State In Stroke Patients Research Articles

Епілепсія після ішемічного інсульту: чи є сенс призначати антиконвульсанти після першого нападу?

Актуальність. Частота розвитку епілептичних нападів у хворих, які перенесли інсульт, коливається в широкому діапазоні — від 3 до понад 60 % [8, 11–15]. Сьогодні в темі постінсультної епілепсії залишаються до кінця не вивченими чимало аспектів цієї проблеми, в тому числі питання щодо призначення протиепілептичних препаратів. Мета дослідження — визначити прогноз розвитку симптоматичної епілепсії після інсульту залежно від прийому антиконвульсантів пацієнтами після першого епілептичного нападу. Матеріали та методи. Комплексно обстежено 1012 пацієнтів (562 чоловіки і 450 жінок) віком від 49 до 90 років, які перенесли ішемічний інсульт протягом 2011–2014 років. Під час проведення аналізу стану всіх 1012 пацієнтів було встановлено, що протягом 6 місяців після перенесеного інсульту хоча б один епілептичний напад було зафіксовано у 161 пацієнта. За типом нападів переважали фокальні (89,9 %; р < 0,001), і лише в 11,1 % пацієнтів були діагностовані первинно-генералізовані епілептичні напади. Результати та обговорення. Для порівняння перебігу стану пацієнтів з інсультом після першого епілептичного нападу нами були сформовані подібні групи: перша (n = 81) і друга (n = 80). У першій групі призначали протиепілептичні препарати після першого епілептичного нападу, у другій групі не призначали. Стан пацієнтів було оцінено через рік після виникнення першого епілептичного нападу. Критеріями оцінки були: наявність другого епілептичного нападу і більше, тобто діагностика симптоматичної постінсультної епілепсії, або взагалі відсутність жодного епілептичного нападу. Відповідно до результатів спостереження, у першій групі, яка приймала антиконвульсанти, протягом року повторні епілептичні напади були зафіксовані у 22 пацієнтів, що становило 27,1 %, тоді як у другій групі, де не проводилося лікування антиконвульсантами, протягом року повторні епілептичні напади були зафіксовані у 43 пацієнтів, що становило 53,75 %. Висновок. Дані результати є підставою для подальших досліджень та можливої рекомендації призначення протиепілептичних препаратів вже після першого епілептичного нападу у пацієнтів, які перенесли інсульт.

Clinical Evidence Based Nursing (EBNP) Penggunaan Berg Balance Scale Untuk Mengkaji Keseimbangan Pada Pasien Stroke

Stroke can affect balance. Balance is the ability to maintain the body in a balanced position both in static and dynamic conditions. However, the assessment of the existing balance is only done in a static state in stroke patients. The balance assessment describes the balance of stroke patients so that they can be written on asessment form and the transfer record and can determine the need for balance training as one of the rehabilitation of stroke patients. This EBN application aims to find out the use of Berg Balance Scale to assess the balance of both static and dynamic conditions in stroke patients. The method used is conducting PICO analysis, searching database, critical appraisal, and determining relevant journals. EBN implementation was carried out on 10 people who had a stroke in zone A on the 5th floor of Building A RSUPN Dr. Cipto Mangunkusumo. This study uses the Berg Balance Scale scale in Indonesian. The analysis showed that stroke patients who experienced balance disorders were 7 people and did not experience a balance of 3 people BBS can assess the balance of stroke patients in accordance with existing evidence. BBS can be used as a balance assessment in stroke patients.

