The Impact of Progressive Rehabilitation Nursing on Physical Rehabilitation and Quality of Life in Patients with Cerebral Infarction

Aim

Cerebral infarction, a common type of stroke, results from a sudden interruption of blood flow to the brain, leading to a myriad of challenges and complications for patients. Among these complications, decreased muscle strength is a prominent issue that can have profound implications for patients' overall well-being and functional independence. Decreased muscle strength in cerebral infarction often manifests as weakness, loss of mobility, and impaired ability to perform activities; the psychological impact of these physical limitations can lead to anxiety and depression, further exacerbating the patient's condition. To investigate the effect of progressive rehabilitation nursing on the physical rehabilitation and quality of life of patients with cerebral infarction, to provide valuable insights and guidance for enhancing the functional recovery of individuals affected by cerebral infarction.

Design

100 cerebral infarction patients combined with decreased muscle strength admitted to our hospital between October 2019 and October 2020 were randomly selected as the study subjects for prospective analysis.

Methods

They were divided into a control group (n = 50) and an experimental group (n = 50) using the random number table method. Patients in the control group underwent rehabilitation treatment, while patients in the experimental group underwent progressive rehabilitation nursing intervention guided by quality nursing intervention. The Fugl-Meyer Assessment (FMA) motor function score, National Institute of Health Stroke Scale (NIHSS) neurological function score, Barthel Index (BI), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores, nursing efficiency and the incidence rate of adverse mood after 1, 2 and 3 weeks of nursing were recorded and compared between the two groups.

Results

The FMA and BI index scores of patients in the experimental group were notably higher than those in the control group, and the comparison was statistically significant (P < .05); The NIHSS, SAS and SDS scores of patients in the experimental group were notably lower than those of the control group, and the results of the comparison were statistically significant (P < .05); The nursing efficiency and nursing satisfaction of patients in the experimental group was remarkably higher, and the results of the comparison were statistically significant (P < .05); The incidence of bad mood in the experimental group was significantly lower than that in the control group after 1, 2 and 3 weeks of nursing, and the incidence rate of adverse mood in the experimental group was improved with time, that is, 1>2>3 weeks in descending order (P < .05).

Patient or Public Contribution

Progressive rehabilitation nursing not only enhances muscle strength and restores their physical functions to a certain extent while reducing the incidence of adverse reactions and physical function but also mitigates the risk of adverse mood states. Ultimately, it contributes to an improved overall quality of life and psychological well-being of patients affected by cerebral infarction.

Combined Effects of Transcranial Magnetic Stimulation and Argatroban on Balance Function and Daily Living Activities in Hemiplegic Patients Following Cerebral Infarction

Objective

This study aimed to investigate the impact of combining transcranial magnetic stimulation (TMS) with argatroban on balance function and activities of daily living in patients with hemiplegia following cerebral infarction (CI).

Methods

A retrospective analysis was conducted on the clinical data of 104 patients with hemiplegia after CI who were admitted to our hospital from July 2020 to July 2021. The patients were randomly assigned to either the experimental group (EG) or the control group (CG), with 52 patients in each group. The EG received TMS in combination with argatroban, while the CG received argatroban alone. The Berg Balance Scale (BBS) and modified Barthel index (BI) were used to assess the balance function and activities of daily living in both groups after treatment.

Results

After treatment, the EG demonstrated significantly higher BBS and BI scores compared to the CG (P < .001). Additionally, the EG showed significantly improved upper limb and lower limb Functional Ambulation Profile (FAM) scores compared to the CG (P < .05).

Conclusions

The combination of TMS and argatroban proves to be an effective approach for enhancing balance function and activities of daily living in hemiplegic patients with CI. Therefore, it is recommended as a valuable rehabilitation treatment for such patients.

Assessing the effect of transcranial magnetic stimulation on peak cough flow in patients with supratentorial cerebral infarction: A retrospective cohort study

Respiratory dysfunction following supratentorial cerebral infarction leads to pneumonia and is a major cause of mortality. Decreased voluntary cough function impairs the ability to clear mucus or secretions from the airways and increases the risk of aspiration pneumonia. Peak cough flow (PCF) is one of the objective tools for evaluating voluntary cough function. Repetitive transcranial magnetic stimulation (rTMS) could be applied to the respiratory motor cortex to improve respiratory function. Little is known about the effect of rTMS on PCF in patients with supratentorial cerebral infarction during the subacute period. This study aimed to determine whether rTMS treatment could improve PCF in patients with supratentorial cerebral infarction. We retrospectively recruited patients with subacute supratentorial cerebral infarction who underwent a PCF test. The rTMS group received a combination of rTMS treatment for 2 weeks and conventional rehabilitation for 4 weeks. However, the control group underwent only conventional rehabilitation for 4 weeks. PCF tests were performed before and after treatment and the results were compared between the 2 groups. In total, 145 patients with supratentorial cerebral infarctions were recruited. The PCF parameters before and after treatment increased in both the rTMS and control groups. However, the rTMS group showed a greater increase in PCF values compared with the control group. In patients with supratentorial cerebral infarction, the combination of conventional rehabilitation and rTMS in the subacute period may be helpful in improving voluntary cough function compared with conventional rehabilitation alone.

Effects of atrial fibrillation on motor outcome in patients with cerebral infarction

BACKGROUND

Atrial fibrillation (AF) has been a leading cause of cerebral infarction, but the association with motor outcome after cerebral infarction remains unreported. In this study, we attempted to identify whether AF affects motor outcomes after cerebral infarction.

METHODS

Seventy-six patients with a first-incidence cerebral infarction and who completed 6 months of rehabilitation were recruited to this retrospective study. The patients were divided into two groups based on the presence of AF (AF and non-AF groups). The upper extremity motricity index, lower extremity motricity index (LMI), modified Brunnstrom classification, and functional ambulation category (FAC) were evaluated, and those results were obtained within the first day and after 6 months of onset. Clinical factors that could affect motor outcome after cerebral infarction were also obtained.

RESULTS

Compared with the non-AF group, the AF group had an upper extremity motricity index (47.15 ± 20.30 vs 58.66 ± 19.19; P = .032), LMI (53.42 ± 12.27 vs 65.58 ± 13.86; P = .001), and FAC scores (2.39 ± 0.93 vs 3.35 ± 0.93; P < .001) at 6 months after onset. Moreover, the AF group showed a lower FAC score gain than the non-AF group at 6 months after onset (2.33 ± 0.95 vs 3.28 ± 0.94; P < .001). Multivariate linear regression analyses showed that presence of AF had negative correlation with LMI gain (β = -0.197; P = .010) and FAC gain (β = -0.254; P = .011).

CONCLUSION

We observed that AF had a negative effect on the motor outcome of the affected leg and the recovery of gait function in patients with cerebral infarction.

Acupuncture-Moxibustion Combined with Rehabilitation Training Is Conducive to Improving the Curative Effect, Cognitive Function, and Daily Activities of Patients with Cerebral Infarction

Objective

To elucidate the effect of acupuncture-moxibustion combined with rehabilitation training (RHT) on the curative effect, cognitive function (CF), and activities of daily living (ADL) of patients with cerebral infarction (CI).

Methods

This study enrolled 150 patients with CI admitted to the Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University from June 2020 to July 2021. Among them, 80 patients who were treated with acupuncture-moxibustion combined with RHT were included in the research group, and 70 patients who received acupuncture-moxibustion alone were included in the control group. The efficacy, CF, and ADL were observed in both groups, and the influences of the two therapies on serum uric acid (UA), high-sensitivity C-reactive protein (hs-CRP), and cystatin C (Cys-C) were compared. Among the various indexes, the CF of patients was assessed by the Montreal Cognitive Assessment (MoCA), and the ADL was evaluated by the Barthel index.

