early recovery period
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2021 ◽  
Vol 40 (4) ◽  
pp. 95-100
Author(s):  
Igor A. Voznjuk ◽  
Alexandra V. Polyakova ◽  
Diana V. Tokareva

Disability after a stroke is most often associated with decreased patient activity due to walking disorder. In case of severe paresis, the function of the limb in the early stages of recovery is advisable to support with the help of partial prosthetics, using methods that provide functional stimulation. The complex treatment of central paresis includes botulinum therapy, which is due to the high incidence of spasticity. Aim: of the study: evaluation of the efficacy of functional electrical stimulation in a complex of multimodal effects in restoring movement in stroke patients with lower limb paresis. Materials and methods: Stimulation and neuroprosthetic methods (Bioness L300) were used as the main therapeutic program of rehabilitation treatment for patients with motor disorders of the lower limb after an ischemic stroke (n = 70). The median period of stroke was 21 [11; 47] days, median age 54 [42; 65] years. Scales and questionnaires were used to assess the loss of strength and volume of movement disorders, spasticity, walking speed and self-care (Medical Research Council Weakness Scale (1981, MRC), Barthel Index (1965), Modified Ashworth Scale (MAS), 10-meter test). Results: The effectiveness of personalized therapy with the use of a neuroprothesis (Bioness L300) in patients in the acute and early recovery period of ischemic stroke was shown. The additional use of botulinum toxin made it possible to eliminate the inhibitory effect of spasticity, which expanded the possibility of using intensive methods of physical rehabilitation. There was an increase in daily activity, walking speed, and the level of self-care of patients in 90 % of cases. Conclusion: The use of a complex of stimulating personalized techniques in the acute period of a stroke is justified and safe. The functional electrical stimulation helps to overcome power paresis, increases the overall level of physical activity of patients after a stroke, motivation for recovery and improves the quality of life. (1 figure, 2 tables, bibliography: 9 refs)


2021 ◽  
Author(s):  
Dmitry Skvortsov ◽  
Sergey Kaurkin ◽  
Galina Ivanova ◽  
Boris Poliaev ◽  
Maria Bulatova

Yes


PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259806
Author(s):  
Brent Strong ◽  
Michele C. Fritz ◽  
Liming Dong ◽  
Lynda D. Lisabeth ◽  
Mathew J. Reeves

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.


2021 ◽  
Vol 67 (6) ◽  
pp. 13-20
Author(s):  
O.M. Bakunovsky ◽  
◽  
H.V. Lukyantseva ◽  
S.S. Malyuga ◽  
L.T. Kotlyarenko ◽  
...  

We studied the changes in central hemodynamics in the early recovery period after physical load in 28 young men. Dynamic loading was induced using a modified Martine functional test, static loading - by maintaining on the standing dynamometer DS-200 muscle effort in the amount of 50% of maximum standing force. The change in central hemodynamic para- meters was recorded by tetrapolar thoracic impedance rheo- plethysmogram using a computerized diagnostic complex «Cardio +». Dynamic exercise during early recovery did not lead to a significant increase in heart rate, however, it caused a decrease in the resistance of resistive blood vessels and an increase in pulse blood pressure. The increase in minute blood volume in our study is mainly due to an increase in stroke volume, pointing for high functional reserves of the heart. In the case of static physical activity, the adaptive reactions of central hemodynamics and the course of the processes of early recovery of the circulatory system are radically different from similar indicators during dynamic physical activity. In subjects with a normodynamic type of response of the cardiovascular system to dynamic load, no significant changes in the minute volume of blood flow were registered at a similar volume of active muscle mass static load. In subjects with a normodynamic type of cardiovascular response to dynamic load, no significant changes in cardiac output were observed at a similar static load in terms of active muscle mass. However, during early recovery period, the total peripheral vascular resistance and systolic arterial pressure were increased. The increase in total peripheral resistance may be due to reactive hyperemia in ischemic skeletal muscle caused by increased blood flow to the capillaries after muscle relaxation and delayed outflow into the veins. The significant increase in systolic blood pressure can be explained by the mechanical obstruction of blood flow in the muscle capillaries during prolonged static contraction.


