Subacute Stage Research Articles

EMG-based co-contraction indexes for the assessment of motor impairments in persons post-stroke

Neuromuscular coordination can be described by activations of agonist–antagonist (AA) muscle pairs and plays an important role in the performing of daily activities. It is an important mechanism used by the central nervous system to regulate joint stability and provide movement accuracy [1]. As a result of a stroke there is an alteration in these coordination patterns that results in motor deficits of the arm function [2]. In fact, persons post-stroke have an exaggerated AA muscle co-contraction [2] associated to a higher joint stiffness [1]. The amount of co-contraction can be quantified through the use of EMG- based co-contraction indexes (CCIs) [1,2]. Therefore, the purpose of the study was to evaluate whether such EMG-based CCIs are able to assess impairment in the motor control of the upper limb in persons post-stroke. Thirty-five persons post-stroke, in chronic or sub-acute stages, were recruited in this study. Both paretic and non-paretic arms were evaluated during the execution of functional tasks related to activities of daily living (i.e., reaching, object placing and forearm pronation). The upper limb kinematics and EMG data of three AA muscle pairs (anterior/posterior deltoids, triceps/biceps and pronator/supinator) were recorded through a movement analysis system. Ten healthy subjects (HS) provided the normative data. The Rudolph’s CCI [1] was computed as proposed by Don (range 0-100%, higher values indicate a greater AA muscle co-contraction) [3]. All participants post-stroke were clinically assessed through the Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE). The differences of Rudolph’s CCI between HS and subjects post-stroke, considering both the more affected (MA) and the less affected (LA) arm, were tested by ANOVA. Bonferroni post-hoc analysis was also used to establish if there were statistically significant differences among the three groups. A deviation from normative data for the MA CCIs was found in almost all functional tasks and antagonist muscle pairs. The LA CCIs also showed a significant deviation from HS. Such pattern is reported in Fig. 1 for Rudolph’s CCI during the forearm pronation task. Higher values of the EMG-based CCI were found both in LA and MA arms in persons post-stroke, indicating alterations in the neuromotor coordination for both sides. The altered AA muscle activation of the LA arm (non-paretic, ipsilateral to the brain lesion) in persons post-stroke, despite its kinematics not being compromised, could be a consequence of the over-use of the non-paretic limb in performing functional tasks. Therefore, also the non-paretic upper limb may benefit from rehabilitation, as recently suggested [4]. Our results show that EMG-based CCI is a quantitative and objective measure able to detect motor control impairment, not detectable by clinical scales.

Deep brain stimulation for movement disorders after stroke: a systematic review of the literature.

Stroke remains the leading cause of disability in the United States. Even as acute care for strokes advances, there are limited options for improving function once the patient reaches the subacute and chronic stages. Identification of new therapeutic approaches is critical. Deep brain stimulation (DBS) holds promise for these patients. A number of case reports and small case series have reported improvement in movement disorders after strokes in patients treated with DBS. In this systematic review, the authors have summarized the patient characteristics, anatomical targets, stimulation parameters, and outcomes of patients who have undergone DBS treatment for poststroke movement disorders. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PubMed, Scopus, and SpringerLink databases were searched for the keywords "DBS," "stroke," "movement," and "recovery" to identify patients treated with DBS for movement disorders after a stroke. The Joanna Briggs Institute Critical Appraisal checklists for case reports and case series were used to systematically analyze the quality of the included studies. Data collected from each study included patient demographic characteristics, stroke diagnosis, movement disorder, DBS target, stimulation parameters, complications, and outcomes. The authors included 29 studies that described 53 patients who underwent placement of 82 total electrodes. Movement disorders included tremor (n = 18), dystonia (n = 18), hemiballism (n = 6), spastic hemiparesis (n = 1), chorea (n = 1), and mixed disorders (n = 9). The most common DBS targets were the globus pallidus internus (n = 32), ventral intermediate nucleus of thalamus (n = 25), and subthalamic area/subthalamic nucleus (n = 7). Monopolar stimulation was reported in 43 leads and bipolar stimulation in 13. High-frequency stimulation was used in 57 leads and low-frequency stimulation in 6. All patients but 1 had improvement in their movement disorders. Two complications were reported: speech impairment in 1 patient and hardware infection in another. The median (interquartile range) duration between stroke and DBS treatment was 6.5 (2.1-15.8) years. This is the first systematic review of DBS for poststroke movement disorders. Overall, most studies to date have been case reports and small series reporting heterogeneous patients and surgical strategies. This review suggests that DBS for movement disorders after a stroke has the potential to be effective and safe for diverse patients, and DBS may be a feasible option to improve function even years after a stroke.