Results

After treatment, the research group presented significantly better efficacy, CF, and ADL than the control group, with lower levels of serum UA, hs-CRP, and Cys-C than the control group and before treatment.

Conclusion

Acupuncture-moxibustion combined with RHT can inhibit serum UA, hs-CRP, and Cys-C levels of patients with CI while improving the curative effect, CF, and ADL, which is worthy of clinical promotion.

Effects of paired associated stimulation with different stimulation position on motor cortex excitability and upper limb motor function in patients with cerebral infarction

OBJECTIVE

To investigate the effects of paired associated stimulation (PAS) with different stimulation position on motor cortex excitability and upper limb motor function in patients with cerebral infarction.

METHOD

A total of 120 volunteers with cerebral infarction were randomly divided into four groups. Based on conventional rehabilitation treatment, the PAS stimulation group was given the corresponding position of PAS treatment once a day for 28 consecutive days. The MEP amplitude and RMT of both hemispheres were assessed before and after treatment, and a simple upper limb Function Examination Scale (STEF) score, simplified upper limb Fugl-Meyer score (FMA), and improved Barthel Index (MBI) were used to assess upper limb motor function in the four groups.

RESULTS

Following PAS, the MEP amplitude decreased, and the RMT of abductor pollicis brevis (APB) increased on the contralesional side, while the MEP amplitude increased and the RMT of APB decreased on the ipsilesional side. After 28 consecutive days the scores of STEF, FMA, and MBI in the bilateral stimulation group were significantly better than those in the ipsilesional stimulation group and the contralesional stimulation group, but there was no significant difference in the scores of STEF, FMA, and MBI between the ipsilesional stimulation group and the contralesional stimulation group.

CONCLUSION

The excitability of the motor cortex can be changed when the contralesional side or the ipsilesional side was given the corresponding PAS stimulation, while the bilateral PAS stimulation can more easily cause a change of excitability of the motor cortex, resulting in better recovery of the upper limb function.

Motor recovery by the aberrant pyramidal pathway in a patient with cerebral infarct

INTRODUCTION

The aberrant pyramidal tract (APT) refers to the collateral pathway of the pyramidal tract (PT) descending through the medial lemniscus in the midbrain and pons. We report on a patient who showed changes of the APT from the early stage to the chronic stage concurrent with motor recovery following an infarct in the cerebral peduncle.

PATIENT CONCERNS

An 84-year-old female patient presented with moderate motor weakness of her upper and lower extremities (2/2) due to cerebral infarct on the right cerebral peduncle of midbrain. One week after her stroke, her motor weakness was similar to that at the onset (2/2). During 5 weeks' rehabilitation, her motor weakness recovered to the point that she was able to move upper and lower extremities against gravity with some resistance (4/4).

DIAGNOSIS

Cerebral infarct on the right cerebral peduncle of midbrain INTERVENTIONS:: She participated in a comprehensive rehabilitative management program, including movement therapy, neurotrophic drugs, and neuromuscular electrical stimulation therapy of the left finger extensor and ankle dorsiflexor muscles.

OUTCOMES

On 1-week and 6-week diffusion tensor tractographys (DTTs), the right PT was not reconstructed, but the right APT, which descended through the medial lemniscus pathway at the midbrain and pons and the pyramid at the medulla, was observed. The right APT became thicker on six-week DTT compared with 1-week DTT. On 1-week transcranial magnetic stimulation study, an motor evoked potential with delayed latency and decreased amplitude was evoked from the affected (right) hemisphere (latency: 24.4 msec and amplitude: 0.2uV). In contrast, its latency was decreased and amplitude was increased on six-week transcranial magnetic stimulation study (latency: 21.8 msec, amplitude: 0.8 uV) CONCLUSIONS:: We demonstrated changes in the APT from the early stage to the chronic stage concurrent with motor recovery in a patient with an infarct in the cerebral peduncle. Our findings have important implications that a spared APT could contribute to the motor recovery in patients with cerebral infarct when the PTis completely injured at the onset of cerebral infarct,.

Relationship between recovery of motor function and neuropsychological functioning in cerebral infarction patients: the importance of social functioning in motor recovery

Impaired motor function is a common disabling sequela after stroke. It is closely associated with the patient's quality of life and independence. Neuropsychological dysfunctions also frequently occur in stroke patients. In this paper, we evaluate the relationship between the recovery of motor function and neuropsychological functions, including cognition, language, emotion, behavior, personality, and social interaction, to provide appropriate and effective therapy for stroke patients. Motor function, neuropsychological status, social functioning, as well as emotional aspects such as depression and anxiety symptoms, were initially evaluated one month after cerebral infarction onset. The evaluations were repeated three months after the onset. Motor function was assessed with the Modified Barthel Index. The neuropsychological status was evaluated using the Mini-Mental State Examination, Global Deterioration Scale, digit span test, Korean-Boston Naming Test, Vineland Social Maturity Scale, Neuropsychiatric Inventory, Beck's Depression Inventory, and Beck Anxiety Inventory. In the results, the Modified Barthel Index, Mini-Mental State Examination, Global Deterioration Scale, digit span test, and Vineland Social Maturity Scale were significantly different between the two-time points (P < 0.05). Initial Social Maturity Scale Social Age and Social Maturity Scale Social Quotient categories of the Vineland Social Maturity Scale and Mini-Mental State Examination scores were significantly correlated with Modified Barthel Index improvement (P < 0.05). The amount of change in the Social Maturity Scale Social Age and Social Maturity Scale Social Quotient scores was significantly correlated with Modified Barthel Index improvement (P < 0.05). In multiple linear regression analysis, only the initial Social Maturity Scale Social Quotient score and the amount of score change in Social Maturity Scale Social Quotient showed a significant correlation with Modified Barthel Index improvement (P < 0.05). Social function and interaction are important in motor recovery of ischemic stroke patients.

[Influence of Pre-existing Cognitive Impairment on Rehabilitation Outcomes in Patients with Cerebral Infarction]

BACKGROUND AND PURPOSE

The present study determined the effects of pre-existing cognitive impairment (PreCI) on the rehabilitation outcomes in patients with cerebral infarction.

METHODS

From June 2013 to August 2015, we classified 52 patients with unilateral cerebral hemispheric infarction into the PreCI and non-PreCI group based on three-dimensional stereotactic surface projection (3D-SSP) cerebral blood flow (CBF) decrease images and the past history of dementia. Furthermore we investigated the related clinical factors and functional independence measure (FIM).

RESULTS

1. Multivariate analysis revealed that the most important factors that affect total FIM at discharge were age, National institutes of Health Stroke Scale (NIHSS) and the Mini-Mental State Examination (MMSE) (R²=0.756). 2. The mean CBF values (P<0.05) were significantly associated with lesion volume, (P<0.001, P<0.05), the NIHSS score (P<0.001, P<0.01), the MMSE score (P<0.001, P<0.005), and total FIM (P<0.005, P<0.05) at discharge. 3. Both cognitive and motor FIM at discharge were significantly lower in the PreCI group (P<0.005, P<0.005). 4. The MMSE score of ZSAM abnormal group was significantly lower in the case of NIHSS score<10 of lesion and non lesion sides.

CONCLUSIONS

PreCI, age, and neurological severity, affected the outcomes of stroke rehabilitation Therefore, the diagnosis of PreCI is considered important for effective stroke rehabilitation. (Received August 3, 2017; Accepted February 9, 2018; Published June 1, 2018).

