Stroke Outpatients Research Articles

Evaluation of Swallowing Disorder in Ischemic Stroke Patients By Flexible Endoscopic

Introduction: Dysphagia is one of the complications of stroke and closely associated with increasing of aspiration pneumonia. Evaluation of dysphagia was necessary to prevent pneumonia due to aspiration has effectively done by fiberoptic endoscopic evaluation of swallowing (FEES). Methods: The study was a cross sectional study with convenience sampling. The subjects were stroke outpatients from July to December 2018. The FEES was conducted to assess the swallowing dysfunction and the data were collected. Results: There was six post ischemic stroke subjects, mean age (SD) was 55.17 (9.13) years and 4 subjects were male. All subjects had standing secretion in pre-swallowing assessment. 3 subjects used nasogastric tube (NGT) to fulfill the intake safely. In swallowing assessment, all subjects had residue at vallecula and/or pyriformis sinus. 2 subjects had penetration only and 4 subjects had penetration with aspiration. There was inadequate cough reflex in 2 subjects.

The effect of grade white matter hyperintensities (WMH) to cognitive function in ischaemic stroke outpatients at Dr. Saiful Anwar Hospital, Malang

The effect of grade white matter hyperintensities (WMH) to cognitive function in ischaemic stroke outpatients at Dr. Saiful Anwar Hospital, Malang

Gambaran Self-Management Pada Pasien Stroke Yang Menjalani Rawat Jalan

Stroke patients require a long-term treatment, both to prevent recurrent stroke and to minimize further complications. One of the efforts to succeed the stroke patients' treatment is Self-Management. This study aimed to identify the self-management of stroke outpatients. This quantitative descriptive study involved 40 stroke outpatients in RSAI who are able to communicate well, taken by using consecutive sampling techniques for one week. The data were collected by using a Stroke Self-Management Questionnaire (SSMQ) consisting of 4 domains (capacity, confidence in interaction, strategy, and guidance by health professionals). The collected data were analyzed descriptively by using the mean value. The result showed that the percentage of respondents with high self-management category (52,5%) was higher than the low category. Furthermore, the percentage of the good category was higher in the domain of confidence in interaction, strategy (52.5%), as well as guidance by health professionals (55%). Meanwhile, the percentage of the low category was found higher in the domain of capacity (52.5%). Keywords: Self-Management, Stroke

Evaluation of Swallowing Disorder in Ischemic Stroke Patients By Flexible Endoscopic

Introduction: Dysphagia is one of the complications of stroke and closely associated with increasing of aspiration pneumonia. Evaluation of dysphagia was necessary to prevent pneumonia due to aspiration has effectively done by fiberoptic endoscopic evaluation of swallowing (FEES).Methods: The study was a cross sectional study with convenience sampling. The subjects were stroke outpatients from July to December 2018. The FEES was conducted to assess the swallowing dysfunction and the data were collected.Results: There was six post ischemic stroke subjects, mean age (SD) was 55.17 (9.13) years and 4 subjects were male. All subjects had standing secretion in pre-swallowing assessment. 3 subjects used nasogastric tube (NGT) to fulfill the intake safely. In swallowing assessment, all subjects had residue at vallecula and/or pyriformis sinus. 2 subjects had penetration only and 4 subjects had penetration with aspiration. There was inadequate cough reflex in 2 subjects.Conclusion: Standing secretion and residue became the most dominant findings in post ischemic stroke patients, which a risk to have Aspiration.Keywords: Swallowing Disorder, Stroke, Flexible Endoscopic Evaluation of Swallowing (FEES)

Effectiveness of Robot-Assisted Upper Limb Training on Spasticity, Function and Muscle Activity in Chronic Stroke Patients Treated With Botulinum Toxin: A Randomized Single-Blinded Controlled Trial

