Side Of Stroke Research Articles

The beneficial effect of intravenous zoledronic acid therapy following an acute stroke in rats

Purpose Changes of bone metabolism begin from the initial stages of stroke; therefore, early prevention of these changes has become important. The most appropriate target for preventive therapy is to restrict the profound increase in osteoclastic bone resorption that occur soon after stroke. Oral bisphosphonates, which selectively target osteoclasts and their precursors, are appropriate drugs, but dysphagia or drowsiness after acute stroke can make it difficult to easily administer these compounds to stroke patients. The intravenous (IV) administration of bisphosphonates is an alternative method that can overcome these limitations. In order to determine the effect of IV bisphosphonates at the initial stages of stroke for preventing bone loss, an experiment using ischemic stroke rats was conducted. Methods Female Sprague–Dawley rats ( n = 100) were randomly divided into four separate groups; sham surgery and vehicle-treated group (sham-vehicle), stroke and vehicle-treated group (stroke-vehicle), stroke with low-dose zoledronic acid treatment group (stroke-low) and stroke with high-dose zoledronic acid treatment group (stroke-high). Permanent occlusion of the left middle cerebral artery was performed, resulting in right hemiplegia. The bone mineral density (BMD) of the 4th and 5th lumbar vertebrae and the femur on the stroke side were measured in vivo on the day before stroke and on the 10th and 21st day after stroke. The osteocalcin and carboxy-terminal telopeptide blood levels were measured on the 10th and 21st day after stroke. The BMD of the excised proximal tibia and the maximum load of femoral neck were measured on the 21st day after stroke. Results After 21 days of stroke, the BMD of the lumbar vertebrae, femur, and excised tibia and the maximum load of the femoral neck in the sham-vehicle, stroke-low, and stroke-high groups were significantly higher than those in the stroke-vehicle group ( P < 0.05). The carboxy-terminal telopeptide levels in the sham-vehicle and stroke-high groups were significantly lower than those in the stroke-vehicle group ( P < 0.05). Conclusion The results suggest that IV zoledronic acid treatment might prevent bone loss during the initial stages of stroke.

Pre-morbid personality and depression following stroke

The role of individual differences, including pre-morbid personality, in the development of post-stroke depression, has received relatively little attention. We undertook a cross-sectional study to investigate the relationship between pre-morbid personality and other individual differences, and depression following acute stroke. We studied 61 consecutive patients admitted to a dedicated stroke inpatient unit. DSM-IV depressive diagnoses were ascertained using the Composite International Diagnostic Interview and depressive symptoms were ascertained on the Hamilton Depression Rating Scale and the Center for Epidemiologic Studies Depression Scale. Informant-rated personality scores were obtained on the full 240-item Neuroticism, Extraversion and Openness Personality Inventory--Revised. Adaptive function was measured on the Modified Barthel Index and the Instrumental Activities of Daily Living scale. Cognitive function was assessed on the Mini-mental State Examination. An increased risk of post-stroke depression was conferred by both pre-morbid neuroticism [odds ratio (OR) 3.69; 95% confidence interval (95% CI) 1.25-10.92] and a past history of mental disorder (OR 10.26; 95% CI 3.02-34.86). There was no significant relationship demonstrated between lesion location and post-stroke depression. Informant-rated pre-morbid neuroticism and a past history of mental disorder were important predictors of depression following stroke. Stroke side was not significantly related to risk of depressive symptoms following stroke.

