scholarly journals Inter-hemispheric inhibition in stroke survivors is related to fatigue and cortical excitability

2019 ◽  
Author(s):  
Sasha Ondobaka ◽  
Nick Ward ◽  
Annapoorna Kuppuswamy
Keyword(s):  
Cortical Excitability ◽  
Effective Connectivity ◽  
Self Report ◽  
Stroke Survivors ◽  
Corticomotor Excitability ◽  
Post Stroke ◽  
Motor Cortex Excitability ◽  
Persistent Fatigue ◽  
Fatigue Severity ◽  
Exercise Induced

ABSTRACTObjectivePersistent post-stroke fatigue is a major debilitating condition that has been linked to low corticomotor excitability and aberrant attention, both phenomena that are associated with the inter-hemispheric inhibition balance in the brain. In this study, we examined the relationship between inter-hemispheric inhibitory effective connectivity, motor cortex excitability and chronic persistence of post-stroke fatigue.MethodsWe tested eighteen non-depressed stroke survivors with minimal motoric and cognitive impairments using spectral dynamic causal modelling (spDCM) of ‘resting state’ magnetic resonance imaging (rs-fMRI) and transcranial magnetic stimulation (TMS) measures of cortical excitability. We also assessed the levels of non-exercise induced, persistent fatigue using Fatigue Severity Scale (FSS) - a self-report questionnaire which has been widely applied and validated across different conditions. To understand neural effective connectivity mechanisms involved in fatigue and corticomotor excitability we examined the balance in inhibitory connectivity between homologue regions in M1, anterior insula, caudate and thalamus of the resting brain.ResultsInter-hemispheric inhibition balance between left and right M1 accounted for 67% of variability in the reported fatigue (R=.82, p<0.001). Inter-hemispheric inhibition balance in M1 also accounted for 54% of variability in the corticomotor excitability characterised by individual resting motor thresholds (R=.74, p<0.001), a measure that has been associated with subjective fatigue reports. Other examined inter-hemispheric connections did not show significant relationships with either fatigue or cortical excitability measures.ConclusionOur findings suggest that the balance in inter-hemispheric effective connectivity between primary motor regions is involved in regulation of corticomotor excitability and could explain subjective post-stroke fatigue.

scholarly journals Psychometric evaluation of a newly developed measure of emotionalism after stroke (TEARS-Q)

2020 ◽  
pp. 026921552098172
Author(s):  
Niall M Broomfield ◽  
Robert West ◽  
Allan House ◽  
Theresa Munyombwe ◽  
Mark Barber ◽  
...  
Keyword(s):  
Item Response ◽  
Psychometric Evaluation ◽  
Self Report ◽  
Stroke Survivors ◽  
Reference Standard ◽  
Stroke Units ◽  
Post Stroke ◽  
Response Variance ◽  
Mild Stroke ◽  
Functional Outcome Measures

Objective: To evaluate, psychometrically, a new measure of tearful emotionalism following stroke: Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q). Setting: Acute stroke units based in nine Scottish hospitals, in the context of a longitudinal cohort study of post-stroke emotionalism. Subjects: A total of 224 clinically diagnosed stroke survivors recruited between October 1st 2015 and September 30th 2018, within 2 weeks of their stroke. Measures: The measure was the self-report questionnaire TEARS-Q, constructed based on post-stroke tearful emotionalism diagnostic criteria: (i) increased tearfulness, (ii) crying comes on suddenly, with no warning (iii) crying not under usual social control and (iv) crying episodes occur at least once weekly. The reference standard was presence/absence of emotionalism on a diagnostic, semi-structured post-stroke emotionalism interview, administered at the same assessment point. Stroke, mood, cognition and functional outcome measures were also completed by the subjects. Results: A total of 97 subjects were female, with a mean age 65.1 years. 205 subjects had sustained ischaemic stroke. 61 subjects were classified as mild stroke. TEARS-Q was internally consistent (Cronbach’s alpha 0.87). TEARS-Q scores readily discriminated the two groups, with a mean difference of −7.18, 95% CI (−8.07 to −6.29). A cut off score of 2 on TEARS-Q correctly identified 53 of the 61 stroke survivors with tearful emotionalism and 140 of the 156 stroke survivors without tearful emotionalism. One factor accounted for 57% of the item response variance, and all eight TEARS-Q items acceptably discriminated underlying emotionalism. Conclusion: TEARS-Q accurately diagnoses tearful emotionalism after stroke.