Background: The combined use of Robot-assisted UL training and Botulinum toxin (BoNT) appear to be a promising therapeutic synergism to improve UL function in chronic stroke patients.Objective: To evaluate the effects of Robot-assisted UL training on UL spasticity, function, muscle strength and the electromyographic UL muscles activity in chronic stroke patients treated with Botulinum toxin.Methods: This single-blind, randomized, controlled trial involved 32 chronic stroke outpatients with UL spastic hemiparesis. The experimental group (n = 16) received robot-assisted UL training and BoNT treatment. The control group (n = 16) received conventional treatment combined with BoNT treatment. Training protocols lasted for 5 weeks (45 min/session, two sessions/week). Before and after rehabilitation, a blinded rater evaluated patients. The primary outcome was the Modified Ashworth Scale (MAS). Secondary outcomes were the Fugl-Meyer Assessment Scale (FMA) and the Medical Research Council Scale (MRC). The electromyographic activity of 5 UL muscles during the “hand-to-mouth” task was explored only in the experimental group and 14 healthy age-matched controls using a surface Electromyography (EMGs).Results: No significant between-group differences on the MAS and FMA were measured. The experimental group reported significantly greater improvements on UL muscle strength (p = 0.004; Cohen's d = 0.49), shoulder abduction (p = 0.039; Cohen's d = 0.42), external rotation (p = 0.019; Cohen's d = 0.72), and elbow flexion (p = 0.043; Cohen's d = 1.15) than the control group. Preliminary observation of muscular activity showed a different enhancement of the biceps brachii activation after the robot-assisted training.Conclusions: Robot-assisted training is as effective as conventional training on muscle tone reduction when combined with Botulinum toxin in chronic stroke patients with UL spasticity. However, only the robot-assisted UL training contributed to improving muscle strength. The single-group analysis and the qualitative inspection of sEMG data performed in the experimental group showed improvement in the agonist muscles activity during the hand-to-mouth task.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03590314

Effects of the sleep quality of chronic stroke outpatients on patterns of activity performance and quality of life

Effects of the sleep quality of chronic stroke outpatients on patterns of activity performance and quality of life

The effects of time-use intervention on the quality of life of outpatients with chronic stroke.

[Purpose] The purpose of this study was to examine the effects of time-use intervention on the quality of life of outpatients with chronic stroke. [Participants and Methods] This study randomly allocated 31 chronic stroke outpatients into an experimental group (n=16) and a control group (n=15). The experiment group was given general rehabilitative therapy three times per week for eight weeks, and time-use intervention through counselling once per week for eight weeks. The control group was given general rehabilitative therapy only for three times per week for eight weeks. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) was used to measure the changes in the quality of life of the participants. [Results] After the intervention, the experimental group showed a significant improvement in the overall quality of life in comparison with the control group. Looking at specific categories, the experimental group showed significant improvements in the physical, spiritual, and environmental areas in contrast to the control group. [Conclusion] The findings of this study demonstrated the positive effects of time-use intervention on an improvement in the quality of life of outpatients with chronic stroke.

Validation of the Spanish version of the Oxford Cognitive Screen (S-OCS): psychometric properties of a short cognitive stroke-specific screening tool

Objective: The aim of this study is to examine the psychometric properties of the Spanish version of the Oxford Cognitive Screen in a subacute stroke population. Participants and setting: Fifty-seven subacute stroke outpatients and 54 healthy individuals were recruited in Alicante province, Spain. Main measure: The Oxford Cognitive Screen. Other measures: The Montreal Cognitive Assessment, the Barcelona test, and the Barthel Index. Design: A validation study was conducted to analyze the inter-rater, intra-rater, test–retest, and internal consistency of the Spanish version of the Oxford Cognitive Screen. Concurrent validity was assessed using the Montreal Cognitive Assessment and the Barcelona test, and divergent validity using the Barthel index. Discriminant indices such as the sensitivity, specificity, predictive values, and optimal cut-offs were also estimated. Results: The subtests of the Spanish version of the Oxford Cognitive Screen showed excellent estimates for the inter-reliability (intraclass correlation coefficient (ICC) = 0.790 to 1.000; rs = 0.693 to 1.000), and acceptable-good for intra-reliability (ICC = 0.181 to 0.990) and test–retest reliability (rs = 0.173 to 0.971). Internal consistency was also excellent (standardized Cronbach’s α = 0.907). Spearman correlations for the concurrent validity were low-strong (rs = −0.193 to 0.95) and low-moderate (rs = −0.091 to 0.443) for divergent validity. The optimal cut-offs estimated for the subtests of the Spanish version of the Oxford Cognitive Screen showed good-high specificity (66.7%–100%) and positive predictive value (67.9%–100%), and low-good sensitivity (14.8%–83.3%) and moderate-good negative predictive value (53.5%–76.6%). Discriminant power as measured by the area under the curve indicated acceptable-good values (0.397 to 0.894). Conclusion: Our findings support that the Spanish version of the Oxford Cognitive Screen is a reliable and valid tool for screening cognitive impairments in subacute stroke patients.