Morphea overlapping borderline leprosy: An unusual association

Leprosy, or Hansen’s disease, is a chronic infectious disease with a low transmission rate, affecting the skin, peripheral nerves, eyes, and mucous membranes of the upper respiratory tract, yet it may also be systemic. Cases of borderline leprosy are the acute or subacute stages of the disease. They are immunologically unstable and reflect the gradual variation in resistance against the etiological agent. Localized scleroderma or morphea is a fibrosing disease of the skin and underlying tissues that results from the disrupted function of growth factors (platelet-derived growth factor, i.e., PDGF) and receptor expression (as in the case of transforming growth factor b, i.e., TGF-b). Herein, we report a female patient with borderline tuberculoid leprosy (BT) who, during multidrug treatment (MDT), developed an indurated lesion of morphea exactly on the surface of an infiltrated patch.

Serum neurofilament light chain levels are correlated with the infarct volume in patients with acute ischemic stroke.

Neurofilament light chains (NfLs) are promising biomarkers of neuroaxonal damage in stroke patients. We investigated the correlations between NfL levels and infarct volume, initial stroke severity, and functional outcomes at discharge in patients with acute ischemic stroke.We prospectively included 15 patients with first-ever acute ischemic stroke and 8 age- and sex-matched healthy controls without other neurological disorders. Serum NfL levels were measured using the single-molecule array (Simoa) technique twice within 24 hours of admission (NfL1D) and on the seventh hospital day (NfL7D) in patients with stroke and once in healthy controls. We assessed the infarct volume on diffusion-weighted magnetic resonance imaging using the free software ITK-SNAP.Serum NfL1D levels in stroke patients were significantly higher (28.4 pg/mL; interquartile range [IQR], 43.0) than in healthy controls (14.5 pg/mL; IQR, 3.2; P = .005). Temporal pattern analyses demonstrated that NfL7D levels were increased (114.0 pg/mL; IQR, 109.6) compared to NfL1D levels in all stroke patients (P = .001). There was a strong correlation between NfL7D levels and infarct volume (R = 0.67, P = .007). The difference between NfL1D and NfL7D (NfLdiff levels) was strongly correlated with the infarct volume (R = 0.63; P = .013). However, there was no statistically significant correlation between NfL levels and the initial stroke severity or functional outcomes at discharge.NfL levels in the subacute stage of stroke and the NfL difference between admission and 7th day of hospital were correlated with infarct volume in patients with acute ischemic stroke.

Investigating Recovery After Subarachnoid Hemorrhage With the Imaging, Cognition and Outcome of Neuropsychological Functioning After Subarachnoid Hemorrhage (ICONS) Study: Protocol for a Longitudinal, Prospective Cohort Study

