scholarly journals Effciency of a rehabilitation training method by means of special infant formulas in patients with ischemic stroke and neurogenic dysphagia as part of combined therapy

2019 ◽  
Vol 11 (2) ◽  
pp. 65-70
Author(s):  
V. I. Ershov ◽  
A. A. Belkin ◽  
A. V. Karpets ◽  
S. V. Zdvizhkova ◽  
A. P. Gonchar-Zaikin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Effect ◽  
Combined Therapy ◽  
Gradual Transition ◽  
Infant Formulas ◽  
Training Method ◽  
Neurogenic Dysphagia ◽  
Swallowing Function ◽  
Solid Foods ◽  
Receptor Apparatus

Objective: to evaluate the efficiency of a training method using special infant formulas as part of combined rehabilitation for patients with ischemic stroke and neurogenic dysphagia.Patients and methods. The investigation enrolled 55 patients (30 men and 25 women) aged 45–80 years with dysphagia during the acute period of ischemic stroke. Thirty patients used special astringent formulas as part of combined therapy and 25 patients did not. The investigators studied the time of course of changes in the restoration of swallowing function, by using the Penetration-Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from probe feeding to independent one.Results and discussion. The best restoration of swallowing function was shown to be achieved through training using formulas with different astringency. Stronger astringent formulas, like solid foods, stimulate better the pharyngeal receptor apparatus; the most active restoration of a dynamic swallowing stereotype occurs. The gradual transition to a milder astringent formula allows restoration of the skill to swallow thinner liquid foods. It takes 10 days to achieve a significant clinical effect in most patients, mainly in those with pseudobulbar disorders. Training may be prolonged to 2 weeks or more in severe cases, in bulbar dysfunctions.Conclusion. The training rehabilitation method using special infant formulas in combination with electrical stimulation in patients with ischemic stroke and neurogenic dysphagia allows achieving the significantly better indicators of restoration of swallowing function in accordance with the PAS scale. The application of the method contributes to the significantly better transition from probe feeding to independent one.

The treatment effi cacy of disturbed swallowing function in patients with ischemic stroke and neurogenic dysphagia

2021 ◽  
Vol 26 (3) ◽  
pp. 51-57
Author(s):  
V. I. Ershov ◽  
A. A. Borzdyko ◽  
V. V. Silkin
Keyword(s):  
Ischemic Stroke ◽  
Combination Therapy ◽  
Comparison Group ◽  
Dynamic Assessment ◽  
Control Group ◽  
Training Method ◽  
Severity Scale ◽  
Neurogenic Dysphagia ◽  
Swallowing Function ◽  
Penetration Aspiration Scale

The aim. To evaluate the effi cacy of swallowing recovery of patients with ischemic stroke carried out with the use of training rehabilitation method using special nutrient mixtures as part of combination therapy. Material and methods. The study included 65 patients (35 men and 30 women, aged 45 to 80 years) with dysphagia in the acute period of ischemic stroke. Thirty patients (control group) were treated with special binding compounds as part of a combination therapy. Thirty fi ve patients (comparison group) did not use the mixture. The dynamics of the recovery function of swallowing using the Penetration–Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from tube to independent feeding were studied. Results. The training method of rehabilitation using special nutritional mixtures is eff ective assessed with PAS and FEDSS in patients with ischemic stroke and neurogenic dysphagia (p < 0.05). The most pronounced eff ect was achieved in the group of patients with pseudobulbar syndrome. In patients with bulbar syndrome no statistically signifi cant diff erences were observed in the dynamic assessment of the severity of dysphagia on the PAS and FEDSS scales. The application of the training method leads to a signifi cantly better transition from tube to independent feeding. Conclusion. The training method of rehabilitation using special nutritional mixtures is eff ective in patients with ischemic stroke and neurogenic dysphagia and leads to a signifi cantly better transition from tube to independent feeding.

scholarly journals Privileged Quinolylnitrones for the Combined Therapy of Ischemic Stroke and Alzheimer’s Disease

2021 ◽  
Vol 14 (9) ◽  
pp. 861
Author(s):  
José M. Alonso ◽  
Alejandro Escobar-Peso ◽  
Alejandra Palomino-Antolín ◽  
Daniel Diez-Iriepa ◽  
Mourad Chioua ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Ischemic Stroke ◽  
Cortical Neurons ◽  
Combined Therapy ◽  
Glucose Deprivation ◽  
Dual Therapy ◽  
Amyloid Peptide ◽  
Neuroprotective Effects ◽  
Number Of Patients

Cerebrovascular diseases such as ischemic stroke are known to exacerbate dementia caused by neurodegenerative pathologies such as Alzheimer’s disease (AD). Besides, the increasing number of patients surviving stroke makes it necessary to treat the co-occurrence of these two diseases with a single and combined therapy. For the development of new dual therapeutic agents, eight hybrid quinolylnitrones have been designed and synthesized by the juxtaposition of selected pharmacophores from our most advanced lead-compounds for ischemic stroke and AD treatment. Biological analyses looking for efficient neuroprotective effects in suitable phenotypic assays led us to identify MC903 as a new small quinolylnitrone for the potential dual therapy of stroke and AD, showing strong neuroprotection on (i) primary cortical neurons under oxygen–glucose deprivation/normoglycemic reoxygenation as an experimental ischemia model; (ii), neuronal line cells treated with rotenone/oligomycin A, okadaic acid or β-amyloid peptide Aβ25–35, modeling toxic insults found among the effects of AD.