Effects of hospital-community-family nursing model among stroke patient combined with pressure injury

Objective To explore the effects of hospital-community-family nursing model on curative effect and quality of life (QOL) of stroke patient combined with the pressure injury. Methods From January to October 2016, we selected 60 stroke outpatients with pressure injury who needed long-term lying discharged from the Department of Neurology, Rehabilitation Department and other of the Fifth Affiliated Hospital of Guangzhou Medical University as subjects. All of the patients were divided into observation group and control group based on the stages of pressure injury, 30 cases in each group. Patients of control group received routine nursing, while patients of observation group were treated with hospital-community-family nursing model. Three months later, we evaluated the quality of life of patients between two groups with the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) and determined the cure rate and stages of pressure injury. Results After intervention, the dimension scores of QOL of patients in observation group were higher than those in control group with statistical differences (P<0.05) ; the cure rates of pressure injury of patients in observation group was better than those in control group with statistical differences (P<0.05) . Conclusions The application of hospital-community-family nursing model in stroke patient combined with pressure injury can effectively increase the cure rate of pressure injury, improve clinical symptoms and QOL of patients. Key words: Stroke; Quality of life; Pressure injury; Hospital-community-family nursing

Relationships Between Cognitive Function and Quality of Life of Elderly Stroke Patients

The purpose of this study was to assess the effects and find the correlation of LOTCA-G and SS-QOL on the cognitive function and quality of life of elderly stroke patients. The time period of the experiment was from March 1, 2018 to March 30, 2018, and the study sample was composed of 102 stroke out-patients who participated in the rehabilitation center in G-city and received treatment of LOTCA-G and SS-QOL. The raw scores of the cognitive function of the elderly stroke patients varied depending on their gender, age, education, and marital status, but the differences were not statistically significant. Second, the raw scores of the quality of life of the elderly stroke patients varied depending on their gender, age, education, and marital status, but only marital status showed significance (p <0.01). The elderly stroke patients’ cognitive function and the quality of life showed a statistically significant correlation (p <0.01). LOTCA-G and SS-QOL generally showed significant correlation even among sub-categories, but energy, one of the sub-categories of quality of life, did not show significant correlation with any of the other sub-categories of cognitive function. By combining the study results, it was possible to see that there were high levels of correlation between cognitive function and quality of life in elderly stroke patients shown through LOTCA-G and SS-QOL. Based on this study, if the raw scores of cognitive function and quality of life could be validated and various basic data could be provided for increasing quality of life, it can be considered that the stroke patients’ quality of life will be improved.

Evolution of short cognitive test performance in stroke patients with vascular cognitive impairment and vascular dementia: Baseline evaluation and follow-up.

