Using MRI art, poetry, photography and patient narratives to bridge clinical and human experiences of stroke recovery

2019 ◽  
Vol 46 (3) ◽  
pp. 243-249 ◽  
Author(s):  
Gabrielle Brand ◽  
Ashlee Osborne ◽  
Steve Wise ◽  
Collette Isaac ◽  
Christopher Etherton-Beer
Keyword(s):  
Health Professional ◽  
Professional Staff ◽  
Workforce Education ◽  
Reflective Learning ◽  
Stroke Recovery ◽  
Depth Of Field ◽  
Stroke Patients ◽  
Staff Perceptions ◽  
Improvement Project ◽  
Patient Narratives

Integrating co-produced humanities-based pedagogy into patient and workforce education is of growing interest. The aim of our Depth of Field: Exploring Stroke Recovery project grew from a strong commitment to use patients' lived experiences as a voice to educate new stroke patients and the health professional staff who will care for them. The aim of the initial Quality Improvement project at a West Australian Stroke Rehabilitation Unit (SRU) was to co-produce a reflective learning resource with stroke patients and their families to help navigate the stroke recovery journey. A series of artefacts (documentary-style photographs, audio-narrated vignettes, MRI images and poetry) were collected from four stroke patients and their families at differing stages of recovery over 12 months as they recounted the honest and raw reality of what life is really like following a stroke. These artefacts were used in a pilot qualitative project to explore new stroke patients, their families and SRU health professional staff perceptions towards the artefacts in order to inform the final educational resource. These findings enhance our understandings of how we can use art and patient (healthcare consumers) voice to widen the lens of stroke recovery and provides a valuable template to co-produce peer-to-peer and health professions education reflective learning resources to promote more human- centred approaches to care.

Abstract W P386: Matrix Metalloproteinase Levels May Mediate Ischemic Stroke Incidence and Recovery in Stroke Patients with Metabolic Syndrome

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ashley B Petrone ◽  
Taura L Barr ◽  
Kelly Devlin ◽  
Sara B Fournier ◽  
Evan D Devallance ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Stroke Risk ◽  
Plasma Concentrations ◽  
Stroke Recovery ◽  
Ultrasound Images ◽  
Stroke Patients ◽  
Stroke Incidence ◽  
The Metabolic Syndrome ◽  
Diabetes Status ◽  
Increased Risk

Intro: The metabolic syndrome (MetS) is highly prevalent in the US characterized by a combination of risk factors that can lead to cardiovascular disease (CVD). While the association between CVD, inflammation, and stroke risk has been characterized, the immune mechanisms underlying increased risk of stroke in MetS is unclear. While stroke risk is higher among MetS, MetS individuals tend to have better stroke recovery than controls. The immune response may mediate these paradoxical observations in stroke. In particular, matrix metalloproteinases (MMP) enzymes play a role in stroke incidence and recovery. Similar to MetS, MMPs have a dual role in stroke, as they are harmful immediately after stroke, but play a vital role in brain repair and recovery following stroke. We hypothesize that elevated levels of MMPs in MetS may account for the paradoxical increased stroke risk, yet better recovery seen in stroke patients with MetS. Methods: MMP protein concentrations were obtained from fasting venous samples and quantified using a Multi-Analyte Profiling Kit (Millipore) on the Luminex®. Each subject was assigned a metabolic risk score (MRS) based on sex, age, SBP, treatment for hypertension, smoking and diabetes status, HDL, and total cholesterol. B-mode ultrasound images of the right common carotid artery were obtained to measure intima-medial thickness (cIMT). Spearman correlations were used to measure the relationship between MRS, cIMT, and MMP levels. Results: In n=68 subjects (60% female) with a mean age of 48+14 yrs, MRS of 25+12, and cIMT of 0.57+0.12 mm. MRS was significantly correlated with cIMT (r=0.39, p< .001). Further, cIMT was positively correlated with MMP1 (r=0.025, p=0.04), MMP7 (r=0.5, p=0.01), and MMP9 (r=0.31, p=0.01). Conclusion: Plasma concentrations of MMP1, 7, and 9 were significantly correlated with cIMT, indicating that increased severity of MetS is associated with increased inflammation. Elevated MMP protein levels may account for the increased stroke risk, yet better recovery seen in stroke patients with MetS.

scholarly journals 2190 Longitudinal changes in EEG power envelope connectivity are proportional to motor recovery in chronic stroke patients

