1
|
Yen HC, Pan GS, Jeng JS, Chen WS. Impact of Early Mobilization on Patients With Acute Ischemic Stroke Treated With Thrombolysis or Thrombectomy: A Randomized Controlled Trial. Neurorehabil Neural Repair 2024:15459683241236443. [PMID: 38426480 DOI: 10.1177/15459683241236443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Early mobilization (EM) within 24 to 72 hours post-stroke may improve patients' performance and ability. However, after intravenous thrombolysis (IVT) or mechanical thrombectomy (MT), the increased risk of hemorrhagic complications impacts the implementation of early out-of-bed mobilization. Few studies have investigated EM after IVT or MT for acute ischemic stroke (AIS), and its impact in these patients is unknown. OBJECTIVE To investigate the effect of EM on AIS treated with IVT or MT.|. METHODS We recruited 122 patients with first AIS; 60 patients were treated with IVT, and 62 patients were treated with MT. For each IVT and MT cohort, the control groups received standard early rehabilitation, and the intervention groups received an EM protocol. The training lasted 30 minutes/day, 5 days/week until discharge. MAIN OUTCOMES MEASURES The effectiveness of the interventions was evaluated using the motor domain of the Functional Independence Measure (FIM-motor) and the Postural Assessment Scale for Stroke Patients (PASS) at baseline, 2-week, 4-week, and 3-month post-stroke, the Functional Ambulation Category 2-week post-stroke, and the total length of stay at the stroke center. RESULTS Both IVT and MT treatment groups showed improved FIM-motor and PASS scores over time; however, only the IVT EM group had significantly improved FIM-motor performance within 1 month after stroke than the control group. Conclusion. An EM protocol with the same intervention time and session frequency per day as in the standard care protocol was effective in improving the functional ability of stroke patients after IVT.
Collapse
Affiliation(s)
- Hsiao-Ching Yen
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Guan-Shuo Pan
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center & Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
2
|
Gu M, Huang H. Effect of early rehabilitation nursing on neurological function and quality of life of patients with hemiplegia after stroke: A meta-analysis. Medicine (Baltimore) 2023; 102:e34919. [PMID: 37653810 PMCID: PMC10470741 DOI: 10.1097/md.0000000000034919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Meta-analysis was used to systematically evaluate the effects of early rehabilitation nursing on neurological function and quality of life of patients with hemiplegia after stroke. METHODS Literature was searched from PubMed, Web of Science, cochrane library, China National Knowledge Infrastructure, and Wanfang Database. Relevant literature up to 2022 was screened, followed by data extraction and quality evaluation. Next, Stata17.0 was employed for meta-analysis. RESULTS A total of 18 articles, including 1631 subjects, were enrolled in this study. The control group subjects (n = 825) received routine nursing, and the observation group subjects (n = 806) underwent early rehabilitation nursing. The results of meta-analysis showed that early rehabilitation nursing could significantly improve neurological function the National Institute of Health Stroke Scale [standardized mean difference (SMD) = -1.623, 95% confidence interval (CI) (-2.280, -0.967), P < .001], Fugl-Meyer assessment [SMD = 2.688, 95% CI (1.767, 3.608), P < .001], cure rate [relative risk = 1.333, 95% CI (1.138, 1.562), P < .001], quality of life activity of daily living [SMD = 1.784, 95% CI (0.791, 2.777), P < .001], Barthel index [SMD = 1.617, 95% CI (1.138, 2.096), P < .001] and nursing satisfaction [relative risk = 1.191, 95% CI (1.091, 1.300), P < .001] in patients with hemiplegia after stroke. There was no obvious publication bias for the included articles in this research. CONCLUSION Compared with the controls, early rehabilitation nursing can effectively improve neurological function and quality of life of patients with hemiplegia after stroke. This study provides a theoretical basis for the clinical application of early rehabilitation nursing in patients with hemiplegia after stroke.