BackgroundA subarachnoid hemorrhage is a hemorrhage in the subarachnoid space that is often caused by the rupture of an aneurysm. Patients who survive a subarachnoid hemorrhage have a high risk of complications and a negative long-term outcome.ObjectiveThe aim of the Imaging, Cognition and Outcome of Neuropsychological functioning after Subarachnoid hemorrhage (ICONS) study is to investigate whether and to what extent deficits exist in multiple domains after subarachnoid hemorrhage, including cognition, emotion and behavior, and to investigate whether brain damage can be detected in patients with subarachnoid hemorrhage. We aim to determine which early measures of cognition, emotion and behavior, and brain damage in the subacute stage play a role in long-term recovery after subarachnoid hemorrhage. Recovery is defined as functioning at a societal participation level, with a focus on resuming and maintaining work, leisure activities, and social relationships over the long term.MethodsThe ICONS study is an observational, prospective, single-center cohort study. The study includes patients with subarachnoid hemorrhage admitted to the Neurosurgery Unit of the University Medical Centre Groningen in the Netherlands. The inclusion criteria include diagnosis of an aneurysmal subarachnoid hemorrhage or an angiographically negative subarachnoid hemorrhage, sufficient ability in the Dutch language, and age older than 18 years. Patients will undergo neuropsychological assessment and magnetic resonance imaging 6 months after the subarachnoid hemorrhage. Furthermore, patients will be asked to fill in questionnaires on multiple psychosocial measures and undergo a structured interview at 6 months, 1 year, and 2 years after the subarachnoid hemorrhage. The primary outcome measure of the ICONS study is societal participation 1 year after the subarachnoid hemorrhage, measured with the Dutch version of the Impact on Participation and Autonomy questionnaire.ResultsThe study was launched in December 2019 and recruitment is expected to continue until June 2023. At the time of the acceptance of this paper, 76 patients and 69 healthy controls have been included. The first results are expected in early 2023.ConclusionsThe ICONS study is the first to collect and combine data after subarachnoid hemorrhage in a variety of domains, including cognition, emotion and behavior, and brain damage. The results will contribute to a more comprehensive understanding of the consequences of both aneurysmal subarachnoid hemorrhage and angiographically negative subarachnoid hemorrhage, which may ultimately optimize timely treatment for this patient group by setting realistic and attainable goals to improve daily functioning.Trial RegistrationNetherlands Trial Register NL7803; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7803International Registered Report Identifier (IRRID)DERR1-10.2196/38190

Walking speed at the acute and subacute stroke stage: A descriptive meta-analysis.

Gait disorders are one of the leading patient complaints at the sub-acute stroke stage (SSS) and a main determinant of disability. Walking speed (WS) is a major vital and functional index, and the Ten-Meter Walk Test is considered the gold standard after stroke. Based on a systematic review of the literature, studies published between January 2000 and November 2021 were selected when WS was reported (ten-meter walk test for short distance and/or 6-min walking distance for long distance) within 6 months following a first ischemic and/or hemorrhagic stroke (SSS) in adults prior to receiving specific walking rehabilitation. Following PRISMA guidelines, a meta-analysis was conducted on two kinds of WS: the principal criterion focused on short-distance WS (ten-meter walking test) and the secondary criteria focused on long-distance WS (6-min test) and meta-regressions to study the association of WS with balance, cognitive disorders and autonomy. Nine studies comprising a total of 939 data on post-stroke patients were selected. The weighted average age was 61 years [95% IC [55-67] and males represented 62% ± 2.7 of patients [57-67]. Average short-distance WS was 0.36 ± 0.06 m.s−1 [95% CI (0.23–0.49)]. Average long-distance WS was 0.46 ± 0.1 m.s−1 [95% CI (0.26–0.66)]. The funnel plot revealed asymmetry of publication bias and high heterogeneity of the nine studies (I2 index 98.7% and Q-test p < 0.0001). Meta-regressions of secondary endpoints could not be performed due to a lack of study data. At the SSS, WS would be lower than data in general population published in literature, but above all, lower than the WS required for safe daily autonomy and community ambulation after stroke. WS must be a priority objective of stroke rehabilitation to increase walking function but also for survival, autonomy, social participation and health-related quality of life.

Bilateral Lower Limb Training for Post-stroke Survivors: A Bibliometric Analysis.

Stroke is one of the most disabling conditions affecting the middle-aged population all around the world. This study aims to explore the rehabilitation of stroke patients using bibliometric analysis, which includes statisticalanalysis of recent articles, books, and other kinds of publications, to assess scientific output and determine the significance of scientific investigations in terms of both quality and quantity. In this study, an analysis of global trends in research in bilateral lower limb training for training balance and walking for patients in the subacute stage post-stroke between 1988 and 2021 was done. All the articles were obtained from PubMed databases. CiteSpace software was used to analyze the relationship between publications and country, journals, institutions, authors, references, and the keywords used. A total of 160 publications were included in the analysis. There was a tremendous increase in the research of physiotherapy intervention in patients who had residual disability post-stroke with a publication rate of 7.1 articles per year of publications. The use of the sophisticated PubMed database to extract articles allowed for a thorough and powerful bibliometric analysis of stroke rehabilitation research published between 1988 and 2020. In general, the number of studies on bilateral training has increased in recent decades. This historical overview of rehabilitation for post-stroke survivors will serve as a valuable starting point for future study into possible collaborators, focus issues, and trends. This bibliometric analysis highlights the potential value of exercise therapy for stroke survivors in creating more effective hemiplegia rehabilitation programs. This research may encourage the use of strengthening in the therapeutic therapy of hemiplegia balance. The groundwork will be laid for future research on strengthening stroke to be organized and given top priority.