ABSTRACT.There is limited evidence about the progression of cognitive performance during the post-stroke stage.Objective:To assess the evolution of cognitive performance in stroke patients without vascular cognitive impairment (VCI), patients with vascular mild cognitive impairment (MCI), and patients with vascular dementia (VD).Methods:A prospective cohort of stroke outpatients from two secondary medical centers in Lima, Peru was studied. We performed standardized evaluations at definitive diagnosis (baseline evaluation), and control follow-ups at 6 and 12 months, including a battery of short cognitive tests: Clinical Dementia Rating (CDR), Addenbrooke's Cognitive Examination (ACE), and INECO Frontal Screening (IFS).Results:152 outpatients completed the follow-up, showing progressive increase in mean score on the CDR(0.34 to 0.46), contrary to the pattern observed on the ACE and IFS (78.18 to 76.48 and 23.63 to 22.24). The box plot for the CDR test showed that VCI patients had progressive worsening (0.79 to 0.16). Conversely, this trend was not observed in subjects without VCI. The box plot for the ACE and IFS showed that, for the majority of the differentiated stroke types, both non-VCI and VCI patients had progressive worsening.Conclusion:According to both ACE and IFS results during a 1-year follow-up, the cognitive performance of stroke patients worsened, a trend which was particularly consistent in infarction-type stroke patients.

Comparison between mini mental state examination (MMSE) and Montreal cognitive assessment Indonesian version (MoCA-Ina) as an early detection of cognitive impairments in post-stroke patients

Mild cognitive impairment (MCI) is defined as cognitive impairment that may never develop into dementia. Cognitive impairment is one long-term complication of a stroke. The Mini Mental State Examination (MMSE), which is commonly used as a screening tool for cognitive impairment, has a low sensitivity to detect cognitive impairment, especially MCI. Alternatively, the Montreal Cognitive Assessment Indonesian version (MoCA-Ina) has been reported to have a higher sensitivity than the MMSE. The aim of this study was to compare the proportion of MCI identified between the MMSE and MoCA-Ina in stroke patients. This was a cross-sectional study of stroke outpatients who attended the Polyclinic Neuromuscular Division, Rehabilitation Department, and Polyclinic Stroke, Neurology Department Cipto Mangunkusumo General Hospital, Jakarta. The proportion of MCI identified using the MMSE was 31.03% compared to 72.41% when using the MoCA-Ina. This difference was statistically significant (Fisher’s exact test, p = 0.033). The proportion of MCI in stroke patients was higher when using the MoCA-Ina compared to the MMSE. The MoCA-Ina should be used as an alternative in the early detection of MCI in stroke patients, especially those undergoing rehabilitation.

Post-Stroke Bacteriuria: A Longitudinal Study among Stroke Outpatients and Inpatients at the Korle-Bu Teaching Hospital in Ghana.

Infections of the urinary tract constitute an important post-stroke complication but in Africa, little is known about such infections in relation to stroke patients. The aim of the study was to investigate the epidemiology of bacteriuria among stroke patients at the Korle-Bu Teaching Hospital (KBTH) in Ghana including the prevalence, incidence, risk factors and aetiological agents. This was a longitudinal study involving 55 outpatients and 16 inpatients of stroke from the physiotherapy clinic and stroke admission ward of KBTH respectively. Urine cultures for inpatient subjects were done each day until the patient was discharged. With outpatients, urine specimens were analysed every week or two for 6 months. Information on demographics and clinical history of the study participants were extracted from their clinical records. The results showed that the prevalence of bacteriuria among stroke outpatients and inpatients were 10.9% (6/55) and 18.8% (3/16) respectively (p = 0.411). Among both the outpatients and inpatients, there was one new case of bacteriuria each during the period of follow-up. Overall, 1/9 (11%) of the bacteriuria cases among the stroke patients was symptomatic. Severe stroke (OR = 17.7, p = 0.008) and pyuria (OR = 38.7, p = 0.002) were identified as predictors of bacteriuria. Escherichia coli was the most common organism implicated in bacteriuria and was susceptible to amikacin, but resistant to augmentin, ampicillin, cefuroxime, cotrimoxazole, meropenem, norfloxacin and tetracycline. Overall, bacteriuria is a common complication among both stroke inpatients and outpatients at KBTH, though it appears to be more common among the former. Stroke severity appears to be the main stroke-related determinant of bacteriuria among stroke patients. Bacteriuria among stroke patients is mainly asymptomatic and E. coli is the most important aetiological agent.