Bone loss after stroke over 52 weeks at os calcis: influence of sex, mobility and relation to bone density at other sites

As life expectancy increases after stroke, skeletal consequences become increasingly important, and patients at risk of fracture require identification. We have investigated peripheral bone mineral density (BMD) measurement at the heel as a possible surrogate for hip dual energy X-ray absorptiometry measurement and we have related bone loss over 52 weeks to balance and mobility. BMD at the heel (PIXI), proximal femur and whole body (QDR4500A), Tinetti (a measure of mobility and balance) and Barthel (a measure of activities of daily living) scores were measured in 52 patients (27 males and 25 females) within 8 weeks of stroke and repeated in 27 (15 males and 12 females) after 52 weeks. BMD was not initially low at the femoral neck (FN). A significant fall occurred on the stroke side (SS) over 52 weeks at the heel, FN and total hip (TH), in both sexes, but was greater in women. On the non-SS, women lost bone at the TH and heel. Patients who were in the lowest Tinetti score tertile initially, showed significant loss of bone in the FN (14.5%) and at the heel (12.2%) on the SS. BMD at the SS heel correlated with the FN at 8 weeks (r = 0.64, P<0.01) and at 52 weeks (r = 0.60, P<0.01) after stroke. Women lost more bone than men on SS but also lost bone on the non-SS at the same sites, suggesting that SS bone loss may result from factors additional to stroke. Heel BMD was a useful surrogate for hip BMD. Low initial Tinetti scores were an indicator of bone loss and, together with initial BMD measurements, provide a useful indication for those needing early prophylaxis against bone loss.

Hand dominance and side of stroke affect rehabilitation in chronic stroke

To examine the difference between upper extremity deficits in subjects with left versus right hemispheric lesions at baseline and after bilateral arm training. A one-way ANOVA was used to detect group differences and a least square means analysis used to determine significance in pre-to-post scores for each group. Testing was in the Physical Therapy and Rehabilitation Science Department Research Laboratory, University of Maryland, Baltimore. Training was at the Senior Exercise Rehabilitation Center in the Veterans Administration Hospital, Baltimore. Twenty-two (11 left hemispheric lesion, 11 right hemispheric lesion) right-handed subjects with chronic stroke. A six-week nonprogressive repetitive bilateral arm training with rhythmic auditory cueing (BATRAC). Fugl-Meyer Upper Extremity Test, Wolf Motor Arm Test, University of Maryland Arm Questionnaire for Stroke (UMAQS), isometric strength and active and passive range of motion for both sides. No statistical differences were seen at baseline between groups in this sample. Both groups demonstrated improvement after BATRAC in Fugl-Meyer Upper Extremity Test (change scores of those with left lesions = 5.5; right lesions = 3.6) and UMAQS (change scores of those with left lesions = 5 and right lesions = 2.9). Additionally, patients with left hemispheric lesions but not right lesions made improvements in the Wolf Motor Arm Test (time and weight), in strength measures of paretic elbow flexion, shoulder extension, shoulder abduction and nonparetic wrist flexion, wrist extension and shoulder abduction. There were no baseline motor function differences between those with left and right hemispheric lesions in this sample. There was a clear training response advantage for patients with left hemispheric lesions after completing six weeks of bilateral arm training. As a result, treatment approaches for upper extremity hemiparesis may need to be more specifically selected based on side of stroke.

Dynamic Cerebral Autoregulation in Acute Ischemic Stroke Assessed From Spontaneous Blood Pressure Fluctuations

This study investigates dynamic cerebral autoregulation assessed from spontaneous blood pressure (ABP) and cerebral blood flow velocity (CBFV) fluctuations and its time course in acute ischemic stroke. Forty patients admitted with acute ischemic stroke in the territory of the middle cerebral artery (MCA) were enrolled. Admission National Institutes of Health Stroke score was 6+/-4. Study 1 was performed within 22 (+/-11) hours and study 2 was performed within 134 (+/-25) hours of ictus. The final analysis comprised 33 and 29 patients for study 1 and study 2, respectively. Twenty-five age- and sex-matched controls were studied. ABP (Finapres method) and CBFV in both MCAs (transcranial Doppler) were recorded over 10 minutes. Correlations between diastolic and mean ABP and CBFV fluctuations were averaged, yielding the correlation coefficient indices (Dx, Mx). Transfer function analysis was applied to obtain phase shift and gain between ABP and CBFV oscillations. No disturbance of autoregulation was indicated by all parameters at study 1. Separate analyses for clinical severity, stroke side, and size did not reveal significant differences for the various autoregulatory indices at study 1 and 2. At study 2, MCA flow velocity was significantly increased on both sides, the autoregulation index Mx was slightly but significantly (P<0.05) worse on both sides in comparison to study 1, and phase showed a trend toward poorer values on affected sides. No significant differences to controls occurred. Clinical outcome in patients completing both studies was good in all but one patient. Dynamic cerebral autoregulation assessed from spontaneous blood pressure fluctuations does not seem to be relevantly disturbed in early minor MCA stroke. At the subacute stage, slight autoregulatory disturbance may be present.