Median Nerve Electrical Stimulation–Induced Changes in Effective Connectivity in Patients With Stroke as Assessed With Functional Near-Infrared Spectroscopy

Background. The cortical plastic changes in response to median nerve electrical stimulation (MNES) in stroke patients have not been entirely illustrated. Objective. This study aimed to investigate MNES-related changes in effective connectivity (EC) within a cortical network after stroke by using functional near-infrared spectroscopy (fNIRS). Methods. The cerebral oxygenation signals in the bilateral prefrontal cortex (LPFC/RPFC), motor cortex (LMC/RMC), and occipital lobe (LOL/ROL) of 20 stroke patients with right hemiplegia were measured by fNIRS in 2 conditions: (1) resting state and (2) MNES applied to the right wrist. Coupling function together with dynamical Bayesian inference was used to assess MNES-related changes in EC among the cerebral low-frequency fluctuations. Results. Compared with the resting state, EC from LPFC and RPFC to LOL was significantly increased during the MNES state in stroke patients. Additionally, MNES triggered significantly higher coupling strengths from LMC and LOL to RPFC. The interregional main coupling direction was observed from LPFC to bilateral motor and occipital areas in responding to MNES, suggesting that MNES could promote the regulation function of ipsilesional prefrontal areas in the functional network. MNES can induce muscle twitch of the stroke-affected hand involving a decreased neural coupling of the contralesional motor area on the ipsilesional MC. Conclusions. MNES can trigger sensorimotor stimulations of the affected hand that sequentially involved functional reorganization of distant cortical areas after stroke. Investigating MNES-related changes in EC after stroke may help further our understanding of the neural mechanisms underlying MNES.

Polish Helicopter Emergency Medical Service (HEMS) Response to Stroke: A Five-Year Retrospective Study

BackgroundA stroke is a serious life-threatening emergency that requires immediate intervention in an appropriate therapeutic center. The aim of this study was to analyze the time of medical procedures at the scene and changes in the state of stroke patients during transport by HEMS in Poland. The presented research is the first nationwide study covering such a large group of stroke patients, for whom aerial support was used in the therapeutic process.Material/MethodsA retrospective cross-sectional study of 48553 missions performed by Polish Medical Air Rescue (PMAR) during the 5-year study period resulted in 3906 stroke patients who, after medical rescue operations by HEMS crew, were transported by helicopters to hospitals.ResultsHelicopters in 3475 (88.97%) cases were utilized as a support for Ground Emergency Medical Service (GEMS). The maximum duration of HEMS operation from activation to patient transfer to the hospital did not exceed 108 min and the median was 60 min. Over 87% of patients with HEMS reported stroke symptoms and arrived at the medical center with the possibility of implementing thrombolytic therapy. The factor that affected the deterioration of patients’ condition was the drawing out of the extent of time spent by the crew at the scene.ConclusionsThe use of HEMS in Poland in the case of patients with stroke symptoms ensures fast and professional assistance at the site of the medical emergency as well as safe transport to specialized centers, shortening the time of proper treatment implementation.

Detecting intention to walk in stroke patients from pre-movement EEG correlates.

BackgroundMost studies in the field of brain-computer interfacing (BCI) for lower limbs rehabilitation are carried out with healthy subjects, even though insights gained from healthy populations may not generalize to patients in need of a BCI.MethodsWe investigate the ability of a BCI to detect the intention to walk in stroke patients from pre-movement EEG correlates. Moreover, we also investigated how the motivation of the patients to execute a task related to the rehabilitation therapy affects the BCI accuracy. Nine chronic stroke patients performed a self-initiated walking task during three sessions, with an intersession interval of one week.ResultsUsing a decoder that combines temporal and spectral sparse classifiers we detected pre-movement state with an accuracy of 64 % in a range between 18 % and 85.2 %, with the chance level at 4 %. Furthermore, we found a significantly strong positive correlation (r = 0.561, p = 0.048) between the motivation of the patients to perform the rehabilitation related task and the accuracy of the BCI detector of their intention to walk.ConclusionsWe show that a detector based on temporal and spectral features can be used to classify pre-movement state in stroke patients. Additionally, we found that patients’ motivation to perform the task showed a strong correlation to the attained detection rate of their walking intention.