HUBUNGAN TINGKAT STRES, ASUPAN NATRIUM, DAN RIWAYAT MAKAN DENGAN KEJADIAN STROKE

Stroke is a condition of the local neurological disorder that occurs suddenly, causing blood supply into the brain tissue stop and also causing impaired brain function. There are many causal factors that lead to stroke such as age, stress, natrium consumption, and food history. This study aims to analyze the relation between stress level, natrium consumption, and food history with the incidence of stroke in among stroke outpatients aged ≥ 45 years. This is an analytic observational study using case control design in Neural Poly of Airlangga University Hospital. The population of case group was stroke outpatients aged ≥ 45 years while control group was outpatients aged ≥ 45 years who didn’t have stroke. The sample was 11 patients for each group and were taken using simple random sampling technique. Relation among variables were analyzed using Chi-Square test. The result of this study showed that there is signifi cant relation between natrium consumption level (p = 0,032; OR = 0,083) and food history (p = 0,003; OR = 45,000) with the incidence of stroke. There is no signifi cant relation between stress level (p = 1,000) with the incidence of stroke. It is necessary to give the information about natrium food source and healthy diet in order to prevent the occurrence of stroke.Keywords: natrium, food history, stress, stroke

Using robot fully assisted functional movements in upper-limb rehabilitation of chronic stroke patients: preliminary results.

Robotic rehabilitation is promising to promote function in stroke patients. The assist as needed training paradigm has shown to stimulate neuroplasticity but often cannot be used because stroke patients are too impaired to actively control the robot against gravity. To verify whether a rehabilitation intervention based on robot fully assisted reaching against gravity (RCH) and hand-to-mouth (HTM) can promote upper-limb function in chronic stroke. Cohort study. Chronic stroke outpatients referring to the robotic rehabilitation lab of a rehabilitation centre. Ten chronic stroke patients with mild to moderate upper-limb hemiparesis. Patients underwent 12 sessions (3 per week) of robotic treatment using an end-effector robot Every session consisted of 20 minutes each of RCH and HtM; movements were fully assisted, but patients were asked to try to actively participate. The Fugl-Meyer Assessment (FMA) was the primary outcome measure; Medical Research Council and Modified Ashworth Scale were the secondary outcome measures. All patients, but one, show functional improvements (FMA section A-D, mean increment 7.2±3.9 points, P<0.008). This preliminary study shows that a robotic intervention based on functional movements, fully assisted, can be effective in promoting function in chronic stroke patients. These results are promising considering the short time of the intervention (1 month) and the time from the stroke event, which was large (27±20 months). A larger study, comprehensive of objective instrumental measures, is necessary to confirm the results. This intervention could be extended even to subacute stroke and other neurological disorders.

A Validation of the Essen Stroke Risk Score in Outpatients with Ischemic Stroke

Little is known about the predictive accuracy of the Essen Stroke Risk Score (ESRS) for Chinese stroke outpatients. Our goal was to perform an external validation of the ESRS using a large multicenter cohort of outpatients with ischemic stroke (IS). We estimated the 1-year cumulative event rates for both recurrent stroke and combined vascular events for patients in different ESRS categories using data from a prospective cohort of 3316 outpatients with IS admitted to 18 hospitals in China. In addition, we evaluated the predictive accuracy of the ESRS for both recurrent stroke and combined vascular events using C statistic. In the nonatrial fibrillation IS outpatients, the cumulative 1-year event rate was 2.47% (95% confidence interval [CI], 1.97%-3.06%) for recurrent stroke and 4.32% (95% CI, 3.65%-5.06%) for combined vascular events. The event rates were significantly higher in patients in higher ESRS categories. The ESRS had a predictive accuracy of .63 (.57-.69) for recurrent stroke and .63 (.58-.68) for combined vascular events. Among the Chinese outpatients with IS, the ESRS was able to stratify the risk of both recurrent stroke and combined vascular events equally well. A prediction model suitable for Chinese IS populations is needed.

Correlates of Depressive Symptoms in Stroke Outpatients

Correlates of Depressive Symptoms in Stroke Outpatients

Cognitive performance after ischaemic stroke.

