scholarly journals Einfluss kognitiver Dysfunktionen auf die Mobilität im Verlauf der neurologischen Rehabilitation nach Schlaganfall

2020 ◽  
Vol 26 (4) ◽  
pp. 207-213
Author(s):  
M. Froß ◽  
M. Sailer ◽  
J. Lamprecht
Keyword(s):  
Executive Functions ◽  
Motor Impairment ◽  
Cognitive Disorders ◽  
Neurological Rehabilitation ◽  
Kognitive Störungen ◽  
Schlüsselwörter Schlaganfall ◽  
Stroke Patients ◽  
Rehabilitation Process ◽  
Post Stroke ◽  
The Impact

Zusammenfassung Kognitive Störungen treten häufig nach einem Schlaganfall auf, persistieren meistens länger als motorische Funktionsstörungen und können den Verlauf der Therapie beeinflussen, da die kognitive »Performance« und das motorische Lernen in Beziehung zueinander stehen. Die Studie adressiert daher folgende Fragen: a) Welche kognitiven Störungen weisen Schlaganfallpatienten zu Beginn der Rehabilitation auf? b) Wie verändert sich die Mobilität im Rehabilitationsverlauf? c) Welche kognitiven Störungen beeinflussen die Verbesserung der Mobilität im Rehabilitations-verlauf negativ? Im Ergebnis zeigte sich, dass ein Drittel der Schlaganfallpatienten zu Rehabili-tationsbeginn unter kognitiven Störungen, vor allem im Bereich der Exekutivfunktionen, leidet. Dabei haben insbesondere Einschränkungen im konvergenten Denken einen negativen Einfluss auf eine Mobilitätsverbesserung im Verlauf der neurologischen Rehabilitation. Schlüsselwörter: Schlaganfall, Neurorehabilitation, Kognition, Exekutivfunktionen, Mobilität The impact of cognitive dysfunctions post stroke on the mobility during the neurorehabilitation process Abstract Cognitive impairment post stroke is common and usually persists longer than motor impairment and may influence the rehabilitation process, because cognition and motor learning are related. Therefore, this study addresses the following questions: a) Which cognitive disorders appear in stroke patients at the beginning of rehabilitation (admission)? b) How does mobility change during the rehabilitation process? Which cognitive disorders negatively influence the improvement of mobility during the rehabilitation process? The results reveal that one-third of stroke patients suffer from cognitive disorders at admission, especially in the domain of executive functions. Particularly impairments in convergent thinking negatively influence the improvement in mobility during the neurological rehabilitation process. Keywords: stroke, neurorehabilitation, cognition, executive functions, mobility

scholarly journals Augmentative And Alternative Communication Systems For Post-Stroke Patients With Severe Communication And Motor Impairment

2017 ◽  
pp. 66
Author(s):  
Talieh Zarifian ◽  
Amin Mahnam ◽  
Atabak Vosoughi
Keyword(s):  
Eye Movements ◽  
Augmentative And Alternative Communication ◽  
Motor Impairment ◽  
Written Language ◽  
Alternative Communication ◽  
Stroke Patients ◽  
Neurological Condition ◽  
Post Stroke ◽  
The Impact ◽  
Communication Methods

