scholarly journals Cerebrolysin Combined with Rehabilitation Enhances Motor Recovery and Prevents Neural Network Degeneration in Ischemic Stroke Patients with Severe Motor Deficits

2021 ◽  
Vol 11 (6) ◽  
pp. 545
Author(s):  
Won Hyuk Chang ◽  
Jungsoo Lee ◽  
Yong-Il Shin ◽  
Myoung-Hwan Ko ◽  
Deog Young Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Diffusion Tensor ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Rehabilitation Therapy ◽  
Severe Motor ◽  
Severe Motor Impairment ◽  
Over Time

The objective of this study was to evaluate whether Cerebrolysin combined with rehabilitation therapy supports additional motor recovery in stroke patients with severe motor impairment. This study analyzed the combined data from the two phase IV prospective, multicenter, randomized, double-blind, placebo-controlled trials. Stroke patients were included within seven days after stroke onset and were randomized to receive a 21-day treatment course of either Cerebrolysin or placebo with standardized rehabilitation therapy. Assessments were performed at baseline, immediately after the treatment course, and 90 days after stroke onset. The plasticity of the motor system was assessed by diffusion tensor imaging and resting state fMRI. In total, 110 stroke patients were included for the full analysis set (Cerebrolysin n = 59, placebo n = 51). Both groups showed significant motor recovery over time. Repeated-measures analysis of varianceshowed a significant interaction between time and type of intervention as measured by the Fugl–Meyer Assessment (p < 0.05). The Cerebrolysin group demonstrated less degenerative changes in the major motor-related white matter tracts over time than the placebo group. In conclusion, Cerebrolysin treatment as an add-on to a rehabilitation program is a promising pharmacologic approach that is worth considering in order to enhance motor recovery in ischemic stroke patients with severe motor impairment.

scholarly journals Combined Brain and Peripheral Nerve Stimulation in Chronic Stroke Patients With Moderate to Severe Motor Impairment

2017 ◽  
Vol 21 (2) ◽  
pp. 176-183 ◽  
Author(s):  
Isabella S. Menezes ◽  
Leonardo G. Cohen ◽  
Eduardo A. Mello ◽  
André G. Machado ◽  
Paul Hunter Peckham ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Motor Impairment ◽  
Chronic Stroke ◽  
Peripheral Nerve Stimulation ◽  
Stroke Patients ◽  
Severe Motor ◽  
Severe Motor Impairment

scholarly journals Cerebrolysin combined with rehabilitation promotes motor recovery in patients with severe motor impairment after stroke

BMC Neurology ◽  
2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Won Hyuk Chang ◽  
Chang-hyun Park ◽  
Deog Young Kim ◽  
Yong-Il Shin ◽  
Myoung-Hwan Ko ◽  
...  
Keyword(s):  
Motor Impairment ◽  
Motor Recovery ◽  
Severe Motor ◽  
Severe Motor Impairment

scholarly journals Model for prompt and effective classification of motion recovery after stroke considering muscle strength and coordination factors

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Álvaro Costa-García ◽  
Ken-ichi Ozaki ◽  
Hiroshi Yamasaki ◽  
Matti Itkonen ◽  
Fady Alnajjar S. ◽  
...  
Keyword(s):  
Brain Damage ◽  
Motor Impairment ◽  
Muscle Coordination ◽  
Motor Impairments ◽  
Stroke Patients ◽  
Neural Adaptations ◽  
Two Factors ◽  
Severe Motor ◽  
Motor Strength ◽  
Severe Motor Impairment

Abstract Background Muscle synergies are now widely discussed as a method for evaluating the existence of redundant neural networks that can be activated to enhance stroke rehabilitation. However, this approach was initially conceived to study muscle coordination during learned motions in healthy individuals. After brain damage, there are several neural adaptations that contribute to the recovery of motor strength, with muscle coordination being one of them. In this study, a model is proposed that assesses motion based on surface electromyography (sEMG) according to two main factors closely related to the neural adaptations underlying motor recovery: (1) the correct coordination of the muscles involved in a particular motion and (2) the ability to tune the effective strength of each muscle through muscle fiber contractions. These two factors are hypothesized to be affected differently by brain damage. Therefore, their independent evaluation will play an important role in understanding the origin of stroke-related motor impairments. Results The model proposed was validated by analyzing sEMG data from 18 stroke patients with different paralysis levels and 30 healthy subjects. While the factors necessary to describe motion were stable across heathy subjects, there was an increasing disassociation for stroke patients with severe motor impairment. Conclusions The clear dissociation between the coordination of muscles and the tuning of their strength demonstrates the importance of evaluating these factors in order to choose appropriate rehabilitation therapies. The model described in this research provides an efficient approach to promptly evaluate these factors through the use of two intuitive indexes.

scholarly journals Prediction of Motor Recovery Using Diffusion Tensor Tractography in Supratentorial Stroke Patients With Severe Motor Involvement

2015 ◽  
Vol 39 (4) ◽  
pp. 570 ◽  
Author(s):  
Kang Hee Kim ◽  
Yun-Hee Kim ◽  
Min Su Kim ◽  
Chang-hyun Park ◽  
Ahee Lee ◽  
...  
Keyword(s):  
Diffusion Tensor ◽  
Motor Recovery ◽  
Diffusion Tensor Tractography ◽  
Stroke Patients ◽  
Severe Motor

scholarly journals TMS-Induced Central Motor Conduction Time at the Non-Infarcted Hemisphere is Associated with Spontaneous Motor Recovery of the Paretic Upper Limb after Severe Stroke

