Stroke Subjects Research Articles

Changes in intermuscular connectivity during active elbow extension reveal a functional simplification of motor control after stroke.

BackgroundStroke alters muscle co-activation and notably leads to exaggerated antagonist co-contraction responsible for impaired motor function. However, the mechanisms underlying this exaggerated antagonist co-contraction remain unclear. To fill this gap, the analysis of oscillatory synchronicity in electromyographic signals from synergistic muscles, also called intermuscular coherence, was a relevant tool.ObjectiveThis study compares functional intermuscular connectivity between muscle pairs of the paretic and non-paretic upper limbs of stroke subjects and the dominant limb of control subjects, concomitantly between two muscle pairs with a different functional role, through an intermuscular coherence analysis.MethodsTwenty-four chronic stroke subjects and twenty-four healthy control subjects were included. Subjects performed twenty elbow extensions while kinematic data and electromyographic activity of both flexor and extensor elbow muscles were recorded. Intermuscular coherence was analyzed in the beta frequency band compared to the assessment of antagonist co-contraction.ResultsIntermuscular coherence was higher in the stroke subjects’ paretic limbs compared to control subjects. For stroke subjects, the intermuscular coherence of the antagonist-antagonist muscle pair (biceps brachii—brachioradialis) was higher than that of the agonist-antagonist muscle pair (triceps brachii—brachioradialis). For the paretic limb, intermuscular coherence of the antagonist-antagonist muscle pair presented a negative relationship with antagonist co-contraction.ConclusionDifferences in intermuscular coherence between the paretic limbs of stroke subjects and control subjects suggest a higher common central drive during movement. Furthermore, results highlight the association between stroke-related alteration of intermuscular functional connectivity and the alteration of motor function.

Adherence to positive airway pressure therapy initiated in the early subacute phase of ischemic stroke: a PRESS study follow-up.

BackgroundSleep-disordered breathing (SDB) is frequent in stroke patients and negatively affects stroke outcomes. Positive airway pressure (PAP) is the standard first-line treatment for patients with moderate-to-severe SDB. Despite a strong link between PAP adherence and therapeutic response, rates of post-stroke PAP adherence remain underexplored. Our study aimed to determine PAP adherence in patients undergoing comprehensive sleep apnea assessment and in-lab PAP titration in the early subacute phase of stroke.MethodsIn-hospital screening pulse oximetry was performed in consecutive patients with imaging-confirmed acute ischemic stroke. Subjects with desaturation index ≥ 15.3/h were selected as PAP candidates, and polysomnography was recommended. In a sleep laboratory setting, subjects underwent a diagnostic night followed by a titration night, and PAP therapy was initiated in subjects with apnea–hypopnea index ≥ 15/h. Adherence to PAP therapy was assessed at a 6-month follow-up visit.ResultsOf 225 consecutive patients with acute ischemic stroke, 116 were PAP candidates and 52 were able to undergo polysomnography. PAP therapy was initiated in 35 subjects. At a 6-month follow-up visit, out of 34 stroke survivors, PAP adherence (PAP use of > 4 h per night) was present in 47%. Except for the significantly lower minimal nocturnal O2 saturation determined from the polysomnography (74.6 ± 11.7% vs. 81.8 ± 5.2%, p = 0.025), no other significant difference in characteristics of the groups with PAP adherence and PAP non-adherence was found.ConclusionsLess than half of the stroke subjects remained adherent to PAP therapy at 6 months post-PAP initiation. Special attention to support adaptation and adherence to PAP treatment is needed in this group of patients.

Quantitative Evaluation of Biceps Brachii Muscle by Shear Wave Elastography in Stroke Patients.

