Proprioception and developmental motor training: A new treatment for chronic-phase stroke patients

Stroke is a leading cause of disability and death worldwide and social burden is huge in terms of disabilities, mortality and healthcare costs. Recently, in an acute stroke setting, renewed interest in disease-modifying therapies and novel approaches has led to enhanced recovery and the reduction of long-term disabilities of patients who suffered a stroke. In the last few years, the basic principle “time is brain” was overcome and better results came through the implementation of novel neuroimaging tools in acute clinical practice, allowing one to extend acute treatments to patients who were previously excluded on the basis of only a temporal selection. Recent studies about thrombectomy have allowed the time window to be extended up to 24 h after symptoms onset using advanced neuroradiological tools, such as computer tomography perfusion (CTP) and magnetic resonance imaging (MRI) to select stroke patients. Moreover, a more effective acute management of stroke patients in dedicated wards (stroke units) and the use of new drugs for stroke prevention, such as novel oral anticoagulants (NOACs) for atrial fibrillation, have allowed for significant clinical improvements. In this editorial paper, we summarize the current knowledge about the main stroke-related advances and perspectives and their relevance in stroke care, highlighting recent developments in the definition, management, treatment, and prevention of acute and chronic complications of stroke. Then, we present some papers published in the Special Issue “Clinical Research on Ischemic Stroke: Novel Approaches in Acute and Chronic Phase”.

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Combined cognitive and motor training improves the outcome in the early phase after stroke and prevents a decline of executive functions: A pilot study

Neurorehabilitation ◽

10.3233/nre-201583 ◽

2020 ◽

pp. 1-12

Author(s):

Mareike Eschweiler ◽

Lara Bohr ◽

Josef Kessler ◽

Gereon R. Fink ◽

Elke Kalbe ◽

...

Keyword(s):

Working Memory ◽

Pilot Study ◽

Cognitive Flexibility ◽

Negative Impact ◽

Low Frequency ◽

Control Group ◽

Motor Training ◽

Set Shifting ◽

Stroke Patients ◽

Motor Functioning

BACKGROUND: The negative impact of cognitive dysfunction on motor rehabilitation as a relearning-process is well known in stroke patients. However, evidence for combined cognitive and motor training (CMT) is lacking. OBJECTIVE: To evaluate the effects of combined CMT in early stroke rehabilitation. METHODS: In a controlled pilot study, 29 moderately affected stroke patients with low-level motor performance and cognitive impairment received motor therapy plus either cognitive (experimental group, EG) or low-frequency ergometer training (control group, CG) for eight days. RESULTS: Both groups improved their motor functioning significantly. After training, between-group comparison revealed significant differences for cognitive flexibility and trends for set-shifting, working memory, and reaction control in favor of the EG. Within-group effects showed improvement across all cognitive domains in the EG, which correlated with gains in bed-mobility, while the CG showed no significant improvement in cognition. Rather, a trend towards reaction control decline was observed, which correlated with less functional progression and recovery. Furthermore, a decline in cognitive flexibility, set-shifting, and working memory was descriptively observed. CONCLUSIONS: Combined CMT may enhance cognition and motor relearning early after stroke and is superior to single motor training. Further studies are needed to replicate these results and investigate long-term benefits.

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Abstract 2903: Nutritional Access of Dysphagic Patients 3 Months after Onset of Acute Stroke -From Database of 5,000 Patients in a Single Stroke Center-

Stroke ◽

10.1161/str.43.suppl_1.a2903 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Makoto Nakajima ◽

Yuichiro Inatomi ◽

Toshiro Yonehara ◽

Yoichiro Hashimoto ◽

Teruyuki Hirano

Keyword(s):