Collapse
Affiliation(s)
- Minghuan Gu
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hong Huang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
3
|
Geng H, Li M, Tang J, Lv Q, Li R, Wang L. Early Rehabilitation Exercise after Stroke Improves Neurological Recovery through Enhancing Angiogenesis in Patients and Cerebral Ischemia Rat Model. Int J Mol Sci 2022; 23:ijms231810508. [PMID: 36142421 PMCID: PMC9499642 DOI: 10.3390/ijms231810508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Among cerebrovascular diseases, ischemic stroke is a leading cause of mortality and disability. Thrombolytic therapy with tissue plasminogen activator is the first choice for clinical treatment, but its use is limited due to the high requirements of patient characteristics. Therefore, the choice of neurological rehabilitation strategies after stroke is an important prevention and treatment strategy to promote the recovery of neurological function in patients. This study shows that rehabilitation exercise 24 h after stroke can significantly improve the neurological function (6.47 ± 1.589 vs. 3.21 ± 1.069 and 0.76 ± 0.852), exercise ability (15.68 ± 5.95 vs. 162.32 ± 9.286 and 91.18 ± 7.377), daily living ability (23.37 ± 5.196 vs. 66.95 ± 4.707 and 6.55 ± 2.873), and quality of life (114.39 ± 7.772 vs. 168.61 ± 6.323 and 215.95 ± 10.977) of patients after 1 month and 3 months, and its ability to promote rehabilitation is better than that of rehabilitation exercise administered to patients 72 h after stroke (p < 0.001). Animal experiments show that treadmill exercise 24 h after middle cerebral artery occlusion and reperfusion can inhibit neuronal apoptosis, reduce the volume of cerebral infarction on the third (15.04 ± 1.07% vs. 30.67 ± 3.06%) and fifth (8.33 ± 1.53% vs. 30.67 ± 3.06%) days, and promote the recovery of neurological function on the third (7.22 ± 1.478 vs. 8.28 ± 1.018) and fifth (4.44 ± 0.784 vs. 6.00 ± 0.767) days. Mechanistic studies have shown that treadmill exercise increases the density of microvessels, regulates angiogenesis, and promotes the recovery of nerve function by upregulating the expression of vascular endothelial growth factor and laminin. This study shows that rehabilitation exercise 24 h after stroke is conducive to promoting the recovery of patients’ neurological function, and provides a scientific reference for the clinical rehabilitation of stroke patients.
Collapse
Affiliation(s)
- Huixia Geng
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health Sciences, Henan University, Kaifeng 475004, China
| | - Min Li
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health Sciences, Henan University, Kaifeng 475004, China
| | - Jing Tang
- The School of Life Sciences, Henan University, Kaifeng 475000, China
| | - Qing Lv
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health Sciences, Henan University, Kaifeng 475004, China
| | - Ruiling Li
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health Sciences, Henan University, Kaifeng 475004, China
- Correspondence: (R.L.); (L.W.); Tel.: +86-371-2388-7799 (R.L. & L.W.)
| | - Lai Wang
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health Sciences, Henan University, Kaifeng 475004, China
- The School of Life Sciences, Henan University, Kaifeng 475000, China
- Correspondence: (R.L.); (L.W.); Tel.: +86-371-2388-7799 (R.L. & L.W.)
| |
Collapse
|
4
|
Sayyah M, Seydyousefi M, Moghanlou AE, Metz GAS, Shamsaei N, Faghfoori MH, Faghfoori Z. Activation of BDNF- and VEGF-mediated Neuroprotection by Treadmill Exercise Training in Experimental Stroke. Metab Brain Dis 2022; 37:1843-1853. [PMID: 35596908 DOI: 10.1007/s11011-022-01003-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 04/21/2022] [Indexed: 12/01/2022]
Abstract
Early treatment of ischemic stroke is one of the most effective ways to reduce brains' cell death and promote functional recovery. This study was designed to examine the effect of aerobic exercise on post ischemia/reperfusion injury on concentration and expression of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) after inducing a neuronal loss in CA1 region of hippocampus in Male Wistar rats. Three experimental groups including sham(S), ischemia/reperfusion-control (IRC) and ischemia/reperfusion exercise (IRE) were used for this purpose. The rats in the IRE group received a bilateral carotid artery occlusion treatment. They ran for 45 minutes on a treadmill five days per week for eight consecutive weeks. Cresyl violet (Nissl), Hematoxylin (H & E) and Eosin staining procedure were used to determine the extent of damage. A ladder rung walking task was used to assess the functional impairments and recovery after the ischemic lesion. ELISA and immunohistochemistry method were employed to measure BDNF and VEGF protein expressions. The result showed that the brain ischemia/reperfusion condition increased the cell death in hippocampal CA1 neurons and impaired motor performance on the ladder rung task whereas the aerobic exercise program significantly decreased the brain cell's death and improved motor skill performance. It was concluded that ischemic brain lesion decreased the BDNF and VEGF expression. It seems that the aerobic exercise following the ischemia/reperfusion potentially promotes neuroprotective mechanisms and neuronal repair and survival mediated partly by BDNF and other pathways.
