Therapy In Stroke Patients Research Articles

The effect of sleep hygiene education for improving sleep quality among patients with stroke: A systematic review

Background: One of the problems experienced by stroke sufferers is sleep problems. Stroke patients report having difficulty sleeping about 50% of the time in the early months after a stroke. Cognitive behavioral therapy (CBT) including sleep hygiene, controlling environmental stimuli, sleep restriction, positioning therapy, and educational management are some of the methods used to treat sleep problems. Purpose: To determine sleep hygiene education on the outcomes of cognitive behavioral therapy in stroke patients with sleep disorders. Method: Systematic review research using the Covidence application in the data extraction process. The framework used in this paper uses PICO, so the researchers set the research question in this systematic review as "Is sleep hygiene more effective than no sleep hygiene for sleep disorders in stroke patients?". Literature searches were carried out from Scopus, Wiley, Sciencedirect, Sage, Embase, Pubmed, Proquest and Medline for articles published up to March 19, 2023. Results: Three articles were included in this systematic review. All three articles provide sleep hygiene education on sleep-related cognitive behavioral therapy to help improve sleep disorders after stroke. Conclusion: Sleep hygiene education in cognitive behavioral therapy significantly improves sleep quality in stroke patients, but long-term studies are needed to test further significance.

Effect of cognitive multisensory rehabilitation on upper extremity function in stroke patients: A randomized controlled trial

The aim of this study was to examine the impact of upper extremity (UE) rehabilitation based on neurocognitive multisensory therapy in stroke patients, focusing on assessing its effects on the recovery of UE function and suggesting it as a post-stroke therapeutic method. The study was conducted as a randomized, prospective, controlled trial with a pre- and post-experimental design. Thirty stroke patients were equally divided into study and control groups and evaluated before and after treatment. Outcome measures included the Action Research Arm Test (ARAT), Manual Function Test (MFT), Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), and Fugl Myer Assessment upper extremity (FMA-UE). Both groups received a specific physiotherapy program, while the study group also received Cognitive Multisensory Rehabilitation (CMR). All analyses were performed using SPSS (version 25). There were no significant differences between the groups in age, weight, height, BMI, duration of illness, MMSE, sex, or spasticity grade distribution (p > 0.05). Post-treatment comparison between both groups showed a statistically significant increase in the ARAT, MFT, MESUPES, and FMA-UE scores in the study group compared to the control group (p < 0.05). For stroke patients, CMR intervention is considered a beneficial neuro-rehabilitation strategy for enhancing upper extremity sensorimotor capabilities through physical therapy.

Cerebrolysin as an early add-on to reperfusion therapy: heterogeneous treatment effect analysis in ischemic stroke patients with varying risk of hemorrhagic transformation

The study goal was the assessment of heterogeneous treatment effects of Cerebrolysin as an early add-on to reperfusion therapy in stroke patients with varying risk of hemorrhagic transformation (HT). It was post hoc analysis of the CEREHETIS trial (ISRCTN87656744). Patients with middle cerebral artery infarction (n=238) were stratified by HT risk with the HTI score. The study outcomes were symptomatic and any HT, and functional outcome measured with the modified Rankin Scale (mRS) on day 90. Favorable outcome was defined as an mRS score of ≤2. Heterogeneous treatment effect analysis was performed using techniques of meta-analysis and the matching-smoothing method. Heterogeneity of Cerebrolysin treatment effects was moderate (I2=36.98-69.3%, H2=1.59-3.26) and mild (I2=18.33-32.39%, H2=1.22-1.48) for symptomatic and any HT, respectively. A positive impact of the Cerebrolysin treatment on HT and functional outcome was observed in patients with moderate (HTI=1) and high (HTI≥2) HT risk. However, the effect was neutral in those with low risk (HTI=0). In high HT risk patients, there was a steady decline in the rate of symptomatic (HTI=0 vs. HTI≥2: by 3.8%, p=0.120 vs. 14.3%, p<0.001) and any HT (HTI=0 vs. HTI≥2: by 0.6%, p=0.864 vs. 19.5%, p<0.001). Likewise, Cerebrolysin treatment resulted in an overall decrease in the mRS scores (HTI=0 vs. HTI≥2: by 2.1%, p=0.893 vs. 63%, p<0.001) with a reciprocal increase of the fraction with favorable outcome (HTI=0 vs. HTI≥2: by 2% p=0.634 vs. 19.2%, p<0.001). Clinically meaningful heterogeneity of Cerebrolysin treatment effects on HT and functional outcome was established in stroke patients. The Cerebrolysin positive impact was significant in those whose estimated on-admission HT risk was either moderate or high.

