RESUMEN
BACKGROUND: The impact of different stroke types on specific activities of daily living (ADL) is unclear. OBJECTIVE: To investigate how differences between intracerebral hemorrhage (ICH) and cerebral infarction (CI) affect improvement of ADL in patients with stroke within a hospital by focusing on the sub-items of the Functional Independence Measure (FIM). METHODS: Patients with first-stroke hemiplegia (nâ=â212) were divided into two groups: ICH (86 patients) and CI (126 patients). Primary assessments included 13 motor and 5 cognitive sub-items of the FIM assessed at admission and discharge. Between-group comparisons and multiple regression analyses were performed. RESULTS: Upon admission, the ICH group exhibited significantly lower FIM scores than those of the CI group across various activities, including grooming, dressing (upper body and lower body), toileting, bed/chair transfer, toilet transfer, walking/wheelchair, and stairs. Age and FIM motor scores at admission influenced both groups' total FIM motor scores at discharge, whereas the duration from onset affected only the CI group. CONCLUSION: Several individual FIM motor items were more adversely affected by ICH than by CI. Factors related to ADL at discharge may differ depending on stroke type. Recognizing these differences is vital for efficient rehabilitation practices and outcome prediction.
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Actividades Cotidianas , Hemorragia Cerebral , Infarto Cerebral , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Anciano , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/rehabilitación , Estudios Retrospectivos , Infarto Cerebral/rehabilitación , Infarto Cerebral/complicaciones , Persona de Mediana Edad , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Anciano de 80 o más Años , Recuperación de la Función/fisiologíaRESUMEN
This work was to evaluate the impacts of comprehensive rehabilitation acupuncture therapy on the recovery of neurological function in cerebral infarction (CI) patients and to utilize convolutional neural network (CNN) intelligent algorithms to optimize head computed tomography (CT) images and improve lesion localization accuracy. 98 CI patients were divided into a control group (Ctrl group) and an experimental group (Exp group), with 48 patients in each group. The patients in the Ctrl group received CT evaluation combined with comprehensive rehabilitation acupuncture therapy. While, those in the Exp group received CT evaluation with the use of CNN algorithms for optimization, along with comprehensive rehabilitation acupuncture therapy. Acupuncture therapy included selecting acupoints on the patient's head, selecting two horizontal needling needles from top to bottom at the acupoints on the front side of the lesion, and then horizontal needling along the top midline. The differences in treatment outcomes were compared between the two groups based on Fugl-Meyer upper limb assessment (FMA) scores, Barthel Index (BI) scores, National Institutes of Health Stroke Scale (NIHSS4) scores, Modified Edinburgh-Scandinavian Stroke Scale (MESSS) scores, and hemodynamics. Simultaneously, the CT images were optimized using CNN intelligent algorithms to improve image quality and lesion localization accuracy. The results showed that the CI CT images processed by the CNN-based intelligent algorithm showed significant improvements in clarity and contrast compared to conventional CT images. The CNN-based intelligent algorithm demonstrated higher sensitivity (97.5â¯%, 93.8â¯%), higher PSNR (30.14â¯dB, 24.72â¯dB), and lower missed detection rate (0.52â¯%, 1.88â¯%) in detecting CI lesions. The total effective rate in the Exp group was 95.83â¯%, which was significantly higher than the 85.42â¯% in the Ctrl group (P < 0.05). The Exp group showed significantly higher levels in FMA and BI scores (P < 0.05). After treatment, the NIHSS4 and MESSS scores in the Exp group were lower than those in the Ctrl group (P < 0.05). Additionally, post-treatment, the plasma concentrations and whole-blood viscosity (low shear and high shear) in the Exp group were lower than those in the Ctrl group, and the plasma concentration and whole-blood viscosity (high shear) were also lower than those in the Ctrl group (P < 0.05). In conclusion, comprehensive rehabilitation acupuncture therapy had a positive impact on the recovery of neurological function in CI patients. By applying CNN-based intelligent algorithms to optimize head CT images, lesion localization accuracy can be improved, thereby guiding rehabilitation treatment more effectively.