Ischemic stroke can have a T1w hyperintense appearance in absence of intralesional hemorrhage.

Magnetic resonance imaging (MRI) signal changes associated with ischemic stroke are typically described as T2w and FLAIR hyperintense, and T1w isointense lesions. Intralesional T1w hyperintensity is generally attributed to either a hemorrhagic stroke, or an ischemic stroke with hemorrhagic transition, and has an associated signal void on gradient echo (GE) sequences. Cases of ischemic stroke with T1w hyperintense signal in absence of associated signal void on GE sequences have been sporadically demonstrated in human stroke patients, as well as in dogs with experimentally induced ischemia of the middle cerebral artery. This multicenter retrospective descriptive study investigates the presence of T1w hyperintensity in canine stroke without associated signal void on GE sequences. High field (1.5 Tesla) MRI studies of 12 dogs with clinical presentation, MRI features, and cerebrospinal fluid results suggestive of non-hemorrhagic stroke were assessed. The time between the observed onset of clinical signs and MRI assessment was recorded. All 12 patients had an intralesional T1w hyperintense signal compared to gray and white matter, and absence of signal void on T2*w GE or SWI sequences. Intralesional T1w hyperintensities were either homogenously distributed throughout the entire lesion (6/12) or had a rim-like peripheral distribution (6/12). The mean time between the recorded onset of clinical signs and MRI assessment was 3 days; however, the age range of lesions with T1w hyperintense signal observed was 1–21days, suggesting that such signal intensities can be observed in acute, subacute, or chronic stages of ischemic stroke. Follow-up was recorded for 7/12 cases, all of which showed evidence of neurological improvement while in hospital, and survived to discharge. Correlation of the age and MRI appearance of lesions in this study with similar lesions observed in human and experimental studies suggests that these T1w hyperintensities are likely caused by partial tissue infarction or selective neuronal necrosis, providing an alternative differential for these T1w hyperintensities observed.

Kawasaki disease complicated by peripheral artery thrombosis: a case report and literature review

BackgroundPeripheral gangrene is rarely documented as a possible complication of Kawasaki disease (KD). There are many causes of peripheral gangrene, and the common cause is in situ thrombosis or embolism. Most cases are reported to have regrettable outcomes (amputation or necrotic shedding). Herein, we report the successful management of KD complicated by peripheral artery thrombosis in an older Chinese boy, and a review of all cases of peripheral gangrene in KD in the literature.Case presentationWe found that most of the children with this complication were under 1 year old, had a heavy inflammatory response combined with the use of cortisol and immunoglobulin, and most children had coronary artery lesions. In addition, Peripheral gangrene mainly occurred in the subacute or chronic stage, and the prognosis is poor.ConclusionsIn the presence of high risk factors, we consider it is necessary to monitor coagulation function and administer prophylactic anticoagulation therapy. When peripheral artery thrombosis or embolism occur, heparin and prostaglandins can be used for treatment.

Join us on an amazing journey towards next-generation treatments for CNS disorders: Launch of Neuroprotection, a new high-quality journal in translational neuroscience.

Join us on an amazing journey towards next-generation treatments for CNS disorders: Launch of Neuroprotection, a new high-quality journal in translational neuroscience.

Astrocytes regulate vascular endothelial responses to simulated deep space radiation in a human organ-on-a-chip model.