Background and aims: Adults with acquired neurological disorders (stroke, Traumatic Brain Injury ...) develop their verbal communication and literacy capabilities as typical speakers and writers. They use these skills to participate academically, vocationally, recreationally, and socially. Depending upon their neurological condition, they gradually or suddenly lose their speech or language capabilities and are required to rely on Augmentative and Alternative Communication (AAC) systems to meet their communication needs. In addition to the loss of their spoken communication, the impact of their neurological condition on their participation patterns is potentially profound with reduced ability to care for themselves, a reduction or loss of employment, and usually a sudden or gradual restriction of their social networks. AAC is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. During the past five decades, AAC technologies have been developed to compensate for these natural communication losses.     Stroke is one of the main causes of disability in the world. About 20% of stroke patients experience aphasia, with 20-30% of these individuals exhibiting severe communication deficits for at least a portion of their recovery period. Augmentative and Alternative Communication (AAC) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production of spoken or written language.  Specifically designed Human Computer Interfaces (HCI), as an assistive technology, provides new channels of communication for patients with aphasia, dysarthria, and dyspraxia, when accompanied by movement impairments.      In this workshop after stating a science review of the following types of issues: AAC acceptance (individually, culturally); AAC availability; AAC use patterns; AAC limitations are main issues, an AAC technology for post-stroke patients will be presented which developed by a knowledgebase company in Iran. The system allows patients with communication and motor impairment to state their intentions and feelings by a minimum movement in their body, or just by moving their eyes. Different sensors and switches are available to adopt based on the limited ability of the patients. For detecting eye movements, a novel wearable miniaturized system has been developed that is worn as a headband and detects eye movements based on processing electro-oculogram. A high performance graphical user interface has been developed to type letters and numbers in Persian language. The system also provides words prediction, text to speech conversion with natural voice, and sending/receiving messages in the mobile networks for a convenient communication experience. The developed system has been tested successfully by more than 20 patients with different disabilities, and is now commercially available.The proposed system can also help the severely disabled people with amyotrophic lateral sclerosis, quadriplegia, muscular dystrophy or cerebral palsy to communicate with others and mention their intentions, needs and feelings. This low-cost wearable device assures high level of comfort for the user without fatigue and do not need long time training. The system can also be adapted for the patients who can speak, but could not move their hands, to work with the computer and enjoy using the internet.  

scholarly journals Effect of post-stroke spasticity on voluntary movement of the upper limb

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Hadar Lackritz ◽  
Yisrael Parmet ◽  
Silvi Frenkel-Toledo ◽  
Melanie C. Baniña ◽  
Nachum Soroker ◽  
...  
Keyword(s):  
Upper Limb ◽  
Target Location ◽  
Distance Measure ◽  
Movement Time ◽  
Motor Impairment ◽  
Reach To Grasp ◽  
Motion Patterns ◽  
Post Stroke ◽  
The Impact ◽  
Elbow Motion

Abstract Background Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. Methods Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. Results Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. Conclusions The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.

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.

scholarly journals Association of Prior Atherosclerotic Cardiovascular Disease with Dementia After Stroke: A Retrospective Cohort Study

2020 ◽  
Vol 77 (3) ◽  
pp. 1157-1167
Author(s):  
Zhirong Yang ◽  
Duncan Edwards ◽  
Stephen Burgess ◽  
Carol Brayne ◽  
Jonathan Mant
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Practice Research Datalink ◽  
Atherosclerotic Cardiovascular Disease ◽  
Stroke Patients ◽  
Post Stroke ◽  
Increased Risk ◽  
The Impact

Background: Prior atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease (CHD) and peripheral artery disease (PAD), are common among patients with stroke, a known risk factor for dementia. However, whether these conditions further increase the risk of post-stroke dementia remains uncertain. Objective: To examine whether prior ASCVD is associated with increased risk of dementia among stroke patients. Methods: A retrospective cohort study was conducted using the Clinical Practice Research Datalink with linkage to hospital data. Patients with first-ever stroke between 2006 and 2017 were followed up to 10 years. We used multi-variable Cox regression models to examine the associations of prior ASCVD with dementia and the impact of prior ASCVD onset and duration. Results: Among 63,959 patients, 7,265 cases (11.4%) developed post-stroke dementia during a median of 3.6-year follow-up. The hazard ratio (HR) of dementia adjusted for demographics and lifestyle was 1.18 (95% CI: 1.12–1.25) for ASCVD, 1.16 (1.10–1.23) for CHD, and 1.25 (1.13–1.37) for PAD. The HRs additionally adjusted for multimorbidity and medications were 1.07 (1.00–1.13), 1.04 (0.98–1.11), and 1.11 (1.00–1.22), respectively. Based on the fully adjusted estimates, there was no linear relationship between the age of ASCVD onset and post-stroke dementia (all p-trend >0.05). The adjusted risk of dementia was not increased with the duration of pre-stroke ASCVD (all p-trend >0.05). Conclusion: Stroke patients with prior ASCVD are more likely to develop subsequent dementia. After full adjustment for confounding, however, the risk of post-stroke dementia is attenuated, with only a slight increase with prior ASCVD.

