Efficiency of Leg Exoskeleton Use in Rehabilitation of Cerebral Stroke Patients

Abstract The study aimed to evaluate the effectiveness of functional and motor activity restoration, including the walking function, in patients after an ischemic stroke using the ExoAtlet lower limb exoskeleton. Patients and methods. A clinical study was carried out on 42 patients who had undergone a cerebral infarction in the mid cerebral artery system with a post-stroke paresis of the leg, and who had undergone a rehabilitation course in a round-theclock hospital during the early recovery period. Patients were randomized into two equal groups comparable in terms of the stroke severity: the patients in group 1 were receiving a standard rehabilitation program (control group), the patients in group 2 were additionally receiving a course of gait rehabilitation using the ExoAtlet exoskeleton - 10 sessions, 5 sessions per week for 14 days. Results. The study demonstrated the effectiveness of the ExoAtlet exoskeleton used in the rehabilitation of stroke patients over the standard course of rehabilitation. The advantages include a decrease in the hemiparesis degree, an increase in the muscle strength of the paretic limb, an improvement in balance, an improvement and acceleration of the walking process. The obtained results of the instrumental study confirmed the benefits of physical training on the Exoskeleton, which was demonstrated through an increase in stability and balance, as well as through a decrease in the energy consumption index for maintaining the stable verticalization. Conclusion. The usage of the ExoAtlet exoskeleton increases the effectiveness of rehabilitation measures and improves motor and functional activities of patients who have suffered a cerebral stroke.

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A Study of Biofeedback Gait Training in Cerebral Stroke Patients in the Early Recovery Phase with Stance Phase as Target Parameter

Sensors ◽

10.3390/s21217217 ◽

2021 ◽

Vol 21 (21) ◽

pp. 7217

Author(s):

Dmitry V. Skvortsov ◽

Sergey N. Kaurkin ◽

Galina E. Ivanova

Keyword(s):

Stance Phase ◽

Recovery Period ◽

Biomechanical Analysis ◽

Control Group ◽

Cerebral Stroke ◽

Stroke Patients ◽

Early Recovery ◽

Phase Duration ◽

Gait Symmetry ◽

Early Recovery Period

Walking function disorders are typical for patients after cerebral stroke. Biofeedback technology (BFB) is currently considered effective and promising for training walking function, including in patients after cerebral stroke. Most studies recognize that BFB training is a promising tool for improving walking function; however, the data on the use of highly selective walking parameters for BFB training are very limited. The aim of our study was to investigate the feasibility of using BFB training targeting one of the basic parameters of gait symmetry—stance phase duration—in cerebral stroke patients in the early recovery period. The study included 20 hemiparetic patients in the early recovery period after the first hemispheric ischemic stroke. The control group included 20 healthy subjects. The BFB training and biomechanical analysis of walking (before and after all BFB sessions) were done using an inertial system. The mean number of BFB sessions was nine (from 8 to 11) during the three weeks in clinic. There was not a single negative response to BFB training among the study patients, either during the sessions or later. The spatiotemporal parameters of walking showed the whole syndrome complex of slow walking and typical asymmetry of temporal walking parameters, and did not change significantly as a result of the study therapy. The changes were more significant for the functioning of hip and knee joints. The contralateral hip amplitude returned to the normal range. For the knee joint, the amplitude of the first flexion increased and the value of the amplitude of hyperextension decreased in the middle of the stance phase. Concerning muscle function, the observed significant decrease in the function of m. Gastrocnemius and the hamstring muscles on the paretic side remained without change at the end of the treatment course. We obtained positive dynamics of the biomechanical parameters of walking in patients after the BFB training course. The feasibility and efficacy of their use for targeted correction need further research.

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Changes in PHQ-9 depression scores in acute stroke patients shortly after returning home

PLoS ONE ◽

10.1371/journal.pone.0259806 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259806

Author(s):

Brent Strong ◽

Michele C. Fritz ◽

Liming Dong ◽

Lynda D. Lisabeth ◽

Mathew J. Reeves

Keyword(s):