Effects of action observation therapy on upper extremity function, daily activities and motion evoked potential in cerebral infarction patients

BACKGROUND

The aim of this study was to explore the effects of action observation therapy on motor function of upper extremity, activities of daily living, and motion evoked potential in cerebral infarction patients.

METHOD

Cerebral infarction survivors were randomly assigned to an experimental group (28 patients) or a control group (25 patients). The conventional rehabilitation treatments were applied in both groups, but the experimental group received an additional action observation therapy for 8 weeks (6 times per week, 20 minutes per time). Fugl-Meyer assessment (FMA), Wolf Motor Function Test (WMFT), Modified Barthel Index (MBI), and motor evoked potential (MEP) were used to evaluate the upper limb movement function and daily life activity.

RESULTS

There were no significant differences between experiment and control group in the indexes, including FMA, WMFT, and MBI scores, before the intervention. However, after 8 weeks treatments, these indexes were improved significantly. MEP latency and center-motion conduction time (CMCT) decreased from 23.82 ± 2.16 and 11.15 ± 1.68 to 22.69 ± 2.11 and 10.12 ± 1.46 ms. MEP amplitude increased from 0.61 ± 0.22 to 1.25 ± 0.38 mV. A remarkable relationship between the evaluations indexes of MEP and FMA was found.

CONCLUSIONS

Combination of motion observation and traditional upper limb rehabilitation treatment technology can significantly elevate the movement function of cerebral infarction patients in subacute seizure phase with upper limb dysfunction, which expanded the application range of motion observation therapy and provided an effective therapy strategy for upper extremities hemiplegia in stroke patients.

Rehabilitation outcomes after brain injury: disability measures or goal achievement?

Background: The outcome of rehabilitation interventions following brain injury is commonly rated by disability scales. Goal-setting and achievement are important in inpatient rehabilitation, but seldom assessed as outcomes.

Objective: To compare the information acquired from using disability ratings and goal attainment/variances as outcome measures in brain injury rehabilitation.

Setting: An inpatient regional neurological rehabilitation unit.

Subjects: One hundred and seventy-seven patients admitted after single incident brain injury over a three-year period.

Main measures: (1) Disability outcomes by the Barthel Index and the Functional Independence Measure, (2) goal achievement and variance distribution, and (3) the influence of diagnosis and demographics on these measures.

Results: Patients improved significantly on all disability scales employed (p < 0.0001), with the baseline admission scores being inversely correlated with changes in dependency by discharge (rho∼0.4). The median attainment rate of long-term goals was 75% per patient. Nonachievement was most frequently due to cognitive problems (38%), followed by behavioural difficulties and physical limitations (18% each). Goal achievement correlated poorly with disability outcome at discharge (rho∼0.3). Patients who accomplished all their goals tended to be less disabled at admission. Diagnostic groups and demographic factors had little influence on either disability or goal achievement outcomes.

Conclusions: The use of a simple goal achievement and variance coding scheme has been relatively straight forward to incorporate into the daily practice of the unit. It provides useful information on rehabilitation process and outcome after brain injury that is complementary to the utilization of disability measures.

Patient- and Hospital-Level Determinants of Rehabilitation for In-Patient Stroke Care: An Observation Analysis

During acute stroke care, rehabilitation usage may be influenced by patient- and hospital-related factors. We would like to identify patient- and hospital-level determinants of population-level inpatient rehabilitation usage associated with acute stroke care.From data obtained from the claim information from the National Health Insurance Administration (NHIA) in Taiwan (2009-2011), we enrolled 82,886 stroke patients with intracerebral hemorrhage and cerebral infarction from 207 hospitals. A generalized linear mixed model (GLMM) analyses with patient-level factors specified as random effects were conducted (for cross-level interactions).The rate of rehabilitation usage was 51% during acute stroke care. The hospital-related factors accounted for a significant amount of variability (intraclass correlation, 50%). Hospital type was the only significant hospital-level variable and can explain the large amount of variability (58%). Patients treated in smaller hospitals experienced few benefits of rehabilitation services, and those with surgery in a smaller hospital used fewer rehabilitation services. All patient-level variables were significant.With GLMM analyses, we identified the hospital type and its cross-level interaction, and explained a large portion of variability in rehabilitation for stroke patients in Taiwan.

Correlation Between the Integrity of the Circle of Willis and the Severity of Initial Noncardiac Cerebral Infarction and Clinical Prognosis

The quality of collateral circulation affects the severity and prognosis of stroke patients. The effect of the circle of Willis, which is the primary collateral circulation, on ischemic stroke has attracted significant attention. This study was designed to investigate the effect of different circles of Willis types on stroke severity and prognosis in patients with noncardiac stroke.A total of 376 patients with noncardiac ischemic stroke, who were treated by the specialty team of cerebrovascular diseases at the First Affiliated Hospital of Sun Yat-sen Hospital, were successively enrolled in this study. The detailed clinical characteristics of the patients were recorded upon admission, including risk factors of vascular disease and National Institutes of Health Stroke Scale (NIHSS) scores. The patients were divided into groups of different circles of Willis types based on magnetic resonance angiography (MRA) that was performed within 3 days of admission-type I: complete circle of Willis; type II: complete anterior half of the circle of Willis and incomplete posterior half of the circle of Willis; type III: incomplete anterior half of the circle of Willis and complete posterior half of the circle of Willis; and type IV: incomplete anterior and posterior halves of the circle of Willis. Patients were re-evaluated for NIHSS scores at discharge and after discharge. The modified Rankin score (mRS) was recorded for 90 days, and stroke recurrence and death after 90 days were also recorded until the end of the study.The 376 patients were divided into 4 groups based on the MRA-type I group: 92 patients (24.5%); type II group: 215 patients (57.2%); type III group: 12 patients (3.2%), and type IV group: 57 patients (15.2%). NIHSS scores at admission and discharge were significantly lower for the type I group compared with those for the type II and type IV groups (P < 0.05). NIHSS scores were higher in the groups with an incomplete circle of Willis compared with the group with a complete circle of Willis. A poor recovery rate was highest for the type IV group, whereas a good recovery rate was highest for the type I group. The logistic regression analysis showed that a complete circle of Willis was one of the predictors of suitable recovery (odds ratio [OR] = 0.708, 95% confidence interval [CI]: 0.554-0.906).Circle of Willis type was associated with stroke severity and patient prognosis, whereas an incomplete circle of Willis was associated with more severe conditions and a higher 90-day poor diagnosis rate. A complete circle of Willis was an independent predictor of good prognosis.

[Effects of synchronous treatment of bilateral scalp acupuncture and rehabilitation training on activities of daily life in patients with cerebral infarction at acute phase]

OBJECTIVE

To observe the improvements of synchronous treatment of bilateral scalp acupuncture and rehabilitation training on activities of daily life in patients with cerebral infarction at acute phase, so as to compare the efficacy differences between scalp acupuncture at bilateral and affected side as well as differences between synchronous and non-synchronous treatment.

METHODS

Ninety patients of acute-phase cerebral infarction with motor dysfunction were randomly divided into three groups. The observation group was treated with synchronous treatment of scalp acupuncture at the Dingzhongxian (middle line of vertex), bilateral Dingnieqianxiexian (anterior oblique line of vertex-temporal) and bilateral Dingniehouxiexian (posterior oblique line of vertex-temporal) and rehabilitation training; the control group A was treated with synchronous treatment of affected scalp acupuncture at the Dingzhongxian, affected Dingnieqianxiexian and affected Dingniehouxiexian and rehabilitation training; the control group B was treated with bilateral scalp acupuncture for 4 h, followed by rehabilitation training. All the patients took the treatment once a day, and 6 days for a course of treatment for total of 4 courses. The modified Barthel index (MBI), activities of daily living (ADL) and Fugl-Meyer motor assessment (FMA) were used to perform efficacy assessment before treatment, in the 14th days of treatment and in the 28th days of treatment in three groups.