The potential of a combined cell‐based therapy and rehabilitation approach for stroke recovery

AbstractActivation of neuroprotective and particularly later neurorestorative mechanisms after stroke attempts to restore or compensate for lost functions. This potentially opens a wide window for restorative therapies to promote brain repair and improve long‐term functional recovery. Although extensively demonstrated in the preclinical setting, the efficacy of cell‐based therapies in stroke patients has been modest at best, if any at all. Translational failure may be due to the ineffective survival and integration of transplanted cells in pro‐death stroke microenvironments that are not conducive for the structural reconstruction of damaged brain tissue and repair‐related network reorganization. Optimal systemic delivery, timing, cell product, and dose remain open as well. Fortunately, a better understanding of the brain plasticity mechanisms underlying stroke recovery has ushered in a combination approach of cell‐based therapy and rehabilitation that is aimed at achieving additive, synergistic, or even maximal beneficial effects. This novel combination therapy is not only targeted at promoting exogenous and endogenous cell survival and augmenting stand‐alone restorative mechanisms but also at utilizing rehabilitation to facilitate a graft–host structural and functional integration and plasticity that would effectively remodel stroke tissue and restitute lost functions. This review presents an overview of the combination of cell‐based therapy and experimental rehabilitation in stroke models. It also discusses associated shortcomings as well as proposes strategies to address them and help facilitate the advancement of this combination approach.

Abstract 14130: Efficacy and Safety of Endovascular Therapy in Stroke Patients With Large Ischemic Core in Comparison to Medical Management: Meta-Analysis of Randomized Control Studies

Introduction: Endovascular therapy (EVT) is a treatment recommended for stroke patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥6. However, the utility of EVT in patients with large core ischemic stroke has not been well established. Methods: This meta-analysis assesses EVT's efficacy and safety using available trials comparing EVT to medical management (MM) in stroke patients with large ischemic core. Eligibility criteria: 1) were randomized controlled trials, 2) compared EVT with MM alone, 3) studied patients presenting with LIC cerebrovascular events, and 4) reported outcomes of interest. We extracted data for the major imaging inclusion criteria, the National Institutes of Health Stroke Scale (NIHSS) score, pre-stroke mRs score, and occlusion site. We also extracted outcome data for the EVT groups vs MM groups, including measurement of early neurological recovery, and definition of sICH. Results: Our primary end point was the mean modified Rankin scale score (RSS) at 90-day follow up. EVT was associated with higher odds of significant improvement in functional status with reduction in mean mRS by -0.31 [-0.47; -0.14]) compared to MM. The odds of achieving mRS 0 to 2 was higher in the EVT arm compared to the MM arm (2.53 [1.59; 4.02]). There was no difference in achieving mRS 0 to 3, early neurologic improvement defined according to NIHSS score, overall 90-day mortality and risk of symptomatic ICH between patients treated with EVT or MM in our analysis. Conclusions: Our study suggests that EVT may lead to improved outcomes in stroke patients with large core ischemia.

A comprehensive guide to BCI-based stroke neurorehabilitation interventions

Brain-Computer Interfaces (BCIs) offer the potential to facilitate neurorehabilitation in stroke patients by decoding user intentions from the central nervous system, thereby enabling control over external devices. Despite their promise, the diverse range of intervention parameters and technical challenges in clinical settings have hindered the accumulation of substantial evidence supporting the efficacy and effectiveness of BCIs in stroke rehabilitation. This article introduces a practical guide designed to navigate through these challenges in conducting BCI interventions for stroke rehabilitation. Applicable regardless of infrastructure and study design limitations, this guide acts as a comprehensive reference for executing BCI-based stroke interventions. Furthermore, it encapsulates insights gleaned from administering hundreds of BCI rehabilitation sessions to stroke patients.•Presents a comprehensive methodology for implementing BCI-based upper extremity therapy in stroke patients.•Provides detailed guidance on the number of sessions, trials, as well as the necessary hardware and software for effective intervention.