2018 ◽  
Vol 2 (S1) ◽  
pp. 17-17
Author(s):  
Joseph B. Humphries ◽  
David T. Bundy ◽  
Eric C. Leuthardt ◽  
Thy N. Huskey
Keyword(s):  
Motor Cortex ◽  
Motor Imagery ◽  
Stroke Rehabilitation ◽  
Brain Computer Interface ◽  
Chronic Stroke ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Computer Interface ◽  
Beta Band ◽  
Stroke Patients

OBJECTIVES/SPECIFIC AIMS: The objective of this study is to determine the degree to which the use of a contralesionally-controlled brain-computer interface for stroke rehabilitation drives change in interhemispheric motor cortical activity. METHODS/STUDY POPULATION: Ten chronic stroke patients were trained in the use of a brain-computer interface device for stroke recovery. Patients perform motor imagery to control the opening and closing of a motorized hand orthosis. This device was sent home with patients for 12 weeks, and patients were asked to use the device 1 hour per day, 5 days per week. The Action Research Arm Test (ARAT) was performed at 2-week intervals to assess motor function improvement. Before the active motor imagery task, patients were asked to quietly rest for 90 seconds before the task to calibrate recording equipment. EEG signals were acquired from 2 electrodes—one each centered over left and right primary motor cortex. Signals were preprocessed with a 60 Hz notch filter for environmental noise and referenced to the common average. Power envelopes for 1 Hz frequency bands (1–30 Hz) were calculated through Gabor wavelet convolution. Correlations between electrodes were then calculated for each frequency envelope on the first and last 5 runs, thus generating one correlation value per subject, per run. The chosen runs approximately correspond to the first and last week of device usage. These correlations were Fisher Z-transformed for comparison. The first and last 5 run correlations were averaged separately to estimate baseline and final correlation values. A difference was then calculated between these averages to determine correlation change for each frequency. The relationship between beta-band correlation changes (13–30 Hz) and the change in ARAT score was determined by calculating a Pearson correlation. RESULTS/ANTICIPATED RESULTS: Beta-band inter-electrode correlations tended to decrease more in patients achieving greater motor recovery (Pearson’s r=−0.68, p=0.031). A similar but less dramatic effect was observed with alpha-band (8–12 Hz) correlation changes (Pearson’s r=−0.42, p=0.22). DISCUSSION/SIGNIFICANCE OF IMPACT: The negative correlation between inter-electrode power envelope correlations in the beta frequency band and motor recovery indicates that activity in the motor cortex on each hemisphere may become more independent during recovery. The role of the unaffected hemisphere in stroke recovery is currently under debate; there is conflicting evidence regarding whether it supports or inhibits the lesioned hemisphere. These findings may support the notion of interhemispheric inhibition, as we observe less in common between activity in the 2 hemispheres in patients successfully achieving recovery. Future neuroimaging studies with greater spatial resolution than available with EEG will shed further light on changes in interhemispheric communication that occur during stroke rehabilitation.

scholarly journals Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Helena Hybbinette ◽  
Ellika Schalling ◽  
Jeanette Plantin ◽  
Catharina Nygren-Deboussard ◽  
Marika Schütz ◽  
...  
Keyword(s):  
Left Hemisphere ◽  
Motor Impairment ◽  
Stroke Recovery ◽  
Similar Amount ◽  
Apraxia Of Speech ◽  
Stroke Patients ◽  
Post Stroke ◽  
Language Functions ◽  
Brain Recovery ◽  
Recovery Mechanisms

Objective: Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. In addition, we also explored factors predicting recovery from AOS.Methods: Seventy participants with mild to severe paresis in the upper extremity were assessed; 50% of these (n = 35) had left hemisphere (LH) lesions. Aphasia, AOS and hand motor assessments and magnetic resonance imaging were conducted at 4 weeks (A1) and at 6 months (A2) after stroke onset. Recovery was characterized in 15 participants showing initial aphasia that also had complete follow-up data at 6 months.Results: All participants with AOS and/or aphasia had LH lesions. In LH lesioned, the prevalence of aphasia was 71% and of AOS 57%. All participants with AOS had aphasia; 80% of the participants with aphasia also had AOS. Recovery in aphasia (n = 15) and AOS (n = 12) followed a parallel pattern to that observed in hand motor impairment and recovery correlated positively across speech-language and motor domains. The majority of participants with severe initial aphasia and AOS showed a limited but similar amount of recovery across domains. Lesion volume did not correlate with results from behavioral assessments, nor with recovery. The initial aphasia score was the strongest predictor of AOS recovery.Conclusion: Our findings confirm the common occurrence of AOS and aphasia in left hemisphere stroke patients with a hand motor impairment. Recovery was similar across speech-language and motor domains, even in patients with severe impairment, supporting the shared recovery hypothesis and that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. These observations contribute to the knowledge of AOS and its relation to motor and language functions and add information that may serve as a basis for future studies of post stroke recovery. Studies including neuroimaging and/or biological assays are required to gain further knowledge on shared brain recovery mechanisms.