Analysis of the brachial-ankle pulse wave velocity of stroke patients according to change of posture for healthy science research: A randomized controlled pilot trial

Brachial-ankle pulse wave velocity (BaPWV) in the as sessment of cardiovascular risk factors is often used to predict early cardiovascular disease, and it is used as a clinical indicator. A high value of BaPWV indicates high cardiovascular disorder. However, BaPWV and pressure waveforms after stroke are not fully understood in change of posture. Therefore, this study investigated the effects of BaPWV on posture changes in subjects. BaPWV was measured in twenty-eight subjects (sixteen healthy volunteers and twelve stroke patients) while they were in the body position such as supine, sitting, and standing posture. BaPWV was significantly increased in the stroke group compared with the healthy volunteers in supine and standing posture. BaPWV improved significantly in stroke patients of standing posture after the 4-week intervention program. Furthermore, analysis of the pressure waveforms of supine and standing posture showed that the peak pressure was significantly increased in the stroke group compared with the healthy group. The peak pressure of supine and standing posture on both the affected and non-affected sides was also significantly greater than in the healthy group. However, the rise and decay times were significantly decreased in the stroke group compared with the healthy group in supine and standing posture. The rise and decay time on both the affected and non-affected sides were significantly more decreased than in the control group. These results suggest that changed BaPWV and pulse waves are related with the pathologic states of stroke patients in various body postures.

脳卒中後の回復期病棟入院時の身体機能面，心理・精神的側面，社会的側面，およびQuality of Lifeの関係 3．リハビリテーションに対するモチベーション

〔目的〕集中的なリハビリテーションが行われる回復期病棟入院時の脳卒中者に対し，リハビリテーションに対するモチベーションを調査し，その関連因子を抽出することによって，より円滑で効果的なリハを提供する一助を得ること．〔対象〕脳卒中者23名．〔方法〕モチベーションはリハビリテーションに対する期待度を聴取することで評価し，それと身体機能面，心理・精神的側面，社会的側面およびQOLとの関連を相関分析と回帰分析を用い調査した．〔結果〕モチベーションは日常生活動作能力や自立度，良好なコミュニケーション能力や気分，およびバイタリティと関連し，特に日常生活自立度と気分が重要であった（R2=0.524）．〔結語〕日常生活自立度の向上，良好なコミュニケーション，および心理的ケアがモチベーションを向上させる可能性が示唆された．

脳卒中後の回復期病棟入院時の身体機能面，心理・精神的側面，社会的側面，およびQuality of Lifeの関係 1．抑うつ症状とアパシー

脳卒中後の回復期病棟入院時の身体機能面，心理・精神的側面，社会的側面，およびQuality of Lifeの関係 1．抑うつ症状とアパシー

Assessing stroke patients with the International Classification of Functioning, Disability and Health core sets

Objective To investigate the functional states of stroke patients using the International Classification of Functioning, Disability and Health (ICF) core sets for stroke. Methods Fifty in-patients with stroke participated in this study. Twenty-five patients less than one month after a stroke were assigned to the acute group, and another 25 patients with more than one month since their stroke were assigned to the sub-acute and chronic group. All the patients were assessed using the Glasgow coma scale, Rankin grading and the Barthel index. The ICF core set for stroke assessment was also used with both groups. The data was analyzed by using a Chi squared frequency test. Results Rankin grades and Barthel indices were significantly different between the two groups, and the functional states in the acute group were better than those in the sub-acute and chronic group. Some of the items, such as consciousness state, functions of structures adjoining the eyes, hearing, substitutive sound, accessory respiration, temperature regulation and protection function of the skin had no significant difference between the groups. The number of patients suffering from disorders of joint motion, joint stability, muscle endurance and control of voluntary movement was significantly greater in the sub-acute and chronic group than in the acute group. Both groups were influenced to different degrees by most of the environmental factors. Conclusion The ICF core sets correctly indicated joint motion, joint stability, muscle endurance and control of voluntary movement difficulties of stroke patients. Key words: International Classification of Functioning, Disability and Health; Stroke; Motor function

Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico

Rehabilitation strategies have been developed to improve functional state in stroke patients. The main objective of this study was to evaluate the effectiveness of the early rehabilitation at hospital and its continuity at home provided by nurses, on the functional recovery of basic and social activities in stroke patients compared with conventional care. A randomised clinical trial was carried out in three general hospitals of the Mexican Institute of Social Security (IMSS) in Mexico City between April 2003-May 2004. Stroke patients. Two rehabilitation strategies provided by nurses for stroke patients were compared: physiotherapy plus caregiver education in rehabilitation (strategy 1, S1) vs. education alone (strategy 2, S2). The main outcome variables were the basic (Barthel index) and social (Frenchay activities index) activities of daily living, of each patient. Age, sex, morbidity, stroke symptoms, complications, neurological damage (Canadian Scale), cognitive state (mini-mental state examination questionnaire) and duration of hospitalisation were defined as the control variables. Patients were evaluated at baseline and months one, three and six thereafter. One hundred and ten patients with ischaemic stroke were enrolled and randomised; 59 were assigned to S1 and 51 to S2. Comparison of the outcome variables showed that patients improved significantly over time, but no differences were observed between groups. We observed no significant difference in strategy performance with regard to the basic and instrumental activities of daily living. Participants who received physiotherapy with additional caregiver education benefit no more than those whose caregivers received education alone. Those countries that do not have integral rehabilitation programmes for stroke patients should understand their importance and budget resources for them. Meanwhile, both caregiver education and nurses trained in specific care and physiotherapy are alternatives that benefit these patients.

Cognitive function and the emotional state of stroke patients on antihypertensive therapy

Combined antihypertensive therapy based on 2.5-5 mg of cilazapril (an angiotensin-converting enzyme inhibitor) to normalize arterial pressure (ABP) was studied in 22 patients (12 male, 10 female) aged 49-74 years (mean 63 +/- 7 years) with stroke (18 patients) or transient ischemic attacks (three patients). Magnetic resonance tomography (MRT) including perfusion studies, along with neuropsychological studies and assessment of emotional status (Beck depression inventory, Spielberger anxiety scale), were performed before and after treatment. After six months of treatment, patients showed normalization of ABP (systolic pressure decreased from 154.7 +/- 12 to 128 +/- 23 mmHg, diastolic from 90.3 +/- 9.6 to 79.4 +/- 23 mmHg). There were no side effects and no patient experienced stroke. MRT revealed no signs of new foci and there were no significant changes in brain blood flow. By the end of treatment, improvements in cognitive functions were noted on the Mini Mental State Examination, the 10-word memory test, the Boston naming test, or the Wisconsin card-sorting test, though there were no changes in the patients' emotional status.

The Role of Nutrition and Diet in Stroke Rehabilitation

Nutritional and dietary issues are important factors to consider in the rehabilitation of patients that have sustained a stroke. The recent study of post-stroke nutrition has brought to light new information regarding the high prevalence of the undernourished state in stroke patients. Stroke patients are nutritionally vulnerable because they have a large number of neurologic deficits that can contribute to decreased dietary intake and, eventually, malnutrition. Adverse outcomes have been associated with these malnourished states. This article focuses on nutritional assessment and the specific nutritional and dietary concerns of stroke patients. Management strategies for the in-hospital and at-home stroke patient are offered.

Neglect in elderly stroke patients: A comparison of five tests

Neglect is a disabling state in stroke patients. Five tests for visuo-spatial neglect, star cancellation, line crossing, line bisection, draw a clock and copy a cross, were compared in 57 elderly patients. Sensitivity and intercorrelations between the tests were determined. Patients with neglect were studied as regards their activities of daily living, motor activity and cognition. Left-hemisphere neglect in patients with right-hemisphere lesions was more severe than right-sided neglect in patients with left-sided lesions in the star cancellation test. Sensitivity of the tests was moderate for star cancellation, line bisection and draw a clock, and low for line crossing and copy a cross. Significant correlations existed between the tests and cognitive and functional ability. Intercorrelations between the tests were moderate. Neglect patients showed a slower recovery after 6 and 12 months. Draw a clock and a cross displayed no sensitivity for neglect in patients with hemianopia, which may be due to the fact that these tests also evaluate constructional apraxia. The cancellation tests were influenced by hemianopia and there is evidence that hemianopia exacerbates neglect. This study shows that a battery of neglect tests is required to diagnose the neglect syndrome.