STROKE PATIENTS AND THEIR PARTNER’S PERCEPTIONS OF SURVIVOR FUNCTIONING

2017 ◽  
Vol 15 (2) ◽  
pp. 0-0 ◽  
Author(s):  
Chloe Witty ◽  
Thomas Heffernan ◽  
Leigh Riby
Keyword(s):  
Verbal Memory ◽  
Digit Span ◽  
Qualitative Interviews ◽  
Stroke Survivor ◽  
Self Report ◽  
Stroke Recovery ◽  
Step Test ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Significant Difference

[b]Background: [/b]Research into stroke survivors and their partners have shown that the partner frequently rates the stroke survivor as less capable than the survivors rate themselves through self-report questionnaires or qualitative interviews; however, no research to date has used cognitive tasks as a method for in vestigation. This paper aims to investigate if the stroke survivor or the partner rate the stroke survivor as worse across all cognitive domains. [b]Material/ Methods:[/b]This research aimed to observe the incongruence of stroke survivors and their spouse’s perception of survivor functioning by rating their confidence on Picture Memory, Verbal Memory, Digit Span, Luria’s Three Step Test, NART and Raven’s Matrices. Participants, and to compare these score to see if either could predict the actual score. [b]Results: [/b]Showed that neither the stroke survivor nor the partner consistently rated functioning as worse, but there was a significant difference between the dyad. Further, the stroke survivor and the partner’s confidence had no relationship with raw scores. A thematic analysis was also conducted and themes emerged from the data. These were “Confidence,” “Insight into Ability,” and “Post-Stroke Changes.”[b]Conclusions:[/b]These themes were shown to interlink with the scores provided in the qualitative analysis, and implied that low self-efficacy may be crucial in post stroke recovery. Limitations and implications are discussed in full.

Abstract TP144: Intracortical Circuits Reveal Muscle- and Task-specific Dysfunction Contributing to Weakness Following Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Virginia L Little ◽  
Eric R Walker ◽  
Carolynn Patten
Keyword(s):  
Cortical Excitability ◽  
Isometric Force ◽  
Force Production ◽  
Intracortical Inhibition ◽  
Medial Gastrocnemius ◽  
Stroke Survivors ◽  
Pattern Reversal ◽  
Dynamic Force ◽  
Post Stroke ◽  
Intracortical Circuits

Introduction: Weakness is a prominent clinical manifestation following stroke. While central factors, including activation impairment, contribute to hemiparetic weakness, specific mechanisms remain poorly understood. Here we probed functioning of the corticospinal pathway and intracortical circuits mediating dynamic force production. Hypothesis: We hypothesized that impairments of intracortical inhibition and excitation contribute to deficits in plantarflexor (PF) force production capacity following stroke. Methods: We studied 19 chronic stroke survivors (age: 66.0±9.6 yrs; chronicity: 77.3±60.9 mo) and 7 controls (age: 61.3±9.7 yrs) and used the Short Physical Performance Battery to group stroke survivors by functional ability (i.e., HIGH, MED, LOW). We obtained peak isometric PF force during a series of maximal voluntary contractions. Single and paired pulse transcranial magnetic stimulation (TMS) was delivered over the ipsilesional hemisphere during isometric and dynamic PF contractions to assess corticomotor excitability, short intracortical inhibition (SICI), and short intracortical facilitation (SICF). Results: Peak isometric force (p=0.04) and cortical excitability in both medial gastrocnemius (MG) and soleus (SO) were progressively reduced across functional levels post-stroke (p’s<0.01). Controls revealed task-dependent modulation of motor evoked responses (MEPs) between isometric and dynamic contractions in MG, but not SOL while the MED and LOW groups failed to modulate MEPs. SICF revealed no differences between muscles, contraction type, or groups. In SO, controls revealed attenuation of SICI during movement. Stroke survivors revealed a progressive reduction in SICI during isometric PF across functional level while SICI increased during dynamic PF, resulting in a pattern reversal between controls and LOW (p=0.02). Conclusion: Deficits in dynamic PF post-stroke appear to be driven by changes in SICI rather than SICF, suggesting dysregulation of GABA-A. Impaired intracortical inhibition could reduce PF capacity by interfering with selective muscle recruitment during dynamic tasks.

scholarly journals Effects of a Single Session of High Intensity Interval Treadmill Training on Corticomotor Excitability following Stroke: Implications for Therapy

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Sangeetha Madhavan ◽  
James W. Stinear ◽  
Neeta Kanekar
Keyword(s):  
Skill Acquisition ◽  
High Intensity ◽  
Chronic Stroke ◽  
Treadmill Training ◽  
Stroke Survivors ◽  
Single Session ◽  
Corticomotor Excitability ◽  
Acquisition Task ◽  
High Intensity Interval ◽  
Exercise Induced