Role of d-serine in the beneficial effects of repetitive transcranial magnetic stimulation in post-stroke patients

2020 ◽  
Vol 32 (3) ◽  
pp. 128-134 ◽  
Author(s):  
Masachika Niimi ◽  
Yuko Fujita ◽  
Tamaki Ishima ◽  
Kenji Hashimoto ◽  
Nobuyuki Sasaki ◽  
...  
Keyword(s):  
Amino Acids ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Beneficial Effects ◽  
Depressed Patients ◽  
Before And After ◽  
The Impact

AbstractObjective:Abnormalities in neurotransmission via N-methyl-d-aspartic acid receptor (NMDAR) play a role in the pathophysiology of neuropsychiatric disorders. The impact of repetitive transcranial magnetic stimulation (rTMS) on NMDAR-related amino acids remains unknown. We aim to investigate the effects of rTMS on NMDAR-related amino acids in serum of post-stroke patients.Methods:Ninety-five consecutive post-stroke patients with upper limb hemiparesis were recruited. In 27 patients, the Beck Depression Inventory (BDI) score was 10 or higher. Twelve depressed patients underwent rehabilitation in combination with rTMS and 15 non-depressed patients underwent rehabilitation only without rTMS for 14 days. 1 Hz rTMS was applied to the primary motor area in the non-lesional hemisphere. BDI was conducted before and after treatment. Serum glutamine, glutamate, glycine, l-serine, and d-serine levels were measured before and after treatment.Results:There were no differences between depressed patients and non-depressed patients in clinical characteristics, levels of the five amino acids in serum, and the ratio of amino acids. However, in 27 depressed patients, there was a significant correlation between levels of glutamate in serum and BDI (ρ = 0.428, p = 0.026). BDI decreased significantly in depressed patients after treatment with or without rTMS. d-serine decreased in the rehabilitation with rTMS group, but increased in the rehabilitation without rTMS group. l-serine increased in the rehabilitation with rTMS group, but decreased in the rehabilitation without rTMS group.Conclusion:The results suggest that rTMS can modulate NMDAR-related amino acids in blood, producing beneficial effects.

scholarly journals The influence of dance-based activities on recovery and improvement of motor functions in post-stroke patients: A systematic review

2019 ◽  
Vol 9 (2) ◽  
pp. 57-67
Author(s):  
Jelena Nikolić ◽  
Fadilj Eminović ◽  
Ljiljana Šimpraga ◽  
Angelka Pešterac-Kujundžić
Keyword(s):  
Motor Skills ◽  
Causes Of Death ◽  
Rehabilitation Program ◽  
Clinical Syndrome ◽  
Stroke Patients ◽  
Research Papers ◽  
Motor Functions ◽  
Rehabilitation Process ◽  
Post Stroke ◽  
Motor Abilities

Stroke is a clinical syndrome, and one of the leading causes of death and disability, occurring under the influence of a large number of risk factors. The symptoms of a stroke are in correlation with the size, time and location of the lesion. Rehabilitation, which involves the application of conventional and supplementary methods, relates to the assessment of the ability, the level of damage of the affected functions, and an adequately designed rehabilitation program. The use of dance, as a rehabilitation procedure in post-stroke patients, requires listening and active participation of an individual with a specific motor reaction to the stimulus. The primary aim of this article is to demonstrate the importance and effects of the application of dance in the rehabilitation process in post-stroke patients, with a special emphasis on the process of improving motor skills and functions. In accordance with the set criteria and purpose of study, scientific research papers were collected and analysed from the PubMed/MEDLINE, Science Direct and Oxford Academic databases, all published in the period between 2010 and 2019, and all indicating the importance of the application of dance when treating post-stroke conditions. The obtained results suggest that dance, which is basically a sports-recreational activity, when applied for therapeutic purposes in persons after stroke, contributes to the development and recovery of motor abilities, balance, mobility, endurance, coordination, motor skills, stance, walking and precision. Also, dancing is of great importance for the improvement of the functioning of the whole organism, which directly or indirectly affects the recovery of motor functions and the overall welfare of an individual.

scholarly journals Exploring Nurses’ Experience of Managing Attention and Mood in Post-Stroke Patients: A Qualitative Study