Carotid intima-media thickness: is it correlated with stroke side?

The objective of the present study was to investigate the possible correlation between the common carotid artery (CCA) intima-media thickness (IMT) and the infarct side. The CCA IMTs in patients with atherosclerotic non-lacunar stroke were measured. The mean age of the patients was 64.3 +/- 10.7 years (range 40-83 years) and 42 of 100 patients were male. The infarcts were at the left side in 53 patients and at the right side in 47 patients. The mean CCA IMT was 1.02 +/- 0.18 mm at the infarct side and 0.87 +/- 0.17 mm at the contralateral side. The difference between them was statistically significant (P < 0.01). Although the mean age of the patients with a left-sided infarct was greater than that of the patients with a right-sided infarct, the difference was not statistically significant. Our results suggest that CCA IMT may be used in prediction of possible infarct side, and in the prediction of potential risk of stroke by evaluating the IMT of both CCAs separately.

The influence of stroke laterality on coping with stroke outcome

Objective of this study was to asses the influence of coping activities on stroke disability- and handicap-outcomes. Of special interest was to investigate if and how the variable "side of lesion" influenced the relationship between coping activities and outcomes. 105 stroke patients (50 women, 55 men, mean age 71.1 years) were investigated. The coping activities of the stroke patients were investigated with the "Freiburg Questionnaire of Coping with Illness" (PQCI). The Disability Outcomes were investigated with the "Depression Status Inventory" (DSI) and the "Self Concept Scale for General Feelings of Self Worth". The Handicap-Outcomes were investigated with the "Perceived Quality of Life Scale" (PQoL) and the "Oxford Handicap Scale" (OHS). Unaffected by the side of lesion, depressive coping showed negative influences on the investigated outcomes. The strategy "trivialization and wishful thinking" intensified significantly the prevailing mood of depression of patients who suffered a right hemisphere stroke. The same negative influence of this strategy was detected on the psycho-social condition of these patients. The influence of the strategies "active and problem-focused coping", "distractive and self-reconstructive coping" and "religious and meaning-searching coping" remained unaffected by the stroke side. These strategies showed no influence on the investigated outcomes. Depressive coping should be avoided.

Altered cerebral vasoregulation in hypertension and stroke.

Autoregulation of blood flow that maintains steady perfusion over the range of systemic blood pressure is compromised by stroke. To determine whether cerebral vasoregulation is impaired in stroke during orthostatic stress. Subjects included 30 control subjects, 30 with hypertension, and 20 with minor stroke and were studied using transcranial Doppler. Bilateral blood flow velocities (BFVs) from middle cerebral arteries, heart rate, blood pressure (BP), and CO2 were obtained during hyperventilation and CO2 rebreathing during supine rest and tilt at 80 degrees. Side-to-side BFV difference, vasomotor range (VMR), and cerebrovascular resistance (CVR) were calculated during normo-, hypo-, and hypercapnia. Mean BFVs were similar between groups in supine position but differed during tilt. BFV diminished on the stroke side during tilt with hyperventilation and CO2 rebreathing (p < 0.0001). CVR increased (p < 0.0001) and VMR decreased (p < 0.01) on the stroke side. Vasoregulation was preserved on the normal side. BFV asymmetry differentiated patients with stroke from the other groups (p < 0.0001). BFV difference between the normal vs stroke side was the largest in stroke-normotensive (n = 7) compared with stroke-hypertensive (n = 13) patients and the two other groups (p < 0.0001). BFV asymmetry in stroke was associated with lower orthostatic BP (p < 0.0001). Cerebral vasoregulation is impaired with minor stroke, and cerebral blood flow depends on blood pressure. Decline of blood flow velocities during orthostatic stress may pose a risk of silent hypoperfusion.

