Lower Limb Kinematic Coordination during the Running Motion of Stroke Patient: A Single Case Study

The purpose of this study was to clarify the lower limb joint motor coordination of para-athletes during running motion from frequency characteristics and to propose this as a method for evaluating their performance. The subject used was a 43-year-old male para-athlete who had suffered a left cerebral infarction. Using a three-dimensional motion analysis system, the angles of the hip, knee, and ankle joints were measured during 1 min of running at a speed of 8 km/h on a treadmill. Nine inter- and intra-limb joint angle pairs were analyzed by coherence and phase analyses. The main characteristic of the stroke patient was that there were joint pairs with absent or increased coherence peaks in the high-frequency band above 4 Hz that were not found in healthy subjects. Interestingly, these features were also observed on the non-paralyzed side. Furthermore, a phase analysis showed different phase differences between the joint motions of the stroke patient and healthy subjects in some joint pairs. Thus, we concluded there was a widespread functional impairment of joint motion in the stroke patient that has not been revealed by conventional methods. The coherence analysis of joint motion may be useful for identifying joint motion problems in para-athletes.

RANCANG BANGUN ALAT MONITORING PERKEMBANGAN PASIEN PASCA STROKE BERBASIS IoT (INTERNET of THINGS)

The design of this IoT (Internet of Things)-based post-stroke patient monitoring tool was built to monitor patient progress remotely. Flex sensor hardware was used to retrieve data from every movement of the patient's finger muscle strength, then processed by the NodeMCU ESP32 after that the data will be sent to the web server via the IoT platform using a local wireless network. The results of research on the development of post-stroke patients can be displayed to a web server in the form of a table plot of data values for the index finger, middle finger, and ring finger. The post-stroke patient monitoring system can be accessed on PC and Android devices. The results of the sample test from the device obtained the highest value of 3.26 MMT and the lowest value of 0.2 MMT so that the patient's finger muscle strength was declared unstable and frequent changes in muscle strength.

The Effectiveness of Post-Stroke Patient Care Education Intervention in Stroke Caregivers: A Literature Review

Background: Educational interventions about stroke have been carried out by the health workers, one of which is by the nurse. However, the majority of the interventions focus more on the stroke patients than the stroke caregivers. Meanwhile, post-stroke patient care education interventions are urgently needed by the caregivers. Therefore, the author intends to review current literature about post-stroke patient care education interventions on stroke caregivers. Objective: This literature review aims to identify the effectiveness, methods, and impacts of daily care educational interventions for post-stroke patients on stroke caregivers. Methods: The method utilized was by analyzing online databases about the related topics from reputable sources. Seven articles that met the inclusions criteria considering Randomized Controlled Trial (RCT) and Quasi-experimental design, time of publication, and English full text were obtained, and the results were presented. Result: Educational intervention could be carried out by several methods, including direct education at the patient's bedside, lectures followed by questions and answers, and booklets, home visits or telephone follow-up. Educational interventions could improve caregiver knowledge and skills in providing daily care for post-stroke patients, reduce burdens, reduce anxiety and improve the caregiver's quality of life. Educational interventions also positively impacted post-stroke patients, including improving the quality of life, functional abilities and the ability to do daily activities (ADL), reducing cognitive impairment, anxiety, and depression.Conclusion: Daily care education interventions for post-stroke patients can reduce the burden on the caregiver, either physical, psychological or social burdens.

Pengaruh Pelatihan Tentang Perawatan Pasien Pasca Stroke Terhadap Peningkatan Pengetahuan Kader