PurposeThe present study aimed to investigate the differences in muscle size and shear wave speed (SWS) values of biceps brachii muscle (BBM) between stroke survivors and healthy controls.MethodsThis study comprised 61 stroke survivors and 24 healthy subjects, examined at Guangzhou First People’s Hospital within one year. Each participant underwent ultrasonic examinations for recording some specific measurement indicators, including muscle thickness, cross-sectional area (CSA), and shear wave speed (SWS) of BBM. The muscular tension of the paretic arm was scored using the modified Ashworth scale (MAS). These above-mentioned indexes were compared between stroke survivors and healthy controls. Also, the correlations among SWS and MAS scores were assessed.ResultsWhen the lifting arm angle was set for 45°, the CSA and muscle thickness of BBM were obviously decreased in the paretic arms of stroke subjects compared to the non-paretic arms as well as the arms of healthy controls. Moreover, the paretic arms had obviously higher SWS than the non-paretic arms and the healthy arms at 45° or 90°. When the angles of paretic arms were lifted at 90° and 45°, respectively, a positive correlation was established between MAS and SWS.ConclusionUltrasonic examination assessing muscle thickness, CSA, and SWS of the BBM could be used as a means of assessment of the paretic arms of stroke survivors.

Plasma protein alterations during human large vessel stroke: A controlled comparison study

BackgroundStroke is a major cause of death and disability in the United States. Mechanical thrombectomy (MT) and tissue plasminogen activator are the current treatments for ischemic stroke, which have improved clinical outcomes. Despite these treatments, functional and cognitive deficits still occur demonstrating a need for predictive biomarkers for beneficial clinical outcomes which can be used as therapeutic targets for pharmacotherapy. The aim of this study compares the proteomic expression of systemic arterial blood collected at the time of MT to those from a matched cerebrovascular disease (CVD) control cohort. MethodsThe Blood And Clot Thrombectomy Registry And Collaboration (BACTRAC) (clinicaltrials.gov NCT03153683) collects and banks arterial blood, both distal and proximal to the thrombus, from ischemic stroke subjects undergoing MT. Arterial blood from patients undergoing a diagnostic angiogram was also collected and banked as CVD controls. Changes in cardiometabolic and inflammatory proteins between stroke and CVD controls were analyzed via Olink Proteomics. ResultsProteins including ARTN, TWEAK, HGF, CCL28, FGF-5, CXCL9, TRANCE and GDNF were found to be decreased in stroke subjects when compared to CVD controls. CXCL1, CCL5, OSM, GP1BA, IL6, MMP-1, and CXCL5 were increased in stroke subjects when compared to CVD controls. These proteins were also significantly correlated to stroke outcome metrics such as NIHSS, infarct volume and MoCA scoring. ConclusionOverall, acute stroke patients had an increase in inflammatory proteins with a decrease in trophic proteins systemically compared to matched CVD controls. Using our CVD controls, proteins of interest were directly compared to stroke patients with the same cerebrovascular risk factors instead of statistically controlling for comorbidities. The novel methodology of matching an arterial blood CVD control group to a stroke group, as well as controlling for age and comorbid status add to the literature on prognostic stroke biomarkers, which are specific targets for future therapeutics.

Frontoparietal network activation is associated with motor recovery in ischemic stroke patients

Strokes cause lesions that damage brain tissue, disrupt normal brain activity patterns and can lead to impairments in motor function. Although modulation of cortical activity is central to stimulation-based rehabilitative therapies, aberrant and adaptive patterns of brain activity after stroke have not yet been fully characterized. Here, we apply a brain dynamics analysis approach to study longitudinal brain activity patterns in individuals with ischemic pontine stroke. We first found 4 commonly occurring brain states largely characterized by high amplitude activations in the visual, frontoparietal, default mode, and motor networks. Stroke subjects spent less time in the frontoparietal state compared to controls. For individuals with dominant-hand CST damage, more time spent in the frontoparietal state from 1 week to 3-6 months post-stroke was associated with better motor recovery over the same time period, an association which was independent of baseline impairment. Furthermore, the amount of time spent in brain states was linked empirically to functional connectivity. This work suggests that when the dominant-hand CST is compromised in stroke, resting state configurations may include increased activation of the frontoparietal network, which may facilitate compensatory neural pathways that support recovery of motor function when traditional motor circuits of the dominant-hemisphere are compromised.