Objective. High intensity interval treadmill training (HIITT) has been gaining popularity for gait rehabilitation after stroke. In this study, we examined the changes in excitability of the lower limb motor cortical representation (M1) in chronic stroke survivors following a single session of HIITT. We also determined whether exercise-induced changes in excitability could be modulated by transcranial direct current stimulation (tDCS) enhanced with a paretic ankle skill acquisition task.Methods. Eleven individuals with chronic stroke participated in two 40-minute treadmill-training sessions: HIITT alone and HITT preceded by anodal tDCS enhanced with a skill acquisition task (e-tDCS+HIITT). Transcranial magnetic stimulation (TMS) was used to assess corticomotor excitability of paretic and nonparetic tibialis anterior (TA) muscles.Results. HIIT alone reduced paretic TA M1 excitability in 7 of 11 participants by ≥ 10%. e-tDCS+HIITT increased paretic TA M1 excitability and decreased nonparetic TA M1 excitability.Conclusions. HIITT suppresses corticomotor excitability in some people with chronic stroke. When HIITT is preceded by tDCS in combination with a skill acquisition task, the asymmetry of between-hemisphere corticomotor excitability is reduced.Significance. This study provides preliminary data indicating that the cardiovascular benefits of HIITT may be achieved without suppressing motor excitability in some stroke survivors.

Exploring The Views Of Stroke Survivors Around Post Stroke Fatigue In Saudi Arabia: A Qualitative Interview Study

2019 ◽  
Vol 26 (6) ◽  
pp. 6-6
Author(s):  
Wafa Alahmari ◽  
Ahmed Alhowimel ◽  
Mazyad Alotaibi ◽  
Eirini Kontou ◽  
Pip Logan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Saudi Arabia ◽  
Standard Deviation ◽  
Fatigue Severity Scale ◽  
Stroke Survivors ◽  
Severity Scale ◽  
Post Stroke ◽  
Fatigue Severity

Background/Aims Among stroke survivors, post-stroke fatigue is highly prevalent, ranging from 25% to 85% and has a significant impact on their quality of life. The available literature on post-stroke fatigue is still rudimentary, especially from middle-eastern countries such as Saudi Arabia, which is a country with a complex health care system and diverse population. The aim of this study is to explore the post-stroke survivors' experiences and perceptions of their post-stroke fatigue. To our knowledge, this is the first attempt to understand post-stroke fatigue among stroke survivors living in Saudi Arabia. Methods This was a qualitative study where semi-structured interviews were conducted with stroke survivors who were diagnosed to have fatigue based on the Fatigue Severity Scale. A total of eight participants were recruited using a purposive sampling technique for the study. Interviews with the participants were recorded, transcribed verbatim and analysed using inductive thematic analysis. Validity was ensured through data triangulation with participants. Results The 8 participants (male=4; female=4), aged between 27 and 65 years (mean 52, standard deviation 14), were interviewed. Their scores on the Fatigue Severity Scale ranged from 4.5 to 6 (mean 5.3, standard deviation 0.5). On analysing the interview transcripts, 8 over-arching themes were generated: fatigue after stroke; symptomatology of post-stroke fatigue; pre-stroke fatigue levels and lifestyle; stroke survivors' perspectives of post-stroke fatigue; post-stroke fatigue's impact on daily living; coping with post-stroke fatigue; post-stroke fatigue patients' perception on physiotherapy; type of support from family and health care professional. Conclusions The results from this study highlights the lack of awareness about fatigue after stroke among stroke survivors. Also, the themes indicate that there is a need to educate stroke patients and their caregivers about post-stroke fatigue and how they should manage it. Based on patients ‘experiences’, physiotherapy seems to be helpful in reducing fatigue symptoms after stroke, but sill there is a need to design specific physiotherapy interventions with suitable frequency and intensity to target fatigue after stroke. In summary, post-stroke fatigue has a significant impact on their quality of life concerning social participation and their daily life. Stroke survivors did not receive enough support from health care professionals with respect to post-stroke fatigue, and it is highly essential to train health care practitioners to identify and acknowledge post-stroke fatigue appropriately.

Abstract TP322: Towards better screening for Post Stroke Depression

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Alyssa J Herzig ◽  
Nancy Mayo ◽  
Syd Miller
Keyword(s):  
Length Of Hospital Stay ◽  
Critical Factor ◽  
Self Report ◽  
Screening Tools ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Rehabilitation Outcomes ◽  
C Statistic ◽  
Post Stroke Depression