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Terapia por Acupuntura , Infarto Cerebral , Tomografía Computarizada por Rayos X , Humanos , Terapia por Acupuntura/métodos , Masculino , Femenino , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/rehabilitación , Infarto Cerebral/terapia , Persona de Mediana Edad , Anciano , Tomografía Computarizada por Rayos X/métodos , Algoritmos , Redes Neurales de la Computación , Rehabilitación de Accidente Cerebrovascular/métodos , Resultado del TratamientoRESUMEN
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.
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Infarto Cerebral , Hemiplejía , Rehabilitación de Accidente Cerebrovascular , Humanos , Actividades Cotidianas , Infarto Cerebral/complicaciones , Infarto Cerebral/rehabilitación , Hemiplejía/rehabilitación , Estudios Retrospectivos , Estimulación Magnética TranscranealRESUMEN
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.
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Infarto Cerebral , Rehabilitación de Accidente Cerebrovascular , Humanos , Infarto Cerebral/complicaciones , Infarto Cerebral/rehabilitación , Tos/etiología , Tos/fisiopatología , Tos/prevención & control , Estudios Retrospectivos , Estimulación Magnética Transcraneal/métodos , Neumonía/etiología , Neumonía/prevención & controlRESUMEN
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 (ß = -0.197; P = .010) and FAC gain (ß = -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.
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Fibrilación Atrial , Fibrilación Atrial/complicaciones , Infarto Cerebral/complicaciones , Infarto Cerebral/rehabilitación , Marcha , Humanos , Incidencia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
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.
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Terapia por Acupuntura , Infarto Cerebral , Moxibustión , Actividades Cotidianas , Terapia por Acupuntura/efectos adversos , Proteína C-Reactiva/análisis , Infarto Cerebral/rehabilitación , Infarto Cerebral/terapia , Cognición , Cistatina C/sangre , Humanos , Ácido Úrico/sangreRESUMEN
Background. Neuroimaging biomarkers are valuable predictors of motor improvement after stroke, but there is a gap between published evidence and clinical usage. Objective. In this work, we aimed to investigate whether machine learning techniques, when applied to a combination of baseline whole brain volumes and clinical data, can accurately predict individual motor outcome after stroke. Methods. Upper extremity Fugl-Meyer Assessments (FMA-UE) were conducted 1 week and 12 weeks, and structural MRI was performed 1 week, after onset in 56 patients with subcortical infarction. Proportional recovery model residuals were employed to assign patients to proportional and poor recovery groups (34 vs 22). A sophisticated machine learning scheme, consisting of conditional infomax feature extraction, synthetic minority over-sampling technique for nominal and continuous, and bagging classification, was employed to predict motor outcomes, with the input features being a combination of baseline whole brain volumes and clinical data (FMA-UE scores). Results. The proposed machine learning scheme yielded an overall balanced accuracy of 87.71% in predicting proportional vs poor recovery outcomes, a sensitivity of 93.77% in correctly identifying poor recovery outcomes, and a ROC AUC of 89.74%. Compared with only using clinical data, adding whole brain volumes can significantly improve the classification performance, especially in terms of the overall balanced accuracy (from 80.88% to 87.71%) and the sensitivity (from 92.23% to 93.77%). Conclusions. Experimental results suggest that a combination of baseline whole brain volumes and clinical data, when equipped with appropriate machine learning techniques, may provide valuable information for personalized rehabilitation planning after subcortical infarction.
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Encéfalo/patología , Infarto Cerebral/diagnóstico , Infarto Cerebral/patología , Aprendizaje Automático , Anciano , Encéfalo/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/rehabilitación , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pronóstico , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Rehabilitación de Accidente CerebrovascularRESUMEN
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.
