scholarly journals Brain disconnectivity mapping of post-stroke fatigue

2020 ◽  
Author(s):  
Kristine M. Ulrichsen ◽  
Knut K. Kolskår ◽  
Geneviève Richard ◽  
Dag Alnæs ◽  
Erlend S. Dørum ◽  
...  
Keyword(s):  
Bayes Factor ◽  
Linear Models ◽  
Chronic Phase ◽  
Stroke Patients ◽  
Lesion Location ◽  
Post Stroke ◽  
Novel Approach ◽  
Alternative Hypotheses ◽  
Brain Correlates ◽  
Methodological Considerations

AbstractStroke patients commonly suffer from post stroke fatigue (PSF). Despite a general consensus that brain perturbations constitute a precipitating event in the multifactorial etiology of PSF, the specific predictive value of conventional lesion characteristics such as size and localization remain unclear. The current study represents a novel approach to assess the neural correlates of PSF in chronic stroke patients. While previous research has focused primarily on lesion location or size, with mixed or inconclusive results, we targeted the extended structural network implicated by the lesion, and evaluated the added explanatory value of a disconnectivity approach with regards to the brain correlates of PSF. To this end, we estimated individual brain disconnectome maps in 84 stroke survivors in the chronic phase (≥ 3 months post stroke) using information about lesion location and normative white matter pathways obtained from 170 healthy individuals. PSF was measured by the Fatigue Severity Scale (FSS). Voxel wise analyses using non-parametric permutation-based inference were conducted on disconnectome maps to estimate regional effects of disconnectivity. Associations between PSF and global disconnectivity and clinical lesion characteristics were tested by linear models, and we estimated Bayes factor to quantify the evidence for the null and alternative hypotheses, respectively. The results revealed no significant associations between PSF and disconnectome measures or lesion characteristics, with moderate evidence in favor of the null hypothesis. These results suggest that symptoms of post-stroke fatigue are not simply explained by lesion characteristics or brain disconnectome measures in stroke patients in a chronic phase, and are discussed in light of methodological considerations.

scholarly journals Dynamics of language reorganization after left temporo-parietal and frontal stroke

Brain ◽  
2020 ◽  
Vol 143 (3) ◽  
pp. 844-861 ◽  
Author(s):  
Anika Stockert ◽  
Max Wawrzyniak ◽  
Julian Klingbeil ◽  
Katrin Wrede ◽  
Dorothee Kümmerer ◽  
...  
Keyword(s):  
Functional Mri ◽  
Chronic Phase ◽  
Global Network ◽  
Lesion Location ◽  
Post Stroke ◽  
Language Functions ◽  
Language Recovery ◽  
Patient Groups ◽  
The Impact ◽  
General Networks

Abstract The loss and recovery of language functions are still incompletely understood. This longitudinal functional MRI study investigated the neural mechanisms underlying language recovery in patients with post-stroke aphasia putting particular emphasis on the impact of lesion site. To identify patterns of language-related activation, an auditory functional MRI sentence comprehension paradigm was administered to patients with circumscribed lesions of either left frontal (n = 17) or temporo-parietal (n = 17) cortex. Patients were examined repeatedly during the acute (≤1 week, t1), subacute (1–2 weeks, t2) and chronic phase (>6 months, t3) post-stroke; healthy age-matched control subjects (n = 17) were tested once. The separation into two patient groups with circumscribed lesions allowed for a direct comparison of the contributions of distinct lesion-dependent network components to language reorganization between both groups. We hypothesized that activation of left hemisphere spared and perilesional cortex as well as lesion-homologue cortex in the right hemisphere varies between patient groups and across time. In addition, we expected that domain-general networks serving cognitive control independently contribute to language recovery. First, we found a global network disturbance in the acute phase that is characterized by reduced functional MRI language activation including areas distant to the lesion (i.e. diaschisis) and subsequent subacute network reactivation (i.e. resolution of diaschisis). These phenomena were driven by temporo-parietal lesions. Second, we identified a lesion-independent sequential activation pattern with increased activity of perilesional cortex and bilateral domain-general networks in the subacute phase followed by reorganization of left temporal language areas in the chronic phase. Third, we observed involvement of lesion-homologue cortex only in patients with frontal but not temporo-parietal lesions. Fourth, irrespective of lesion location, language reorganization predominantly occurred in pre-existing networks showing comparable activation in healthy controls. Finally, we detected different relationships of performance and activation in language and domain-general networks demonstrating the functional relevance for language recovery. Our findings highlight that the dynamics of language reorganization clearly depend on lesion location and hence open new perspectives for neurobiologically motivated strategies of language rehabilitation, such as individually-tailored targeted application of neuro-stimulation.