2019 ◽  
Vol 7 (2) ◽  
Author(s):  
Tri Suraning Wulandari ◽  
Suhartini Ismail
Keyword(s):  
Physical Problem ◽  
Initial Assessment ◽  
Health Providers ◽  
Structured Interviews ◽  
Early Assessment ◽  
Stroke Patients ◽  
Post Stroke ◽  
Professional Health ◽  
The Impact ◽  
Spiritual Problems

Attention is an important aspect of cognitive development in the perspective of information processing, whereas mood is an affective aspect relating to expectations about positive or negative feelings. Decreased attention and mood in post-stroke patients can cause instability, cognitive impairment, and long-term rehabilitation. These impacts affect the patients’ activity daily living (ADL). Priority of post stroke patient care in hospital was priority on physical problem rather than psychological, social and spiritual problems. Nurses as caregivers in the hospitals  should understand in manage bio-psycho-socio-cultural-spiritual problems in post-stroke patients. This descriptive study that used a descriptive qualitative research was conducted to describe the barrier of managing attention and mood in post stroke from the perspective of nurses. This research was a pilot study using qualitative design and involved six nurses at Temanggung General Hospital, Indonesia. The data collection was carried out using in-depth semi-structured interviews. The data analyzed using inductive content analysis. Five themes emerging from data included the nurse's focus on the physical problem, lack of awareness to manage attention and mood, unavailability of early assessment for attention and mood, family participation in nursing care and lack of information about the interventions in handling attention and mood. The initial assessment of attention and mood greatly encourages nurses to provide alternative or complementary nursing that can be administered in the hospital. Nurses’ understanding of knowledge and skills are essential to prevent the impact of reduced attention and mood. The management of attention and mood should be supported by all professional health providers, and facilities in hospitals, as well as the role of the family.

scholarly journals Disruptions of Anaerobic Gut Bacteria Are Associated with Stroke and Post-stroke Infection: a Prospective Case–Control Study

2020 ◽  
Author(s):  
Bastiaan W. Haak ◽  
Willeke F. Westendorp ◽  
Tjitske S. R. van Engelen ◽  
Xanthe Brands ◽  
Matthijs C. Brouwer ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Hemorrhagic Stroke ◽  
Case Control Study ◽  
Case Control ◽  
Gut Bacteria ◽  
Stroke Patients ◽  
Post Stroke ◽  
The Impact ◽  
Control Study ◽  
Prospective Case Control Study

Abstract In recent years, preclinical studies have illustrated the potential role of intestinal bacterial composition in the risk of stroke and post-stroke infections. The results of these studies suggest that bacteria capable of producing volatile metabolites, including trimethylamine-N-oxide (TMAO) and butyrate, play opposing, yet important roles in the cascade of events leading to stroke. However, no large-scale studies have been undertaken to determine the abundance of these bacterial communities in stroke patients and to assess the impact of disrupted compositions of the intestinal microbiota on patient outcomes. In this prospective case–control study, rectal swabs from 349 ischemic and hemorrhagic stroke patients (median age, 71 years; IQR: 67–75) were collected within 24 h of hospital admission. Samples were subjected to 16S rRNA amplicon sequencing and subsequently compared with samples obtained from 51 outpatient age- and sex-matched controls (median age, 72 years; IQR, 62–80) with similar cardiovascular risk profiles but without active signs of stroke. Plasma protein biomarkers were analyzed using a combination of nuclear magnetic resonance (NMR) spectroscopy and liquid chromatography–mass spectrometry (LC-MS). Alpha and beta diversity analyses revealed higher disruption of intestinal communities during ischemic and hemorrhagic stroke compared with non-stroke matched control subjects. Additionally, we observed an enrichment of bacteria implicated in TMAO production and a loss of butyrate-producing bacteria. Stroke patients displayed two-fold lower plasma levels of TMAO than controls (median 1.97 vs 4.03 μM, Wilcoxon p < 0.0001). Finally, lower abundance of butyrate-producing bacteria within 24 h of hospital admission was an independent predictor of enhanced risk of post-stroke infection (odds ratio 0.77, p = 0.005), but not of mortality or functional patient outcome. In conclusion, aberrations in trimethylamine- and butyrate-producing gut bacteria are associated with stroke and stroke-associated infections.

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