Does cognition influence the functional impairment degree of post-stroke patients?

Background: The post-stroke subjects have several sequelae after the disease, which should be investigated and identified so that the clinical treatment includes these people in all aspects. Objective: To identify if there is a correlation between level of education, cognitive function, functional independence and the sensory-motor abilities of post-stroke subjects. Methods: The sample consisted of 27 post-stroke patients who were evaluated through the following scales: Mini-Mental State Exam (MMSE), Functional Independence Measure (FIM) and Fugl-Meyer Assessment (FMAA) and sociodemographic data collection. Results: A positive and statistically significant correlation was found between MMSE and FIM. When the scores were correlated with education, motor FIM (p = 0.005), total FIM (p = 0.006), temporal orientation MMSE (p = 0.03) and total MMSE (p = 0.01) were statistically significant. Furthermore, a positive correlation but not statistically significant was identified between the cognitive levels and sensory-motor impairment assessed by FMAA. Conclusion: It is concluded that the education of subjects is associated with motor function after stroke. In addition, cognitive impairments interfere with the level of post-stroke functionality, but do not have a direct influence on the degree of sensory-motor impairment.

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Postural Assessment Scale for Stroke Patients in Acute, Subacute and Chronic Stage: A Construct Validity Study

Diagnostics ◽

10.3390/diagnostics11020365 ◽

2021 ◽

Vol 11 (2) ◽

pp. 365

Author(s):

Cecilia Estrada-Barranco ◽

Roberto Cano-de-la-Cuerda ◽

Vanesa Abuín-Porras ◽

Francisco Molina-Rueda

Keyword(s):

Construct Validity ◽

Functional Independence Measure ◽

Functional Independence ◽

Assessment Scale ◽

Validity Study ◽

Stroke Patients ◽

Chronic Stage ◽

Post Stroke ◽

Valid Instrument ◽

Postural Assessment

(1) Background: Observational scales are the most common methodology used to assess postural control and balance in people with stroke. The aim of this paper was to analyse the construct validity of the Postural Assessment Scale for Stroke Patients (PASS) scale in post-stroke patients in the acute, subacute, and chronic stroke phases. (2) Methods: Sixty-one post-stroke participants were enrolled. To analyze the construct validity of the PASS, the following scales were used: the Functional Ambulatory Category (FAC), the Wisconsin Gait Scale (WGS), the Barthel Index (BI) and the Functional Independence Measure (FIM). (3) Results: The construct validity of the PASS scale in patients with stroke at acute phase was moderate with the FAC (r = −0.791), WGS (r = −0.646) and FIM (r = −0.678) and excellent with the BI (r = 0.801). At subacute stage, the construct validity of the PASS scale was excellent with the FAC (r = 0.897), WGS (r = −0.847), FIM (r = −0.810) and BI (r = −0.888). At 6 and 12 months, the construct validity of the PASS with the FAC, WGS, FIM and BI was also excellent. (4) Conclusions: The PASS scale is a valid instrument to assess balance in post-stroke individuals especially, in the subacute and chronic phases (at 6 and 12 months).

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Functional recovery in post-stroke patients on hemodialysis during the convalescent phase: a comparison with those not undergoing hemodialysis

Renal Replacement Therapy ◽

10.1186/s41100-021-00347-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Takeki Ishida ◽

Kenichi Kono ◽

Yuusuke Nishida ◽

Masahiro Yoshida

Keyword(s):