RESULTS

After treatment, three indices at each time point were superior to those before the treatment in three groups (all P<0.01) ; the improvements of ADL and FMA in the observation group after 28 days of treatment were superior to those in the control group A and control group B (all P<0.05), and the improvement of MBI was superior to that in the control group B (P<0.05).

CONCLUSION

The synchronous treatment of bilateral scalp acupuncture and rehabilitation training could significantly improve the activities of daily life and motor function in patients with cerebral infarction at acute phase, which is superior to scalp acupuncture at affected side and non-synchronous treatment.

A case for the implementation of cognitive-communication screenings in acute stroke

PURPOSE

The purpose of this article was to illustrate the importance of the implementation of cognitive-communication screenings in acute stroke and to discuss the need for further research on whether and how these screenings are implemented. Cognitive-communication screenings after stroke are the subject of existing practice guidelines and are supported by accumulated evidence.

METHOD

The author uses an autoethnographic narrative--a tool founded in phenomenology--to provide an in-depth description of the experiences of a family in which one member experienced right-hemispheric stroke. She uses systematic introspection to produce a narrative using literary techniques.

RESULTS

The narrative illustrates the experiences of one family when one of their members has a right-hemisphere stroke, and cognitive-communication impairments are never formally identified by professionals involved in the patient's care.

CONCLUSIONS

The narrative is linked to the published literature and the importance of identifying and managing cognitive-communication impairments after stroke. A model of implementation science is presented as one way to consider the challenges clinicians face when attempting to implement evidence-based practices. The model and examples from other fields show avenues for further research.

[Promotion of compound fujian tablet on the motor function rehabilitation and neurotization in rats with cerebral infarction]

OBJECTIVE

To study the effects of Compound Fujian Tablet (FJT)on the neurotization in the cerebral infarction rats and to explore its mechanisms for promoting the motor skills.

METHODS

Totally 90 Wistar rats were randomly divided into the drug group, the model group, and the sham-operation group, 30 in each group. The rat model of middle cerebral artery occlusion (MCAO) was successfully established by electrocoagulation. Six hours after successful modeling, the rats of the drug group were orally administered with 9 g/kg FJT water solution, and the other groups were orally administered with equal volume of normal saline, once a day for two weeks. The motor skills of rats were examined by beam walking test. The expressions of nestin, polysialic acid neural cell adhesion molecule (PSA-NCAM), microtubule-associated protein 2 (MAP-2), growth-associated protein (GAP-43), and synaptophysin (Syn) in the brain tissue around the infarction were observed by in immunohistochemical assay. The mean staining gray or the optical density value were detected.

RESULTS

The 86 rats were recruited in the result analysis. After two weeks of administration, the neural function scoring was obviously higher in the drug group than in the model group with statistical difference (P < 0.01). The expressions of nestin, PSA-NCAM, MAP-2, GAP-43, and Syn in the brain tissue around the infarction were more obviously enhanced in the drug group than in the model group, showing statistical difference (P < 0.01).

CONCLUSION

FJT can promote neurotization and improve the motor skill recovery after cerebral infarction.

Assisting patients with disabilities to actively perform occupational activities using battery-free wireless mice to control environmental stimulation

The latest studies have adopted software technology to turn the battery-free wireless mouse into a high performance object location detector using a newly developed object location detection program (OLDP). This study extended OLDP functionality to assess whether two patients recovering from cerebral vascular accidents would be able to actively perform occupational activities by controlling their favorite environmental stimulation using battery-free wireless mice and OLDP software. Using an ABAB design we found substantial increases in both participants' target responses (i.e. the performance of occupational activities) to activate the control system to produce environmental stimulation during intervention phrases. The practical and developmental implications of the findings are discussed.

[Randomized controlled study on rehabilitation of hemiplegia in cerebral infarction at the early stage with acupuncture and moxibustion based on meridian harmonization and zang-organ regulation]

OBJECTIVE

To explore the better therapeutic method for the treatment of hemiplegia in cerebral infarction.

METHODS

One hundred and fifty cases were randomized into a meridian-harmonization group (group A), a zang-organ regulation group (group B) and a meridian-harmonization and zang-organ regulation group (group C), 50 cases in each one. On the basis of conventional treatment, in group A, the acupoints were selected along meridians, such as Hegu (LI 4), Taichong (LR 3), Jianyu (LI 15), Waiguan (TE 5), Huantiao (GB 30) and Yanglingquan (GB 34)ect. In group B, the acupoints were selected in light of abdominal acupuncture such as Zhongwan (CV 12), Xiawan (CV 10), Qihai (CV 6), Guanyuan (CV 4), Shangqu (KI 17, healthy side) and Daheng (SP 15)etc. In group C, the acupoints in group A and group B were selected in combination. Before and after treatment, all the patients received the test of Barthel Index (BI) to assess the disability level and the simple Fugl-Meyer Motor Scale (FMMS) for the evaluation of motor function.

RESULTS

After treatment, all the three groups presented the significant improvement of BI, the down-regulation of disability rate and up-regulation of FMMS score, indicating significant differences in statistics as compared with those before treatment (P < 0.05, P < 0.01). In group C, the results of BI improvement, the down-regulation of disability rate and the improvement of limb motor function were all superior to those in either group A or group B (P < 0.05, P < 0.01).

CONCLUSION

Acupuncture in light of meridian-harmonization and zang-organ regulation is the better approach for the early-stage rehabilitation of hemiplegia in cerebral infarction and its efficacy is superior to that of either simple meridian harmonization therapy or zang-organ regulation therapy.

[Effect of electro-needling at acupoints of the yangming meridian on the expression of PAC-1 and lower limb functions in acute cerebral infarction patients]

OBJECTIVE

To observe the effect of electro-needling at acupoints of the yangming meridian on the expression of platelet associated complement-1 (PAC-1) and lower limb functions in acute cerebral infarction (ACI) patients.

METHODS

58 ACI patients were randomly assigned to the treatment group and the control group. Conventional therapies were given to all patients. Additionally, the electro-needling at acupoints of the yangming meridian was given to patients in the treatment group. Changes of PAC-1 were detected using flow cytometry. Effect of lower limbs functions of ACI patients before and after electro-needling was assessed using Fugl-Meyer Index. Meanwhile, 20 healthy subjects were selected for reference value.

RESULTS

In the acute stage, the PAC-1 level in ACI patients were significantly higher than that in healthy subjects (P<0.05). The PAC-1 level in the electro-needling group was obviously lowered after treatment (P<0.01). There was no significant difference in the control group between before and after treatment. Significant difference was found in Fugl-Meyer index in the same group between before and after two-week treatment (P<0.05). It was higher in the electro-needling group than in the control group, showing significant difference (P<0.01).

CONCLUSIONS

Platelet activation exists in the acute stage of ACI. Electro-needling at acupoints of the yangming meridian showed obvious inhibition on PAC-1 levels, could improve lower limbs functions of ACI patients. It was inferred that electro-needling at acupoints of the yangming meridian promoted the recovery of paralyzed lower limbs at the early stage mainly by regulating PAC-1 levels, thus postponing the progress of ACI.

[Billing based on a case-based lump sum for stroke. Did this lead to discharge of patients in a worse clinical condition?]