The Reaching Phase of Feeding and Self-Care Actions Optimizes Action Observation Effects in Chronic Stroke Subjects

Background The Action Observation Therapy (AOT) is a well-established post-stroke rehabilitation treatment based on the theoretical framework of the Mirror Neuron System (MNS) activation. However, AOT protocols are still heterogeneous in terms of video contents of observed actions. Objective The aim of this study was to analyze electroencephalographic (EEG) recordings in stroke patients during the observation of different videos of task-specific upper limb movements, and to define which category of actions can elicit a stronger cortical activation in the observer’s brain. Methods Signals were analyzed from 19 chronic stroke subjects observing customized videos that represented 3 different categories of upper limb actions: Finalized Actions, Non-Finalized Actions, and Control Videos. The Event-Related Desynchronization in the µ and β bands was chosen to identify the involvement of the cerebral cortex: the area of the normalized power spectral density was calculated for each category and, deepening, for the reaching and completion sub-phases of Finalized Actions. For descriptive purposes, the time course of averaged signal power was described. The Kruskal–Wallis test (P < .05) was applied. Results The analysis showed a greater desynchronization when subjects observed Finalized Actions with respect to Non-Finalized in all recorded areas; Control videos provoked a synchronization in the same areas and frequency bands. The reaching phase of feeding and self-care actions evoked a greater suppression both in µ and β bands. Conclusions The observation of finalized arm movements seems to elicit the strongest activation of the MNS in chronic stroke patients. This finding may help the clinicians to design future AOT-based stroke rehabilitation protocols. Clinical Trial Registration: Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT04047134.

Regional cerebral blood perfusion changes in chronic stroke survivors as potential brain correlates of the functional outcome following gamified home-based rehabilitation (IntelliRehab)—a pilot study

BackgroundHospital-based stroke rehabilitation for stroke survivors in developing countries may be limited by staffing ratios and length of stay that could hamper recovery potential. Thus, a home-based, gamified rehabilitation system (i.e., IntelliRehab) was tested for its ability to increase cerebral blood flow (CBF), and the secondary impact of changes on the upper limb motor function and functional outcomes.ObjectiveTo explore the effect of IntelliRehab on CBF in chronic stroke patients and its correlation with the upper limb motor function.MethodsTwo-dimensional pulsed Arterial Spin Labelling (2D-pASL) was used to obtain CBF images of stable, chronic stroke subjects (n = 8) over 3-months intervention period. CBF alterations were mapped, and the detected differences were marked as regions of interest. Motor functions represented by Fugl-Meyer Upper Extremity Assessment (FMA) and Stroke Impact Scale (SIS) were used to assess the primary and secondary outcomes, respectively.ResultsRegional CBF were significantly increased in right inferior temporal gyrus and left superior temporal white matter after 1-month (p = 0.044) and 3-months (p = 0.01) of rehabilitation, respectively. However, regional CBF in left middle fronto-orbital gyrus significantly declined after 1-month of rehabilitation (p = 0.012). Moreover, SIS-Q7 and FMA scores significantly increased after 1-month and 3-months of rehabilitation. There were no significant correlations, however, between CBF changes and upper limb motor function.ConclusionsParticipants demonstrated improved motor functions, supporting the benefit of using IntelliRehab as a tool for home-based rehabilitation. However, within-participant improvements may have limited potential that suggests the need for a timely administration of IntelliRehab to get the maximum capacity of improvement.

Comparative effects of passive and active mode robot-assisted gait training on brain and muscular activities in sub-acute and chronic stroke.