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Infarto Cerebral/fisiopatología , Infarto Cerebral/rehabilitación , Terapia por Estimulación Eléctrica , Corteza Motora/fisiopatología , Extremidad Superior/fisiopatología , Adulto , Potenciales Evocados Motores , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/inervación , Músculo Esquelético/fisiología , Rehabilitación de Accidente Cerebrovascular/métodos , Estimulación Magnética TranscranealRESUMEN
INTRODUCTION: Recovery of all brain functions affected after stroke is essential for the patient's quality of life, with comprehensive rehabilitation key. OBJECTIVES: Identify social and environmental factors affecting access to comprehensive post-ictus rehabilitation, and assess long-term effects of comprehensive rehabilitation on patient functionality. PATIENTS AND METHOD: 171 consecutive patients (84 women and 87 men) hospitalized in 2015 in Neurology Service with first ischemic stroke, without prior functional dependence, candidates for comprehensive rehabilitation are studied. Various socio-environmental and clinical variables potentially associated with access to it are analyzed. The long-term prognostic impact (average period of 54 months) on the functional situation is studied using the Barthel index. RESULTS: The average age of patients is 69 years. Only 53% were able to access the recommended comprehensive rehabilitation. Predictor variables of access were resulted: residence in urban environment (OR: 2,957; 95% CI: 1,067-8,199; p = 0.037), complement with private rehabilitation (OR: 2,89; 95% CI: 1,130-7,392; p = 0.027), best Rankin to high (OR: 22,437; 95% CI: 3,247-155,058; p = 0.014). After average follow-up for 54 months, of the 137 survivors, access to comprehensive post-ictus rehabilitation was independently associated with better long-term functional situation (OR: 12,441; 95% CI: 4.7-32.5; p < 0.001). CONCLUSIONS: Comprehensive post-ictus rehabilitation is associated with better long-term prognosis, but access to it is conditioned by environmental and social factors such as the place of residence and the possibility of contracting private services.
TITLE: Rehabilitación integral postictus: efectos a largo plazo y factores socioambientales condicionantes del acceso.Introducción. La recuperación de todas las funciones cerebrales afectadas tras un ictus es esencial para la calidad de vida del paciente y la rehabilitación integral resulta clave. Objetivos. Identificar los factores sociales y ambientales condicionantes del acceso a la rehabilitación integral postictus, y valorar los efectos a largo plazo de la rehabilitación integral en la funcionalidad del paciente. Pacientes y método. Se estudia a 171 pacientes consecutivos (84 mujeres y 87 hombres) hospitalizados en 2015 en el servicio de neurología con un primer ictus isquémico, sin dependencia funcional previa, candidatos a rehabilitación integral. Se analizan diversas variables socioambientales y clínicas potencialmente asociadas al acceso a ésta. Se estudia el impacto pronóstico a largo plazo (período medio de 54 meses) sobre la situación funcional mediante el índice de Barthel. Resultados. La edad media de los pacientes era de 69 años. Sólo el 53% pudo acceder a la rehabilitación integral recomendada. Resultaron variables predictoras del acceso: residencia en medio urbano odds ratio (OR): 2,957; intervalo de confianza al 95% (IC 95%): 1,067-8,199; p = 0,037, complemento con rehabilitación privada (OR: 2,89; IC 95%: 1,13-7,392; p = 0,027) y mejor Rankin en el momento del alta (OR: 22,437; IC 95%: 3,247-155,058; p = 0,014). Tras un seguimiento medio durante 54 meses de los 137 supervivientes, el acceso a rehabilitación integral postictus se asoció independientemente a mejor situación funcional a largo plazo (OR: 12,441; IC 95%: 4,7-32,5; p menor de 0,001). Conclusiones. La rehabilitación integral postictus está asociada a un mejor pronóstico a largo plazo, pero su acceso está condicionado por factores ambientales y sociales, como el lugar de residencia y la posibilidad de contratar servicios privados.
