken with 20 people (12 males and 8 females) with mild to moderate stroke or transient ischaemic attack (1 week to 6 months' post event) and seven of their carers. Each interview was transcribed and a thematic analysis approach guided the analytic process. Results: Patients with sub-acute, mild to moderate stroke were positive about healthy lifestyles and their ability to achieve them post stroke. Three core themes were identified: perceptions related to exercise; perceptions related to other lifestyle factors; and understanding of stroke and healthy lifestyles. Conclusions: In the sub-acute phase of stroke recovery, barriers to exercise such as lack of motivation do not appear to be an issue. People with stroke have a lack of understanding of healthy guidelines, risk factors and cause of their stroke. It is not clear if this is due to a lack of information provision or a lack of recall. They also do not appear to make the link between lifestyle choices and the cause of their stroke.

Diverse Functions and Mechanisms of Pericytes in Ischemic Stroke

Background: Every year, strokes take millions of lives and leave millions of individuals living with permanent disabilities. Recently more researchers embrace the concept of the neurovascular unit (NVU), which encompasses neurons, endothelial cells (ECs), pericytes, astrocyte, microglia, and the extracellular matrix. It has been well-documented that NVU emerged as a new paradigm for the exploration of mechanisms and therapies in ischemic stroke. To better understand the complex NVU and broaden therapeutic targets, we must probe the roles of multiple cell types in ischemic stroke. The aims of this paper are to introduce the biological characteristics of brain pericytes and the available evidence on the diverse functions and mechanisms involving the pericytes in the context of ischemic stroke.Methods: Research and online content related to the biological characteristics and pathophysiological roles of pericytes is review. The new research direction on the Pericytes in ischemic stroke, and the potential therapeutic targets are provided.Results: During the different stages of ischemic stroke, pericytes play different roles: 1) On the hyperacute phase of stroke, pericytes constriction and death may be a cause of the no-reflow phenomenon in brain capillaries; 2) During the acute phase, pericytes detach from microvessels and participate in inflammatory-immunological response, resulting in the BBB damage and brain edema. Pericytes also provide benefit for neuroprotection by protecting endothelium, stabilizing BBB and releasing neurotrophins; 3) Similarly, during the later recovery phase of stroke, pericytes also contribute to angiogenesis, neurogenesis, and thereby promote neurological recovery.Conclusion: This emphasis on the NVU concept has shifted the focus of ischemic stroke research from neuro-centric views to the complex interactions within NVU. With this new perspective, pericytes that are centrally positioned in the NVU have been widely studied in ischemic stroke. More work is needed to elucidate the beneficial and detrimental roles of brain pericytes in ischemic stroke that may serve as a basis for potential therapeutic targets.

Influence chronopharmacology therapy methionine (melaxen) on the dynamics of sleep disturbance, cognitive and emotional disorders, brain-derived neurotrophic factor (BDNF) in patients with cerebral stroke in the early and late recovery periods

To study the efficacy of melaxen on the dynamics of sleep disturbance, cognitive and emotional disorders, BDNF and the level of secretion of melatonin (6-SOMT) in patients with stroke in the early and late recovery phase. One hundred and ten patients in the rehabilitation period of stroke (mean age of 58.4±6.4 years), including 60 patients in the early recovery phase (group 1) and 50 patients in the late phase (group 2), were studied. Patients received melaxen in dose of 3 mg/day for 3 months along with standard treatment. The efficacy of therapy was assessed by the dynamics of sleep disorders, emotional status, dynamics of serum BDNF levels, 6-SOMT concentration in the urine. The study has demonstrated the high efficacy of melaxen in the rehabilitation of patients in early and late recovery phase of stroke. The drug significantly increased the BDNF level that correlated with improved sleep, emotional status, quality of life of patients.