Cognitive impairment after stroke affects the patient recovery process. Therefore, the identification of factors associated with cognitive outcomes is important since it allows risk profiles of stroke survivors to be determined.ObjectiveTo assess cognitive outcome of stroke outpatients and investigate associations among clinical and demographic variables, vascular risk factors, depression symptoms and functional ability; and to describe the neuropsychological profile of these patients.MethodsA cross-sectional design study was conducted. Subjects who suffered a first-ever ischaemic stroke 6 to 10 months prior to data collection underwent neuropsychological assessment and screening for depressive symptoms and functional ability. The outcome "cognitive performance" was analyzed considering two groups: "cognitive impairment" and "no cognitive impairment".ResultsThere was a statistically significant association between cognitive impairment and female gender, age, stroke severity and functional ability. Regarding neuropsychological profile, the cognitive impairment group exhibited more generalized deficits in attention, visuospatial organization, verbal functions and verbal memory domains compared to the community control group.ConclusionThe occurrence of cognitive impairment among patients was high, especially in women, older participants, individuals with more severe stroke, and greater impairment in functional ability. Multiple cognitive domains are affected and this may hamper recovery and negatively impact independence and quality of life after stroke.

Quantitative assessment and correlation analysis of cerebral microbleed distribution and leukoaraiosis in stroke outpatients

Objective:Cerebral microbleeds (CMBs) are bleeding events associated with cerebral small vessel disease (SVD). Strictly lobar CMBs and strictly deep CMBs are likely caused by cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy, respectively. Leukoaraiosis (LA) reflects an ischaemic change in SVD, and LA severity has been correlated with CMBs. However, whether different locations (aetiologies) of CMBs correlate with LA is unknown.Methods:Patients receiving brain MRI and tbl2*-weighted gradient-recalled echo scans in a stroke outpatient department were screened for CMBs. The MRI results of the patients with CMBs were sent to investigators for further review and were evaluated using the Microbleed Anatomical Rating Scale. Cerebral microbleed severity was graded using a numerical scale. Leukoaraiosis severity was assessed using the Fazekas scale.Results:Cerebral microbleeds were observed in 14.6% of the 1289 screened patients. The CMB incidence increased with age (in years, < 50: 1.3%; 50–59: 10.7%; 60–69: 17.6% and ≥ 70: 23.6%; P = 0.000). The CMB locations were distributed as follows: 23.4% strictly lobar, 12.2% strictly deep, 6.4% strictly infratentorial and 58.0% mixed. Cerebral microbleed severity correlated with the total Fazekas scale score. The numbers of lobar, deep and infratentorial CMBs correlated with the total Fazekas scale score. The mixed CMB group displayed a significantly higher Fazekas scale score than the strictly lobar CMB group (P = 0.000).Discussion:Cerebral microbleed incidence increased with age. Mixed CMB type displayed the highest incidence. The severity and number of CMBs at any location correlated with LA severity. These results suggested interactions between hypertension and CAA during LA progression.

Feasibility of Applying the Extended ICF Core Set for Stroke to Clinical Settings in Rehabilitation: A Preliminary Study.

ObjectiveTo evaluate the potential feasibility of application of the extended International Classification of Functioning, Disability and Health (ICF) Core Set for stroke.MethodsWe retrospectively reviewed the medical records of 40 stroke outpatients (>6 months after onset) admitted to the Department of Rehabilitation Medicine for comprehensive rehabilitation. Clinical information of the patients were respectively evaluated to link to the 166 second-level categories of the extended ICF Core Set for stroke.ResultsClinical information could be linked to 111 different ICF categories, 58 categories of the body functions component, eight categories of the body structures component, 38 categories of the activities and participation component, and seven categories of the environmental factors component.ConclusionThe body functions component might be feasible for application of the extended ICF Core Set for stroke to clinical settings. The activities and participation component and environmental factors component may not be directly applied to clinical settings without additional evaluation tools including interview and questionnaire.