Acute Stroke ◽

Chronic Phase ◽

Oral Intake ◽

Continuous Variables ◽

Operating Characteristics ◽

Stroke Patients ◽

Nihss Score ◽

Swallowing Dysfunction ◽

Stroke Center ◽

Dysphagic Patients

Background and purpose: Prediction of swallowing function in dysphagic patients with acute stroke is indispensable for discussing percutaneous endoscopic gastrostomy (PEG) placement. We performed a retrospective study using database of a large number of acute ischemic stroke patients to clarify predictors for acquisition of oral intake in chronic phase. Methods: A total 4,972 consecutive acute stroke patients were admitted to our stroke center during 8.5 years; a questionnaire was sent to all the survivors after 3 months of onset. We investigated nutritional access after 3 months of onset in 588 patients who could not eat orally 10 days after admission, and analyzed predictive factors for their acquisition of oral intake. Continuous variables were dichotomized to identify the most sensitive predictors; the cutoff values were investigated by receiver operating characteristics curve analysis. Results: Out of 588 dysphagic patients, 75 died during the 3 months, and 143 (28%) of the residual 513 achieved oral intake after 3 months. In logistic-regression models, age ≤80 years, absence of hyperlipidemia, absence of atrial fibrillation, modified Rankin Scale score 0 before onset, and low National Institutes of Health Stroke Scale (NIHSS) score independently predicted oral intake 3 months after onset. From two different model analyses, NIHSS score ≤17 on day 10 (OR 3.63, 95% CI 2.37-5.56) was found to be a stronger predictor for oral intake than NIHSS score ≤17 on admission (OR 2.34, 95% CI 1.52-3.59). At 3 months, 17/143 (12%) patients with oral intake were living at home, while only 1/370 (0.3%) patients without oral intake were. Conclusion: A quarter of dysphagic patients with acute stroke obtained oral intake 3 months after onset. Clinicians should be cautious about PEG placement for stroke patients with severe dysphagia who were independent prior to the stroke, aged ≤80 years, and show NIHSS score ≤17 on day 10, because their swallowing dysfunction may improve in a few months.

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SWALLOWING DIFFICULTIES IN STROKE PATIENTS: A NEW TREATMENT

Age and Ageing ◽

10.1093/ageing/14.6.361 ◽

1985 ◽

Vol 14 (6) ◽

pp. 361-365 ◽

Cited By ~ 19

Author(s):

WILFRED G. SELLEY

Keyword(s):

Stroke Patients ◽

Swallowing Difficulties ◽

New Treatment

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rTMS with motor training modulates cortico-basal ganglia-thalamocortical circuits in stroke patients

Restorative Neurology and Neuroscience ◽

10.3233/rnn-2012-110162 ◽

2012 ◽

Vol 30 (3) ◽

pp. 179-189 ◽

Cited By ~ 10

Author(s):

Won Hyuk Chang ◽

Yun-Hee Kim ◽

Woo-Kyoung Yoo ◽

Kyoung-Hyup Goo ◽

Chang-hyun Park ◽

...

Keyword(s):

Basal Ganglia ◽

Motor Training ◽

Stroke Patients

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Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation

Neurorehabilitation and Neural Repair ◽

10.1177/1545968308324548 ◽

2008 ◽

Vol 23 (2) ◽

pp. 184-190 ◽

Cited By ~ 47

Author(s):

Sabine Mangold ◽

Corina Schuster ◽

Thierry Keller ◽

Andrea Zimmermann-Schlatter ◽

Thierry Ettlin

Keyword(s):

Electrical Stimulation ◽

Upper Extremity ◽

Shoulder Pain ◽

Functional Electrical Stimulation ◽

Intervention Group ◽

Passive Movement ◽

Control Group ◽

Motor Training ◽

Stroke Patients ◽

Subacute Stroke

Background. Functional electrical stimulation (FES) allows active exercises in stroke patients with upper extremity paralysis. Objective. To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and/or hand paralysis. Methods. For this pilot study, 23 acute and subacute stroke patients were randomly assigned to the intervention (n = 12) and control group (n = 11). Distributed over 4 weeks, FES training replaced 12 conventional training sessions in the intervention group. An Extended Barthel Index (EBI) subscore assessed the performance of activities of daily living (ADL). The Chedoke McMaster Stroke Assessment (CMSA) measured hand and arm function and shoulder pain. The Modified Ashworth Scale (MAS) assessed resistance to passive movement. Unblinded assessments were performed prior to and following the end of the training period. Results. The EBI subscore and CMSA arm score improved significantly in both groups. The CMSA hand function improved significantly in the FES group. Resistance to passive movement of finger and wrist flexors increased significantly in the FES group. Shoulder pain did not change significantly. None of the outcome measures, however, demonstrated significant gain differences between the groups. Conclusions. We did not find clear evidence for superiority or inferiority of FES. Our findings, and those of similar trials, suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences.