Cell Surface CD36 Protein in Monocyte/Macrophage Contributes to Phagocytosis during the Resolution Phase of Ischemic Stroke in Mice

Infiltrating monocyte-derived macrophages (M-MΦ) influence stroke-induced brain injury. Although the inflammatory nature of M-MΦ in acute stroke has been well documented, their role during the resolution phase of stroke is less clear. With emerging evidence for the involvement of scavenger receptors in innate immunity, this study addresses an M-MΦ CD36 role in mediating phagocytosis during the recovery phase of stroke. Stroke increases CD36 and TSP-1/2 mRNA levels in the ipsilateral hemisphere at acute (3-day (d)) and recovery (7d) periods. Quantification of total, intracellular, and cell surface CD36 protein levels showed relatively unchanged expression at 3d post-ischemia. At 7d, there was a significant increase in cell surface CD36 (p < 0.05) with a concurrent reduction of intracellular CD36 (p < 0.05) in the ipsilateral hemisphere. Both cell surface and intracellular CD36 were found in whole brain lysates, whereas cell surface CD36 was predominantly detected in isolated brain mononuclear cells, blood monocytes, and peritoneal macrophages, suggesting that cell surface CD36 expressed in the post-ischemic brain originates from the periphery. The stroke-induced CD36 mRNA level correlated with increased expression of lysosomal acid lipase, an M2 macrophage marker. Functionally, higher CD36 expression in M-MΦ is correlated with higher phagocytic indices in post-ischemic brain immune cells. Moreover, pharmacological inhibition of CD36 attenuated phagocytosis in peritoneal macrophages and brain M-MΦ These findings demonstrate that cell surface CD36 on M-MΦ mediates phagocytosis during the recovery phase in post-stroke brains and suggests that CD36 plays a reparative role during the resolution of inflammation in ischemic stroke.

Physical activity and inactivity level of stroke patients including in physical activity incitation program

Physical activity (PA) and exercise are two successful approaches to reduce sedentary behavior and risk managing in stroke patients. The aims of the study are to evaluate PA and physical inactivity levels in post-stroke patients and to correlate PA parameters with gait performance, fatigue, anxiety, and anthropometry parameters in subacute phase of stroke recovery. Preliminary analysis of 24 patients in PA incitation program (mean age: 61.3 ± 13.85 years; weight 78.2 ± 12.8 kg; stroke delay: 76.5 ± 37.7 days). Each patient achieved 6 minutes walking test (6MWT), hospital anxiety and depression scale (HADS), multidimensional fatigue inventory questionnaire (MFI-20) and body composition assessment before the hospital discharge. Total energy expenditure (TEE), number of steps (NS), sitting time (ST), activity energy expenditure (> 3 MET) (AEE) and physical activity time (PAT) per day were collected at home by the SenseWear Armband monitor system during the first (T1) and sixth (T6) month of PA incitation program. ST and PAT reduced significantly between T1 and T6 respectively (65.6 ± 89.5 and 35.3 ± 48.6 min, p = 0.048) and (94.7 ± 67.3 and 75.5 ± 56.7 min, P = 0.049). In contrast, NS increased significantly between T1 and T6 (3750 ± 2440 and 4415 ± 3810 steps, P = 0.044). TEE were positively associated with 6MWT and HADS ( r = 0.488, P = 0.0182 and r = −0.401, P = 0.04 respectively) at T1. Furthermore, PAT was positively associated with the body lean mass ( r = 0.48, P = 0,017) and weight ( r = −0.502, P = 0.0124) at T1 and ( r = −0.524, P = 0,008) at T6. In addition, there is positive correlation between AEE and the percentage of muscular mass at T6 ( r = 0.513, P = 0.0123). Finally TEE, NS, AEE and PAT were correlated with MFI at T6 ( r = −0.463, r = −0.457, r = −0.527, r = −0.594, P < 0.05). These preliminary results revealed that stroke patients included in PA incitation program decreased ST and increased NS despite PAT reduction. Even the presence of PA incitation program, PA is higher in patients with a few physical limitations than patients with a physical and psychological impairments.