Application of Mirror Therapy of the Face on Facial Muscle Ability in Stroke Patients at RST Dr. Soedjono Magelang

Stroke is a reduced blood flow and oxygen to the brain due to blockage, narrowing, or rupture of blood vessels. Stroke leading weakness of the face, according to damage in the frontal motor area. One way to overcome a facial weakness is to apply mirror therapy of the face which is a combination of mirror therapy and facial exercises. The purpose of this case study is to illustrate the application of facial mirror therapy in stroke patients with facial muscle abilities. This type of research is descriptive by using a case study approach. The subjects in this study were 2 stroke patients with the criteria for facial muscle weakness, which is having a sagging face, having a recurrent attack or having just had a stroke. The study showed that an increase in facial muscle ability in subject 1 from the sufficient category (score 21) to the good category (score 29), subject 2 from the sufficient category (score 24) to the good category (score 32). Recommendation : Nurses can apply Mirror Therapy of the Face to improve the ability of facial muscles in stroke patients.

Prescription Pattern of Anti-Plateletic Drugs, Clinical Manifestations and Risk Factors in Cerebro Vascular Accident: A Prospective Observational Study

Aim: The aim and objective of the study is to evaluate the prescription pattern of anti-plateletic agents used in the treatment of stroke and clinical symptoms and risk factors, among hospitalized stroke patients. Materials and Method: A six-month prospective observational study that was carried out in the neurology department. A standard procedure was followed for the documentation and analysis of all the data. A total of 120 patients selected for the study who satisfying the inclusion and exclusion criteria. Results: Out of total 120 patients, the most prevalent type of stroke was found to be ischemic stroke of 92%. Females were found mostly to be diagnosed by stroke. Aspirin (65%) was found to be the most common anti-plateletic agent used in the treatment of stroke followed by clopidogrel and its combination. Majority of patients experienced slurred speech (37.5%), followed by weakness as the clinical presentation of stroke. Hypertension (49.1%) was found to be the most prevalent risk factor of stroke followed by diabetes mellitus. Conclusion: The study provides a concise summary of the clinical symptoms, risk factors, and prescription pattern of anti-platelet therapy in stroke patients. By proper identification and rectification of the strong contributable risk factor for stroke may lead to a good prognosis of treatment of stroke.

Effect of teleconsultation on the application of thrombolytic therapy in stroke patients in the emergency department.

Recently, telemedicine has become a widely used method worldwide for the treatment of patients with acute ischemic stroke in hospitals where neurologists are unavailable. The purpose of this study was to determine the accuracy and reliability of treatment decisions made by remote neurologists via teleconference assisted by emergency physicians in acute stroke cases and to determine whether the use of teleconsultation would lead to any delays in assessment and treatment decisions. This single-center and prospective study was performed with 104 patients who met the inclusion criteria. Patients were concurrently assessed by a teleneurologist (TN) experienced in stroke and an on-site neurologist (OS-N). The TN performed their assessment via teleconference and assisted by an emergency physician for test results and physical examination. NIHSS (The National Institutes of Health Stroke Scale) scores, assessment times, treatment decisions by the two neurologists, and patient outcomes were recorded separately. The TN was asked to rate the quality of communication. Of the 104 patients in the study, 59.6% (n = 62) were men and the median age was 66 (interquartile range = 56-78) years. The median duration of assessment by the OS-N was 30 (18-45) min and the median duration of assessment by the TN was 6 (5-8) min; the duration of assessment by the TN was significantly shorter (6.56 min vs. 33.35 min; Z = 8.669; p < 0.001). The median rating assigned by the TN to the quality of teleconsultation was 5.0 (4.25-5.0) (Table 1). The NIHSS scores assigned by both neurologists showed significant correlation (p < 0.001). Analysis of the agreement between the OS-N and TN in their treatment decisions yielded a Kappa value of 74.3% for interrater agreement. Teleconsultation was a successful and reliable strategy in assessing patients with ischemic stroke and making decisions for IV-tPA. Moreover, patient assessment via teleconsultation was less time consuming. The results of the study are promising for the use of teleconsultation in the future.