Subjective Change in Emotive, Cognition and Behaviour After Stroke: Factors Affecting the Perception of Patients and Partners

The presence and severity of changes in emotion and cognition experienced by left- and right-sided stroke patients and observed by their partners were compared at 3 months poststroke. The results showed that, regardless of the side of stroke, several changes were reported by half of the stroke patients and their partners. It appeared that while left hemisphere stroke patients agreed with their partners on the number and severity of most changes, partners of right hemisphere patients reported more frequent and more severe changes than the patients themselves. The level of observability of the altered behaviour, distress of the partner, distress of left-sided stroke patients and hemispatial neglect of right-sided stroke patients emerged as factors related to disagreement between stroke patient and partner.

Expression of angiotensin type 1 and 2 receptors in brain after transient middle cerebral artery occlusion in rats

Angiotensin II (Ang II) type 2 receptors (AT2Rs) have been associated with apoptosis. We hypothesized that AT2Rs are increased in stroke and may contribute effects of stroke to the brain. To test this, we have examined the expression of Ang II type 1 receptor (AT1R), AT2R and Ang II levels in the brain 24 h after transient middle cerebral artery occlusion (MCAO). The densities of AT1R and AT2R were measured by quantitative autoradiography ( n=6). The levels of Ang II were measured by radioimmunoassay (RIA) ( n=6) and by immunohistochemistry ( n=3). AT1R levels on autoradiography showed a significant decrease (0.87±0.06 to 1.39±0.07 fmol/mg, p<0.01) in the ventral cortex of the stroke side compared to the cortices of non-stroke (NS) rats ( n=4). There was no significant difference on ATIR in the contralateral verbal cortex of the stroke rats compared to NS control. In contrast, levels of AT2R in the ventral cortex of both the stroke and the contralateral sides were significantly increased (0.77±0.06, p<0.05 and 0.91±0.05, p<0.01 compared to 0.60±0.03 fmol/mg tissue, respectively). RIA showed that Ang II in the ventral cortex of both the stroke and the contralateral sides were significantly increased (241.63±47.72, p<0.01 and 165.51±42.59, p<0.05 compared to 76.80±4.10 pg/g tissue, respectively). Also, Ang II in the hypothalamus was significantly increased (179.50±17.49 to 118.50±6.65 pg/g tissue, p<0.05). Immunohistochemistry confirmed the increase of Ang II. These results demonstrate that brain Ang II and AT2Rs are increased whereas AT1Rs are decreased after transient MCAO in rats. We conclude that in stroke, Ang II and AT2R are activated and may contribute neural effects to brain ischemia.

Intra-arterial thrombolysis for acute ischemic stroke

Intra-arterial thrombolysis, administered within six hours of symptoms onset, has been shown in a randomized, prospective, multicenter trial and in several nonrandomized case series to be beneficial in acute ischemic stroke caused by occlusion of the middle cerebral artery or its major divisions. Benefit has been reported in a relatively small number of nonrandomized case series beyond the six-hour time window in basilar artery occlusion. Although intra-arterial thrombolysis appears to be an effective and relatively safe form of therapy for certain patients with acute ischemic stroke, better outcomes and fewer side effects than currently reported are to be desired. Whether this will be achieved in part by a better selection of patients based on physiologic rather than chronologic criteria, by achieving higher and faster recanalization rates (through combined use of intra-arterial and intravenous therapy or through use of mechanical clot-dissolution devices), or by combining thrombolysis with neuroprotectant strategies remains to be established by future trials.