Central nervous system (CNS) damage by galactic cosmic ray radiation is a major health risk for human deep space exploration. Simulated galactic cosmic rays or their components, especially high Z-high energy particles such as 56Fe ions, cause neurodegeneration and neuroinflammation in rodent models. CNS damage can be partially mediated by the blood-brain barrier, which regulates systemic interactions between CNS and the rest of the body. Astrocytes are major cellular regulators of blood-brain barrier permeability that also modulate neuroinflammation and neuronal health. However, astrocyte roles in regulating CNS and blood-brain barrier responses to space radiation remain little understood, especially in human tissue analogs. In this work, we used a novel high-throughput human organ-on-a-chip system to evaluate blood-brain barrier impairments and astrocyte functions 1-7 days after exposure to 600 MeV/n 56Fe particles and simplified simulated galactic cosmic rays. We show that simulated deep space radiation causes vascular permeability, oxidative stress, inflammation and delayed astrocyte activation in a pattern resembling CNS responses to brain injury. Furthermore, our results indicate that astrocytes have a dual role in regulating radiation responses: they exacerbate blood-brain barrier permeability acutely after irradiation, followed by switching to a more protective phenotype by reducing oxidative stress and pro-inflammatory cytokine and chemokine secretion during the subacute stage.

Structural Changes in the Arcuate Fasciculus and Recovery of Post-stroke Aphasia: A 6-Month Follow-up Study using Diffusion Tensor Imaging

Background Temporal changes in the structural connectivity of major language tracts after stroke and their contribution to aphasia recovery are unclear. Objective To investigate longitudinal arcuate fasciculus (AF) integrity changes and their relationship with post-stroke aphasia recovery using diffusion tensor imaging (DTI). Methods Thirty-five patients with aphasia due to first-ever left hemispheric stroke underwent the Korean version of the Western Aphasia Battery and DTI at 1- and 6-month post stroke onset. Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) of both AF tracts were analyzed to evaluate the temporal changes in tract integrity and determine the correlation between changes (Δ; follow-up − initial) in DTI parameters and language scores. Results At 6 months post-stroke, the mean FA decreased, and mean MD and RD increased in both hemispheres; however, compared with mean AD observed after 1 month, the mean observed at 6 months increased only in the left hemisphere (P < .05). ΔFA of the left AF and proportional change in the aphasia quotient showed a significant positive correlation (r = 0.365, P = .031). No correlation was found between changes in the right AF parameters and language score. The group with increased FA in the left AF showed more significant language improvement than the group with decreased FA. Conclusions: During the subacute stage, the integrity of AF decreased in both hemispheres in patients with aphasia, and the change in structural connectivity of the left AF was associated with language improvement.

STAT1 Contributes to Microglial/Macrophage Inflammation and Neurological Dysfunction in a Mouse Model of Traumatic Brain Injury.

Traumatic brain injury (TBI) triggers a plethora of inflammatory events in the brain that aggravate secondary injury and impede tissue repair. Resident microglia (Mi) and blood-borne infiltrating macrophages (MΦ) are major players of inflammatory responses in the post-TBI brain and possess high functional heterogeneity. However, the plasticity of these cells has yet to be exploited to develop therapies that can mitigate brain inflammation and improve the outcome after TBI. This study investigated the transcription factor STAT1 as a key determinant of proinflammatory Mi/MΦ responses and aimed to develop STAT1 as a novel therapeutic target for TBI using a controlled cortical impact model of TBI on adult male mice. TBI induced robust upregulation of STAT1 in the brain at the subacute injury stage, which occurred primarily in Mi/MΦ. Intraperitoneal administration of fludarabine, a selective STAT1 inhibitor, markedly alleviated proinflammatory Mi/MΦ responses and brain inflammation burden after TBI. Such phenotype-modulating effects of fludarabine on post-TBI Mi/MΦ were reproduced by tamoxifen-induced, selective KO of STAT1 in Mi/MΦ (STAT1 mKO). By propelling Mi/MΦ away from a detrimental proinflammatory phenotype, STAT1 mKO was sufficient to reduce long-term neurologic deficits and brain lesion size after TBI. Importantly, short-term fludarabine treatment after TBI elicited long-lasting improvement of TBI outcomes, but this effect was lost on STAT1 mKO mice. Together, our study provided the first line of evidence that STAT1 causatively determines the proinflammatory phenotype of brain Mi/MΦ after TBI. We also showed promising preclinical data supporting the use of fludarabine as a novel immunomodulating therapy to TBI.SIGNIFICANCE STATEMENT The functional phenotype of microglia and macrophages (Mi/MΦ) critically influences brain inflammation and the outcome after traumatic brain injury (TBI); however, no therapies have been developed to modulate Mi/MΦ functions to treat TBI. Here we report, for the first time, that the transcription factor STAT1 is a key mediator of proinflammatory Mi/MΦ responses in the post-TBI brain, the specific deletion of which ameliorates neuroinflammation and improves long-term functional recovery after TBI. We also show excellent efficacy of a selective STAT1 inhibitor fludarabine against TBI-induced functional deficits and brain injury using a mouse model, presenting STAT1 as a promising therapeutic target for TBI.