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Accesibilidad a los Servicios de Salud , Rehabilitación de Accidente Cerebrovascular , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/rehabilitación , Infarto Cerebral/rehabilitación , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pronóstico , Recuperación de la Función , Estudios Retrospectivos , Clase Social , Determinantes Sociales de la Salud , España , Centros de Atención Terciaria/estadística & datos numéricos , Resultado del TratamientoRESUMEN
Disuse of the paretic hand after stroke is encouraged by compensatory reliance on the nonparetic hand, to exacerbate impairment and potentially constrain motor rehabilitation efficacy. Rodent stroke model findings support that learning new unimanual skills with the nonparetic forelimb diminishes functional improvements that can be driven by rehabilitative training of the paretic forelimb. The influence of learning new ways of skillfully using the two hands together on paretic side function is much less clear. To begin to explore this, we developed a new cooperative bimanual skilled reaching task for rats, the Popcorn Retrieval Task. After motor cortical infarcts impaired an established unimanual reaching skill in the paretic forelimb, rats underwent a 7 week period of de novo bimanual training (BiT) or no-training control procedures (Cont). Probes of paretic forelimb unimanual performance revealed significant improvements during and after the training period in BiT vs. Cont. We additionally observed a striking change in the bimanual task strategy over training days: a switch from the paretic to the nonparetic forelimb for initiating reach-to-grasp sequences. This motivated another study to test whether rats that established the bimanual skill prior to the infarcts would similarly switch handedness, which they did not, though paretic paw use for manipulative movements diminished. These results indicate that unimanual function of the paretic side can be improved by novel bimanual skill practice, even when it involves compensatory reliance on the nonparetic hand. They further support the suitability of the Popcorn Retrieval Task for studying bimanual skill learning effects in rats.
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Infarto Cerebral/fisiopatología , Miembro Anterior/fisiopatología , Corteza Motora/fisiopatología , Rehabilitación Neurológica , Paresia/fisiopatología , Paresia/rehabilitación , Desempeño Psicomotor/fisiología , Animales , Conducta Animal/fisiología , Infarto Cerebral/complicaciones , Infarto Cerebral/rehabilitación , Masculino , Paresia/etiología , Práctica Psicológica , Ratas , Ratas Long-EvansRESUMEN
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.
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Infarto Cerebral/psicología , Infarto Cerebral/rehabilitación , Recuperación de la Función , Conducta Social , Rehabilitación de Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/psicología , Anciano , Femenino , Humanos , Masculino , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Interacción SocialRESUMEN
INTRODUCCIÓN: Este documento técnico se realiza a solicitud del Instituto Nacional de Ciencias Neurológicas. Cuadro clínico: El accidente cerebral vascular (ACV) se define como los síntomas y signos de compromiso neurológico focal, de inicio brusco, que llevan a la muerte o que duran más de 24 horas y que no pueden ser atribuibles a otra causa aparente que la vascular. Los pacientes con ACV por oclusión aguda de la ACI no han sido tradicionalmente candidatos a una revascularización carotídea mediante la implantación de un stent con o sin angioplastia, sin embargo, nuevos estudios indican que el tratamiento endovascular de la oclusión aguda de la ACI es factible, seguro y puede mejorar el pronóstico funcional de estos pacientes. Tecnología sanitária: La cirugía como tratamiento de rescate en ACV consiste en el tratamiento endovascular (TEV) que puede incluir la fibrinolisis arterial, la trombólisis mecánica (TM) y la endarterectomía de la estenosis u oclusión de la ACI. Para minimizar los retrasos en el inicio del tratamiento, se han diseñado estrategias que combinan la rapidez de administración de la trombólisis IV con la eficacia de la trombólisis intraarterial. Esta estrategia, denominada de rescate, beneficiaría principalmente a aquellos pacientes con escasas probabilidad de respuesta a la trombólisis endovenosa OBJETIVO: Evaluar la eficacia y seguridad, así como documentos relacionados a la decisión de cobertura de la cirugía de rescate vascular en el tratamiento de pacientes con Infarto cerebral agudo por oclusión de vaso de arteria carótida interna. METODOLOGÍA: Se realizó una búsqueda en las principales bases de datos bibliográficas: MEDLINE, LILACS, COCHRANE, así como en buscadores genéricos de Internet incluyendo Google Scholar y TRIPDATABASE. Adicionalmente, se hizo una búsqueda dentro de la información generada por las principales instituciones internacionales de cirugía vascular, y agencias de tecnologías sanitarias que realizan revisiones sistemáticas (RS), evaluación de tecnologías sanitarias (ETS) y guías de práctica clínica (GPC). RESULTADOS: Se identificaron una RS, cinco GPC y una ETS. Adicionalmente se seleccionaron dos estudios observacionales. No se encontraron evaluaciones económicas de Perú o la región latinoamericana. CONCLUSIONES: La evidencia con respecto a la cirugía de rescate vascular en el tratamiento de pacientes con infarto cerebral agudo por oclusión de vaso de arteria carótida interna es escaso. Basado en una revisión sistemática, se muestra un beneficio en la mortalidad de este procedimiento comparado a manejo no quirúrgico especialmente en manejo de vasos grandes. Sin embargo, los resultados podrían referir que no hay un beneficio diferencial con respecto a hemorragias intracraneales. Basado en estudios observacionales la tecnología se muestra como eficaz y segura sin embargo estos resultados no son comparativos por lo que es importante ponerlos en contexto. Las GPC y ETS recabadas mencionan a la tecnología de interés para el manejo de ACV de grandes vasos después del fracaso o contraindicación de trombólisis.