Collapse
Affiliation(s)
- Mansour Sayyah
- Clinical Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mehdi Seydyousefi
- Department of Physical Education and Sport Sciences, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran
| | | | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta, T1K 3M4, Canada
| | - Nabi Shamsaei
- Department of Physical Education and Sport Sciences, Ilam University, Ilam, Iran
| | - Mohammad Hasan Faghfoori
- Department of Medical Biotechnology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Zeinab Faghfoori
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran.
- Department of Nutrition, School of Nutrition and Food Sciences, Semnan University of Medical Sciences, Semnan, Iran.
| |
Collapse
|
5
|
Dehqanizadeh B, Mohammadi ZF, Kalani AHT, Mirghani SJ. Effect of Early Exercise on Inflammatory Parameters and Apoptosis in CA1 Area of the Hippocampus Following Cerebral Ischemia-reperfusion in Rats. Brain Res Bull 2022; 182:102-110. [DOI: 10.1016/j.brainresbull.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/28/2022]
|
6
|
Compensation of Ipsilateral Motor and Sensory Functions by Contralateral Uncrossed Pathway in a Stroke Patient With Half Brain. Am J Phys Med Rehabil 2021; 100:e4-e8. [PMID: 33534220 DOI: 10.1097/phm.0000000000001432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study reports a case of motor and sensory function recovery after massive left cerebral infarction in a young man, along with preserved function of the injured hemisphere. He received early rehabilitation therapy in a nerval care unit within 1 wk of surgery, and the rehabilitation lasted for more than 3 yrs. When he gradually recovered from coma, his motor, sensory, and speech functions improved significantly. Two years later, he was able to live independently and returned to work. The findings of functional magnetic resonance imaging, diffusion tensor imaging, somatosensory evoked potential, and motor evoked potential confirmed that there was a strong connection between his right brain and the right limbs. Thus, early rehabilitation is a promising approach for restoring motor and sensory function after massive brain injury or extensive brain tissue damage.
Collapse
|
7
|
Zhang L, Yang X, Yin M, Yang H, Li L, Parashos A, Alawieh A, Feng W, Zheng H, Hu X. An Animal Trial on the Optimal Time and Intensity of Exercise after Stroke. Med Sci Sports Exerc 2021; 52:1699-1709. [PMID: 32102062 DOI: 10.1249/mss.0000000000002318] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Although exercise is a safe, cost-effective, and therapeutic poststroke therapy, the proper time window and dosage of exercise are still unknown. We aim to determine the optimal combination of time window and intensity of exercise by assessing infarct volume, neurological recovery, and underlying mechanisms in middle cerebral artery occlusion rats. METHODS The study contains two parts: the time-window and the dosage experiments. The time-window experiment assessed the effects of moderate-intensity exercise that was initiated at 24, 48, 72, 96 h and the control. In the dosage experiment, moderate and another two intensity exercise groups (low, high) were assessed. Forced wheel running was the exercise technique used. Infarct volume and neurological function (modified neurological severity scores [mNSS]) were measured. Inflammatory cytokines, cell death, and proliferation were further detected in the ischemic penumbra. RESULTS The time window part revealed that neither infarct volume nor mNSS was reduced in the exercise group initiated at 24 h. The other three groups with exercise initiated after 24 h had reduced infarct volume and reduced mNSS but those outcomes do not differ from each other. In the dosage part, the low- and moderate-intensity groups with exercise initiated at 48 h were both better than the high-intensity group in terms of infarct volume and mNSS at 14 d; however, there was no statistical difference between these low and moderate groups. Exercise initiated at 24 h or high-intensity promoted proinflammatory cytokines and cell death. CONCLUSIONS Exercise at 24 h is harmful. Low- and moderate-intensity exercise initiated at 48 h poststroke appears to be the optimal combination for maximal functional recovery.