Depressive Symptoms ◽

Acute Stroke ◽

Recovery Period ◽

Stroke Severity ◽

Stroke Survivors ◽

Stroke Patients ◽

Early Recovery ◽

Post Stroke ◽

Early Recovery Period ◽

Over Time

Introduction Post-stroke depression is a disabling condition that occurs in approximately one-third of stroke survivors. There is limited information on changes in depressive symptoms shortly after stroke survivors return home. To identify factors associated with changes in post-stroke depressive symptoms during the early recovery period, we conducted a secondary analysis of patients enrolled in a clinical trial conducted during the transition period shortly after patients returned home (MISTT). Methods The Michigan Stroke Transitions Trial (MISTT) tested the efficacy of social worker case management and access to online information to improve patient-reported outcomes following an acute stroke. Patient Health Questionnaire-9 (PHQ-9) scores were collected via telephone interviews conducted at 7 and 90 days post-discharge; higher scores indicate more depressive symptoms. Generalized estimating equations were used to identify independent predictors of baseline PHQ-9 score at 7 days and of changes over time to 90 days. Results Of 265 patients, 193 and 185 completed the PHQ-9 survey at 7 and 90 days, respectively. The mean PHQ-9 score was 5.9 at 7 days and 5.1 at 90 days. Older age, being unmarried, and having moderate stroke severity (versus mild) were significantly associated with lower 7-day PHQ-9 scores (indicating fewer depressive symptoms). However, at 90 days, both unmarried patients and those with moderate or high stroke severity had significant increases in depressive symptoms over time. Conclusions In stroke patients who recently returned home, both marital status and stroke severity were associated with depressive symptom scores; however, the relationships were complex. Being unmarried and having higher stroke severity was associated with fewer depressive symptoms at baseline, but both factors were associated with worsening depressive symptoms over time. Identifying risk factors for changes in depressive symptoms may help guide effective management strategies during the early recovery period.

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COMPARISON OF THE DYNAMIC CHANGES OF AMINO ACID BLOOD PLASMA SPECTRUM IN PATIENTS WITH THE PRIMARY CEREBRAL ISCHEMIC STROKE DEPENDING ON THE POSTAPOPLECTIC SPASTICITY DEVELOPMENT IN THE RECOVERY PERIOD

EUREKA Health Sciences ◽

10.21303/2504-5679.2016.00095 ◽

2016 ◽

Vol 3 ◽

pp. 17-23

Author(s):

Anzhelika Payenok ◽

Maria Bilobryn ◽

Iryna Mitelman

Keyword(s):

Ischemic Stroke ◽

Blood Plasma ◽

Recovery Period ◽

Control Group ◽

Cerebral Stroke ◽

Early Recovery ◽

Dynamic Changes ◽

Acute Period ◽

Cerebral Ischemic Stroke ◽

Cerebral Ischemic

The aim of research was to reveal the dynamic changes of the level of excitatory and inhibitory neuroamino acids in patients with the primary cerebral ischemic stroke depending on postapoplectic spasticity presence at the end of the early recovery period. For this aim was studied the concentration of excitatory and inhibitory neuroamino acids in the blood plasma in first 72 hours in 97 patients with the primary ischemic cerebral stroke depending on postapoplectic spasticity on the sixth month after ischemic event. The control group included 15 patients with diagnosed chronic cerebral ischemia. In the result of research we revealed that the common sign for the two groups (with spasticity on the sixth month and without it) was the reliable rise of the level of excitatory amino acids comparing with the control. In patients without spasticity the heightened level of excitatory neurotransmitters in the most acute period of ischemic cerebral stroke was attended with the heightened level of inhibitory neuroamino acids. The distinctive feature of patients with postapoplectic spasticity was the decreased or stable level of transmitters of inhibitory action. During 6th moth after ischemic stroke was detected the rise of all studied neuroamino acids in patients with spasticity unlike to the ones without spasticity who were characterized only with the rise of taurine level and decrease of glycine and aspartate levels. So, the received results allow assume the insufficient activation of the inhibitory neuroamino acids system in the most acute period of the ischemic stroke in certain category of patients that in future are inclined to the spasticity development after stroke.

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Comparative Characterization of Candidate Molecular Markers in Ischemic and Hemorrhagic Stroke

General Reanimatology ◽

10.15360/1813-9779-2021-5-23-34 ◽

2021 ◽

Vol 17 (5) ◽

pp. 23-34

Author(s):

A. M. Golubev ◽

A. V. Grechko ◽

V. E. Zakharchenko ◽

M. M. Kanarsky ◽

M. V. Petrova ◽

...

Keyword(s):