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Relationship between Age and Activities of Daily Living using Modified Shah Barthel Index on Stroke Patient in Chronic Phase

Journal Of The Indonesian Medical Association ◽

10.47830/jinma-vol.70.6-2020-237 ◽

2020 ◽

Vol 70 (6) ◽

pp. 115-120

Author(s):

Malika Sabrina Yunifananda ◽

Widjajalaksmi Kusumaningsih

Keyword(s):

Barthel Index ◽

Chronic Phase ◽

Chronic Stroke ◽

Daily Activities ◽

Bivariate Analysis ◽

Age Group ◽

Stroke Patients ◽

Cross Sectional ◽

Cross Sectional Design

Background: Stroke is the chief cause of long-term disability in the world. Predominantly, the disease is known as a degenerative disease on geriatrics age group, yet several studies have proven that incidence on productive ages are also increasing. Objective: The study aimed to know whether there are any difference in Modified Shah Barthel Index (MSBI) score in different age group, geriatric and productive age group and to know independence score in daily activities based on age. Method: The study utilized the cross-sectional design and analytical observational method. Twenty five samples of chronic stroke patients was recruited and grouped into two groups productive and geriatric age group. MSBI score was calculated and compared between two groups. Result: Bivariate analysis proves that there is a significant association between MSBI score and age of stroke patients on chronic phase (p=0.017). Discussion. There is a significant association between age and MSBI score on stroke patients in chronic phase. Conclusion: There was a significance difference between productive and geriatric age with daily activities using MSBI in chronic stroke patients. The productive age group has a higher Modified Shah Barthel Index score than the geriatric age group.

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Bosutinib (BOS) for chronic phase (CP) chronic myeloid leukemia (CML) after imatinib (IMA) failure: ≥8-y update of a phase I/II study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7549 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7549-7549

Author(s):

Tim H. Brümmendorf ◽

Jorge E. Cortes ◽

Yeow Tee Goh ◽

Musa Yilmaz ◽

Rebecca B. Klisovic ◽

...

Keyword(s):

Phase I ◽

Kinase Inhibitor ◽

Lymphoblastic Leukemia ◽

Philadelphia Chromosome ◽

Chronic Phase ◽

Dose Intensity ◽

Term Treatment ◽

Prior Therapy ◽

Long Term Treatment ◽

New Treatment

7549 Background: BOS is approved for newly diagnosed CP CML and CML resistant/intolerant to prior therapy. In a phase I/II study, BOS showed durable efficacy and manageable toxicity in patients (pts) with CP CML after IMA failure. We report an ≥8-y update of this phase I/II and ongoing extension study. Methods: Pts with CP CML resistant/intolerant to IMA (CP2L) or IMA + dasatinib and/or nilotinib (CP3L) or with accelerated/blast phase (AP/BP) CML or Philadelphia chromosome+ acute lymphoblastic leukemia with prior tyrosine kinase inhibitor (TKI) therapy (ADV) received BOS starting at 500 mg/d. Results: 54/284 (19%) CP2L pts were still on BOS after ≥9 y and 8/119 (7%) CP3L and 5/167 (3%) ADV pts after ≥8 y; 61 CP2L pts discontinued BOS since y 5 and 21 CP3L and 12 ADV pts since y 4. Overall, the most common reason for discontinuation was disease progression/lack of efficacy in CP2L (27%), CP3L (42%) and ADV (50%) pts; last dose before discontinuation was ≥500 mg/d in 59 (21%), 28 (24%) and 46 (28%) pts, respectively. In CP2L pts, median (range) of follow-up was 54 (1–155) mo, treatment duration 26 (<1–155) mo and dose intensity 438 (87–599) mg/d; responses were durable (Table) and overall survival (OS) at 9 y was 74% vs 84% at 5 y. OS at 8 y was 69% in CP3L, 54% in AP CML and 23% in BP CML pts vs 78%, 59% and 23% at 4 y. 55 CP2L, 29 CP3L and 98 ADV pts died on study (10, 3 and 2 since the 4/5-y reports); 15, 5 and 3 had on-treatment transformations to AP/BP. Most common new treatment-emergent adverse events since y 5 in CP2L pts were pleural effusion (n=13), arthralgia (n=12) and increased blood creatinine (n=11). Conclusions: After ≥8 y, BOS continued to show durable efficacy and no new safety signals in pts with CP CML on long-term treatment, providing further support for BOS use after prior TKIs. Clinical trial information: NCT00261846 and NCT01903733 . [Table: see text]

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Stroke patients set to receive new treatment

Emergency Nurse ◽

10.7748/en.23.7.13.s11 ◽

2015 ◽

Vol 23 (7) ◽

pp. 13-13

Author(s):

Layla Haidrani

Keyword(s):

Stroke Patients ◽

New Treatment ◽

To Receive

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Brain disconnectivity mapping of post-stroke fatigue

10.1101/2020.11.13.380972 ◽

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.

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