Post stroke depression (PSD), occurring in 33% of stroke survivors, is considered the most critical obstacle to rehabilitation after stroke. PSD is consistently linked with increased length of hospital stay, motivation to undergo rehabilitation, poorer rehabilitation outcomes, decreased engagement in recreational and social pursuits, decreased quality of life, and mortality. Although addressing PSD should be considered a critical factor in stroke recovery, the condition remains largely under-diagnosed. A challenge to diagnosis of PSD is a lack of appropriate screening tools. Existing screening tools were not designed for stroke populations or are too time consuming and complex to be utilized routinely. The goal of the present study was to identify a quick, two item screening tool for PSD that requires no training or scoring. Specifically, we examined what brief combination of dichotomized self-report questions can be used as indicators for a DSM-IV-TR classification of depression in stroke survivors In this prospective natural history study, a consecutive sample of 121 stroke survivors completed comprehensive interviews at 10 days post stroke. Contender questions assessing mood, cognition, physical functioning, social support, and relationship profiles were selected based on previous findings. At 10 days, 7 of 121 participants were classified as depressed in accordance with the SCID-I, the gold standard diagnostic tool for clinical depression. Results of logistic regression indicated that patients who met threshold on two MHI item, are you a happy person and have you been so down in the dumps, were 25 times more likely to be depressed than patients who did not (C Statistic > 0.90). As well, these brief questions better predicted PSD at 10 days than did the total MHI score. In the present paper, screening models are considered with regard to practical and theoretical issues in the assessment of PSD. The present study indicates that quick and simple screening tools designed for PSD can be used to select patients for diagnostic assessments and facilitate timely diagnoses of PSD. The present study contributes to our understanding of the clinical presentation of depression in the context of stroke and to our goal of facilitating recovery from stroke.

scholarly journals Stroke survivors experience elevated levels of loneliness: a multi-year analysis of the National Survey for Wales

2020 ◽  
Author(s):  
Christopher Byrne ◽  
Christopher W. N. Saville ◽  
Rudi Coetzer ◽  
Richard Ramsey
Keyword(s):  
Social Isolation ◽  
Large Scale ◽  
Self Report ◽  
Objective Measures ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Annual Survey ◽  
Societal Relevance ◽  
Human Stroke ◽  
Nationally Representative

AbstractDespite clinical observation that stroke survivors frequently experience loneliness, there is no large-scale empirical evidence to support this observation. To address this issue, we completed two pre-registered analyses of a nationally representative annual survey that included a self-report measure of loneliness (N>21000). Across two separate cohorts, the results consistently showed that human stroke survivors report higher levels of loneliness compared to healthy individuals, and this relationship could not be accounted for by demographic factors (e.g., age, sex) or objective measures of social isolation (e.g., marital status, number of household members). These findings demonstrate that elevated levels of loneliness post-stroke are robust in that they replicate in large nationally representative samples and cannot be reduced to objective measures of social isolation. The work has clinical and societal relevance by suggesting that loneliness post-stroke is unlikely to be adequately “treated” if only the quantity and not the quality of social experiences are considered.

scholarly journals Post-stroke fatigue: A factor associated with inability to return to work in patients <60 years—A 1-year follow-up

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255538
Author(s):  
Nicole Anna Rutkowski ◽  
Elham Sabri ◽  
Christine Yang
Keyword(s):  
Return To Work ◽  
Young Patients ◽  
Outpatient Rehabilitation ◽  
Stroke Severity ◽  
Loss To Follow Up ◽  
Post Stroke ◽  
Persistent Fatigue ◽  
Fatigue Severity ◽  
Driving Fatigue

This study investigated the association between post-stroke fatigue and inability to return to work/drive in young patients aged <60 years with first stroke who were employed prior to infarct while controlling for stroke severity, age, extent of disability, cognitive function, and depression. The Fatigue Severity Scale (FSS) was used to evaluate post-stroke fatigue in this 1-year prospective cohort study. Follow-ups were completed at 3, 6, and 12 months post rehabilitation discharge. A total of 112 patients were recruited, 7 were excluded, due to loss to follow-up (n = 6) and being palliative (n = 1), resulting in 105 participants (71% male, average age 49 ±10.63 years). Stroke patients receiving both inpatient and outpatient rehabilitation were consecutively recruited. Persistent fatigue remained associated with inability to return to work when controlling for other factors at 3 months (adjusted OR = 18, 95% CI: 2.9, 110.3, p = 0.002), 6 months (adjusted OR = 29.81, 95% CI: 1.7, 532.8, p = 0.021), and 12 months (adjusted OR = 31.6, 95% CI: 1.8, 545.0, p = 0.018). No association was found between persistent fatigue and return to driving. Fatigue at admission was associated with inability to return to work at 3 months but not return to drive. Persistent fatigue was found to be associated with inability to resume work but not driving. It may be beneficial to routinely screen post-stroke fatigue in rehabilitation and educate stroke survivors and employers on the impacts of post-stroke fatigue on return to work.

scholarly journals Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ingrid Johansen Skogestad ◽  
Marit Kirkevold ◽  
Petra Larsson ◽  
Christine Råheim Borge ◽  
Bent Indredavik ◽  
...  
Keyword(s):  
Future Development ◽  
Health Professionals ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Stroke Survivors ◽  
Structured Interviews ◽  
Post Stroke ◽  
Patient Reported Outcome Measure ◽  
Patient Reported ◽  
Initial Hospital

Abstract Background Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity.

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