Stroke is a neurological disease that can cause damage to the brain, the damage has an impact on the decline of the body's functional organs. Physical exercise carried out by post-stroke patients is also able to restore recovery, it is necessary to have a companion when doing these exercises from family members or closest neighbors, one of which can be done by Elderly Cadres. Cadre training can increase the knowledge of cadres which is expected to be able to improve the services provided to post-stroke patients. The purpose of this community service is to determine the effect of training on increasing the knowledge of cadres regarding post-stroke patient care. The method used is a question and answer lecture, discussion, and demonstration. The number of cadres who participated in this activity was 20 cadres. The instrument used to determine the increase in knowledge is a questionnaire. The results of this community service show that before the cadre training was carried out there were 15 cadres (75%), and after the cadre training the knowledge increased to Good as many as 17 cadres (85%). The effect of increasing the knowledge of cadres statistically is training with a value of 0.003 (<0.05), this means that training changes the knowledge of cadres before and after regarding post-stroke patient care. Suggestions for puskesmas in order to increase the knowledge of cadres can be through similar training with other themes.Keywords: Cadre; training; knowledge AbstrakStroke merupakan penyakit neurologi yang dapat menyebabkan kerusakan pada otak, kerusakan tersebut berdampak pada kemunduran organ fungsional tubuh. Latihan fisik yang dilakukan pasien pasca stroke juga mampu mempercepat pemulihan, perlunya ada pendamping ketika lansia melakukan latihan tersebut bisa dari anggota keluarga atau tetangga terdekat salah satunya dapat dilakukan oleh Kader Lansia. Pelatihan kader dapat meningkatkan pengetahuan kader yang diharapkan mampu untuk meningkatkan pula pelayanan yang diberikan kepada pasien pasca stroke. Tujuan dari pengabdian masyarakat ini adalah untuk mengetahui pengaruh pelatihan terhadap peningkatan pengetahuan kader mengenai perawatan pasien pasca stroke. Metode yang digunakan adalah ceramah tanya jawab, diskusi, dan demontrasi. Jumlah kader yang mengikuti kegiatan ini adalah 20 kader. Instrumen yang digunakan untuk mengetahui peningkatan pengetahuan adalah kuesioner. Hasil pengabdian masyarakat ini bahwa sebelum dilakukan pelatihan pengetahuan kader ada pada kategori cukup sebanyak 15 kader (75%), dan setelah dilakukan pelatihan pengetahuan kader meningkat menjadi Baik sebanyak 17 kader (85%). Pengaruh pelatihan dalam meningkatkan pengetahuan kader secara statistic dengan nilai p 0,003 (<0,05) hal ini berarti pelatihan berpengaruh mengubah pengetahuan kader sebelum dan setelah pelatihan mengenai perawatan pasien pasca stroke. Saran bagi puskesmas agar dapat meningkatkan pengetahuan kader dapat melalui pelatihan sejenis dengan tema yang lain. Keywords: Kader;pelatihan;pengetahuan

Transcranial direct electrical stimulation for hand function in a stroke patient with severe upper limb paralysis due to lenticulostriate artery occlusion: a case report

Background Transcranial direct current stimulation, a therapeutic modality to modulate the excitability of injured and uninjured brain hemispheres in stroke patients, is expected to be effective in treating upper limb paralysis. We describe the use of transcranial direct current stimulation to improve the function and frequency of use of the paralyzed hand of a patient with lenticulostriate artery occlusion. Case presentation A Japanese man in his fifties developed a left internal hindfoot perforator branch infarction owing to lenticulostriate artery occlusion, and presented with severe right upper and lower limb paralysis. Multiple interventions for the paralyzed hand, primarily robot therapy, did not noticeably change his hand function or frequency of use in daily life. Therefore, transcranial direct current stimulation was used in combination with upper limb functional exercises for 20 minutes a day, five times a week, for 6 weeks. Consequently, scores for the hand items of the Fugl–Meyer Assessment of the upper extremities improved, and pain and subluxation around the shoulder joint were reduced. Furthermore, the frequency of use and the quality of movement of the paralyzed hand were improved. Conclusions Upper limb functional training and transcranial direct current stimulation improved the function and frequency of use of the paralyzed hand in a stroke patient with severe upper limb paralysis, suggesting that this combined intervention could effectively improve hand function in patients with severe upper limb paralysis.