FV 1. Perilesional activation in poststroke language recovery

Background Poststroke aphasia recovery evolves in time. Increased perilesional activity associated with treatment-related language improvements has been confirmed in the chronic phase ( Fridriksson et al., 2011 ), but has not yet been systematically demonstrated during the early phases of stroke recovery. The pathophysiology of stroke suggests that perilesional reorganisation evolves within days, lasting for months after stroke, while increased neuronal excitability might provide a basis for perilesional neuroplasticity ( Schiene et al., 1999 ). Methods We compared fMRI BOLD response to speech (SP) and reversed speech (REV) using an auditory comprehension paradigm ( Saur et al., 2006 ) administered repeatedly (acute (t1) ⩽ 1 week, subacute (t2) = 1–2 weeks, chronic (t3) > 6 months post-onset) to patients with stroke affecting left frontal (FC, N = 17) or temporoparietal cortex (TPC, N = 17). Language activation (SP > REV) obtained from three perilesional ROIs expanding stepwise to 39 mm beyond the lesion (DISTANCE) was compared across TIME and to the improvement of language comprehension/production. Results An ANOVA revealed a significant TIME × DISTANCE interaction (F(4) = 2.9, p = .025) with increased activation from t1 to t3 and t2 to t3 (p). Conclusion To conclude, a remapping of cortical language representations in undamaged left cortices is likely to commence during subacute phase of recovery and improvements of specific language functions differentially involve frontal or temporal perilesional areas.

Perceived Quality of Life After Stroke

Abstract Date Presented 4/7/2016 It is necessary to research and understand quality of life in the continuing adjustment phase of stroke recovery so that people who survive a stroke can engage in preexisting or new meaningful activities, an effort that can be achieved with the assistance of occupational therapy. Primary Author and Speaker: Angela Salvadia Additional Authors and Speakers: Jannessa Miller, Kala Swope, Jacqueline Nunn

Contribution of Paretic and Nonparetic Limb Peak Propulsive Forces to Changes in Walking Speed in Individuals Poststroke

Background. Recent rehabilitation efforts after stroke often focus on increasing walking speed because it is associated with quality of life. For individuals poststroke, propulsive force generated from the paretic limb has been shown to be correlated to walking speed. However, little is known about the relative contribution of the paretic versus the nonparetic propulsive forces to changes in walking speed. Objective. The primary purpose of this study was to determine the contribution of propulsive force generated from each limb to changes in walking speed during speed modulation within a session and as a result of a 12-week training program. Methods. Gait analysis was performed as participants (N = 38) with chronic poststroke hemiparesis walked at their self-selected and faster walking speeds on a treadmill before and after a 12-week gait retraining program. Results. Prior to training, stroke survivors increased nonparetic propulsive forces as the primary mechanism to change walking speed during speed modulation within a session. Following gait training, the paretic limb played a larger role during speed modulation within a session. In addition, the increases in paretic propulsive forces observed following gait training contributed to the increases in the self-selected walking speeds seen following training. Conclusions. Gait retraining in the chronic phase of stroke recovery facilitates paretic limb neuromotor recovery and reduces the reliance on the nonparetic limb’s generation of propulsive force to increase walking speed. These findings support gait rehabilitation efforts directed toward improving the paretic limb’s ability to generate propulsive force.

Hyperforin promotes post-stroke functional recovery through interleukin (IL)−17A-mediated angiogenesis

Hyperforin, the main active ingredient of the medicinal plant Hypericum perforatum, has been shown to be neuroprotective against acute ischemic stroke. However, the long-term actions of hyperforin on the post-stroke functional recovery and underlying mechanisms have not been investigated. C57BL/6 wild-type mice or interleukin (IL)-17A knock-out mice underwent middle cerebral artery occlusion (60min) followed by reperfusion for 28 days. Here, we found that delayed treatment with hyperforin significantly promoted functional recovery and increased IL-17A expression in the ischemic hemisphere at 28 days post-ischemia (dpi). IL-17A knock-out or anti-IL-17A monoclonal antibody (mAb) treatment significantly attenuated the promoting effects of hyperforin on functional recovery. After screening for neurotrophic factors, we revealed that blocking IL-17A significantly decreased, whereas recombinant mouse IL-17A (rIL-17A) treatment significantly increased vascular endothelial growth factor (VEGF) expression. Our data also showed that rIL-17A treatment significantly increased CD34 expression and promoted functional recovery at 28dpi, and the promoting effects were attenuated by VEGF neutralizing antibody treatment. Furthermore, hyperforin treatment significantly increased the expression of VEGF and CD34 in the ischemic hemisphere at 28dpi, and the effects were attenuated by blocking IL-17A. Furthermore, VEGF neutralizing antibody significantly attenuated the promoting role of hyperforin on the cerebral CD34 expression. Thus, our results suggest that, in addition to the acute neuroprotection when delivered immediately after ischemic stroke, hyperforin could also promote functional recovery when delivered in the later phases of stroke recovery. Our results also reveal a previously uncharacterized property of IL-17A/VEGF signaling-induced angiogenesis in hyperforin-mediated functional recovery.