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Humanos , Procedimientos Quirúrgicos Vasculares/métodos , Arteria Carótida Interna/fisiopatología , Infarto Cerebral/rehabilitación , Perú , Evaluación de la Tecnología Biomédica , Análisis Costo-BeneficioRESUMEN
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,.
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Infarto Cerebral/rehabilitación , Tractos Piramidales/fisiopatología , Recuperación de la Función/fisiología , Estimulación Magnética Transcraneal/métodos , Anciano de 80 o más Años , Imagen de Difusión Tensora , Femenino , HumanosRESUMEN
Exercise therapy plays key roles in functional improvements during neurorehabilitation. However, it may be difficult for some people to properly perform exercise because mobility and endurance might be restricted by neurological deficits due to stroke. Additionally, there is little evidence detailing the biological mechanisms underlying the most effective swimming exercise protocols for neuroplasticity after stroke. Thus, the present study investigated the effects of swimming exercise on neuroplasticity in a cerebral infarction rat model according to the timing and intensity of exercise. A total of 45 male Sprague-Dawley rats (300⯱â¯50â¯g, 10 weeks old) were subjected to photothrombotic cerebral infarction and randomly divided into five groups: non-exercise (group A, nâ¯=â¯9); early submaximal (group B, nâ¯=â¯9); early maximal (group C, nâ¯=â¯9); late submaximal (group D, nâ¯=â¯9); and late maximal (group E, nâ¯=â¯9). Swimming exercise was performed five times a week for 4 weeks, and cognition was evaluated with the Morris water maze (MWM) test. Assessments of superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels and immunohistochemical analyses of brain-derived neurotrophic factor (BDNF) were conducted in the ipsilesional hippocampus region. After 4 weeks of exercise, the escape latency was shorter and velocity was greater in group B than in groups A, C, D, and E (p = 0.046, pâ¯<⯠0.001, respectively). Furthermore, SOD activity was higher and MDA levels were lower in group B than in groups A, C, D, and E (p = 0.004, p = 0.019). The immunohistochemistry results revealed that the greatest BDNF immunoreactivity was in group B. Taken together, these results indicate that early submaximal swimming exercise may be the most effective protocol for the recovery of neurological deficits in a rat model of cerebral infarction.
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Infarto Cerebral/rehabilitación , Plasticidad Neuronal/fisiología , Condicionamiento Físico Animal/métodos , Condicionamiento Físico Animal/fisiología , Natación/fisiología , Animales , Infarto Cerebral/fisiopatología , Infarto Cerebral/psicología , Masculino , Aprendizaje por Laberinto/fisiología , Condicionamiento Físico Animal/psicología , Ratas , Ratas Sprague-Dawley , Natación/psicología , Factores de TiempoRESUMEN
INTRODUCTION: Postural reactions have been used to facilitate dorsiflexor activity following stroke. However, the effectiveness of this method is not clear in the literature. This study is designed to test the effect of postural reactions provoked by sitting in an unstable surface on dorsiflexor activity in acute stroke. METHODS: Fifteen first-time acute hemispheric cerebral infarct patients with hemiplegia and 15 age-matched healthy adults participated in the study. Subjects performed static sitting, forward reach and lateral reach on a stool and Swiss ball. The anterior tibial activity was recorded in the normal and affected lower limbs in hemiplegic patients and both lower limbs of healthy adults. Non-parametric testing was used with alpha less than 0.05. RESULTS: All the subjects showed an increase in anterior tibial activity in Swiss ball sitting compared to stool sitting. Lateral reaching resulted in higher levels of anterior tibial activity among the participants. In hemiplegic patients, anterior tibial activity in the affected side was lesser than in the normal side on stable and unstable surfaces. In healthy adults there was no inter-limb difference. The normal side activity in stroke patients was greater than that recorded in healthy individuals (pâ¯<â¯0.05). The anterior tibial activity in the affected side reached values equal to those of healthy adults when using the Swiss ball. CONCLUSION: Postural reactions provoked from sitting on a unstable surface is effective in facilitating dorsiflexor activity in acute stroke.