Abstract 3314: The Role of Bridging with Intravenous Thrombolysis in Endovascular Therapy of Acute Ischemic Stroke.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Omar Kass-Hout ◽  
Tareq Kass-Hout ◽  
Maxim Mokin ◽  
David Orion ◽  
Shadi Jahshan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Combined Therapy ◽  
Large Vessel ◽  
P Value ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Nihss Score

Background: Large vessel occlusions with a high clot burden are less likely to improve with the FDA-approved IV strategy. Endovascular therapy within the first 3 h of stroke symptom onset provides an effective alternative treatment in patients with large vessel occlusion. It is not clear if combination of IV thrombolysis and endovascular approach is superior to endovascular treatment alone. Methods: We retrospectively reviewed all cases of acute ischemic stroke with large vessel occlusion treated within the first 3 h stroke onset during the 2005-2010 period. First group received endovascular therapy within the first 3 h of stroke onset. Second group consisted of patients who received IV thrombolysis within the first 3 h followed by endovascular therapy. We compared the following outcomes: revascularization rates, NIHSS score at discharge, mRS at discharge and 3months, symptomatic hemorrhage rates and mortality. Results: Among 104 patients identified, 42 received combined therapy, and 62 received endovascular therapy only. The two groups had similar demographic (age and sex distribution) and vascular risk factors distribution, as well as NIHSS score on admission (14.8±4.7 and 16.0±5.3; p=0.23). We found no difference in TIMI recanalization rates (Thrombolysis in Myocardial Infarction scale score of 2 or 3) following combined or endovascular therapy alone (83.3% and 79.0%; p=0.59). A preferred outcome, defined as a mRS of 2 or less at 90 days also did not differ between the combined therapy group and the endovascular only group (37.5% and 34.5%; p=0.76). There was no difference in mortality rate (22.5% and 31.0%; p=0.36) and the rate of symptomatic intracranial hemorrhage (9.5% and 8.1%; p=0.73). There was a significant difference in mean time from symptom onset to endovascular treatment between the combined group (227±88 min) and endovascular only group (125±40 min; p<0.0001).Patients with good TIMI recanalization rate of 2 or 3 showed a trend of having a better mRS at 90 days in both bridging (16.67% vs. 41.18%, p-value: 0.3813) and endovascular groups (25% vs. 34.78%, p-value: 0.7326).When analyzing the correlation of mRS at 90 days with the site of occlusion, patients in the bridging group showed a trend of a better outcome when the site of occlusion was ICA (33.3% vs 30%) and MCA (66.67% vs. 27.59%) and worse outcome when the site of occlusion was in the posterior circulation (26.32% vs. 50%), however, these results were not statistically significant (p-values: 0.1735& 0.5366). Conclusion: Combining IV thrombolysis and endovascular therapy achieves similar rates of clinical outcomes, revascularization rates, complications and mortality rates, when compared with endovascular treatment alone. The combined therapy, however, significantly delays initiation of endovascular treatment. A randomized prospective trial comparing both treatment strategies in acute ischemic stroke is warranted

scholarly journals Combined therapy of Ulmo honey (Eucryphia cordifolia) and ascorbic acid to treat venous ulcers

2015 ◽  
Vol 23 (2) ◽  
pp. 259-266 ◽  
Author(s):  
Mariano del Sol Calderon ◽  
Carolina Schencke Figueroa ◽  
Jessica Salvo Arias ◽  
Alejandra Hidalgo Sandoval ◽  
Felipe Ocharan Torre
Keyword(s):  
Ascorbic Acid ◽  
Clinical Effect ◽  
Chronic Wound ◽  
Combined Therapy ◽  
Clinical Results ◽  
Venous Ulcer ◽  
Technical Standard ◽  
Female Adult ◽  
Venous Ulcers ◽  
One Year