MicroRNA Analysis of Human Stroke Brain Tissue Resected during Decompressive Craniectomy/Stroke-Ectomy Surgery

Background: Signaling pathways mediated by microRNAs (miRNAs) have been identified as one of the mechanisms that regulate stroke progression and recovery. Recent investigations using stroke patient blood and cerebrospinal fluid (CSF) demonstrated disease-specific alterations in miRNA expression. In this study, for the first time, we investigated miRNA expression signatures in freshly removed human stroke brain tissue. Methods: Human brain samples were obtained during craniectomy and brain tissue resection in severe stroke patients with life-threatening brain swelling. The tissue samples were subjected to histopathological and immunofluorescence microscopy evaluation, next generation miRNA sequencing (NGS), and bioinformatic analysis. Results: miRNA NGS analysis detected 34 miRNAs with significantly aberrant expression in stroke tissue, as compared to non-stroke samples. Of these miRNAs, 19 were previously identified in stroke patient blood and CSF, while dysregulation of 15 miRNAs was newly detected in this study. miRNA direct target gene analysis and bioinformatics approach demonstrated a strong association of the identified miRNAs with stroke-related biological processes and signaling pathways. Conclusions: Dysregulated miRNAs detected in our study could be regarded as potential candidates for biomarkers and/or targets for therapeutic intervention. The results described herein further our understanding of the molecular basis of stroke and provide valuable information for the future functional studies in the experimental models of stroke.

A cutlery set for stroke

<p>Stroke is a common problem that affects approximately 700,000 patients annually in the United States alone and can cause long-term disabilities (Mallory, 2006, p.33). The long-term effects of a stroke can impact on the patient’s ability to use one side of their body. Upper limb, lower limb, postural and communication difficulties are common factors that patients experience after a stroke (Perry, 2004), which can affect the patient’s ability to eat (McLaren, 1997). After a stroke, the impairment of an upper limb can lead to problems that make it difficult for people to use cutlery, and include poor grip, decreased muscle control, tremors and upper limb weakness (Brackenrige, 2016). Currently, there are some assistive technology (AT) cutlery sets aimed to help patients who have difficulty in eating and muscle control. Several reasons why stroke patients abandon AT cutlery are cost, appearance, and function (Vaes, 2014). However, an experiment (Torrens, 2013) in to adaptive cutlery products and previous research suggest that there is a large space to improve this, such as appearance and function. AT cutlery sets have been criticized because of their appearance and inferior functions (Torrens, 2013). This then leads to a disconnection between the user and the AT cutlery products, in which the user experiences visible stigma and links the cutlery to an undesirable characteristic (Vaes, 2012). There are some limitations of the current AT cutlery sets that have been identified in the evaluation (Torren & Smith, 2013), such as poor friction material, stereotypical shapes, and skin-tone handle colour. The limitations create an opportunity for the designers to improve the AT cutlery set to be a selected object and a pleasurable product to use in everyday life. The purpose of this research is to explore how human-centred design can reduce the stigma of using AT cutlery for stroke patients through addressing the appearance and interactions of spoons, forks and knives. The research involves the following steps: observing videos of stroke patients eating, interviewing clinicians, interviewing stroke patients, and iterative design with the supervision of clinicians. Some of the main issues identified surrounding stroke patient eating and using cutlery include grip weakness, muscle contracture, and difficulty of flexion. Based on the product intervention model for stigma (PIMS) (Vaes, 2014), this study utilized existing research surrounding the evaluation of assistive technology. To help understand each stage of the user needs, previous feedback from health-care clinicians and patients will ensure the validity of ergonomic interventions and stigma strategy as a substitute for traditional cutlery design. The output of this research includes a set of cutlery as well as assistive components. The design addresses a patient’s difficulty in using cutlery through an adaptive ring to help the patients’ grip. The utensils allow the user to either carry out eating activities at home or in a restaurant. The feedback from occupational therapists and physiotherapists indicates that the cutlery should accommodate different levels of stroke severity. Based on the findings of literature reviews and feedback, I have focused my design on addressing the stroke patients’ grip weakness, muscle contracture, and difficulty of hand flexion, whilst minimizing stigma, based on the PIMS strategies (Vaes, 2014). The design principle suggests that current cutlery designs with an integrated shape cannot meet all requirements of a stroke patient. Therefore, a combination of additional wearing components needs to be used to help dietary intake.</p>