Penerapan Terapi Genggam Bola Karet Terhadap Kekuatan Otot Pada Pasien Stroke Dibangsal Anyelir Rumah Sakit Umum Daerah (RSUD) dr. Soediran Mangun Sumarso Wonogiri

Background : The number of elderly in RSUD dr. Soediran Mangun Soemarso in April there were 48 people, while in the Anyelir ward itself there were 37 people. Over time, complaints that appear in elderly people who have had a stroke are sudden facial weakness, sudden feeling of confusion, difficulty speaking, nausea, sudden vomiting and numbness or tingling. Objective : To find out the results of implementing rubber ball handheld therapy on muscle strength in stroke patients. Method : This type of research uses a descriptive method with a case study approach. Findings: The muscle scale before hand-held rubber ball therapy in stroke patients was 3, and the muscle scale after hand-held therapy in stroke patients was 4. Implication There are differences in development before and after being given hand-held rubber-ball therapy in the elderly who have had a stroke, namely experienced an increase in motor muscle strength in elderly patients.

Predicting factor analysis of gastrointestinal bleeding complication among hospitalised ischemic stroke patients

Background: Stroke is a common cardiovascular disease and the biggest cause of death and disability in the world. Treatment in affected patients aims to stabilise their condition and prevent further deterioration. One of the therapies in stroke patients is the administration of antiplatelet which may also cause adverse reactions in the form of gastrointestinal bleeding. Objectives: This study aims to analyse the factors that can predict the emergence of gastrointestinal bleeding in hospitalised Ischemic stroke patients. Methods: A cohort study was conducted within a population of hospitalised patients diagnosed with Ischemic stroke. Patients' data from the hospital stroke registry was analysed. The significance of factors that can predict gastrointestinal bleeding incidence and the main predictor was determined. Results: The results showed that out of the 96 patients included, 49 experienced gastrointestinal bleeding. Factors that had significant relationships with the incidence of gastrointestinal bleeding were symptoms of decreased consciousness with OR 9.03; 95% CI: 3.361 – 24.22, and loading dose OR 5.769; 95% CI: 1.191 – 27.941. In addition, the main predicting factor was symptoms of decreased consciousness with a p &lt; 0.05 (&lt;0.010), and OR value of 2.165 with 95% CI: 3.177 – 23.906. Conclusion: The occurrence of decreased consciousness can be a predictor of gastrointestinal bleeding.

Mechanism of action and therapeutic potential of dimethyl fumarate in ischemic stroke.

Dimethyl fumarate (DMF) is an immunomodulatory drug currently approved for the treatment of multiple sclerosis and psoriasis. Its benefits on ischemic stroke outcomes have recently come to attention. To date, only tissue plasminogen activators (tPAs) and clot retrieval methods have been approved by the FDA for the treatment of ischemic stroke. Ischemic conditions lead to inflammation through diverse mechanisms, and recanalization can worsen the state. DMF and the nuclear factor erythroid-derived 2-related factor 2 (Nrf2) pathway it regulates seem to be important in postischemic inflammation, and animal studies have demonstrated that the drug improves overall stroke outcomes. Although the exact mechanism is still unknown, studies indicate that these beneficial impacts are due to the modulation of immune responses, blood-brain barrier permeability, and hemodynamic adjustments. One major component evaluated before, during, and after tPA therapy in stroke patients is blood pressure (BP). Recent studies have found that DMF may impact BP. Both hypotension and hypertension need correction before treatment, which may delay the appropriate intervention. Since BP management is crucial in managing stroke patients, it is important to consider DMF's role in this matter. That being said, it seems further investigations on DMF may lead to an alternative approach for stroke patients. In this article, we discuss the mechanistic roles of DMF and its potential role in stroke based on previously published literature and laboratory findings.