BACKGROUND

It has been supposed that the introduction of a new inpatient reimbursement system starting in 2004 in Germany using the German diagnosis-related groups (G-DRG) may lead to false incentives with encouragement of premature hospital discharge of patients. Exploring a large database on stroke patients, we addressed the question whether length of stay (LOS) and discharge in more severe condition were associated with the introduction of the G-DRG. We further examined other factors with probable effect on LOS such as variations of patient characteristics and treatment during the observation period.

PATIENTS AND METHODS

All stroke patients treated in 2003-2006 in the German state of Hesse (6,100,000 inhabitants) were assessed with respect to stroke severity, symptoms on admission and discharge, LOS and stroke-related deficits on discharge. We compared LOS and outcome in 2003 (before introduction of the G-DRG) with 2004 when the G-DRG had recently been introduced and with 2006 when the G-DRG was already well established in the clinical routine. The effects of LOS and treatment year on outcome were assessed using a logistic regression model.

RESULTS

During the observation period, we evaluated 37,396 stroke patients. The length of stay was reduced significantly from 12.2 to 10.4 days (p<0.001). Both severity of stroke on admission and outcome on discharge decreased during the observation period. A multivariate analysis revealed a minor but significant association [odds ratio (OR): 1.020 per day of hospital treatment; 95% confidence interval (CI): 1.016-1.024] of LOS on outcome. Treatment in 2006 compared to 2003 led to good outcome with an OR of 1.378 (95% CI: 1.279-1.485). Subgroup analysis limited to patients with severe stroke revealed that LOS was significantly lower in 2006 compared to 2003 also in this patient subgroup; moreover, the proportion of patients discharged with severe outcome was lower in 2006 compared to 2003.

CONCLUSIONS

This study reveals a significant reduction of LOS during the years after introduction of the G-DRG. However, reduction of LOS was not associated with more severe outcome on discharge, possibly due to changes in stroke treatment implemented during the observational period. Our results do not support the conjecture that changes in the reimbursement system were associated with compromised patient care.

[Comprehensive therapeutic protocol of electroacupuncture combined with Chinese herbs and rehabilitation training for treatment of cerebral infarction: a multi-center randomized controlled trial]

OBJECTIVE

To evaluate the therapeutic effect of comprehensive therapeutic protocol of electroacupuncture combined with active-blood-and-dissolve-stasis herbs and rehabilitation training for cerebral infarction.

METHODS

A multi-center randomized controlled trial was done, three hundred and twenty cases were divided into four groups: electroacupuncture combined with active-blood and dissolve-stasis herbs and rehabilitation training group (group A), electroacupuncture combined with rehabilitation training group (group B), herbs combined with rehabilitation training group (group C) and rehabilitation training group (group D), 80 cases in each group. The following two groups of acupoints were used alternatively in electroacupuncture treatment: the first group including Vasomotor Area, Jianyu (LI 15), Biguan (ST 31), Hegu (LI 4) and Taichong (LR 3); the second group including Motor Area, Quchi (LI 11), Yanglingquan (GB 34) and Shenshu (BL 23). 20 mL Xiangdan injection and 250 mL 5% glucose injection or 250 mL 0.9% sodium chloride injection were used by intravenous drip in herbs treatment once a day. The rehabilitation training was performed by the professional physical therapist. Each group was treated with corresponding treatment protocol. The therapeutic effect was evaluated by index of the mortality or disability rate 3 months after the onset of disease. The intention to treat analysis (ITT) was used in data.

RESULTS

The mortality or handicap rate 3 months after the onset of disease of four groups were 17.5% (14/80) in group A, 22.5% (18/80) in group B, 40. 0% (32/80) in group C, and 31.3% (25/80) in group D, respectively. The group A has a best therapeutic effect (vs group C, group D, both P<0.05), and there was no adverse event.

CONCLUSION

The combined application of electroacupuncture, active-blood and dissolve-stasis herbs and rehabilitation training is a better treatment for cerebral infarction in clinic.

Do stroke patients with intracerebral hemorrhage have a better functional outcome than patients with cerebral infarction?

OBJECTIVE

To compare the functional outcome of stroke patients with cerebral infarction (CI) and intracerebral hemorrhage (ICH) after rehabilitation.

DESIGN

Review of a prospectively maintained database of all stroke patients admitted to a rehabilitation unit during a 9.5-year period.

SETTING

Rehabilitation unit in a university hospital in Australia.

PATIENTS

A total of 718 consecutive stroke admissions (589 CI and 129 ICH) who met the inclusion criteria.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASUREMENTS

Functional Independence Measure (FIM) gain, FIM efficiency, Motor Assessment Scale (MAS) change, gait velocity, and discharge destination.

RESULTS

Patients who had ICH were more severely disabled on admission compared with patients who had CI and achieved a greater functional improvement with rehabilitation, ie, a greater FIM efficiency and a greater MAS change. Admission FIM score, admission MAS score, and length of stay were significant explanatory variables for the discharge FIM and FIM gain in both ICH and CI patients. On general linear model analyses, stroke type remained a significant explanatory factor for FIM gain, after adjusting for admission FIM, length of stay, age, and days from stroke onset to rehabilitation admission, ie, stroke patients with ICH obtained a better functional outcome than patients with CI. Admission motor FIM, admission MAS, younger age, and increasing length of stay were independent predictors for FIM gain and discharge FIM for both CI and ICH groups. Admission cognitive FIM score predicted discharge FIM for both the CI and ICH groups and FIM gain in the ICH group but was not a predictor of FIM gain for the CI group. The majority of patients in both groups went home at discharge.

CONCLUSIONS

Although patients with ICH had a greater level of disability on admission to rehabilitation, they achieved significantly greater gains in function than patients with CI after rehabilitation. This was found regardless of the severity of disability on admission.

Mental imagery for relearning of people after brain injury

OBJECTIVE

This paper reported on the application of mental imagery to the relearning of daily task performance in people with brain injury.

METHOD

The changes in two subjects who had suffered from cerebral infarction shown throughout a 3-week mental imagery programme were described. The subjects' improvement in task performance and other clinical outcomes illustrated the programme's therapeutic effects on skill relearning, maintenance and generalization.

RESULTS

After completing the programme, the subjects showed improvements in performance at both the trained and untrained tasks. Feedback from the patients also suggested its ability to enhance their day-to-day functioning. Clinical assessment results indicated that the subjects experienced an increase in the attention and sequential processing functions but not in the motor and other cognitive functions.

CONCLUSION

Mental imagery appears to be effective at enhancing the task relearning of subjects after brain injury. The skills acquired under this treatment regime can be retained and then generalized to other tasks. Its therapeutic effect is probably mediated by the improved attention and planning and execution functions associated with the rehearsal. Further research should conduct clinical controlled trials to gather evidence on its efficacy at promoting functional regain in people suffering from neurological disorders.

[Randomized controlled clinical trials for electro-spoon-needles treatment of motor dysfunction in cerebral infarction patients]

OBJECTIVE

To observe the therapeutic effect of spoon-needle cluster electrical stimulation of scalp-points for motor dysfunction of cerebral infarction (CI) patients, so as to analyze its superiority in the treatment of CI.

METHODS

A total of 164 CI inpatients with motor disturbance were randomly divided into spoon-needle cluster (SNO) group (n=84) and filiform-needle cluster (FNC) group (n80). Multiple filiform needles were inserted into the Yu's 7 scalp-points (Parietal region, Antero-parietal region, etc.), and manipulated for a while, followed by 6 hours' retention of the needles. Multiple spoon needles were fixed to the same scalp-points and then these scalp-points were stimulated with electric pulse for 30 mm. The treatment was given once daily, 6 times a week and for 4 weeks. The therapeutic effect was assessed by Fugl-Meyer assessment scale, Barthel Index and clinical neural function-defect assessment respectively.