Functional Recovery ◽

Functional Independence Measure ◽

Functional Independence ◽

Hemodialysis Patients ◽

Stroke Patients ◽

Post Stroke ◽

Rehabilitation Hospital ◽

Convalescent Phase ◽

The Difference ◽

Impaired Motor Function

Abstract Background Low physical fitness is often found in patients undergoing hemodialysis. It may be possible that the recovery of impaired motor function with rehabilitative training might be affected when the patient is on hemodialysis. So far, however, no researcher has clinically investigated this issue in post-stroke patients. The purpose of this study is to clarify the difference of functional recovery during the convalescent phase between post-stroke patients with and without hemodialysis. Methods A cohort of 82 post-stroke hemiparetic patients who were admitted to our rehabilitation hospital, were subjected. On the day of admission and discharge, some clinical parameters including Functional Independence Measure (FIM) and Functional Ambulation Category (FAC) were evaluated for each patient. The changes during the hospitalization and the values at the discharge in these parameters were statistically compared between the patients with and without hemodialysis. Results The FIM motor score at the discharge was significantly lower in hemodialysis patients than non-hemodialysis patients (64.7 ± 21.2 points in hemodialysis patients and 81.8 ± 28.0 points in non-hemodialysis patients, p < 0.05). In addition, the frequency of FAC at the discharge of ≥ 3 was significantly lower in hemodialysis patients than non-hemodialysis patients (40.0% in hemodialysis patients and 72.2% in non-hemodialysis patients, p < 0.05). Conclusion In patients undergoing hemodialysis seem to experience a worse functional recovery during the convalescent phase compared to those not undergoing hemodialysis. We might have to modify the rehabilitative program during the convalescent phase after stroke if the patient was on hemodialysis.

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Does botulinum toxin improve the function of the patient with spasticity after stroke?

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2007000400008 ◽

2007 ◽

Vol 65 (3a) ◽

pp. 592-595 ◽

Cited By ~ 16

Author(s):

Eduardo Cardoso ◽

Glícia Pedreira ◽

Antônio Prazeres ◽

Nildo Ribeiro ◽

Ailton Melo

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin Type A ◽

Functional Independence Measure ◽

Botulinum Toxin Type ◽

Functional Independence ◽

Functional Improvement ◽

Stroke Patients ◽

Early Management ◽

Post Stroke ◽

Upper Limb Function

Post-stroke spasticity is an important cause of disability in adults, due to muscle hyperactivity, which results in limb stiffness and muscle spasm. The prognosis for these patients depends on several features such as early management and adequate physical therapy to avoid muscle shortening, pain, and their consequences. Although several papers have shown that intramuscular injections of botulinum toxin type A (BT-A) decreases spasticity in post-stroke patients, few authors have demonstrated functional improvement after this therapy. In order to assess if individualized BT-A injections improves upper limb function in post-stroke spastic patients, we prospectively followed 20 consecutive patients of 18 years of age or more with spastic hemiparesis secondary to stroke. Fulg-Meyer scale modified for upper limbs, measure of functional independence (MFI), Ashworth modified scale, and goniometry were applied in the beginning of the investigation and in the 16th and 32nd weeks. BT-A was applied at baseline and in the 16th week. All subjects were submitted to rehabilitation therapy. All patients showed improvement according to Ashworth modified scale and increase in the range of motion, which were sustained until the 32nd week (p<0.05). The assessment of the first three parameters of the Fulg-Meyer scale and the evaluations of the motor part of the Functional Independence Measure showed statistically improvement until the end of the study. We conclude that proper choice of muscles and individualized doses of BT-A can improve function in selected post-stroke patients.

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Associated Mirror Therapy Enhances Motor Recovery of the Upper Extremity and Daily Function after Stroke: A Randomized Control Study

Neural Plasticity ◽

10.1155/2021/7266263 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Jin-Yang Zhuang ◽

Li Ding ◽

Bei-Bei Shu ◽

Dan Chen ◽

Jie Jia

Keyword(s):

Upper Extremity ◽

Controlled Trial ◽

Motor Impairment ◽

Functional Independence Measure ◽

Functional Independence ◽

Motor Recovery ◽

Control Group ◽

Mirror Therapy ◽

Stroke Patients ◽

Daily Function

Bimanual cooperation plays a vital role in functions of the upper extremity and daily activities. Based on the principle of bilateral movement, mirror therapy could provide bimanual cooperation training. However, conventional mirror therapy could not achieve the isolation of the mirror. A novel paradigm mirror therapy called associated mirror therapy (AMT) was proposed to achieve bimanual cooperation task-based mirror visual feedback isolating from the mirror. The study was aimed at exploring the feasibility and effectiveness of AMT on stroke patients. We conducted a single-blind, randomized controlled trial. Thirty-six eligible patients were equally assigned into the experimental group (EG) receiving AMT and the control group (CG) receiving bimanual training without mirroring for five days/week, lasting four weeks. The Fugl-Meyer Assessment Upper Limb subscale (FMA-UL) for upper extremity motor impairment was used as the primary outcome. The secondary outcomes were the Box and Block Test (BBT) and Functional Independence Measure (FIM) for motor and daily function. All patients participated in trials throughout without adverse events or side effects. The scores of FMA-UL and FIM improved significantly in both groups following the intervention. Compared to CG, the scores of FMA-UL and FIM were improved more significantly in EG after the intervention. The BBT scores were improved significantly for EG following the intervention, but no differences were found in the BBT scores of CG after the intervention. However, no differences in BBT scores were observed between the two groups. In summary, our study suggested that AMT was a feasible and practical approach to enhance the motor recovery of paretic arms and daily function in stroke patients. Furthermore, AMT may improve manual dexterity for poststroke rehabilitation.