Virtual Rehabilitation – Benefits and Challenges

2003 ◽  
Vol 42 (05) ◽  
pp. 519-523 ◽  
Author(s):  
G. C. Burdea
Keyword(s):  
Virtual Reality ◽  
Data Storage ◽  
Cognitive Deficits ◽  
Video Game ◽  
Rural Areas ◽  
Chronic Phase ◽  
Data Access ◽  
Stroke Patients ◽  
Post Stroke ◽  
Advantages And Disadvantages

Summary Objectives: To discuss the advantages and disadvantages of rehabilitation applications of virtual reality. Methods: VR can be used as an enhancement to conventional therapy for patients with conditions ranging from musculo-skeletal problems, to stroke-induced paralysis, to cognitive deficits. This approach is called “VR-augmented rehabilitation.” Alternately, VR can replace conventional interventions altogether, in which case the rehabilitation is “VR-based.” If the intervention is done at a distance, then it is called “telerehabilitation.” Simulation exercises for post-stroke patients have been developed using a “teacher object” approach or a video game approach. Simulations for musculo-skeletal patients use virtual replicas of rehabilitation devices (such as rubber ball, power putty, peg board). Phobia-inducing virtual environments are prescribed for patients with cognitive deficits. Results: VR-augmented rehabilitation has been shown effective for stroke patients in the chronic phase of the disease. VR-based rehabilitation has been improving patients with fear of flying, Vietnam syndrome, fear of heights, and chronic stroke patients. Telerehabilitation interventions using VR have improved musculo-skeletal and post-stroke patients, however less data is available at this time. Conclusions: Virtual reality presents significant advantages when applied to rehabilitation of patients with varied conditions. These advantages include patient motivation, adaptability and variability based on patient baseline, transparent data storage, online remote data access, economy of scale, reduced medical costs. Challenges in VR use for rehabilitation relate to lack of computer skills on the part of therapists, lack of support infrastructure, expensive equipment (initially), inadequate communication infrastructure (for telerehabilitation in rural areas), and patient safety concerns.

Frequency, phenomenology and anatomical–clinical correlates of major post-stroke depression

1999 ◽  
Vol 175 (2) ◽  
pp. 163-167 ◽  
Author(s):  
G. Gainotti ◽  
A. Azzoni ◽  
C. Marra
Keyword(s):  
Major Depression ◽  
Functional Form ◽  
Stroke Patients ◽  
Clinical Correlates ◽  
Lesion Location ◽  
Post Stroke ◽  
Symptom Profiles ◽  
Post Stroke Depression ◽  
Stroke Lesion ◽  
Frontal Lesions

BackgroundThe meaning of post-stroke depression is controversial.AimsTo investigate the hypothesis that major post-stroke depression (PSD) may be due to organic factors (left frontal lesions) immediately after the stroke, but to psychosocial factors in later stages.MethodWe studied 153 consecutive stroke patients, categorised on the basis of time elapsed since stroke, lesion location and presence/absence of major PSD, Fifty-eight were examined in the first two months following the stroke, 52 between two and four months, and 43 after four months or more. The symptom profiles and anatomical–clinical correlates of major PSD were studied in each subgroup. A group of 30 patients affected by a functional form of major depression were also investigated.ResultsThe symptom profiles and anatomical–clinical correlates of major PSD were not different in the acute and more chronic stages. Clear symptom differences were, however, observed between major PSD and endogenous major depression. Motivated (reactive) symptoms prevailed in the former, whereas unmotivated symptoms prevailed in the latter.ConclusionsOur data are more consistent with a psychological than with a neurological model of post-stroke depression.

Effects of Cortical Lesion Location on Psychiatric Consultation Referral for Depressed Stroke Inpatients

1986 ◽  
Vol 15 (4) ◽  
pp. 311-320 ◽  
Author(s):  
Richard B. Rosse ◽  
Charles P. Ciolino
Keyword(s):  
Referral Rate ◽  
Cortical Lesion ◽  
Psychiatric Consultation ◽  
Speech Impairment ◽  
Stroke Patients ◽  
Lesion Location ◽  
Post Stroke ◽  
Clinical Presentations ◽  
Post Stroke Depression ◽  
Physician Awareness

Although post-stroke depression occurs with lesions to either cortical hemisphere, increasing evidence supports the view that depression is more prevalent after left hemispheric damage. This retrospective study of depressed post-stroke inpatients referred for psychiatric consultation shows a significantly higher referral rate for patients with right-hemispheric lesions. The results suggest an underutilization of psychiatric consultation to patients with left-sided lesions, and perhaps underrecognition of affective disorders in these patients. Various reasons for this underutilization are proposed, including the greater likelihood of speech impairment in left-sided brain-damaged stroke patients, who may have greater difficulty verbally communicating their psychic distress. Increased physician awareness of the clinical presentations of post-stroke depression will result in more patients benefitting from available treatments.