Mechanisms and Biomarker Potential of Extracellular Vesicles in Stroke.

Simple SummaryA stroke occurs when there is a lack of blood flow to the brain. Stroke injures the brain and can have devastating outcomes depending on the size and location of the brain tissue affected. Currently, there are only a limited number of treatment options for stroke. Extracellular vesicles are small vesicles secreted by cells. Importantly, extracellular vesicles have specific markers indicating the cell they were released from and can pass from the brain into the blood. For these reasons, assessing extracellular vesicles in the blood may create a window into changes occurring in the brain. Assessing changes in extracellular vesicles in the blood during stroke may produce new insight into the cellular changes in the brain causing injury during stroke. This in turn may generate potential targets for the development of future treatments. We summarize what is known about changes in brain-cell-specific extracellular vesicles during stroke and stress the importance of continuing to study these changes.Stoke is a prevalent and devastating neurologic condition with limited options for therapeutic management. Since brain tissue is rarely accessible clinically, peripheral biomarkers for the central nervous system’s (CNS’s) cellular response to stroke may prove critical for increasing our understanding of stroke pathology and elucidating novel therapeutic targets. Extracellular vesicles (EVs) are cell-derived, membrane-enclosed vesicles secreted by all cell types within the CNS that can freely pass the blood-brain barrier (BBB) and contain unique markers and content linked to their cell of origin. These unique qualities make brain-derived EVs novel candidates for non-invasive blood-based biomarkers of both cell specificity and cell physiological state during the progression of stroke and recovery. While studies are continuously emerging that are assessing the therapeutic potential of EVs and profiling EV cargo, a vast minority of these studies link EV content to specific cell types. A better understanding of cell-specific EV release during the acute, subacute, and chronic stages of stroke is needed to further elucidate the cellular processes responsible for stroke pathophysiology. Herein, we outline what is known about EV release from distinct cell types of the CNS during stroke and the potential of these EVs as peripheral biomarkers for cellular function in the CNS during stroke.

Telerehabilitation for balance rehabilitation in the subacute stage of stroke: A pilot controlled trial.

Telerehabilitation has been proposed as an effective strategy to deliver post-stroke specific exercise. To assess the effectiveness and feasibility of core stability exercises guided by a telerehabilitation App after hospital discharge. Extension of a prospective controlled trial. Subacute stage stroke survivors were included at the time of hospital discharge where they had participated in a previous 5-week randomized controlled trial comparing conventional physiotherapy versus core stability exercises. After discharge, patients from the experimental group were offered access to telerehabilitation to perform core stability exercises at home (AppG), while those from the control group were subject to usual care (CG). The Spanish-version of the Trunk Impairment Scale 2.0 (S-TIS 2.0), Function in Sitting Test (S-FIST), Berg Balance Scale (BBS), Spanish-version of Postural Assessment for Stroke Patients (S-PASS), the number of falls, Brunel Balance Assessment (BBA) and Gait were assessed before and after 3 months intervention. A total of 49 subjects were recruited. AppG showed greater improvement in balance in both sitting and standing position and gait compared with CG, although no statistically significant differences were obtained. Core stability exercises Telerehabilitation as a home-based guide appears to improve balance in post-stroke stage. Future studies are necessary to confirm the effects as well as identifying strategies to increase telerehabilitation adherence.