Abstract WP166: Dietary Nitrate Supplements and Ischemic Stroke Recovery: A Pilot Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Cheryl Bushnell ◽  
Daniel Beavers ◽  
Gary Miller ◽  
Susan Reeves ◽  
Pamela Duncan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Placebo Group ◽  
Adverse Events ◽  
Gait Speed ◽  
Stroke Recovery ◽  
Beetroot Juice ◽  
Stroke Patients ◽  
Double Blind ◽  
Dietary Nitrate ◽  
Nitrate And Nitrite

Introduction: Dietary nitrate improves cerebral blood flow and enhances physical performance by improving exercise capacity. We designed a proof-of-concept study to show increases in plasma nitrate and nitrite levels in ischemic stroke patients treated with beetroot juice shots vs placebo juice (nitrate removed). We assessed gait speed after 30 days and safety/adverse events with both groups. Methods: In a randomized placebo-controlled double-blind design, patients with NIHSS of ≥ 2 but < 20, with fair or good sitting balance and score >0 on hip flexion on the short Fugl-Meyer, within 5 days of stroke onset were enrolled. Those treated with IV alteplase or endovascular therapy, gait speed > 0.8 cm/sec, or taking nitrate-containing medications were excluded. After consent, patients were randomized to beetroot vs placebo juice. On days 1 and 30, blood was drawn for nitrate and nitrite levels before and one hour after drinking 70 cc (3.8 mM nitrate) beetroot juice (James White Fruit Juices) or an identically-appearing placebo juice, plus vitamin C 500 mg daily for 30 days in each group. On day 30, gait speed (using the 4 m walk) was assessed. Results: Eighteen participants (6 women, 12 men, 12 white, 4 African American and 2 other race-ethnicities, median age 64.6 IQR (58.7, 70.0)) were consented, 17 completed treatment (1 terminated treatment because of nausea), 16 followed for 30 days and 13 for 90 days. Baseline characteristics were balanced with regard to admission NIHSS (median 5.0 in each group), age, sex, race, risk factors, baseline gait speed (median 0.17 m/sec in active and 0.13 m/sec in placebo), and baseline nitrate/nitrite levels. There was no difference in adverse events in the two groups. The mean treatment-specific changes in nitrate were 236 micromoles/L (95% CI 170, 302) in the active and 0 (95% CI -64, 64) in the placebo group (p<0.0001). For nitrite, active group increased by 313 nanomoles/L (37, 588) and 20 nanomoles for placebo (-211, 252); p=0.045. Gait speed increased by 0.26m/sec in the active and 0.30m/sec in placebo group. Conclusions: Beetroot juice was associated with an increase in nitrate and nitrite levels, but was not associated with a change in gait speed after 30 days. Further studies with a larger population of stroke patients may be warranted.

Socioeconomic status and lifestyle in young ischaemic stroke patients: a possible relationship to stroke recovery and risk of recurrent event

2021 ◽  
Vol 29 (3) ◽  
pp. 223-229
Author(s):  
David Franc ◽  
Daniel Šaňák ◽  
Petra Divišová ◽  
Lucie Lysková ◽  
Andrea Bártková ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Ischaemic Stroke ◽  
Recurrent Event ◽  
Stroke Recovery ◽  
Stroke Patients

Abstract TP94: Mesenchymal Stromal Cells Behave Differently When Exposed to Medications Commonly Prescribed to Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nikunj Satani ◽  
Bing Yang ◽  
Duyen M Nghiem ◽  
Xiaopei Xi ◽  
Adrian P Gee ◽  
...  
Keyword(s):  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
High Glucose ◽  
Fold Increase ◽  
Stroke Recovery ◽  
Stroke Patients ◽  
Healthy Humans ◽  
Tnf Α ◽  
High Concentrations ◽  
And Function