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Infarto Cerebral/fisiopatología , Infarto Cerebral/rehabilitación , Extremidad Inferior/fisiopatología , Músculo Esquelético/fisiopatología , Sedestación , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modalidades de FisioterapiaRESUMEN
Currently, many ischemic stroke patients worldwide suffer from physical and mental impairments, and thus have a low quality of life. However, although rehabilitation is acknowledged as an effective way to recover patients' health, there does not exist yet an adaptive training platform for animal tests so far. For this sake, this paper aims to develop an adaptive escalator (AE) for rehabilitation of rats with cerebral ischemia. Rats were observed to climb upward spontaneously, and a motor-driven escalator, equipped with a position detection feature and an acceleration/deceleration mechanism, was constructed accordingly as an adaptive training platform. The rehabilitation performance was subsequently rated using an incline test, a rotarod test, the infarction volume, the lesion volume, the number of MAP2 positive cells and the level of cortisol. This paper is presented in 3 parts as follows. Part 1 refers to the escalator mechanism design, part 2 describes the adaptive ladder-climbing rehabilitation mechanism, and part 3 discusses the validation of an ischemic stroke model. As it turned out, a rehabilitated group using this training platform, designated as the AE group, significantly outperformed a control counterpart in terms of a rotarod test. After the sacrifice of the rats, the AE group gave an average infarction volume of (34.36 ± 3.8)%, while the control group gave (66.41 ± 3.1)%, validating the outperformance of the escalator-based rehabilitation platform in a sense. An obvious difference between the presented training platform and conventional counterparts is the platform mechanism, and for the first time in the literature rats can be well and voluntarily rehabilitated at full capacity using an adaptive escalator. Taking into account the physical diversity among rats, the training strength provided was made adaptive as a reliable way to eliminate workout or secondary injury. Accordingly, more convincing arguments can be made using this mental stress-free training platform.
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Isquemia Encefálica/rehabilitación , Infarto Cerebral/rehabilitación , Rehabilitación de Accidente Cerebrovascular/instrumentación , Animales , Isquemia Encefálica/complicaciones , Isquemia Encefálica/fisiopatología , Infarto Cerebral/etiología , Infarto Cerebral/fisiopatología , Modelos Animales de Enfermedad , Ascensores y Escaleras Mecánicas , Humanos , Masculino , Ratas , Ratas Sprague-Dawley , Recuperación de la Función , Prueba de Desempeño de Rotación con Aceleración ConstanteRESUMEN
PURPOSE: In acute ischemic stroke, infarct location and volume have, separately, been used to determine long-term outcomes after stroke. Little information exists on the combination of these imaging characteristics on rehabilitation outcomes. We evaluated the association between infarct lesion location volume with the Functional Independence Measure (FIM) measure during inpatient rehabilitation facility (IRF) in ischemic stroke patients. METHODS: Between 2012 and 2014, we prospectively enrolled consecutive acute ischemic stroke patients admitted from a Comprehensive Stroke Center and followed to an IRF in Chicago, Illinois. We adjudicated infarct volumes in specific lesion locations using a validated brain atlas. Volumes were calculated using an automated pipeline. FIM measure was extracted from IRF charts. We analyzed the association between acute infarct characteristics and functional measures using adjusted Spearman's correlation. RESULTS: Among 162 stroke patients (mean age 67.6 years, 48.1% male, 58.6% Caucasian), the median FIM at IRF was 52 (IQR 36-62). In an adjusted analysis, infarct volumes in the left basal ganglia (rs = - 0.45, p = 0.02) and left frontal lobe (rs = - 0.38, p = 0.04) were negatively correlated with FIM scores. CONCLUSIONS: There is an association between specific infarct lesion location volume and subsequent FIM scores assessed at IRF. Our findings suggest that imaging during index stroke hospitalization could be used to predict outcomes assessed during IRF.