Robot-assisted gait training (RAGT) was initially developed based on the passive controlled (PC) mode, where the target or ideal locomotor kinematic trajectory is predefined and a patient basically 'rides' the robot instead of actively participating in the actual locomotor relearning process. A new insightful contemporary neuroscience and mechatronic evidence suggest that robotic-based locomotor relearning can be best achieved through active interactive (AI) mode rather than PC mode. The purpose of this study was to compare the pattern of gait-related cortical activity, specifically gait event-related spectral perturbations (ERSPs), and muscle activity from the tibialis anterior (TA) and clinical functional tests in subacute and chronic stroke patients during robot-assisted gait training (RAGT) in passive controlled (PC) and active interactive (AI) modes. The present study involves a two-group pretest-posttest design in which two groups (i.e., PC-RAGT group and AI-RAGT group) of 14 stroke subjects were measured to assess changes in ERSPs, the muscle activation of TA, and the clinical functional tests, following 15- 18 sessions of intervention according to the protocol of each group. Our preliminary results demonstrated that the power in the μ band (8- 12 Hz) was increased in the leg area of sensorimotor cortex (SMC) and supplementary motor area (SMA) at post-intervention as compared to pre-intervention in both groups. Such cortical neuroplasticity change was associated with TA muscle activity during gait and functional independence in functional ambulation category (FAC) and motor coordination in Fugl- Meyer Assessment for lower extremity (FMA-LE) test as well as spasticity in the modified Ashworth scale (MAS) measures. We have first developed a novel neuroimaging experimental paradigm which distinguished gait event related cortical involvement between pre- and post-intervention with PC-RAGT and AI-RAGT in individuals with subacute and chronic hemiparetic stroke.

Effect of Gait-Specific Weight-Bearing Interventions on Physical Performance Among Subjects with Stroke: A Systematic Review and Meta-analysis

Background Postural instability, gait dysfunctions, and tendency to fall resulting from asymmetrical weight-bearing restrict balance and mobility functions among stroke survivors. Symmetrical weight-bearing is essential for restoring mobility functions following stroke. Strategies to improve symmetrical weight-bearing remain a challenge in stroke rehabilitation. Objective To explore the evidence regarding the effectiveness of weight-bearing interventions to improve physical performance among subjects with stroke. Methods Five databases, including PubMed, Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database (PEDro), Google Scholar, and OpenGrey, were screened for identifying published and unpublished studies from their inception and up to 2022. Studies investigating the effect of symmetrical weight-bearing interventions among stroke subjects using objective or self-reporting of physical function as an outcome tool were included. Ten articles with grade 1b level of evidence demonstrated an average PEDro score of 6.4. The risk of bias was moderate among the articles. Results Ten articles with 276 participants were included in this review. Meta-analysis performed using 9 articles report that gait-specific weight-bearing improved balance and gait velocity with an overall effect size of 1.35 (95% confidence interval: 0.88–1.81) and 0.66 (95% confidence interval: 0.20–1.13). However, the effect size of step length (0.51), cadence (0.26), and fall efficacy scale (0.21) indicates nonsignificant improvement. Conclusions This meta-analysis suggests that gait-specific weight-bearing strategies are effective in improving balance and speed of walking but did not improve other parameters of gait and risk of fall. These strategies could be used to improve the symmetrical weight-bearing of stroke subjects in rehabilitation settings who do not have access to technological assistance in rehabilitation.

Analysis of Haematological Parameters in Cerebrovascular Accidents: a Retrospective Study in Tertiary Care Centre

Aim: To analyse hematological parameters in Cerebrovascular disease&#x0D; Study design :A retrospective study&#x0D; Place of Study: The study was carried out in Saveetha Medical College and Hospital, Tamil Nadu, India.&#x0D; Methodology: This is a retrospective study conducted in Saveetha medical college and hospital during the period of December 2020 and May 2021. The study includes 260 cases, of which 130 CVA patients and 130 control group was taken. Haematological parameters were obtained using Sysmex Automated Analyzer XN-1000.&#x0D; Statistical analysis was done by SPSS software version 23, with descriptive and independent t test. The level of significance was taken as p value&lt;0.05&#x0D; Results: CVA are due to two main causes, ischaemic (63.84%) and haemorrhagic infarct (36.15%) The age ranges from 47-69 among stroke subjects. The mean age of control(38.80±12.40years) and CVA group(58.177±11.78years). Both ischaemic and haemorrhagic infarcts are more common among male. On haematological parameters study, analysis showed platelet was increased in CVA than control group. RBC, PCV, MCV, MCHC, TC, neutrophil, lymphocyte, eosinophil, basophil are significant. Haemoglobin, MCH, RDW and monocyte revealed no significance.&#x0D; Conclusion: In this study, haematological parameters of ischemic CVA patients were greatly altered. The presence of persistently altered status of haematological parameters cerebral ischemic event indicate that these parameters can be considered a simple inflammatory indicator during the development of ischemic damage.