Background: As a promising investigational therapy for stroke recovery, mesenchymal stromal cells (MSCs) are in various stages of clinical trials. MSCs may promote recovery through cytokine release and immunomodulation. Stroke patients typically are treated with antiplatelets and medications for hypertension and hyperlipidemia. We explored the effect of commonly prescribed drugs at physiological concentrations on MSCs. Methods: Clinical grade bone marrow MSCs from healthy donor at passage 2 were thawed and re-suspended in serum free media. Monocytes (Mo) were isolated from peripheral blood of healthy humans. MSCs and Mo were cultured alone as well as in co-culture and exposed to simvastatin, atenolol, losartan, captopril, or aspirin. They were also exposed to high glucose (upto 40mM) to simulate hyperglycemia. At 24 hours of incubation, media was collected and TNF-α concentration was measured, as an index of immunomodulation of Mo by MSCs. Cell viability was also measured (using MTT assay and flow cytometry). Results: There were significant effects of all drugs on viability of MSCs but with no impact on Mo. More importantly, Losartan (dose independent), Simvastatin and Atenolol (dose-dependent) reduced the viability of MSCs even at the pharmacologically relevant concentrations (Fig 1). High glucose had no effect on viability of MSCs or Mo. TNF-α secretion from co-culture of MSCs and Mo at 24 hours showed differences at very high doses of aspirin (2-fold increase), atenolol (0.5 fold decrease), and glucose (0.5 fold decrease) (data not shown). However, these high concentrations are unlikely to be achieved pharmacologically in plasma of patients treated with these drugs. Conclusion: Exposure of MSCs to clinically relevant drugs can alter their viability and function. Our results suggest that stroke trials involving use of intravenous MSCs should consider the differential impact of commonly prescribed medications on MSCs function.

Stroke Patients’ Experiences in an Adaptive Healing Room in a Stroke Rehabilitation Unit

2019 ◽  
Vol 13 (2) ◽  
pp. 170-185
Author(s):  
Ifah Arbel ◽  
Bing Ye ◽  
Alex Mihailidis
Keyword(s):  
Stroke Rehabilitation ◽  
Well Being ◽  
Stroke Recovery ◽  
Structured Interviews ◽  
Stroke Patients ◽  
Rehabilitation Unit ◽  
Healing Environment ◽  
Healthcare Settings ◽  
Patient Feedback ◽  
Healing Environments

Objectives: This study evaluated the user experiences (UX) of stroke patients residing in the adaptive healing room (AHR) and compared them to the UX of patients residing in standard private rooms (SPRs). Background: Healing environments in healthcare settings can promote patients’ healing processes, outcomes, and psychological well-being. The AHR was designed as a healing environment for stroke patients and has been previously evaluated in laboratory settings. This study was the first to evaluate it in its intended context—a stroke rehabilitation unit. Methods: The UX of 10 patients residing in the AHR and 15 patients residing in SPRs were collected via structured interviews with a set of open-ended questions and analyzed using quantitative and qualitative methods. Results: The AHR design features (orientation screen, skylight, and nature view) were rated positively by most patients. The skylight emerged as the least favorable. Responses to open-ended questions revealed that UX may be further improved if patients have more control over some of the settings (e.g., light intensity and nature views), and if the system allowed for more stimulation for patients at later stages of their recovery. Additionally, the results suggest that patients in the AHR have better UX than patients in the SPRs. Conclusion: The AHR has the potential to improve UX in the stroke rehabilitation unit. Patient feedback can be used to refine the AHR before carrying out clinical trials to assess the effect of the AHR on patient outcomes (e.g., sleep, mood, and length of stay) and stroke recovery.

Improvement of hand hygiene compliance among health professional staff of Neonatology Department in Nyamata Hospital

2016 ◽  
Vol 24 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Solange Umulisa ◽  
Angele Musabyimana ◽  
Rex Wong ◽  
Eva Adomako ◽  
April Budd ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Professional Staff ◽  
Routine Practice ◽  
Improve Hand Hygiene ◽  
Improvement Project ◽  
Content Type ◽  
Hygiene Compliance

Purpose The purpose of this study is to improve the hand hygiene compliance in a hospital in Rwanda. Hand hygiene is a fundamental routine practice that can greatly reduce risk of hospital-acquired infections; however, hand hygiene compliance in the hospital was low. Design/methodology/approach A multiple-strategy intervention was implemented with a focus on ensuring stable water supply was available through installing mobile hand hygiene facilities. Findings The intervention significantly increased the overall hand hygiene compliance rate by 35 per cent. The compliance for all of the five hand hygiene moments and all professions also significantly increased. Practical implications By implementing an intervention that involved multiple strategies to address the root causes of the problem, this quality improvement project successfully created an enabling environment to increase hand hygiene compliance. The hospital should encourage using the strategic problem-solving method to conduct more quality improvement projects in other departments. Originality/value Findings from this study may be useful for hospitals in similar settings seeking to improve hand hygiene compliance.

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