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Actividades Cotidianas/clasificación , Mapeo Encefálico , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/rehabilitación , Imagen por Resonancia Magnética , Enfermedad Aguda , Anciano , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Enfermedad Cerebrovascular de los Ganglios Basales/rehabilitación , Correlación de Datos , Imagen de Difusión por Resonancia Magnética , Femenino , Lóbulo Frontal/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
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).
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Infarto Cerebral/rehabilitación , Disfunción Cognitiva/complicaciones , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/complicaciones , Infarto Cerebral/complicaciones , Demencia/complicaciones , Humanos , Recuperación de la Función , Resultado del TratamientoRESUMEN
Objective To observe the improvement of negative affect disorders in patients with cerebral infarction and dysphagia by neuromuscular electrical stimulation. Methods One hundred and twelve patients with cerebral infarction and dysphagia were selected and randomized into treatment (n = 59) and control (n = 53) groups. Similar swallowing function was found in both groups before treatment: (1) Water-drinking test in the treatment group proved swallowing function Level III in 24 cases, Level IV in 22 cases and Level V in 13 cases; (2) in the control group, swallowing function was Level III in 21 cases, Level IV in 20 cases and Level V in 12 cases. Both groups received conventional drug therapy and swallowing training. The treatment group additionally received neuromuscular electrical stimulation. Both groups underwent water-drinking test evaluation, Hamilton Anxiety Scale test, and Hamilton Depression Scale test before and after treatment. Results After two courses of treatment, the rate of improvement in swallowing function was 88.1% in the treatment group while 69.8% in the control group. Somatic anxiety, psychogenic anxiety and total scores in the Hamilton Anxiety Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.01). Anxiety, cognitive disorder, psychomotor retardation and total scores in the Hamilton Depression Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.05). Conclusion Patients with cerebral infarction and dysphagia have varying degrees of anxiety, depression, and other negative affect disorders, which could be minimized by neuromuscular electrical stimulation in conjunction with conventional therapy.
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Ansiedad/rehabilitación , Infarto Cerebral/rehabilitación , Trastornos de Deglución/rehabilitación , Depresión/rehabilitación , Terapia por Estimulación Eléctrica , Adulto , Afecto , Anciano , Anciano de 80 o más Años , Ansiedad/etiología , Infarto Cerebral/complicaciones , Infarto Cerebral/fisiopatología , Infarto Cerebral/psicología , Disfunción Cognitiva/etiología , Disfunción Cognitiva/rehabilitación , Deglución , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/psicología , Depresión/etiología , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Rehabilitación de Accidente Cerebrovascular , Resultado del TratamientoRESUMEN
It has been suggested that serotonin (5-HT) may be implicated in functional recovery after stroke; however, the underlying molecular mechanisms remain unknown. Here, the role of 5-HT was verified using ritanserin, a potent 5-HT2A receptor antagonist, and protein expression and modification were analyzed to further understand the association between paralysis recovery and molecular mechanisms in the brain. Experimental cerebral cortex infarctions were induced by photothrombosis in rats. Voluntary exercise was initiated 2 days after surgery. Motor performance was then measured using the rotarod test. Differences in protein expression and phosphorylation in the perilesional cortex were analyzed using western blot. In behavioral evaluations, performance in the rotarod test was significantly increased by exercise. However, there was a significantly lower value in time until falling after combined exercise and ritanserin administration compared with that of exercise alone. Protein expression analysis revealed that phosphorylation of protein kinase C (PKC) α, PKCε, and growth-associated protein 43 (GAP43) was significantly upregulated by exercise. These effects were attenuated by ritanserin administration. These data suggest that 5-HT may be related to the underlying mechanisms of exercise-dependent paralysis recovery, that is, exercise-dependent plasticity through the phosphorylation of PKC and GAP43.