Abstract NS13: Post Stroke Depression and Fatigue are Independently Related to Sleep Disturbances in Acute and Sub-acute Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Smi Choi Kwon ◽  
Minhee Suh ◽  
Jong S Kim
Keyword(s):  
Diabetes Mellitus ◽  
Daytime Sleepiness ◽  
Sleep Disturbances ◽  
Acute Stage ◽  
Stroke Patients ◽  
Chronic Stage ◽  
Lesion Location ◽  
Post Stroke ◽  
Nighttime Sleep

Post-stroke sleep disturbances (PSSD) is common and is associated with unfavorable clinical outcomes. The purpose of this study was to evaluate the characteristics of PSSD and how depression and fatigue affect PSSD in hospitalized and 3 months post stroke patients. Methods: Patients who were hospitalized with stroke at the Asan Medical Center were evaluated. The duration and latency of nighttime sleep, the frequency of waking after sleep onset, and daytime sleepiness were evaluated during the hospitalization and also 3 months post stroke. An actigraph was also performed. The location, circulation and laterality of each lesion were determined using MRI. Depression and fatigue were assessed using the Beck Depression Inventory and the Fatigue Severity Scale, respectively. For environmental factors, the equipment used at the bedside, and the number of other patients in the same room in acute stage and the place of residence, and the number of other person sharing the room in chronic stage were recorded. Results: A total of 282 patients completed the study. The mean age of the patients was 62.3(± 12.76). Sixty (21.3%) reported sleep duration <6 h/night and 110 (39.0%) reported more daytime sleepiness than prior to the stroke. In 54 patients who wore actigraph, self-reported sleep duration was significantly correlated with time in bed measured with an actigraph ( r =.407, p =.002). Quality of nighttime sleep was independently related to cortical lesion location (p=.002), diabetes mellitus (p=.020), and depression (p<.001) whereas increased daytime sleepiness was independently associated with subcortical lesion location (p=.031), fatigue (p=.001), and quality of nighttime sleep (p=.001). In chronic stage, 151 patients completed the study. PSSD persisted in the majority of the patients (75%) and the related factors to PSSD were also similar as compared to those in acute stage. Conclusions: PSSD are common in acute and chronic stroke patients. . Although brain lesion and diabetes mellitus were associated with nighttime PSSD, depression was the most powerful factor predicting nighttime sleep disturbances. Post-stroke daytime sleep was more closely associated with fatigue and subcortical lesion location.

scholarly journals Functional electrical stimulation reduces pain and shoulder subluxation in chronic post-stroke patients?

2020 ◽  
pp. 1-5
Author(s):  
Willian Vasconcellos da Silva ◽  
Gabriele Natane de Medeiros Cirne ◽  
Edson Meneses da Silva Filho ◽  
Enio Walker Azevedo Cacho ◽  
Johnnatas Mikael Lopes ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Total Duration ◽  
Chronic Phase ◽  
Control Group ◽  
Mcgill Pain Questionnaire ◽  
Therapeutic Effects ◽  
Stroke Patients ◽  
Post Stroke ◽  
Scale Scores

Background: Shoulder subluxation is a common complication of cerebral vascular accident (stroke) and the use of Functional Electrical Stimulation (FES) within the rehabilitation process is extremely important. Objective: To analyze the therapeutic effects of FES in the treatment of chronic shoulder subluxation in post-stroke patients. Method: This is a case study of patients with radiologically subluxation confirmed, who were randomly divided into two groups: Control Group (CG) and Treatment Group (TG). Patients were assessed before and after treatment and at the 2-month follow-up. The assessment consisted of the modified Ashworth scale; passive goniometry; Fugl-Meyer scale; McGill pain questionnaire and evaluation of shoulder subluxation by radiography. The CG did not receive physiotherapeutic intervention; and TG underwent 20 sessions of motor kinesiotherapy and FES associated with functional exercises with a total duration of 1 hour, three times a week, for 7 weeks. The data were analyzed descriptively. Results: The mean age of CG participants was 82.5 ± 1.5 years and of the TG was 70.5 ± 13.5 years. All of them were retired, sedentary, non-smokers/alcoholics and had hemiparesis on the left side. There was an approximate increase of 10o for most joint movements of the shoulder, improvement in McGill scale scores and reduction of shoulder subluxation in TG patients. Conclusion: FES associated with functional movements was effective in reducing the degree of subluxation of the shoulder joint and decreased pain in subjectsin the chronic phase of the post-stroke.

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