Determinants of metabolic syndrome and its prognostic implications among stroke patients in Africa: Findings from the Stroke Investigative Research and Educational Network (SIREN) study

BackgroundThe prognostic implications of metabolic syndrome (METS) among African stroke patients are poorly understood. This study aimed to investigate the determinants of METS and its prognostic implications among Africans with newly diagnosed stroke in the SIREN study. MethodsWe included stroke cases (adults aged >18 years with CT/MRI confirmed stroke). The validated tools comprehensively evaluated vascular, lifestyle, and psychosocial factors. We used logistic regression to estimate adjusted odds ratios (OR) with 95% CIs for the association between METS and risk factors. We also computed the prediction power of the domain of covariates in a sequential manner using the area under the receiver operating curve (ROC) curve. ResultsAmong 3998 stroke subjects enrolled in the study, 76.8% had METS by at least one of the clinical definitions. Factors associated with METS were age > 50 years (OR- 1.46, CI-1.19-1.80), male gender (OR 4.06, CI- 3.28-5.03), income >100USD (OR1.42, CI-1.17-1.71), stress (OR1.46, CI-1.14-1.87), family history of diabetes mellitus (OR1.38, CI-1.06-1.78), and cardiac disease (OR1.42, CI-1.18-1.65). Stroke severity was higher among those with METS (SLS = 5.8 ± 4.3) compared with those without METS (6.2 ± 4.5) at p = 0.037. METS was associated with higher odds (aOR 1.31, CI-1.08-1.58) of one-month fatality after adjusting for stroke severity, age > 50 years, and average monthly income >100USD. ConclusionMETS is very common among African stroke patients and is associated with stroke severity and worse one-month fatality. Lifestyle interventions may prevent METS and attenuate its impact on stroke occurrence and outcomes.

Motor unit distribution and recruitment in spastic and non-spastic bilateral biceps brachii muscles of chronic stroke survivors

Objective. This study aims to characterize the motor units (MUs) distribution and recruitment pattern in the spastic and non-spastic bilateral biceps brachii muscles (BBMs) of chronic stroke survivors. Approach. High-density surface electromyography (HD-sEMG) signals were collected from both spastic and non-spastic BBMs of fourteen chronic stroke subjects during isometric elbow flexion at 10%, 30%, 50% and 100% maximal voluntary contractions (MVCs). By combining HD-sEMG decomposition and bioelectrical source imaging, MU innervation zones (MUIZs) of the decomposed MUs were first localized in the 3D space of spastic and non-spastic BBMs. The MU depth defined as the distance between the localized MUIZ and its normal projection on the skin surface was then normalized to the arm radius of each subject and averaged at given contraction level. The averaged MU depth at different contraction levels on a specific arm side (intra-side) and the bilateral depths under a specific contraction level (inter-side) were compared. Main results. The average depth of decomposed MUs increased with the contraction force and significant differences observed between 10% vs 50% (p < 0.0001), 10% vs 100% (p < 0.0001) and 30% vs 100% MVC (p = 0.0017) on the non-spastic side, indicating that larger MUs with higher recruitment threshold locate in deeper muscle regions. In contrast, no force-related difference in MU depth was observed on the spastic side, suggesting a disruption of orderly recruitment of MUs with increase of force level, or the MU denervation and the subsequent collateral reinnervation secondary to upper motor neuron lesions. Inter-side comparison demonstrated significant MU depth difference at 10% (p= 0.0048) and 100% force effort (p= 0.0026). Significance. This study represents the first effort to non-invasively characterize the MU distribution inside spastic and non-spastic bilateral BBM of chronic stroke patients by combining HD-sEMG recording, EMG signal decomposition and bioelectrical source imaging. The findings of this study advances our understanding regarding the neurophysiology of human muscles and the neuromuscular alterations following stroke. It may also offer important MU depth information for botulinum toxin injection in clinical post-stroke spasticity management.