RESULTS

Compared to pre-treatment, the scores of Fugl-Meyer assessment scale and daily-life ability assessment of both SNC and FNC groups increased significantly after the treatment (P < 0.01), and those of clinical neural function-defect assessment of these two groups lowered considerably (P < 0.01). No significant differences were found between two groups in these 3 indexes( P > 0.05). After the treatment, of the 84 and 80 cases in SNC and FNC groups, 0 and 3 were cured basically, 44 and 45 experienced a marked improvement, 35 and 27 had an improvement, 5 and 5 failed, respectively.

CONCLUSION

Spoon-needle cluster electro-stirmilation can effectively improve Cl patients' motor dysfiziction and daily-life activity ability, and is comparable to the filiform-needle cluster stimulation in clinical therapeutic effect.

[Application of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction]

OBJECTIVE

To evaluate the efficacy of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction.

METHODS

77 acute cerebral infarction patients were randomly assigned to stroke rehabilitation unit group and 73 to ordinary group. The NIH stroke scale (NIHSS), activities of daily living (ADL) Barthel index and average hospitalized time were compared in two groups before and after the treatment.

RESULTS

The average NIHSS in two groups before treatment were 9.26 and 9.12 respectively (P > 0.05) but became 2.62 and 7.64 after treatment (P < 0.01). The average ADL Barthel index in two groups before the treatment were 52.04 and 53.16 (P > 0.05) but 87.26 and 64.20 after the treatment (P < 0.01). The average hospitalized time in the two groups were 22.25 and 26.67 days (P < 0.05).

CONCLUSION

When stroke rehabilitation unit being applied in the acute phase of cerebral infarction, it showed positive results in the following aspects as: improving the neurological function, capabilities of managing daily life, and also shortening the days of hospitalization.

Older patients with acute stroke in Denmark: quality of care and short-term mortality. A nationwide follow-up study

BACKGROUND AND PURPOSE

age may predict level of care and subsequent outcome among patients with stroke. We examined fulfilment of quality-of-care criteria according to age and the possible impact of any age-related differences on short-term mortality in a population-based nationwide follow-up study in Denmark.

METHODS

we identified 29,549 patients admitted with stroke between January 2003 and October 2005 in the Danish National Indicator Project (DNIP). Data on 30- and 90-day mortality were obtained from the Civil Registration System. We compared proportions of patients receiving adequate care across age groups, as measured by admission to a specialised stroke unit, administration of antiplatelet or anticoagulant therapy, examination with CT/MR scan, assessment by a physiotherapist and an occupational therapist, or assessment of nutritional risk. Further, we estimated 30- and 90-day mortality rate ratios (MRRs) across age groups, adjusted for fulfilment of quality-of-care criteria and patient characteristics.

RESULTS

the proportion of eligible patients who received adequate care declined with age for all the examined processes. The relative risk (RR) of receiving specific components of care ranged from 0.66 (95% confidence interval (CI): 0.60-0.73) to 0.97 (95% CI: 0.95-0.99) when comparing patients >80 years of age with patients < or =65 years of age. Although mortality increased with age, adjusting for the age-related differences in care did not alter the magnitude of the increase.

CONCLUSIONS

elderly stroke patients in Denmark receive a lower quality of care than do younger stroke patients, however, the age-related differences are modest for most examined quality-of-care criteria and do not appear to explain the higher mortality among older patients.

Reliability and validity of the dynamic gait index in persons with chronic stroke

OBJECTIVE

To establish the test-retest and interrater reliability as well as the concurrent construct validity of the Dynamic Gait Index (DGI) as a measure for dynamic balance in people with chronic stroke.

DESIGN

Cohort study.

SETTING

Day hospital and ambulatory care at a rehabilitation center.

PARTICIPANTS

A consecutive sample of 25 participants, at least 3 months poststroke and able to walk at least 10m with or without a walking aid, participated in the study. Two independent raters rated performances on the DGI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The DGI was administered in 2 testing sessions 3 days apart. In the second session, the participants were rated by 2 raters. Intraclass correlation coefficients (ICCs), model 2,1, and the Bland and Altman method were used to analyze total scores and item scores. Concurrent construct validity was tested by correlating results to the Berg Balance Scale, the timed walking test, the Timed Up & Go test, and the Activities-specific Balance Confidence Scale.

RESULTS

ICCs for test-retest and interrater reliability of total scores were good (.96, .96, respectively) whereas reliability for single item scores was moderate to good (range, .55-.93). The hypotheses for concurrent construct validity were confirmed with all measures (range, .68-.83).

CONCLUSIONS

The DGI showed high reliability and showed evidence of concurrent validity with other balance and mobility scales. It is a useful clinical tool for evaluating dynamic balance in ambulatory people with chronic stroke.

The ExStroke Pilot Trial: rationale, design, and baseline data of a randomized multicenter trial comparing physical training versus usual care after an ischemic stroke

INTRODUCTION

A high level of physical activity is associated with a decreased risk of first stroke and physical activity modifies recognized stroke risk factors and is recommended for stroke survivors. Available research shows that stroke patients can increase their level of physical performance over a short period. When the intervention period is over, physical performance often declines towards baseline level. Currently, there is no evidence on the association between physical activity and the risk of recurrent stroke. The ExStroke Pilot Trial is a randomized clinical trial with the aim of increasing stroke patients' level of physical activity and secondarily to associate the level of physical activity to the risk of recurrent stroke, myocardial infarction, and all-cause mortality in the two groups. We describe the rationale, design, and baseline data of the ExStroke Pilot Trial.

METHODS

Patients with ischemic stroke above 39 years were randomized to intervention or control group. The intervention group will, over a 2-year period, receive information on and verbal instruction to exercise by a physiotherapist or a physician. The control group will receive the department's usual care. Physical activity is assessed in both groups seven times during follow-up using the Physical Activity Scale for the Elderly (PASE) questionnaire, which quantifies the amount of physical activity done in the last seven days prior to interview. The PASE score constitutes the primary outcome measure. The secondary outcome is the time from randomization to recurrent stroke, myocardial infarction, or all-cause mortality. Further outcome measures include: time from randomization to recurrent stroke, myocardial infarction, and vascular death; recurrent stroke; modified Rankin Scale; quality of life; occurrence of falls and fractures.

TRIAL STATUS

From 9 centers in 4 countries, 314 patients were included and follow-up is ongoing. Mean age and standard deviation (SD) of the study participants was 68.4 (11.9) years and 56.4% were male. Mean (SD) PASE score was 84.1 (55.9) and median (interquartile range) Scandinavian Stroke Scale score was 54 (51-58).

[Clinical study of standardized tertiary rehabilitation program in promoting upper and lower limbs motor function in stroke patients]

OBJECTIVE

To investigate the effect of standardized tertiary rehabilitation (STR) on the upper and lower limbs' motor function in the patients with cerebral stroke accompanied by hemiplegia.

METHODS

1365 patients with cerebral stroke accompanied by hemiplegia enrolled sequentially from 22 hospitals were classified into two groups: cerebral infarction group and hemorrhage group, and then randomly subdivided into two groups: test group (n = 688, administered with STR in addition to routine interventions of neurological medicine) and control group (n = 677, given the routine interventions). All patients were assessed with the scale of Modified Fugl-Meyer Motor Assessment (M-FMMA) at the time of enrollment and 1, 3, and 6 months after the stroke respectively. The evaluation was blind on the part of the physician.