Primary stent implantation for bilateral spontaneous cervical ICA dissections with hypoperfusion after 72 h from onset: a case report

BackgroundSpontaneous cervical internal carotid artery dissection (cICAD) is a common cause of stroke in young adults. Endovascular therapy is an indispensable treatment for cICAD in some cases, but it faces great challenges.Case presentationA bilateral spontaneous cICADs with hypoperfusion-related AIS after 72 h from the onset was presented herein. The patient responded well to primary Solitaire stent detachment at the critical flow-limiting site.ConclusionsPrimary stent implantation at the critical flow-limiting site rather than covering the entire dissection may be a therapeutic option in spontaneous cICAD complicated with cerebral hypoperfusion. The Solitaire stent may be a good choice at the acute and subacute stages of cICAD.

Optimal Intervention Timing for Robotic-Assisted Gait Training in Hemiplegic Stroke

This study was designed to determine the best intervention time (acute, subacute, and chronic stages) for Walkbot robot-assisted gait training (RAGT) rehabilitation to improve clinical outcomes, including sensorimotor function, balance, cognition, and activities of daily living, in hemiparetic stroke patients. Thirty-six stroke survivors (acute stage group (ASG), n = 11; subacute stage group (SSG), n = 15; chronic stage group (CSG), n = 10) consistently received Walkbot RAGT for 30 min/session, thrice a week, for 4 weeks. Six clinical outcome variables, including the Fugl–Meyer Assessment (FMA), Berg Balance Scale (BBS), Trunk Impairment Scale (TIS), Modified Barthel Index (MBI), Modified Ashworth Scale (MAS), and Mini-Mental State Examination, were examined before and after the intervention. Significant differences in the FMA, BBS, TIS, and MBI were observed between the ASG and the SSG or CSG. A significant time effect was observed for all variables, except for the MAS, in the ASG and SSG, whereas significant time effects were noted for the FMA, BBS, and TIS in the CSG. Overall, Walkbot RAGT was more favorable for acute stroke patients than for those with subacute or chronic stroke. This provides the first clinical evidence for the optimal intervention timing for RAGT in stroke.

Prevalence and risk factors of stroke-related sarcopenia at the subacute stage: A case control study.

PurposeTo investigate the prevalence and risk factors of stroke-related sarcopenia (SRS) in hospitalized patients receiving rehabilitation treatment.MethodsApproximately, 259 patients with stroke that satisfied the inclusion and exclusion criteria were consecutively recruited between June 2020 and July 2022. The epidemiologic data, history, clinical data, and measured data of the skeletal muscle index were collected. The patients were divided into the sarcopenia and non-sarcopenia group for comparison and analysis with the univariate and multivariate analysis.ResultsSRS was presented in 121 (46.7%) patients with a mean age of 59.6 ± 9.7 years, including 42 women and 79 men. Multivariate logistic regression analysis revealed the following parameters to be significant (p < 0.05) risk factors for SRS: college degree or above (OR, 2.1, 95% CI, 1.1–4.1), ICU stay (OR, 1.7, 95% CI, 1.06–2.8), pneumonia (OR, 1.9, 9% CI, 1.1–3.6), walking ability (OR, 2.6, 95% CI, 1.5–4.6), cognitive impairment (OR, 1.8, 95%, 1.1–2.9), aphasia (OR, 2.1, 95% CI, 1.2–3.5), nasogastric feeding (OR, 3.7, 95%, 1.9–7.3), age (OR, 1.04, 95% CI, 1–1.1), and creatine kinase (OR, 1.1, 95% CI,0.9–1.2).ConclusionsOlder age, light weight, severer clinical conditions, cognitive impairment, and significantly decreased levels of albumin, RAG, creatinine, uric acid, red blood cell count, hemoglobin, prealbumin, iron, and creatine kinase are more significantly present in patients with SRS compared with those without SRS.

The Effects on Knee Swelling, Range of Motion and Pain using a Commercially Available Hot/Cold Contrast Device in a Rehabilitation and Sports Medicine Setting.