Collapse
Affiliation(s)
- Liying Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, CHINA
| | - Xiaofeng Yang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, CHINA
| | - Mingyu Yin
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, CHINA
| | - Huaichun Yang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, CHINA
| | - Lili Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, CHINA
| | - Alexandra Parashos
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Ali Alawieh
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC
| | - Haiqing Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, CHINA
| | - Xiquan Hu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, CHINA
| |
Collapse
|
8
|
Arida RM, Teixeira-Machado L. The Contribution of Physical Exercise to Brain Resilience. Front Behav Neurosci 2021; 14:626769. [PMID: 33584215 PMCID: PMC7874196 DOI: 10.3389/fnbeh.2020.626769] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022] Open
Abstract
Increasing attention has been given to understanding resilience to brain diseases, often described as brain or cognitive reserve. Among the protective factors for the development of resilience, physical activity/exercise has been considered to play an important role. Exercise is known to induce many positive effects on the brain. As such, exercise represents an important tool to influence neurodevelopment and shape the adult brain to react to life's challenges. Among many beneficial effects, exercise intervention has been associated with cognitive improvement and stress resilience in humans and animal models. Thus, a growing number of studies have demonstrated that exercise not only recovers or minimizes cognitive deficits by inducing better neuroplasticity and cognitive reserve but also counteracts brain pathology. This is evidenced before disease onset or after it has been established. In this review, we aimed to present encouraging data from current clinical and pre-clinical neuroscience research and discuss the possible biological mechanisms underlying the beneficial effects of physical exercise on resilience. We consider the implication of physical exercise for resilience from brain development to aging and for some neurological diseases. Overall, the literature indicates that brain/cognitive reserve built up by regular exercise in several stages of life, prepares the brain to be more resilient to cognitive impairment and consequently to brain pathology.
Collapse
Affiliation(s)
- Ricardo Mario Arida
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil
| | | |
Collapse
|
9
|
Zhang P, Yang L, Li G, Jin Y, Wu D, Wang QM, Huang P. Agrin Involvement in Synaptogenesis Induced by Exercise in a Rat Model of Experimental Stroke. Neurorehabil Neural Repair 2020; 34:1124-1137. [PMID: 33135566 DOI: 10.1177/1545968320969939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Agrin is a proteoglycan that aggregates nicotinic acetylcholine receptors (AChRs) on neuromuscular junctions and takes part in synaptogenesis in the development of the central nervous system. However, its effects on neural repair and synaptogenesis after stroke are still unclear. OBJECTIVE This study aimed to investigate the effects of agrin on neural repair and synaptogenesis after stroke and the effects of exercise on this process in vivo and in vitro. METHODS Exercise with gradually increased intensity was initiated at 1 day after middle cerebral artery occlusion (MCAO) for a maximum of 14 days. Neurological deficit scores and foot fault tests were used to assess the behavioral recovery. Western blotting, immunofluorescence, and electron microscopic images were used to detect the expression of agrin, synaptogenesis-related proteins, and synaptic density in vivo. In vitro, the ischemic neuron model was established via oxygen-glucose deprivation (OGD). The lentivirus overexpressed agrin and CREB inhibitor were used to investigate the mechanism by which agrin promoted synaptogenesis. RESULTS Exercise promoted behavioral recovery and this beneficial role was linked to the upregulated expression of agrin and increased synaptic density. Overexpressed agrin promoted synaptogenesis in OGD neuron, CREB inhibitor downregulated the expression of agrin and hampered synaptogenesis in cultured neurons. CONCLUSIONS These results indicated that exercise poststroke improved the recovery of behavioral function after stroke. Synaptogenesis was an important and beneficial factor, and agrin played a critical role in this process and could be a potential therapeutic target for the treatment of stroke and other nervous system diseases.