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Chronic Kidney Disease and Functional Outcomes 6 Months after Ischemic Stroke: A Prospective Multicenter Study

Neuroepidemiology ◽

10.1159/000441281 ◽

2015 ◽

Vol 46 (1) ◽

pp. 24-30 ◽

Cited By ~ 2

Author(s):

Shin Yi Jang ◽

Min Kyun Sohn ◽

Jongmin Lee ◽

Deog Young Kim ◽

Sam-Gyu Lee ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Ischemic Stroke ◽

Kidney Disease ◽

Functional Independence Measure ◽

Functional Independence ◽

Stroke Patients ◽

Nihss Score ◽

Disease Epidemiology ◽

Post Stroke ◽

Obesity Hypertension

Background: The aim of this study was to investigate whether chronic kidney disease (CKD) predicts the outcome of the Functional Independence Measure (FIM) and the Korean version of the modified Barthel Index (K-MBI) 6 months after stroke with adjustment for age, gender, education, smoking, drinking, obesity, hypertension, diabetes mellitus, dyslipidemia, the FIM or K-MBI at discharge and the National Institutes of Health Stroke Scale (NIHSS) score 7 days post stroke. Methods: This study is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation. The sample included 2,037 ischemic stroke patients aged 18 years or older. The FIM and K-MBI scores were assessed at discharge and at 6 months after the onset of stroke. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was defined as an eGFR <60 ml/min/1.73 m2. Results: Overall, the mean age was 65.5 (±12.4) years. The proportion of men was 62.6%. The proportion of CKD cases was 12.7%. The means of the 6-month FIM and K-MBI were 109.8 (±27.9) and 87.0 (±26.4), respectively. In multiple linear regressions, the 6-month FIM after stroke was significantly associated with CKD (-2.85, p < 0.05), age (-0.29, p < 0.01), the FIM at discharge (0.46, p < 0.01) and the 7-day NIHSS score (-1.71, p < 0.01). Additionally, the post-stroke 6-month K-MBI was significantly associated with CKD (-2.88, p < 0.01), age (-0.27, p < 0.01), the K-MBI at discharge (0.46, p < 0.01) and the 7-day NIHSS score (-1.55, p < 0.01). Conclusions: This nationwide hospital-based cohort study showed that CKD might predict poor 6-month FIM and K-MBI scores in ischemic stroke patients.

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AN EVALUATION OF MULTIDISCIPLINARY INTERVENTION GOVERNED BY FUNCTIONAL INDEPENDENCE MEASURE (FIMSM) IN INCONTINENT STROKE PATIENTS

Scandinavian Journal of Rehabilitation Medicine ◽

10.1080/003655098444273 ◽

1998 ◽

Vol 30 (1) ◽

pp. 15-21 ◽

Cited By ~ 36

Author(s):

Barbro Wikander, Peter Ekelund, Ian Milsom

Keyword(s):

Functional Independence Measure ◽

Functional Independence ◽

Stroke Patients ◽

Multidisciplinary Intervention

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Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients

Current Neurovascular Research ◽

10.2174/1567202617666200603150901 ◽

2020 ◽

Vol 17 (4) ◽

pp. 437-445

Author(s):

Irene Ciancarelli ◽

Giovanni Morone ◽

Marco Iosa ◽

Stefano Paolucci ◽

Loris Pignolo ◽

...

Keyword(s):

Outcome Measures ◽

Functional Recovery ◽

Functional Independence Measure ◽

Functional Independence ◽

Enzyme Linked Immunosorbent Assay ◽

Stroke Patients ◽

Rehabilitation Outcomes ◽

Before And After ◽

Forward Stepwise ◽

Clinical Measures

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

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

Frontiers in Neurology ◽

10.3389/fneur.2021.634065 ◽

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.

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