The Effectiveness of Mirror Therapy in Stroke Patients: A Systematic Review

Backgrounds : Stroke is a global problem and the second cause of death in the world. Purpose : To find out the effectiveness of giving mirror therapy in stroke patients. Methods : There are five databases used, namely Science Direct, SAGE Journal, Emerald, ProQuest and PubMed to search for mirror therapy and post-strokes. The inclusion criteria used are for publications for the last 5 years from 2017 to 2022, full-text articles and in English, according to the title, and RCT research or experimental studies. Results : of the total 7 articles submitted for this systematic review after quality assessment, this included 3 randomized controlled trials and 4 experimental studies. All muscle strength studies in post-stroke patients after being given mirror interventions experienced an increase in muscles in parts of the body that experienced hemiperation, thereby increasing independence in patients. From the results of all studies, it was found that the optimal time in starting the therapy is in the chronic stage, and the therapeutic dose is given with the same intensity (at least five sessions per week) and duration (at least 30 minutes to 90 minutes). Conclusion : mirror therapy proved to be an effective and viable approach to rehabilitate post-stroke survivors in acute, sub-acute, and chronic phases of the stroke, despite the long-term effects.

Inpatient rehabilitation therapy in stroke patients with reperfusion therapy: a national prospective registry study

BackgroundLittle is known about the rate of real-world inpatient rehabilitation therapy (IRT) after stroke. We aimed to determine the rate of inpatient rehabilitation therapy and its associated factors in patients who undergo reperfusion therapy in China.MethodsThis national prospective registry study included hospitalized ischemic stroke patients aged 14–99 years with reperfusion therapy between January 1, 2019, and June 30, 2020, collecting hospital-level and patient-level demographic and clinical data. IRT included acupuncture or massage, physical therapy, occupational therapy, speech therapy, and others. The primary outcome was the rate of patients receiving IRT.ResultsWe included 209,189 eligible patients from 2191 hospitals. The median age was 66 years, and 64.2% were men. Four in five patients received only thrombolysis, and the rest 19.2% underwent endovascular therapy. The overall rate of IRT was 58.2% (95% CI, 58.0–58.5%). Differences in demographic and clinical variables existed between patients with and without IRT. The rates of acupuncture or massage, physical therapy, occupational therapy, speech therapy, and other rehabilitation interventions were 38.0%, 28.8%, 11.8%, 14.4%, and 22.9%, respectively. The rates of single and multimodal interventions were 28.3% and 30.0%, respectively. A lower likelihood of receiving IRT was associated with being 14–50 or 76–99 years old, female, from Northeast China, from Class-C hospitals, receiving only thrombolysis, having severe stroke or severe deterioration, a short length of stay, Covid-19 pandemic and having intracranial or gastrointestinal hemorrhage.ConclusionAmong our patient population, the IRT rate was low with limited use of physical therapy, multimodal interventions, and rehabilitation centers and varied by demographic and clinical features. The implementation of IRT remains a challenge for stroke care, warranting urgent and effective national programs to enhance post-stroke rehabilitation and the adherence to guidelines.

Bridging Thrombolysis Before Endovascular Therapy in Stroke Patients With Faster Core Growth.

It is still uncertain that going direct to endovascular thrombectomy (EVT) leads to equivalent outcomes as bridging IV thrombolysis (IVT) in acute ischemic patients. This study aimed to explore whether the rate of ischemic core growth influenced the patient outcomes after bridging IVT vs direct EVT. This was a retrospective cohort study based on the International Stroke Perfusion Imaging Registry (INSPIRE). It selected acute ischemic stroke patients receiving perfusion CT within 4.5 hours of stroke onset. Patients who went direct to EVT were compared with those who received bridging treatment of IVT before EVT. Ischemic core growth rate was estimated by the acute ischemic core volume on perfusion CT divided by the time from stroke onset to perfusion CT, based on the assumption of a linear growth pattern of ischemic core. Core growth rate was stratified into fast (>15 mL/h) and slow (≤15 mL/h), based on its interaction with bridging IVT in predicting the primary outcome. The primary outcome was modified Rankin scale of 0-2 at 3 months. The secondary outcomes included successful thrombectomy reperfusion defined by modified Thrombolysis in Cerebral Infarction score of 2b-3 and time from groin puncture to reperfusion. Of the 1,221 EVT patients in the INSPIRE, 323 patients were selected, of which 82 patients received direct EVT and 241 patients received bridging IVT. Bridging IVT was associated with a higher rate of good clinical outcome among patients with fast core growth (39% vs 7% for direct EVT, odds ratio [OR] 8.75 [1.96-39.1], p = 0.005), but the difference was not notable for patients with slow core growth (55% vs 55% for direct EVT, OR 1.00 [0.53-1.87], p = 0.989). In patients with fast core growth, the bridging and direct EVT patients showed no difference in the reperfusion rate (80% vs 76%, p = 0.616). However, patients who received bridging IVT were more likely to achieve reperfusion earlier (the median groin to reperfusion time of 63.0 vs 94.0 minutes, p = 0.005). Patients with fast core growth were more likely to benefit from bridging IVT. This is likely because prior IVT facilitates clot removal and thus reduces time to reperfusion.