2021 ◽  
Vol 11 (5) ◽  
pp. 648
Author(s):  
Maurits Hoonhorst ◽  
Rinske Nijland ◽  
Cornelis Emmelot ◽  
Boudewijn Kollen ◽  
Gert Kwakkel
Keyword(s):  
Ischemic Stroke ◽  
Upper Limb ◽  
Normative Data ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Conduction Time ◽  
Stroke Patients ◽  
Severe Stroke ◽  
Central Motor Conduction Time ◽  
Post Stroke

Background: Stroke affects the neuronal networks of the non-infarcted hemisphere. The central motor conduction time (CMCT) induced by transcranial magnetic stimulation (TMS) could be used to determine the conduction time of the corticospinal tract of the non-infarcted hemisphere after a stroke. Objectives: Our primary aim was to demonstrate the existence of prolonged CMCT in the non-infarcted hemisphere, measured within the first 48 h when compared to normative data, and secondly, if the severity of motor impairment of the affected upper limb was significantly associated with prolonged CMCTs in the non-infarcted hemisphere when measured within the first 2 weeks post stroke. Methods: CMCT in the non-infarcted hemisphere was measured in 50 patients within 48 h and at 11 days after a first-ever ischemic stroke. Patients lacking significant spontaneous motor recovery, so-called non-recoverers, were defined as those who started below 18 points on the FM-UE and showed less than 6 points (10%) improvement within 6 months. Results: CMCT in the non-infarcted hemisphere was prolonged in 30/50 (60%) patients within 48 h and still in 24/49 (49%) patients at 11 days. Sustained prolonged CMCT in the non-infarcted hemisphere was significantly more frequent in non-recoverers following FM-UE. Conclusions: The current study suggests that CMCT in the non-infarcted hemisphere is significantly prolonged in 60% of severely affected, ischemic stroke patients when measured within the first 48 h post stroke. The likelihood of CMCT is significantly higher in non-recoverers when compared to those that show spontaneous motor recovery early post stroke.

Abstract 87: Neuroimaging, Not Clinical Assessment Predicts Post-Stroke Motor Outcome in Severely Impaired Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Wuwei Feng ◽  
Jing Wang ◽  
Christopher Doughty ◽  
Christine Holmstedt ◽  
Gottfried Schlaug
Keyword(s):  
Clinical Assessment ◽  
Predictive Value ◽  
Motor Impairment ◽  
Stroke Patients ◽  
Lesion Load ◽  
Post Stroke ◽  
Motor Outcome ◽  
Severe Motor ◽  
Stroke Group ◽  
Severe Motor Impairment

Background: Initial motor impairment by clinical assessment and neuroimaging measures of corticospinal tract injury have been shown to predict 3-month motor outcome in mild-to-moderately impaired stroke patients. Clinical assessment alone is good to predict outcome of more severely impaired patients. This study aims to compare clinical assessment with neuroimaging in severely impaired patients. Methods: This study followed 27 first-ever ischemic stroke patients who presented with severe motor impairment at baseline( between 2- 5 days after stroke) which is defined as Upper Extremity Fugl-Meyer (UE-FM) Scale was <=5. Patients will be assessed at 3 months (90 ±14 days) again with UE_FM. A weighted CST lesion load (wCST-LL) was calculated by overlaying each patient’s lesion map on MRI with a probabilistic CST constructed from healthy subjects. A regression analysis was applied to assess the predictive value of wCST-LL and initial motor impairment. Results: Initial motor impairment has no predictive value (p=0.25, R 2 =0.05) while wCST-LL has a strong prediction (p=0.002, R 2 =0.31) for post-stroke motor outcome in this severely impaired stroke group. If wCST is more than 7 cc, no patient recovers more than 20 on UE_FM at 3 months. Conclusion: Compared with clinical assessment, a neuroimaging measure of CST injury excels in post-stroke motor outcome prediction in a severely impaired subgroup.

scholarly journals Relationship between the Corticospinal and Corticocerebellar Tracts and Their Role in Upper Extremity Motor Recovery in Stroke Patients

2021 ◽  
Vol 11 (11) ◽  
pp. 1162
Author(s):  
Jungsoo Lee ◽  
Won Hyuk Chang ◽  
Yun-Hee Kim
Keyword(s):  
Upper Extremity ◽  
Predictive Accuracy ◽  
Diffusion Tensor ◽  
Stroke Onset ◽  
Patient Specific ◽  
Stroke Patients ◽  
Predictive Values ◽  
The Relationship ◽  
Diffusion Tensor Imaging Dti

The corticospinal tract (CST) and corticocerebellar tract (CCT) are both involved in the upper extremity (UE) function after stroke. Understanding the relationship between the tracts and their functions can contribute to developing patient-specific rehabilitative strategies. Seventy ischemic stroke patients who underwent diffusion tensor imaging (DTI) two weeks after the stroke onset and motor function assessments two weeks and three months after the stroke onset were included in this study. To obtain the CST and CCT integrity, the functional anisotropy (FA) values of both tracts were extracted from the DTI data. Linear regression was used to identify the relationship and predictive accuracy. The CST FA data had predictive values, but CCT FA did not. There were interaction effects between the CST and CCT FA values (p = 0.011). The CCT was significantly associated with high CST FA but not low CST FA. When the CST or CCT FA were applied to patients depending on the CST status, the stratified model showed higher predictive accuracy (R2 = 0.380) than that of the CST-only model (R2 = 0.320). In this study, the conditional role of CCT depending on CST status was identified in terms of UE recovery in stroke patients. This result could provide useful information about individualized rehabilitative strategies in stroke patients.

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