Varied Response of EEG Rhythm to Different tDCS Protocols and Lesion Hemispheres in Stroke Subjects with Upper Limb Dysfunction.

Transcranial direct current stimulation (tDCS) provides a way to modulate the cortical activity and promote motor rehabilitation following stroke. However, evidence indicates that the response to tDCS is highly variable. This study was aimed at exploring rhythmic response of Electroencephalography (EEG) to three tDCS protocols in stroke subjects. We hypothesize that tDCS protocols may interact with stoke characteristics, and electrode placement may affect cortical activity which could be reflected by the EEG rhythm. 32 subjects with unilateral stroke were recruited to a single-blinded, randomized, and controlled crossover experiment. All of the subjects underwent four tDCS protocols (anodal (atDCS), cathodal (ctDCS), and bilateral tDCS (bi-tDCS) and sham) with an interval of at least 1 week. Resting-state EEG was acquired before and after the stimulation. We tested the change of EEG spectral power after tDCS and the difference of change among four protocols using the paired-sample t-test and repeated measures analysis of variance. Then, we investigated the clinical factors affecting the above changes using the linear and quadratic regression model. According to the results, EEG responded to atDCS and bi-tDCS protocols on alpha and beta rhythm and subjects with a left lesion had higher response than those with the right lesion. Besides that, the change of alpha and beta power after atDCS and of beta power after bi-tDCS showed association with clinical characteristics only in subjects with the left lesion. In conclusion, the study found varied EEG response with different protocols, lesion hemispheres, and other clinical characteristics supporting the individualized cortical oscillatory effect induced by tDCS.

Bilateral Stroke in Geriatric – Role of Health Care Professionals – An Evidenced Analysis for to Be Redefined

An increasing longevity globally were recorded associated health complications, among geriatric population like falls, stroke, and were under researched. Health care records of subjects above 80 years and bilateral stroke with their prevalence, causes functional recovery were less reported. Hence this clinical presentation with evidenced strives to analyse unaddressed bilateral stroke with its prevalence, risk factors, causes along with functional pattern of recovery gets more significant. As an increasing longevity octogenarian subjects likely to develop bilateral stroke are more in coming years. Bilateral stroke were found to diminish quality of life and increase the level of dependency especially among geriatric subjects. Equally they were linked with longer hospitalization and higher mortality. Aims and objectives of this research were to analyse causes, prognosis and functional recovery among bilateral stroke. This research analysis for 3 years on an octogenarian subject who was obese, hypertensive, diabetic, hyperlipidemia. This longitudinal research were from June 2018 - May 2021. With family support, proper medical intervention, regular physiotherapy functional independence and cognition can be promoted even at the age of 90 years were key outcome, Findings of this research can be used to identify causes, treat them towards prevention and how to functionally accelerate recovery of bilateral stroke subjects in years to come. Also every effort should be driven positively irrespective of age, major thrust of this research.

Design of Spiral-Cable Forearm Exoskeleton to Assist Supination for Hemiparetic Stroke Subjects.

We present the development of a cable-based passive forearm exoskeleton that is designed to assist supination for hemiparetic stroke survivors. Our device uniquely provides torque sufficient for counteracting spasticity within a below-elbow apparatus. The mechanism consists of a spiral single-tendon routing embedded in a rigid forearm brace and terminated at the hand and upper-forearm. A spool with an internal releasable-ratchet mechanism allows the user to manually retract the tendon and rotate the hand to counteract involuntary pronation synergies due to stroke. We characterize the mechanism with benchtop testing and five healthy subjects, and perform a preliminary assessment of the exoskeleton with a single chronic stroke subject having minimal supination ability. The mechanism can be integrated into an existing active hand-opening orthosis to enable supination support during grasping tasks, and also allows for a future actuated supination strategy.