Algoneurodystrophie du membre supérieur de l’hémiplégique : facteurs cliniques de gravité et intérêt du score pronostique de Perrigot

Purpose: The purposes of this study were to evaluate the prognostical factors of reflex sympathetic dystrophy in stroke patients in attempt to improve the Perrigot prognostical score. Material and method: This prospective study included 28 stroke patients with reflex sympathetic dystrophy. An initial clinical assessment including Perrigot score was made at the time of admission (before the end of the first month) and a second evaluation of reflex sympathetic dystrophy at the end of the third month. Patients were assessed using Motricity Index, Ashworth scale, de Bats grading (for glenohumeral alignment), Labrousse criteria (for reflex sympathetic dystrophy severity), and MADRS depression scale. Sensory deficit and unilateral neglect were noted. Results: The length of stay in acute ward was 16 days. The Perrigot score was correlated with the reflex sympathetic dystrophy severity (r = 0.7, p < 0.0001). It predicted the result of therapy. A significant correlation was found between reflex sympathetic dystrophy severity and motor deficit (r = -0.591, p = 0.0007) and spasticity ( p < 0.05). No relation was found with stroke side, unilateral neglect, depression or shoulder subluxation. It wasn’t possible to improve the Perrigot prognostical score. Conclusion: Perrigot score predict reflex sympathetic dystrophy severity and the result of therapy. The shoulder subluxation which is not included in this score appears to be not predictive. Shoulder subluxation is simply a marker of a severe paresis.

Intra-arterial thrombolysis for acute ischemic stroke

Intra-arterial thrombolysis, administered within six hours of symptoms onset, has been shown in a randomized, prospective, multicenter trial and in several nonrandomized case series to be beneficial in acute ischemic stroke caused by occlusion of the middle cerebral artery or its major divisions. Benefit has been reported in a relatively small number of nonrandomized case series beyond the six-hour time window in basilar artery occlusion. Although intra-arterial thrombolysis appears to be an effective and relatively safe form of therapy for certain patients with acute ischemic stroke, better outcomes and fewer side effects than currently reported are to be desired. Whether this will be achieved in part by a better selection of patients based on physiologic rather than chronologic criteria, by achieving higher and faster recanalization rates (through combined use of intra-arterial and intravenous therapy or through use of mechanical clot-dissolution devices), or by combining thrombolysis with neuroprotectant strategies remains to be established by future trials.

Accuracy of prediction of walking for young stroke patients by use of the FIM.

Clinical prediction of walking outcome after a stroke is essential for effective discharge planning. However, its accuracy has hardly been explored. This study took place in a regional unit admitting patients with complex neurological disabilities for specialist inpatient rehabilitation. The aim was to compare predicted outcome (goal score) with achieved outcome (discharge score) on the seven-point locomotion subscale of the Functional Independence Measure (FIM), to evaluate its precision and identify factors influencing accuracy. Admission, goal and discharge scores were analysed retrospectively for 141 subjects (90 M; 51 F) admitted consecutively to the Unit with median age 54 years (range 15-68 years) with median length of stay 13.6 weeks (range 3-35 weeks). Ninety subjects (64%) gained from two to six points; 50 subjects (35%) gained one point or showed no change. One patient deteriorated by two points. Excluding patients admitted with the highest score (FIM level 7), the overall level of agreement between predicted and discharge scores was moderate (weighted kappa 0.47). Prediction was accurate to +/- 1 point in 113 subjects (80%). Overprediction by > or = 2 points occurred in 16 subjects (11%) and underprediction by > or = 2 points in 12 subjects (9%). Analysis of the most-disabled cohort, admitted with FIM levels 1 or 2 scores, revealed a higher sensitivity for predicting 'independence' (FIM levels 5-7) (78%) than 'dependence' (FIM levels 1-4) (65%). Accuracy was not affected by age, gender or side of stroke. Inaccurate predictions were associated with lower admission FIM level scores (p = -0.26; p = 0.002) and a greater length of stay (p = 0.36; p < 0.001). Subjects with quadriplegia were more likely to have inaccurate outcome predictions made than those with hemiplegia (p = 0.025) and those with neglect were more likely to have inaccurate outcome predictions made than those without neglect (p = 0.017). Further investigation into clinical prediction and the variables which confound accuracy is needed for effective planning.