Direct Mechanical Thrombectomy vs. Bridging Therapy in Stroke Patients in A "Stroke Belt" Region of Southern Europe.

The aim of this 4-year observational study is to analyze the outcomes of stroke patients treated with direct mechanical thrombectomy (dMT) compared to bridging therapy (BT) (intravenous thrombolysis [IVT] + BT) based on 3-month outcomes, in real clinical practice in the "Stroke Belt" of Southern Europe. In total, 300 patients were included (41.3% dMT and 58.6% BT). The frequency of direct referral to the stroke center was similar in the dMT and BT group, whereas the time from onset to groin was longer in the BT group (median 210 [IQR 160-303] vs. 399 [IQR 225-675], p = 0.001). Successful recanalization (TICI 2b-3) and hemorrhagic transformation were similar in both groups. The BT group more frequently showed excellent outcomes at 3 months (32.4% vs. 15.4%, p = 0.004). Multivariate analysis showed that BT was independently associated with excellent outcomes (OR 2.7. 95% CI,1.2-5.9, p = 0.02) and lower mortality (OR 0.36. 95% CI 0.16-0.82, p = 015). Conclusions: Compared with dMT, BT was associated with excellent functional outcomes and lower 3-month mortality in this real-world clinical practice study conducted in a region belonging to the "Stroke Belt" of Southern Europe. Given the disparity of results on the benefit of BT in the current evidence, it is of vital importance to analyze the convenience of its use in each health area.

Contraintuitive fallacy in a big-risk-no-gain stroke scenario? Please verify!

Contraintuitive fallacy in a big-risk-no-gain stroke scenario? Please verify!

Clinical Ageing.

Ageing is generally characterised by the declining ability to respond to stress, increasing homeostatic imbalance, and increased risk of ageing-associated diseases . Mechanistically, the lifelong accumulation of a wide range of molecular and cellular impairments leads to organismal senescence. The aging population poses a severe medical concern due to the burden it places on healthcare systems and the general public as well as the prevalence of diseases and impairments associated with old age.In this chapter, we discuss organ failure during ageing as well as ageing of the hypothalamic-pituitary-adrenal axis and drugs that can regulate it. A much-debated subject is about ageing and regeneration. With age, there is a gradual decline in the regenerative properties of most tissues. The goal of regenerative medicine is to restore cells, tissues, and structures that are lost or damaged after disease, injury, or ageing. The question arises as to whether this is due to the intrinsic ageing of stem cells or, rather, to the impairment of stem-cell function in the aged tissue environment. The risk of having a stroke event doubles each decade after the age of 55. Therefore, it is of great interest to develop neurorestorative therapies for stroke which occurs mostly in elderly people. Initial enthusiasm for stimulating restorative processes in the ischaemic brain with cell-based therapies has meanwhile converted into a more balanced view, recognising impediments related to survival, migration, differentiation, and integration of therapeutic cells in the hostile aged brain environment. Therefore, a current lack of understanding of the fate of transplanted cells means that the safety of cell therapy in stroke patients is still unproven. Another issue associated with ischaemic stroke is that patients at risk for these sequels of stroke are not duly diagnosed and treated due to the lack of reliable biomarkers. However, recently neurovascular unit-derived exosomes in response to Stroke and released into serum are new plasma genetic and proteomic biomarkers associated with ischaemic stroke. The second valid option, which is also more economical, is to invest in prevention.

Mirror Therapy in Stroke Patients

Mirror Therapy in Stroke Patients

Computed tomography pattern of severe cerebral amyloid angiopathy in the acute phase of stroke care: what should we do?

Background: Intracerebral hemorrhage is a complication of thrombolytic therapy in stroke patients. Furthermore, Cerebral Amyloid Angiopathy (CAA), which itself can cause hemorrhage, may be a risk factor for thrombolysis related intracerebral hemorrhage.