RESULTS

At each of the following post-stroke checkpoints, the scores of the functions in the cerebral infarction or hemorrhage test group were higher than those in the control (P < 0.01). The M-FMMA scores at the enrollment, and 1, 3, and 6 months after stroke of the cerebral infarction patients in the test group were 28, 47, 65, and 75 respectively, and the M-FMMA scores at the enrollment, and 1, 3, and 6 months after stroke of the cerebral infarction patients in the control group were 26, 37, 48, and 55 respectively. The M-FMMA scores at the enrollment, and 1, 3, and 6 months after stroke of the cerebral hemorrhage patients in the test group were 23, 44, 67, and 80 respectively, and the M-FMMA scores at the enrollment, and 1, 3, and 6 months after stroke of the cerebral hemorrhage patients in the control group were 21, 32, 46, and 55 respectively. During the STR, the scores of functional improvement of both the cerebral infarction and hemorrhage test groups were higher than those of the control groups (both P < 0.01). By the end of the 6th month after stroke, the scores of functional improvement of both the cerebral infarction and hemorrhage test groups went up by 47 and 56 respectively for the 2 test groups, while went up by 29 and 34 respectively for the 2 control groups. Compared with the control groups, the score of functional improvement of the cerebral infarction test group was 18 points higher, and that of the cerebral hemorrhage test group was 22 points higher.

CONCLUSION

STR significantly improves the neurological function in the patients with cerebral strokes accompanied by hemiplegia.

[Amnestic syndrome caused by cerebral infarction in the right medial temporal lobe--case report]

We report here a case of amnestic syndrome with executive dysfunction and attention deficit caused by cerebral infarction in the right temporal lobe was reported. An 80-year-old, right-handed female with complaints of memory impairment, was admitted to our hospital. She had neither motor paresis nor sensory disturbances. She exhibited disorientation, retrograde amnesia, anterograde amnesia, executive dysfunction and attention deficit. Although her immediate recall and remote memory were almost intact, her recent memory was moderately impaired. Both verbal memory and non-verbal memory were impaired. Brain MRI revealed cerebral infarction in the right temporal lobe involving the parahippocampal gyrus, and SPECT demonstrated low perfusion areas in both the cerebral hemispheres involving basal ganglia and the right thalamus. After a 4-month rehabilitation program, her memory impairment improved considerably. We consider that the reason that contributed to these improvement include the fact that her lesion was unilateral and that her executive dysfunction and attention deficit also improved. This finding suggests that memory is related to attention and executive function.

[Late-onset hemorrhagic infarction in patients with patent foramen ovale: reports of two cases]

We presented here two patients with hemorrhagic infarction occurred during subacute phase of brain embolism. The patients were 71-year-old and 73-year-old men who suffered from brain infarction of the left posterior cerebral artery and right middle cerebral artery territory, respectively. Both of them were diagnosed as having cryptogenic stroke and patent foramen ovale. After transferred to rehabilitation hospitals taking aspirin for a secondary prevention of stroke, they developed hemorrhagic infarction at day 17 and day 19, respectively. Their blood pressure remained within normal range throughout acute and subacute phase. Although most of hemorrhagic infarction occurs within 24 hours of stroke onset, some patients develop symptomatic hemorrhagic infarction even after 10 days. We need to be careful about late-onset hemorrhagic infarction, because many patients are now transferred early to rehabilitation hospitals to facilitate dedicated systematic rehabilitation.

Effects of skilled forelimb training on hippocampal neurogenesis and spatial learning after focal cortical infarcts in the adult rat brain

BACKGROUND AND PURPOSE

Environmental stimulation consistently increases dentate neurogenesis in the adult brain and improves spatial learning. We tested the hypothesis whether specific rehabilitative training of an impaired forelimb influences these processes after focal cortical infarcts.

METHODS

Focal cortical infarcts were induced in the forelimb sensorimotor cortex using the photothrombosis model. One group of infarcted animals and sham-operated controls housed in standard cages received one daily session of skilled reaching training of the impaired or dominant forelimb, respectively. A second group was transferred to an enriched environment, whereas a third group remained in the standard cages without further treatment. Bromodeoxyuridine was administered from day 2 until day 6 postinfarct. Proliferation and differentiation of newborn cells was analyzed at day 10 and 42 using immunocytochemistry with neuronal and glial markers and confocal laser scanning microscopy. Spatial learning was tested in the Morris water maze between days 35 and 41.

RESULTS

After cortical infarcts in the forelimb sensorimotor cortex, environmental enrichment as well as daily reaching training of the impaired paw both increase dentate neurogenesis and improve functional performance in the Morris water maze. Nevertheless, the reaching training-induced neurogenic response was significantly greater in nonlesioned controls associated with the best spatial learning performance in the water maze.

CONCLUSIONS

Skilled forelimb training effectively stimulates dentate neurogenesis and spatial learning in the infarcted and healthy brain. However, this reaching training-induced increase in neurogenesis was reduced after cortical infarcts.

Attendance at religious services and physical functioning after stroke among older Mexican Americans

The purpose of this study was to examine the association of attendance at religious services and change in physical functioning among older Mexican Americans who report residual physical limitations due to stroke. Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), generalized linear models were used to evaluate change in physical function over 3 years in persons with stroke aged 65 and older, controlling for demographics, medical conditions, health behaviors, and physical mobility. The results showed frequent attendees at religious services had significantly fewer declines in activities of daily living (ADLs) disability compared to infrequent attendees. The frequent attendance group also showed less decline in lower body function compared to the infrequent attendees. Findings are indicative that church attendance prestroke is associated with better physical function poststroke in older Mexican Americans.

Bouncing back: patterns and predictors of complicated transitions 30 days after hospitalization for acute ischemic stroke

OBJECTIVES

To identify predictors of complicated transitions within 30 days after discharge from hospitalization for acute stroke.

DESIGN

Retrospective analysis of administrative data.

SETTING

Four hundred twenty-two hospitals in the southern and eastern United States.

PARTICIPANTS

Thirty-nine thousand three hundred eighty-four Medicare beneficiaries aged 65 and older discharged after acute ischemic stroke from 1998 to 2000.

MEASUREMENTS

Complicated transition, defined as movement from less- to more-intensive care setting after hospital discharge, with hospital being most intensive and home without home health care being least intensive.

RESULTS

Twenty percent of patients experienced at least one complicated transition; 16% of those experienced more than one complicated transition. After adjustment using logistic regression, factors predicting any complicated transition included older age, African-American race, Medicaid enrollment, prior hospitalization, gastrostomy tube, chronic disease, length of stay, and discharge site. Patients with multiple complicated transitions were more likely to be African American (odds ratio (OR)=1.38, 95% confidence interval (CI)=1.13-1.68), be male (OR=1.21, 95% CI=1.04-1.40), have a prior diagnosis of fluid and electrolyte disorder (e.g., dehydration) (OR=1.23, 95% CI=1.07-1.43), have a prior hospitalization (OR=1.18, 95% CI=1.01-1.36), and be initially discharged to a skilled-nursing facility or long-term care (OR=1.22, 95% CI=1.04-1.44) than patients with only one complicated transition. They were less likely to be initially discharged to a rehabilitation center (OR=0.71, 95% CI=0.57-0.89).

CONCLUSION

Significant numbers of stroke patients experience complicated transitions soon after hospital discharge. Sociodemographic factors and initial discharge site distinguish patients with multiple complicated transitions. These factors may enable prospective identification and targeting of stroke patients at risk for "bouncing back."

The effect of a therapy dog on the communication skills of an adult with aphasia

Little evidence-based research has been published within the field of communication disorders on the role of dogs as catalysts for human communication. This single participant study, a point of entry into this realm of research, explores the effects of a therapy dog on the communication skills of a patient with aphasia receiving intensive speech and language therapy within a rehabilitation setting. The researchers conclude that the presence of the dog does have the potential to stimulate both overt social-verbal and social-nonverbal communication.