The hyperdense sylvian fissure MCA ”dot“ sign: a marker of acute CT ischemia

P40 Background: The hyperdense appearance of the middle cerebral artery is now a familiar early warning of large cerebral infarction, brain oedema and poor prognosis. Less well described, however, is the hyperdensity associated with embolic occlusion of branches of the middle cerebral artery seen in the sylvian fissure (MCA ”dot“ sign). The aim of this study was to define this sign, and to determine the incidence, its diagnostic value, and reliability. Methods: Computed tomographic (CT) scans performed on patients with acute ischemic stroke within 3 hours of symptom onset were analysed for signs of thromboembolic stroke and evidence of early CT ischemia. Two neuroradiologists and two stroke neurologists initially blinded to all clinical information, and then with knowledge of the affected hemisphere evaluated scans for the presence of a hyperdense MCA sign (HMCA), a hyperdense sylvian fissure MCA ”dot“ sign, and for early MCA territory ischemic changes. Results: Of 100 consecutive patients presenting within 3 hours of symptom onset early CT ischemia was seen in 74 % of the baseline CT scans. The HMCA sign was seen in 5% of CT scans whereas the MCA ”dot“ sign was seen in 16% of which 2 were associated with a HMCA sign. The presence of a HMCA sign was associated with a greater probability of dependence or death than when a MCA ”dot“ sign was observed or no hyperdensity was seen (P&lt;0.05). All 5 patients with a HMCA sign, including 2 with an associated MCA ”dot“ sign were either dead or dependent at 3 months. Patients with a dot sign alone had independent outcomes in 64% of cases (P&lt;0.8). Balanced kappa statistics for both signs were in the moderate to good range when the side of stroke was known. Conclusions: The hyperdense sylvian fissure MCA ”dot“ sign is an early marker of thromboembolic occlusion of the distal MCA and of its branches.

Do oarsmen have asymmetries in the strength of their back and leg muscles?

The aim of this study was to establish whether asymmetry of the strength of the leg and trunk musculature is more prominent in rowers than in controls. Nineteen oarsmen and 20 male controls matched for age, height and body mass performed a series of isokinetic and isometric strength tests on an isokinetic dynamometer. These strength tests focused on the trunk and leg muscles. Comparisons of strength were made between and within groups for right and left symmetry patterns, hamstring :quadriceps ratios, and trunk flexor and extensor ratios. The results revealed no left and right asymmetries in either the knee extensor or flexor strength parameters (including both isometric and isokinetic measures). Knee extensor strength was significantly greater in the rowing population, but knee flexor strength was similar between the two groups. No difference was seen between the groups for the hamstring:quadriceps strength ratio. In the rowing population, stroke side had no influence on leg strength. No differences were observed in the isometric strength of the trunk flexors and extensors between groups, although EMG activity was significantly higher in the rowing population. Patterns of asymmetry of muscle activity were observed between the left and right erector spinae muscles during extension, which was significantly related to rowing side ( P < 0.01). These observations could be related to the high incidence of low back pain in oarsmen.