Automatic and Personalized Adaptation of Therapy Parameters for Unsupervised Robot-Assisted Rehabilitation: a Pilot Evaluation.

Growing evidence shows that increasing the dose of upper limb therapy after stroke might improve functional outcomes and unsupervised robot-assisted therapy may be a solution to achieve such an increase without adding workload on therapists. However, most of existing robotic devices still need frequent supervision by trained personnel and are currently not designed or ready for unsupervised use. One reason for this is that most rehabilitation devices are not capable of delivering and adapting personalized therapy without external intervention. Here we present a set of clinically-inspired algorithms that automatically adapt therapy parameters in a personalized way and guide the course of robot-assisted therapy sessions. We implemented these algorithms on a robotic device for hand rehabilitation and tested them in a pilot study with 5 subacute stroke subjects over 10 robot-assisted therapy sessions, some of which unsupervised. Results show that our algorithms could adapt the therapy difficulty throughout the whole study without requiring external intervention, maintaining performance around a predefined 70% target value (mean performance for all the subjects over all the sessions: 64.5%). Moreover, the algorithms could guide patients through the therapy sessions, minimizing the number of actions that subjects had to learn and perform. These results open the door to the use of robotic devices in an unsupervised setting to increase therapy dose after stroke.

Design and development of dual-acting soft actuator for assistance and rehabilitation of finger flexion and extension

The powerfulness of Soft robotic systems is relied to the safe performance. In addition to other advantages: the flexibility and deformability. Developing an assistive tool for Hand rehabilitation through soft pneumatic actuated hand gloves is an improved and suitable way for helping post stroke subjects. The Pneumatic network (Pneu-Net) actuators are soft actuators composed of pneumatic chambers actuates when pressurised with air. Dual acting soft pneumatic Pneu-Net actuator is developed as a part for building the glove, the actuator is designed for assisting both finger flexion and extension motions. Pneumatic network (Pneu-net) actuator is developed and design geometry effect is studied, mainly the influence of the dual actuators on each other in addition to the effect of the number of air chambers per each actuator. Design selection based on the finite element analysis and experimental testing, bending angle and energy efficiency parameters in addition to comfort and safe performance are the main criteria of concern.

Psychiatric morbidity among the patients of first ever ischemic stroke

Ischemic stroke is one of the leading causes of mortality and morbidity worldwide and third common cause of death in developed countries which consumes annually a great cost, directly or indirectly and stroke produces a wide range of psychiatric disorders. This was a cross sectional study, conducted in the department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from 1 July 2013 to 30 June 2014 to evaluate the psychiatric morbidity among the patients of first ever ischemic stroke. For this purpose, 66 ischemic stroke patients of first attack between 2 weeks to 2 years of stroke, aged above 18 years irrespective of sex and 66 accompanying healthy persons of the patients and other patients without any kind of stroke matching age and sex fulfilling inclusion and exclusion criteria were taken in Group[1]A and Group-B respectively. Psychiatric assessment was done using General Health Questionnaire (GHQ12) as a screening tool and all GHQ12 positive cases were evaluated using mental state examination. Diagnoses of psychiatric disorders of all respondents were confirmed by psychiatrist according to Diagnostic and statistical manual of mental disorders (DSM) 5 criteria. Ethical issues were maintained properly and an informed written consent was taken from every patient. After collecting data, editing was done manually and was analyzed with statistical package for social sciences (SPSS) version 21. The result showed that, the mean age of the respondents was 57.6 (SD±5.5) years which was almost identical to control group (p=0.130). Most (87.9%) of the patient were below the age of 65 years. Co-morbid psychiatric disorder was found in (34.8%) patients with ischemic stroke and (13.6%) control subjects (p=0.004). The most common psychiatric disorder was generalized anxiety disorder (13.6%) and major depressive disorder (21.2%) in ischemic stroke group. The results of this study suggested that, a significant number of patients with ischemic stroke were suffering from psychiatric disorders than the age and sex matched control. Bang J Psychiatry 2022;36(1):11-17

Gait Synergy Analysis and Modeling on Amputees and Stroke Patients for Lower Limb Assistive Devices.