Collapse
Affiliation(s)
- Pengyue Zhang
- Yunnan University of Traditional Chinese Medicine, Kunming, China.,Kunming University of Science and Technology, Kunming, China
| | - Liqiang Yang
- Kunming University of Science and Technology, Kunming, China
| | - Guangxiang Li
- Kunming University of Science and Technology, Kunming, China
| | - Yaju Jin
- Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Danli Wu
- Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Qing Mei Wang
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Peidong Huang
- Yunnan University of Traditional Chinese Medicine, Kunming, China
| |
Collapse
|
10
|
Kinoshita T, Yoshikawa T, Nishimura Y, Kamijo YI, Arakawa H, Nakamura T, Hashizaki T, Hoekstra SP, Tajima F. Mobilization within 24 hours of new-onset stroke enhances the rate of home discharge at 6-months follow-up: a prospective cohort study. Int J Neurosci 2020; 131:1097-1106. [PMID: 32449874 DOI: 10.1080/00207454.2020.1774578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND/OBJECTIVE Previous research indicates a better improvement of functional independence measure (FIM) at discharge in acute-stroke patients who received physiatrist and registered therapist operating rehabilitation (PROr) within 24 hrs compared with those who received after 24 hrs was reported. The aim of this prospective cohort study was to determine whether PROr provided within 24 hrs for new-onset stroke patients affects home-discharge rate at 6 months later. METHODS Acute new-onset stroke patients admitted to our hospital and received PROr (n = 227) and were conducted into 3 categories based on the time until starting PROr; within 24 hrs (very early mobilization; VEM; n = 47), 24-48 hrs (early mobilization; EM; n = 77) and >48 hrs (later mobilization; LM; n = 103). Home-discharge rates as well as changes in FIM, and rates of recurrence and mortality during the 6-month follow-up were assessed. RESULTS A total of 139 patients [VEM (n = 32), EM (n = 43), LM (n = 64)] could be followed throughout the 6-month period. The home-discharge rate was ∼80% and significantly higher by ∼20% in VEM than EM. The gains in the motor subscale of FIM at 6 months were significantly higher in VEM than LM, while the mortality and recurrent rates were not significantly different among the categories. CONCLUSIONS Starting PROr within 24 hrs of new-onset stroke may help to increase home-discharge rates at 6-month follow-up, simultaneously with a higher FIM. Very early mobilization in our hospital did not increase the risks of recurrence or death.
Collapse
Affiliation(s)
- Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tatsuya Yoshikawa
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, Morioka, Japan
| | - Yoshi-Ichiro Kamijo
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hideki Arakawa
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Nakamura
- Department of Rehabilitation Medicine, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takamasa Hashizaki
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Sven P Hoekstra
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
11
|
Effect of Early and Intensive Rehabilitation after Ischemic Stroke on Functional Recovery of the Lower Limbs: A Pilot, Randomized Trial. J Stroke Cerebrovasc Dis 2020; 29:104649. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104649] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/25/2019] [Accepted: 01/06/2020] [Indexed: 01/16/2023] Open
|
12
|
The beneficial role of early exercise training following stroke and possible mechanisms. Life Sci 2018; 198:32-37. [DOI: 10.1016/j.lfs.2018.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 12/21/2022]
|
13
|
Coleman ER, Moudgal R, Lang K, Hyacinth HI, Awosika OO, Kissela BM, Feng W. Early Rehabilitation After Stroke: a Narrative Review. Curr Atheroscler Rep 2017; 19:59. [PMID: 29116473 PMCID: PMC5802378 DOI: 10.1007/s11883-017-0686-6] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Despite current rehabilitative strategies, stroke remains a leading cause of disability in the USA. There is a window of enhanced neuroplasticity early after stroke, during which the brain's dynamic response to injury is heightened and rehabilitation might be particularly effective. This review summarizes the evidence of the existence of this plastic window, and the evidence regarding safety and efficacy of early rehabilitative strategies for several stroke domain-specific deficits. RECENT FINDINGS Overall, trials of rehabilitation in the first 2 weeks after stroke are scarce. In the realm of very early mobilization, one large and one small trial found potential harm from mobilizing patients within the first 24 h after stroke, and only one small trial found benefit in doing so. For the upper extremity, constraint-induced movement therapy appears to have benefit when started within 2 weeks of stroke. Evidence for non-invasive brain stimulation in the acute period remains scant and inconclusive. For aphasia, the evidence is mixed, but intensive early therapy might be of benefit for patients with severe aphasia. Mirror therapy begun early after stroke shows promise for the alleviation of neglect. Novel approaches to treating dysphagia early after stroke appear promising, but the high rate of spontaneous improvement makes their benefit difficult to gauge. The optimal time to begin rehabilitation after a stroke remains unsettled, though the evidence is mounting that for at least some deficits, initiation of rehabilitative strategies within the first 2 weeks of stroke is beneficial. Commencing intensive therapy in the first 24 h may be harmful.