Background and PurposeContrast therapy consists of alternating thermotherapy and cryotherapy repeatedly to assist in the management of acute, subacute, and chronic musculoskeletal conditions. This has been utilized for several decades with good to excellent subjective and objective results reported for patients with swelling (acute to chronic), pain, and loss of motion. Typically, the intervention is performed by either the use of a hot and cold whirlpool or by applying hot and cold packs which can be very time consuming and labor intensive. The purpose of this study was to determine the efficacy of a single treatment of the Hyperice X system in reducing knee joint pain, swelling and stiffness in active patients and young injured athletes. A secondary purpose was to measure patient satisfaction with the use of the device.SubjectsFifty subjects (34 males and 16 females) with a mean age of 22.2 +/- 4.9 yrs (ranging from 17 to 45 yrs of age) were recruited. Subjects presented with various types of knee pain, both non-operative and operative, secondary to ligamentous, tendinous, cartilage, muscle, and/or meniscus pathology. The subjects were in various stages of rehabilitation with six in the acute stage, 24 in subacute stage, and 20 in the chronic stage. The subjects participated in a variety of different sports at various levels of competition ranging from recreational to professional.MethodsSubjects were recruited from one of two centers: an athletic training room or an outpatient sports medicine rehabilitation center. They were evaluated for baseline pain using the visual analog scale (VAS),verbal patient satisfaction on a scale of 1-10, verbal assessment of knee tightness, knee circumference, and knee flexion range of motion. The Hyperice X was applied to the knee utilizing the contrast setting for a total of 18 minutes with three six-minute cycles, each consisting of three minutes of heat therapy and three minutes of cold therapy. The contrast therapy was applied at the initiation of the physical therapy session and all subjective and objective measures were repeated immediately post contrast treatment.ResultsThe VAS scores significantly improved following the treatment session with the mean score pretreatment of 2.59 and following the treatment of 1.68. Knee circumference improved for mid patella and 5 cm below mid patella, but no significant improvement was noted at the 5 cm above the patella region. Knee flexion improved from 130 degrees pre-treatment to 134 degrees post treatment. Knee extension improved from 2.72 degrees of hyperextension to 3.44 degrees, both of which were statistically significant(p<.001).ConclusionContrast therapy utilizing the Hyperice X device demonstrated effectiveness in affecting pain reduction, swelling, and knee ROM. A commercially available device providing contrast therapy, may enhance outcomes in athletes after even a single treatment. In addition, the device was found to be easy to use, clinically practical, and demonstrated very high subjective patient satisfaction.Level of EvidenceLevel 3

Neurocognitive screening in patients following SARS-CoV-2 infection: tools for triage

BackgroundCognitive complaints are common in patients recovering from Coronavirus Disease 2019 (COVID-19), yet their etiology is often unclear. We assess factors that contribute to cognitive impairment in ambulatory versus hospitalized patients during the sub-acute stage of recovery.MethodsIn this cross-sectional study, participants were prospectively recruited from a hospital-wide registry. All patients tested positive for SARS-CoV-2 infection using a real-time reverse transcriptase polymerase-chain-reaction assay. Patients ≤ 18 years-of-age and those with a pre-existing major neurocognitive disorder were excluded. Participants completed an extensive neuropsychological questionnaire and a computerized cognitive screen via remote telemedicine platform. Rates of subjective and objective neuropsychological impairment were compared between the ambulatory and hospitalized groups. Factors associated with impairment were explored separately within each group.ResultsA total of 102 patients (76 ambulatory, 26 hospitalized) completed the symptom inventory and neurocognitive tests 24 ± 22 days following laboratory confirmation of SARS-CoV-2 infection. Hospitalized and ambulatory patients self-reported high rates of cognitive impairment (27–40%), without differences between the groups. However, hospitalized patients showed higher rates of objective impairment in visual memory (30% vs. 4%; p = 0.001) and psychomotor speed (41% vs. 15%; p = 0.008). Objective cognitive test performance was associated with anxiety, depression, fatigue, and pain in the ambulatory but not the hospitalized group.ConclusionsFocal cognitive deficits are more common in hospitalized than ambulatory patients. Cognitive performance is associated with neuropsychiatric symptoms in ambulatory but not hospitalized patients. Objective neurocognitive measures can provide essential information to inform neurologic triage and should be included as endpoints in clinical trials.