The concept of synergy has drawn attention and been applied to lower limb assistive devices such as exoskeletons and prostheses for improving human–machine interaction. A better understanding of the influence of gait kinematics on synergies and a better synergy-modeling method are important for device design and improvement. To this end, gait data from healthy, amputee, and stroke subjects were collected. First, continuous relative phase (CRP) was used to quantify their synergies and explore the influence of kinematics. Second, long short-term memory (LSTM) and principal component analysis (PCA) were adopted to model interlimb synergy and intralimb synergy, respectively. The results indicate that the limited hip and knee range of motions (RoMs) in stroke patients and amputees significantly influence their synergies in different ways. In interlimb synergy modeling, LSTM (RMSE: 0.798° (hip) and 1.963° (knee)) has lower errors than PCA (RMSE: 5.050° (hip) and 10.353° (knee)), which is frequently used in the literature. Further, in intralimb synergy modeling, LSTM (RMSE: 3.894°) enables better synergy modeling than PCA (RMSE: 10.312°). In conclusion, stroke patients and amputees perform different compensatory mechanisms to adapt to new interlimb and intralimb synergies different from healthy people. LSTM has better synergy modeling and shows a promise for generating trajectories in line with the wearer’s motion for lower limb assistive devices.

Psychiatric Morbidity Among the Patients of First Ever Ischaemic Stroke

AimsTo evaluate psychiatric morbidity among the patients of first ever ischemic strokeMethodsThis sectional comparative study was carried out in the Department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from 1st July 2013 to 30th June 2014. Sixty six ischaemic stroke patients of first attack between 2 weeks to 2 years of stroke, aged above 18 years irrespective of sex and 66 accompanying healthy person of the patients and other patients without any kind of stroke matching age and sex fulfilling inclusion and exclusion criteria were taken in Group-A and Group-B respectively. Diagnosis of ischaemic stroke was made in these patients by the consultant neurologists reviewing the history, clinical examination and accompanying investigations reports specially CT scan of brain. Psychiatric assessment was done using General Health Questionnaire (GHQ12) as screening tool. All GHQ12 positive cases were evaluated using mental state examination and recorded in a MSE sheet. Diagnosis of psychiatric disorders of all respondents was confirmed by psychiatrist according to DSM-5 criteria.ResultsThe patients with ischaemic stroke and control subjects were similar in age [57.6 (SD ± 5.5) years vs 57.1 (SD ± 4.5) years; p &gt; 0.130] and sex [48 (72.7%) male and 18 (27.3%) female vs 45 (68.2%) male and 21 (31.8%) female; p = 0.567]. Comorbid psychiatric disorder was found in 23 (34.8%) patients of ischaemic stroke and 9 (13.6%) control subjects. The comorbid psychiatric disorder was significantly higher in patients of ischaemic stroke than that of control g subjects (p = 0.004). Comorbid specific psychiatric disorders were generalized anxiety disorder in 9 (13.6%) and major depressive disorder in 14 (21.2%) in stroke group; while comorbid specific psychiatric disorders were generalized anxiety disorder in 2 (3.0%) and major depressive disorder in 7 (10.6%) respondents in control group (p &lt; 0.013).ConclusionComorbid psychiatric disorders are quite common among patients with first ever ischaemic stroke in the form of major depressive disorder and generalized anxiety disorder. Therefore, attention should be paid to the anxiety and depressive symptoms in stroke units and try to relieve the patients’ emotional stress and personal suffering, which could improve their neurological outcome.