LEARNING OUTCOMES

As a result of this activity the reader will be able to (1) describe the beneficial role of dogs to serve as catalysts for human communication (2) describe ways in which a person with aphasia may be assisted by a therapy dog and (3) become familiar with an animal-assisted therapy (AAT) program set-up for patients with communication disorders within a rehabilitation setting.

Spatial and facial processing in the signed discourse of two groups of deaf signers with clinical language impairment

The linguistic and cognitive profiles of five deaf adults with a sign language disorder were compared with those of matched deaf controls. The test involved a battery of sign language tests, a signed narrative discourse task and a neuropsychological test protocol administered in sign language. Spatial syntax and facial processing were examined in detail and correlated with language and cognitive findings. The battery clearly differentiated the performance of the clinical participants from that of the normal controls. Further, test performance of the clinical individuals was distinct and showed marked correlations with neurological history, as well as with cognitive profiles. The important role of narrative discourse as a clinically sensitive diagnostic tool is described.

[Effects of the improved acupoints and rehabilitation exercise on locomotor ability of the upper limbs and ability of daily life in the patient of cerebral infarction]

OBJECTIVE

To search for an effective method for improving locomotor ability of upper limbs and ability of daily life in the patient of cerebral infarction.

METHODS

Five hundred and seventy-eight cases of stroke were randomly divided into 4 groups: an improved acupoints and rehabilitation exercise group (group A, n = 148), a rehabilitation exercise group (group B, n = 142), a routine acupoints and rehabilitation exercise group (group C, n = 144), and a medication group (group D, n = 144). The locomotor ability of the upper limbs and ability of daily life were evaluated respectively by Fugl-Meyer (FMA) and Barthel (BMI).

RESULTS

There were significant differences in FMA and BMI scores in all the groups after treatment as compared with those before treatment (P < 0.05); after treatment, the effect in the group A was significantly superior to those in group B and C (P < 0.05), with no significant difference between the group C and the group B.

CONCLUSION

The improved acupoints combined with rehabilitation exercise can improve locomotor ability of the upper limbs and ability of daily life in the patient of cerebral infarction.

Rasch analysis of the scoring scheme of the HADS Depression subscale in Chinese stroke patients

The Hospital Anxiety and Depression Scale (HADS) is a widely used screening instrument for depression in medically ill patients. The purpose of this study was to examine the optimal scoring scheme, unidimensionality and item fit of the depression subscale of the HADS (HADS-D) in stroke survivors. A research assistant administered the HADS-D to 100 Chinese patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blind to the HADS-D scores, administered the SCID-DSM-III-R to all 100 patients and made a DSM-IV diagnosis of depression, which served as the benchmark for judging the performance of the HADS-D in screening for depression. Rasch analysis has shown that the HADS-D was unidimensional; low endorsements for the higher coded alternative response categories were found in the sample. In clinical samples with a low frequency of depression, the scoring categories of the HADS-D may be reduced.

Postinfarct Cortical Plasticity and Behavioral Recovery

Plasticity phenomena in the cerebral cortex after ischemic injury have been documented repeatedly over the past 2 decades both in animal models and in human stroke survivors. This review highlights many of the major neuroanatomic and neurophysiological changes that characterize poststroke plasticity in experimental animals. Spared regions adjacent to the infarct and far removed from the infarct undergo functional alterations that are modified by behavioral experience. Recent evidence is also reviewed, demonstrating that long-range intracortical pathways can be rerouted to completely novel territories. The implications of this new finding for understanding the brain's capacity for recovery are discussed.

A single injection of D-amphetamine facilitates improvements in motor training following a focal cortical infarct in squirrel monkeys

BACKGROUND

There is growing interest in the use of D-amphetamine (D-AMPH) as a pharmacological treatment to supplement rehabilitative therapy following stroke. Based on the success of earlier animal models, several clinical studies have demonstrated beneficial effects of applying physical rehabilitation while stroke patients are under the influence of D-AMPH. To begin to understand the neural mechanisms underlying this promising adjuvant therapy, the authors examined the effects of a single pairing of D-AMPH and rehabilitative training on motor performance after cortical infarct in squirrel monkeys.

METHODS

Microelectrode stimulation techniques were used to delineate hand movement areas in the primary motor cortex prior to delivering a unilateral infarct to the complete hand representation. Postinfarct recovery was assessed for 3 groups of monkeys: D-AMPH + training, saline + training, and spontaneous recovery (SR). Postinfarct training groups received 14 consecutive days of motor skill training on a reach and retrieval task. A single injection of D-AMPH (0.25 mg/kg) or saline was given only on the 1st day of training (postinfarct day 10). Monkeys in the SR group had only minimal exposure to the training task once per week to monitor recovery.

RESULTS

The results show that a single coupling of D-AMPH + training initiated 10 days after cortical infarct facilitated the rate of recovery and improved performance (68% improvement from 1st day of training) beyond the level achieved by the monkeys in the saline + training group (27% improved from 1st day of training).

CONCLUSIONS

D-AMPH is a potent modulator of behavioral recovery following an ischemic infarct in nonhuman primates.

Head-Mounted Displays for Clinical Virtual Reality Applications: Pitfalls in Understanding User Behavior while Using Technology

The use of virtual environments with head-mounted displays (HMDs) offers unique assets to the evaluation and therapy of clinical populations. However, research examining the effects of this technology on clinical populations is sparse. Understanding how wearers interact with the HMD is vital. Discomfort leads to altered use of the HMD that could confound performance measures; the very measures which might be used as tools for clinical decision making. The current study is a post-hoc analysis of the relationship between HMD use and HMD comfort. The analysis was conducted to examine contributing factors for a high incidence of simulator sickness observed in an HMD-based driving simulator. Pearson correlation analysis was used to evaluate objective and subjective measures of HMD performance and self-reported user comfort ratings. The results indicated weak correlations between these variables, indicating the complexity of quantifying user discomfort and HMD performance. Comparison of two case studies detailing user behavior in the virtual environment demonstrates that selected variables may not capture how individuals use the HMD. The validity and usefulness of the HMD-based virtual environments must be understood to fully reap the benefits of virtual reality (VR) in rehabilitation medicine.

Disruption of sitting balance after stroke: influence of spoken output

OBJECTIVES

To identify the extent of dual task interference between cognitive and motor tasks, (cognitive motor interference (CMI)) in sitting balance during recovery from stroke; to compare CMI in sitting balance between stroke and non-stroke groups; and to record any changes to CMI during sitting that correlate with functional recovery.

METHOD

36 patients from stroke rehabilitation settings in three NHS trusts. Healthy control group: 21 older volunteers. Measures of seated postural sway were taken in unsupported sitting positions, alone, or concurrently with either a repetitive utterance task or an oral word category generation task. Outcome measures were variability of sway area, path length of sway, and the number of valid words generated.

RESULTS

Stroke patients were generally less stable than controls during unsupported sitting tasks. They showed greater sway during repetitive speech compared with quiet sitting, but did not show increased instability to posture between repetitive speech and word category generation. When compared with controls, stroke patients experienced greater dual task interferences during repetitive utterance but not during word generation. Sway during repetitive speech was negatively correlated with concurrent function on the Barthel ADL index.

CONCLUSIONS

The stroke patients showed postural instability and poor word generation skills. The results of this study show that the effort of verbal utterances alone was sufficient to disturb postural control early after stroke, and the extent of this instability correlated with concomitant Barthel ADL function.