Ischemic Stroke ◽

Molecular Markers ◽

Neurotrophic Factor ◽

Hemorrhagic Stroke ◽

Recovery Period ◽

Control Group ◽

Early Recovery ◽

Acute Period ◽

S 100 ◽

Early Recovery Period

According to epidemiological studies, the leading cause of morbidity, disability and mortality are cerebrovascular diseases, in particular ischemic and hemorrhagic strokes. In recent years considerable attention has been given to the study of molecular markers of ischemic and hemorrhagic strokes. These studies are relevant because brain-specific protein biomarkers of neurons and glial cells can provide valuable and timely diagnostic information necessary for clinical decision-making.The aim of the study was to reveal the differences in the serum level of molecular markers in acute, subacute and early recovery periods of ischemic and hemorrhagic strokes.Material and methods. The study included 59 patients. Twenty patients were diagnosed with hemorrhagic stroke and 39 had ischemic stroke. The control group included 20 volunteers. Serum levels of molecular CNS markers were determined in acute, subacute, and early recovery stages of stroke. The serum levels of CNS molecular markers of patients with ischemic and hemorrhagic stroke was measured quantitatively by enzyme immunoassay. Statistical analysis was performed by nonparametric Mann-Whitney method.Results. The level of brain-derived neurotrophic factor (BDNF) in the control volunteers was 574.5 [455.5; 615] pg/ml. Significant differences were found for acute and subacute periods of hemorrhagic stroke: it was 674 [560; 749] pg/ml (P=0.003) and 664 [616; 762] pg/ml (P=0.0001).The level of neuron-specific enolase was significantly increased in all periods of the study: it was 4.15 [3.53; 4.8] ng/ml in the control group, 5.4 [4.4; 6.4] ng/ml in acute period of ischemic stroke (P<0.001), 5.4 [4.4; 6.4] ng/ml in early recovery period of ischemic stroke (P=0.001), 5.1 [4.6; 6.4] ng/ml in acute period of hemorrhagic stroke (P=0.014), 664 [616; 762] ng/ml in subacute period of hemorrhagic stroke (P=0.003).In the control group, the serum S-100 protein level was 4.5 [3.8; 5.4] ng/ml. In the acute and early recovery periods of ischemic stroke, S-100 protein level has significantly fallen down to 4.1 [3.4; 4.6] ng/ml (P<0.031) and 3.9 [3.4; 6] ng/ml (P=0.014), respectively. Glial-cell derived neurotrophic factor level was 1.98 [1.64; 2.1] ng/ml in the controls and increased up to 2.4 [2.2; 5] ng/ml (P=0.002) in the acute period and 2.4 [2.3; 2.6] ng/ml (P<0.001) in the subacute period of hemorrhagic stroke.The vascular endothelial growth factor receptor-1 (VEGFR-1) was significantly lower in the subacute period of hemorrhagic stroke: 485 [211; 945] pg/ml in the subacute period vs 903.5 [626; 1115] pg/ml in the controls (P=0.001).Conclusion. We found differences in the serum level of molecular markers in patients with ischemic and hemorrhagic strokes. In the acute period, early recovery period of ischemic stroke, and subacute period of hemorrhagic stroke, there was an increase in the serum level of neuron-specific enolase. The level of brain-derived neurotrophic factor increased significantly in the acute and subacute periods of hemorrhagic stroke. In the acute and early recovery periods of ischemic stroke, the level of S-100 protein decreased. The level of glial cell-derived neurotrophic factor increased in the acute and subacute periods of hemorrhagic stroke. In the subacute period of hemorrhagic stroke, the level of endothelial growth factor receptor-1 significantly decreased. Moreover, there was significant difference between values of this parameter in the subacute period of hemorrhagic stroke and in the early recovery period of ischemic stroke.

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Plasma and cerebrospinal fluid concentrations of neuropeptide Y, serotonin, and catecholamines in patients under propofol or isoflurane anesthesia

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y99-122 ◽

2000 ◽

Vol 78 (2) ◽

pp. 100-107 ◽

Cited By ~ 12

Author(s):

E Grouzmann ◽

A Borgeat ◽

M Fathi ◽

R C Gaillard ◽

P Ravussin

Keyword(s):

Cerebrospinal Fluid ◽

Neuropeptide Y ◽

Recovery Period ◽

Anesthetic Technique ◽

Strong Increase ◽

Control Group ◽

Volatile Agent ◽

Early Recovery ◽

Isoflurane Anesthesia ◽

Early Recovery Period

Propofol is a widely used anesthetic for both induction and maintenance of anesthesia during surgery. A strong feeling of hunger has been reported during the early recovery period after propofol anesthesia. We have investigated the effect of propofol on appetite in 10 patients undergoing a craniotomy and in parallel measured neuropeptide Y (NPY), catecholamines, and serotonin levels in the cerebrospinal fluid and plasma during anesthesia. Ten patients anesthetized with a volatile agent (isoflurane) served as a control group. Plasma NPY and catecholamines levels were not affected by surgery at any time. We observed a strong increase in NPY concentrations in the cerebrospinal fluid independently of the anesthetic technique agent used, whereas catecholamines were unchanged. We found that serotonin concentrations decreased significantly in the plasma (but not in the cerebrospinal fluid) of patients treated by propofol when compared with the control group; this decrease was associated with an increase of hunger early postoperatively. We concluded that the proappetite effect of propofol is mediated through a decrease of serotonin at the peripheral level.Key words: catecholamines, serotonin, neuropeptide Y (NPY), cerebrospinal fluid, serum, appetite.