OBJECTIVE: to assess the clinical effect of topical treatment using Ulmo honey associated with oral ascorbic acid in patients with venous ulcers. METHOD: longitudinal and descriptive quantitative study. During one year, 18 patients were assessed who were clinically diagnosed with venous ulcer in different stages, male and female, adult, with a mean injury time of 13 months. Ulmo honey was topically applied daily. The dressing was applied in accordance with the technical standard for advanced dressings, combined with the daily oral consumptions of 500 mg of ascorbic acid. The monitoring instrument is the assessment table of venous ulcers. RESULTS: full healing was achieved in 100% of the venous ulcers. No signs of complications were observed, such as allergies or infection. CONCLUSION: the proposed treatment showed excellent clinical results for the healing of venous ulcers. The honey demonstrated debriding and non-adherent properties, was easy to apply and remove and was well accepted by the users. The described results generated a research line on chronic wound treatment.

scholarly journals Physical therapy of post-stroke patients in the residual period

2021 ◽  
pp. 112-116
Author(s):  
L. A. Ruban ◽  
V. B. Misіura
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Gradual Transition ◽  
High Tech ◽  
Rehabilitation Treatment ◽  
Working Age ◽  
Residual Period

The prevalence of ischemic stroke among people of working age requires a deep analysis of modern technologies of physical therapy at different periods of rehabilitation treatment. The issue of restoring working capacity and preventing repeated acute disorders of cerebral circulation is currently very acute. In modern scientific and methodological literature, more attention is paid to the effectiveness of physical rehabilitation in the acute and early periods of recovery. However, it should be noted that the duration of rehabilitation measures is not limited by time, rehabilitation treatment can occur in a later period, that is, in the residual. Rehabilitation of the effects of a stroke is the subject of close attention of physical therapists. The quality of life of patients depends on the timely and professional conduct of physical therapy at different periods of the disease. It has been proven that the basic method of physical therapy is kinesiotherapy, which must be carried out continuously. When conducting classes in the residual period, the emphasis should be on compensating for impaired functions and re-adaptation of the patient. In the classroom, it is recommended to repeat the training of isolated movements with a gradual transition from one type of movement to another, frequent repetition of complex movements that require more attention, aimed at coordination and balance. In addition to kinesiotherapy, the literature contains recommendations for the use of neurodynamic methods and high-tech robotic techniques. However, most authors note that only a differentiated approach and the complex use of kinesiotherapy with other methods of physical therapy are able to improve the quality of life of patients after an ischemic stroke.

scholarly journals Successful treatment of intubation-induced severe neurogenic post-extubation dysphagia using Pharyngeal Electrical Stimulation in a COVID-19 survivor: a case report

2020 ◽  
Author(s):  
Marianna Traugott ◽  
Wolfgang Hoepler ◽  
Reinhard Kitzberger ◽  
Sophie Pavlata ◽  
Tamara Seitz ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Critically Ill ◽  
Rating Scale ◽  
Prolonged Mechanical Ventilation ◽  
Critically Ill Patient ◽  
Neurogenic Dysphagia ◽  
Swallowing Function ◽  
Prolonged Intubation ◽  
Icu Discharge ◽  
Swallowing Dysfunction

Abstract Background A significant portion of critically ill patients with COVID-19 are at high risk of developing ICU-acquired swallowing dysfunction (neurogenic dysphagia) as a consequence of requiring prolonged mechanical ventilation. Pharyngeal Electrical Stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. Previously it has been shown that PES can restore safe swallowing in orally intubated or tracheotomised ICU-patients with neurogenic dysphagia following severe stroke. We report the case of a patient with severe neurogenic post-extubation dysphagia (PED) due to prolonged intubation and severe general muscle weakness related to COVID-19, which was successfully treated using PES.Case Presentation A 71-year-old female patient with confirmed SARS-CoV-2 infection developed neurogenic dysphagia following prolonged intubation in the ICU. To avoid aerosol generating procedures, her swallowing function was evaluated non-instrumentally as recommended by recently published international guidelines in response to the COVID-19 pandemic. Her swallowing function was markedly impaired and PES therapy was recommended. PES led to a rapid improvement of the post-extubation dysphagia (PED), as evaluated by bedside swallowing assessments using the Gugging Swallowing Screen (GUSS), Dysphagia Severity Rating Scale (DSRS) and diet screening using the Functional Oral Intake Scale (FOIS). The improved swallowing, as reflected by these measures, allowed this patient to transfer from the ICU to a non-intensive medical department five days after completing PES treatment.Conclusions PES treatment contributed to the restoration of a safe swallowing function in this critically ill patient with COVID-19 and ICU-acquired swallowing dysfunction. Early clinical bedside swallowing assessment and dysphagia intervention in COVID-19 patients is crucial to optimise their full recovery. Pharyngeal Electrical Stimulation may contribute to a safe and earlier ICU discharge of patients with ICU-acquired swallowing dysfunction. Earlier ICU discharge and reduced rates of re-intubation following PES can help alleviate some of the pressure on ICU bed capacity, which is critical in times of a health emergency such as the ongoing COVID-19 pandemic.