Collapse
Affiliation(s)
- Elisheva R Coleman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA.
| | - Rohitha Moudgal
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kathryn Lang
- Department of Rehabilitation Services, University of Cincinnati, Cincinnati, OH, USA
| | - Hyacinth I Hyacinth
- Aflac Cancer and Blood Disorder Center of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, GA, USA
| | - Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
14
|
Carter CJ. Genetic, Transcriptome, Proteomic, and Epidemiological Evidence for Blood-Brain Barrier Disruption and Polymicrobial Brain Invasion as Determinant Factors in Alzheimer's Disease. J Alzheimers Dis Rep 2017; 1:125-157. [PMID: 30480234 PMCID: PMC6159731 DOI: 10.3233/adr-170017] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Diverse pathogens are detected in Alzheimer's disease (AD) brains. A bioinformatics survey showed that AD genome-wide association study (GWAS) genes (localized in bone marrow, immune locations and microglia) relate to multiple host/pathogen interactomes (Candida albicans, Cryptococcus neoformans, Bornavirus, Borrelia burgdorferri, cytomegalovirus, Ebola virus, HSV-1, HERV-W, HIV-1, Epstein-Barr, hepatitis C, influenza, Chlamydia pneumoniae, Porphyrymonas gingivalis, Helicobacter pylori, Toxoplasma gondii, Trypanosoma cruzi). These interactomes also relate to the AD hippocampal transcriptome and to plaque or tangle proteins. Upregulated AD hippocampal genes match those upregulated by multiple bacteria, viruses, fungi, or protozoa in immunocompetent cells. AD genes are enriched in GWAS datasets reflecting pathogen diversity, suggesting selection for pathogen resistance, as supported by the old age of AD patients, implying resistance to earlier infections. APOE4 is concentrated in regions of high parasitic burden and protects against childhood tropical infections and hepatitis C. Immune/inflammatory gain of function applies to APOE4, CR1, and TREM2 variants. AD genes are also expressed in the blood-brain barrier (BBB), which is disrupted by AD risk factors (age, alcohol, aluminum, concussion, cerebral hypoperfusion, diabetes, homocysteine, hypercholesterolemia, hypertension, obesity, pesticides, pollution, physical inactivity, sleep disruption, smoking) and by pathogens, directly or via olfactory routes to basal-forebrain BBB control centers. The BBB benefits from statins, NSAIDs, estrogen, melatonin, memantine, and the Mediterranean diet. Polymicrobial involvement is supported by upregulation of bacterial, viral, and fungal sensors/defenders in the AD brain, blood, or cerebrospinal fluid. AD serum amyloid-β autoantibodies may attenuate its antimicrobial effects favoring microbial survival and cerebral invasion leading to activation of neurodestructive immune/inflammatory processes, which may also be augmented by age-related immunosenescence. AD may thus respond to antibiotic, antifungal, or antiviral therapy.
Collapse
|
15
|
The Effects of Early Exercise on Motor, Sense, and Memory Recovery in Rats With Stroke. Am J Phys Med Rehabil 2017; 96:e36-e43. [PMID: 27977432 DOI: 10.1097/phm.0000000000000670] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Exercise is an effective, inexpensive, home-based, and accessible intervention strategy for stroke treatment, and early exercise after stroke has attracted a great deal of attention in recent years. However, the effects of early exercise on comprehensive functional recovery remain poorly understood. The present study investigated the effect of early exercise on motor, sense, balance, and spatial memory recovery. DESIGN Adult Sprague-Dawley rats were subjected to unilateral middle cerebral artery occlusion (MCAO) and were randomly divided into early exercise group (EE), non-exercise group (NE), and sham group. EE group received 2 weeks of exercise training initiated at 24 hours after operation. The recovery of motor, sense, and balance function was evaluated every 3 days after MCAO. Spatial memory recovery was detected from 21 to 25 days after MCAO. RESULTS The results showed that early exercise significantly promoted the motor and spatial memory recovery with statistical differences. The rats in EE group have a better recovery in sense and balance function, but there is no statistically significant difference about these results. CONCLUSION Our results showed that early moderate exercise can significantly promote motor and spatial memory recovery, but not the sense and balance functions.
Collapse
|