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The problem of recovery of the patients with cerebrovascular accident (CVA): the capabilities of psychological techniques in the improvement of cognitive functions

E3S Web of Conferences ◽

10.1051/e3sconf/202021017003 ◽

2020 ◽

Vol 210 ◽

pp. 17003

Author(s):

Irina Skirtach ◽

Evgenia Pokul

Keyword(s):

Cognitive Functions ◽

Recovery Period ◽

Cognitive Disorders ◽

Rehabilitation Program ◽

Hospital Environment ◽

Early Recovery ◽

Psychological Techniques ◽

Study Results ◽

Group A ◽

Early Recovery Period

If the appropriate combined measures are not taken to treat the manifestations of cognitive disorders, they have a tendency to progress towards worsening over time in the patients with CVA. The most common cognitive dysfunctions are as follows: disorders of attention, thinking, memory and executive functions. More and more studies are focused on the application of the various methods and techniques for neurorehabilitation of these disorders. Evaluation of the effect of adding the neurorehabilitation techniques in the treatment program in the early recovery period was a part of the objectives of this study. The sample consisted of 70 people with CVA. The study was carried out in the hospital environment. During 10 days, the standard scheme of the drug treatment was supplemented with the neurorehabilitation method using the "Brain jogging" technique and group work techniques in the experimental group. A battery of the psychodiagnostic tests was used, which included the "MMSE Scale" test, Pieron-Ruser test, Ebbinghaus test, and "10-word memorization" technique (according to A.R. Luria). Based on the study results, the features of the dynamics of recovery in the patients with CVA of indicators of cognitive functions are described due to the inclusion of psycho-gymnastic techniques in the rehabilitation program.

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The effectiveness of using modern technologies in early recovery period treatment of post-stroke patients

Clinical Practice ◽

10.17816/clinpract09110-17 ◽

2018 ◽

Vol 9 (1) ◽

pp. 10-17

Author(s):

Z. M. Mizieva ◽

E. V. Shirshova

Keyword(s):

Treatment Effectiveness ◽

Recovery Period ◽

Motor Dysfunction ◽

Upper Limbs ◽

Stroke Patients ◽

Early Recovery ◽

Post Stroke ◽

Early Recovery Period ◽

Positive Effect ◽

Modern Technologies

This study presents the results of investigation «Amadeo», «Armeo» effectiveness in treatment of 61 post-stroke patients during early recovery period with upper limbs motor dysfunction. Comparative characteristics of treatment effectiveness in patients with ischemic and hemorrhage stroke are given. The results of investigation represent positive effect of using robotic technologies in post stroke patients rehabilitation therapy.

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Serum vitamin D levels in acute stroke patients

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-019-0129-0 ◽

2019 ◽

Vol 55 (1) ◽

Author(s):

Fayrouz O. Selim ◽

Rasha M. Fahmi ◽

Ayman E. Ali ◽

Nermin Raafat ◽

Ahmed F. Elsaid

Keyword(s):

Vitamin D ◽

Serum Level ◽

Acute Stroke ◽

Vitamin D Deficiency ◽

Control Group ◽

Cerebral Stroke ◽

Stroke Severity ◽

Stroke Outcome ◽

Stroke Patients ◽

Vitamin D Levels

Abstract Background Vitamin D deficiency has been proposed as a risk factors of cerebrovascular stroke. Objectives The aim of this study was firstly, to assess the serum level of vitamin D in cerebral stroke patients and secondly, to examine if its deficiency was associated with stroke severity and outcome. Methods We utilized a case-control study design and recruited 138 acute stroke patients and 138 age- and sex-matched controls from subjects attending outpatient clinic for other reasons. All participants were subjected to full general and neurological examination. Brain imaging CT and/or MRI was performed. Blood samples were collected for measurement of serum level of vitamin D (ng/ml) by ELISA, alkaline phosphatase, serum calcium, and phosphorous. The stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was assessed by modified Rankin Scale (mRS). Results Stroke patients had significant lower levels of vitamin D compared with the control group. Vitamin D deficiency remained significantly associated with the NIHSS stroke severity score and the mRS 3-month stroke outcome after controlling for other significant factors such as age, dyslipidemia, and infarction size using multivariable logistic regression analysis. Conclusion Our results demonstrated that stroke patients suffer from vitamin D deficiency, which was associated with both stroke severity and poor outcome. Vitamin D supplementation could exert a therapeutic role in the management of cerebral stroke.

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