Characteristics of induced spreading depression after transient focal ischemia in the rat

We examined characteristics of spreading depression (SD) induced on the rat cortex 1 day after transient focal ischemia. Male Wistar rats ( n=21) were subjected to transient intraluminal thread occlusion of the right middle cerebral artery for 75 min. Twenty-four hours after the reperfusion, cerebral blood flow (CBF) was determined using laser Doppler flowmeter during multiple SDs elicited on both non-stroke (left) and stroke (right) cortex by the topical application of 2 M KCl. We also examined CBF responses before and after the intravenous administration of the nonspecific NOS inhibitor Nω-nitro- l-arginine methyl ester ( l-NAME, 10 mg/kg) in normal and stroke cortex. Animals were divided into two groups; Group 1 ( n=12), animals with subcortical infarction and Group 2 ( n=9), animals with subcortical plus cortical infarction. There were no differences between non-stroke and stroke sides in the duration or amplitude of the DC potential shifts in either group. The transient CBF hyperemia during SD was not different between non-stroke (372±23% of baseline, mean±S.E.) and stroke sides (383±30%) in Group 1. However, in Group 2, CBF was significantly restricted on the stroke side (192±15% vs. non-stroke side, 374±33%). In four normal animals without ischemia, there were no differences in CBF response between both sides. l-NAME had no effect on the transient CBF hyperemia during SD in any of the groups. These data suggest that the CBF responses during SD in the peri-infarction area is restricted 1 day after the transient focal ischemia, while CBF responses are intact in normal cortex overlapping a subcortical infarct. Further, our results indicate that nitric oxide does not promote CBF responses during SD in normal cortex or in tissue surrounding infarction.

Abstracts of literature

Abstracts of literature

Wallerian degeneration of the pyramidal tract does not affect stroke rehabilitation outcome.

To test whether Wallerian degeneration (WD) of the pyramidal tract as signaled by MRI affects rehabilitation outcome in patients with subcortical infarction (internal capsule or corona radiata). Recent radiologic evidence suggests that WD occurs no earlier than 3 months after a subcortical infarction. A total of 77 consecutive patients with pure motor hemiparesis due to an initial subcortical infarction were assessed on admission and discharge with the Functional Independence Measure (FIM) for disability and Stroke Impairment Assessment Set (SIAS, full = 25) for impairment. WD was defined by a high-intensity area detected along the pyramidal tract below the level of lesion on T2-weighted MR image (WD+). Age, sex, side of stroke, Mini-Mental State Examination score, and volume of lesion were comparable for each group. Length of stay (LOS) was significantly longer (p < 0.05) in WD+ (130 days) than in WD- (105 days). There was no difference in the change of FIM (WD+, 99 to 111; WD-, 95 to 107) or SIAS measures (WD+, 12 to 16; WD-, 13 to 16) made on admission and discharge, nor was there any effect of the timing of the rehabilitation experience (< or = 90 days or >90 days after stroke). After stroke, apparent WD of the pyramidal tract may slow functional recovery but does not limit final rehabilitation outcome of pure motor hemiparesis. Study of the mechanisms of compensation for this delayed pyramidal tract degeneration will enhance the scientific basis for rehabilitation.

State self-esteem following stroke.

Physical rehabilitation after stroke is often highlighted in the absence of consideration of psychosocial factors. This study sought to determine the relationship between state self-esteem and functional independence in patients recovering from stroke. In a longitudinal study, data were collected from 152 stroke patients within 48 hours of admission to a rehabilitation hospital and at 2 weeks and 3 months after admission. The Modified Barthel Index was used to assess functional ability. Patients' current feelings of self-worth were assessed with use of the State Self-Esteem Scale. Additional variables included perceived social support, trait self-esteem, age, previous stroke, side of stroke, comorbidity, marital status, and gender. State self-esteem was significantly correlated to functional independence. The results of linear stepwise regression analysis indicated that functional ability and state self-esteem at 2 weeks, as well as the presence of heart disease, were significant predictors (55%) of functional ability at 3 months. For those with a functional ability score of >/=81 on admission to the rehabilitation unit, state self-esteem and functional ability at 2 weeks as well as previous stroke explained 53% of the variance in functional ability at 3 months. When functional ability was </=80, baseline and 2-week functional ability, state self-esteem at 2 weeks, and age predicted 53% of the variance in functional ability at 3 months. Functional ability at 2 weeks was a stronger predictor than baseline functional ability in this study. The level of state self-esteem was also a consistent factor in the prediction of functional outcome of patients after stroke.