Clinical Efficacy of Cerebrolysin and Cerebrolysin plus Nootropics in the Treatment of Patients with Acute Ischemic Stroke in Vietnam

2021 ◽  
Vol 20 ◽  
Author(s):  
Luc Tran ◽  
X. Anton Alvarez ◽  
Hoang-Anh Le ◽  
Dat-Anh Nguyen ◽  
Thinh Le ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multicenter Study ◽  
Therapeutic Option ◽  
Combined Therapy ◽  
Included Study ◽  
Period Change ◽  
Treatment Needs ◽  
Open Label ◽  
Treatment Regimens

Aims: To investigate the efficacy and safety of Cerebrolysin and Cerebrolysin plus nootropics in the routine treatment of patients with acute ischemic stroke (AIS). Background: Acute ischemic stroke (AIS) is a leading cause of disability with unmet treatment needs lacking effective drug therapy. Multimodal drugs modulating stroke pathophysiology as Cerebrolysin constitute a good therapeutic option. Objective: In this study, we assessed the effects of Cerebrolysin and Cerebrolysin plus nootropics, in comparison with other nootropic drugs alone, on functional, neurological and cognitive recovery of patients with AIS in Vietnam. Methods.: This non-interventional, controlled, open-label, prospective and multicenter study included 398 AIS patients (234 males) treated with Cerebrolysin (n=190; 20 i.v. infusions of 10 ml), other nootropics (comparator group; n=86), or a combination of both (n=122). The study primary endpoint was a modified Ranking Scale (mRS) score on day 90. Secondary endpoints included study-period change in NIHSS score; percentage of well-recovered (mRS 0-2) patients, the proportion of good NIHSS response (≥6 points) cases, and MoCA scores at day 90; and safety indicators. Results: Compared with other nootropics, both Cerebrolysin and combined therapy induced significant improvements (p<0.001) in: Functional recovery (mRS scores); percentage of well-recovered patients (Cerebrolysin: 81.6%; combination: 93.4%; comparator: 43.0%); neurological recovery (study-period NIHSS change); proportion of good NIHSS responders (Cerebrolysin: 77.5%; combination: 92.5%; comparator: 47.6%); and MoCA scores (Cerebrolysin: 23.3±4.8; combination: 23.7±4.1; comparator: 15.9±7.7). Compared to Cerebrolysin, combined therapy improved (p<0.01) mRS outcomes and NIHSS change, but not MoCA scores, in moderate-severe stroke (NIHSS>11) cases only. No drug-related adverse events were reported. Conclusion: Cerebrolysin alone or combined with other nootropics was effective and safe in routine AIS treatment, during both acute and recovery phases, which supports its use in daily clinical practice. Other: According to the results of this multicenter study, the importance of reducing differences in the treatment regimens of AIS in Vietnam should be further emphasized.

scholarly journals E.09 Predictors of optimal endovascular therapy results among patients with acute ischemic stroke

2016 ◽  
Vol 43 (S2) ◽  
pp. S18-S18
Author(s):  
D Catana ◽  
J Badhiwala ◽  
A Koziarz ◽  
K Reddy ◽  
SA Almenawer
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Mechanical Thrombectomy ◽  
Combined Therapy ◽  
Arterial Occlusion ◽  
Functional Independence ◽  
Sensitivity Analyses ◽  
Care Group ◽  
Functional Benefit

Background: Several studies have demonstrated the safety and efficacy of endovascular therapy for patients with acute ischemic stroke. However, patient, imaging and treatment factors associated with the optimal functional outcome require better definition. Methods: We pooled data from 8 randomized controlled trials (SYNTHESIS, MR RESCUE, IMS III, MR CLEAN, ESCAPE, EXTEND-IA, SWIFT-PRIME, and REVASCAT). We conducted subgroup and sensitivity analyses to evaluate predictors of optimal functional results (modified Rankin scale, mRS) at 90 days. Results: Meta-analysis of 8 trials including 2,423 patients yielded that endovascular therapy resulted in 44.6% functional independence (mRS 0-2) versus 31.8% in the usual care group (OR 1.71, 95% CI 1.18-2.49, P=0.005). This treatment effect was significantly greater among patients with confirmed angiographic imaging of proximal arterial occlusion (OR 2.24, 95% CI 1.72-2.90, P<0.001), in patients who received the combined therapy of intravenous tPA and endovascular intervention (OR 2.07, 95% CI 1.46-2.92, P<0.001), and when using stent retriever for mechanical thrombectomy (OR 2.39, 95% CI 1.88-3.04, P<0.001). Conclusions: The relative functional benefit associated with endovascular therapy among patients with acute ischemic stroke was increased when combined with intravenous tPA, with confirmed proximal arterial occlusion on angiographic imaging, and with use of stent retrievers for mechanical thrombectomy.

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