Polysomnographic Characteristics of Sleep in Stroke: A Systematic Review and Meta-Analysis.

BackgroundResearch on sleep after stroke has focused mainly on sleep disordered breathing. However, the extend to which sleep physiology is altered in stroke survivors, how these alterations compare to healthy volunteers, and how sleep changes might affect recovery as well as physical and mental health has yet to be fully researched. Motivated by the view that a deeper understanding of sleep in stroke is needed to account for its role in health and well-being as well as its relevance for recovery and rehabilitation, we conducted a systematic review and meta-analysis of polysomnographic studies comparing stroke to control populations.MethodMedline and PsycInfo databases were searched using "stroke" and words capturing polysomnographic parameters as search terms. This yielded 1692 abstracts for screening, with 15 meeting the criteria for systematic review and 9 for meta-analysis. Prisma best practice guidelines were followed for the systematic review; the Comprehensive Meta-Analysis software was used for random effects modelling.ResultsThe meta-analysis revealed that patients with stroke have poorer sleep than controls. Patients had lower sleep efficiency (mean 75% vs 84%), shorter total-sleep-time (309.4 vs 340.3 min) and more wake-after-sleep-onset (97.2 vs 53.8 min). Patients also spend more time in stage 1 (13% vs 10%) and less time in stage 2 sleep (36% vs 45%) and slow-wave-sleep (10% vs 12%). No group differences were identified for REM sleep. The systematic review revealed a strong bias towards studies in the early recovery phase of stroke, with no study reporting specifically on patients in the chronic state. Moreover, participants in the control groups included community samples as well as other patients groups.ConclusionsThese results indicate poorer sleep in patients with stroke than controls. While strongly suggestive in nature, the evidence base is limited and methodologically diverse, and hands a clear mandate for further research. A particular need regards polysomnographic studies in chronic community-dwelling patients compared to age-matched individuals.

Partial body weight support treadmill training speed influences paretic and non-paretic leg muscle activation, stride characteristics, and ratings of perceived exertion during acute stroke rehabilitation

BackgroundIntensive task-specific training is promoted as one approach for facilitating neural plastic brain changes and associated motor behavior gains following neurologic injury. Partial body weight support treadmill training (PBWSTT), is one task-specific approach frequently used to improve walking during the acute period of stroke recovery (<1month post infarct). However, only limited data have been published regarding the relationship between training parameters and physiologic demands during this early recovery phase. ObjectiveTo examine the impact of four walking speeds on stride characteristics, lower extremity muscle demands (both paretic and non-paretic), Borg ratings of perceived exertion (RPE), and blood pressure. DesignA prospective, repeated measures design was used. MethodsTen inpatients post unilateral stroke participated. Following three familiarization sessions, participants engaged in PBWSTT at four predetermined speeds (0.5, 1.0, 1.5 and 2.0mph) while bilateral electromyographic and stride characteristic data were recorded. RPE was evaluated immediately following each trial. ResultsStride length, cadence, and paretic single limb support increased with faster walking speeds (p⩽0.001), while non-paretic single limb support remained nearly constant. Faster walking resulted in greater peak and mean muscle activation in the paretic medial hamstrings, vastus lateralis and medial gastrocnemius, and non-paretic medial gastrocnemius (p⩽0.001). RPE also was greatest at the fastest compared to two slowest speeds (p<0.05). ConclusionsDuring the acute phase of stroke recovery, PBWSTT at the fastest speed (2.0mph) promoted practice of a more optimal gait pattern with greater intensity of effort as evidenced by the longer stride length, increased between-limb symmetry, greater muscle activation, and higher RPE compared to training at the slowest speeds.