Sensors ◽  
2021 ◽  
Vol 21 (21) ◽  
pp. 7217
Author(s):  
Dmitry V. Skvortsov ◽  
Sergey N. Kaurkin ◽  
Galina E. Ivanova

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.


2021 ◽  
Vol 17 (5) ◽  
pp. 23-34
Author(s):  
A. M. Golubev ◽  
A. V. Grechko ◽  
V. E. Zakharchenko ◽  
M. M. Kanarsky ◽  
M. V. Petrova ◽  
...  

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.


2021 ◽  
Vol 20 (3) ◽  
pp. 38-45
Author(s):  
S. D. Kazakov ◽  
E. S. Koroleva ◽  
N. G. Brazovskaya ◽  
A. A. Zaytsev ◽  
S. A. Ivanova ◽  
...  

Aim. To assess the relationship between changes in serum brain-derived neurotrophic factor (BDNF) level, regression of motor deficiency, and restoration of functional activity in patients with ischemic stroke after stage II of medical rehabilitation.Materials and methods. The study included 49 patients with ischemic stroke in the middle cerebral artery after stage I of medical rehabilitation. Group I (n = 32) went through stage II of rehabilitation in the early recovery period, group II (n = 17) was discharged for outpatient monitoring at the place of residence. Observation points: day 14 and day 90. Evaluation scales: National Institute of Health Stroke Scale (NIHSS), Fugle – Meyer Scale (FMA), Modified Rankin Scale (mRS). Serum BDNF levels were determined using a MAGPIX multiplex analyzer (Luminex, USA).Results. A comparative analysis of the studied population showed that patients who underwent motor rehabilitation in the early recovery period had greater regression of neurologic deficit according to the ΔNIHSS scale (pgr.I–II = 0.043), a more pronounced increase in the functional activity on the ΔmRS scale (pgr.I–II = 0.047), and positive dynamics according to the FMA scale (pday14–90 = 0.003) in comparison with patients who received outpatient follow-up. The concentration of BDNF was significantly reduced by the end of the early recovery in the group II (pday14–90_gr.II = 0.002). On the contrary, there was no decrease in the level of the BDNF (pday14–90_gr.I = 0.613) in the group of patients undergoing rehabilitation.Conclusion. The results of the study demonstrated the clinical effectiveness of stage II of the comprehensive rehabilitation of patients in the early period of stroke recovery. We can suggest that the success of neurorehabilitation is closely associated with an increase of the BDNF level against the background of its performance. This makes BDNF a potential marker of evaluating the effectiveness of ongoing rehabilitation treatment.


2021 ◽  
pp. 1-6
Author(s):  
Raphael Kozaris ◽  
Julian Hanske ◽  
Nicolas von Landenberg ◽  
Sebastian Berg ◽  
Florian Roghmann ◽  
...  

<b><i>Purpose:</i></b> This study aimed to evaluate psychosocial distress in the context of continence and oncological outcome during the early recovery period after radical prostatectomy (RP) for prostate cancer. <b><i>Patients and Methods:</i></b> Retrospectively collected data from 587 patients who underwent inpatient rehabilitation after RP in 2016 and 2017 were analyzed. Psychosocial distress (measured by using a Questionnaire on Stress in Cancer Patients [QSC-R10]) and continence status (urine loss on a 24-h pad test and urine volume on uroflowmetry) were evaluated at the beginning (T1) and end (T2) of a 3-week inpatient rehabilitation. Multivariate logistic regression was performed to identify predictors for high distress (QSC-R10 score ≥15). <b><i>Results:</i></b> The median patient age was 65 years. At the start of rehabilitation, 204 patients (34.8%) demonstrated high distress. Psychosocial distress decreased significantly (<i>p</i> &#x3c; 0.001) from a median of 11.0 at T1 (median 16 days after surgery) to a median of 6.0 at T2 (median 37 days after surgery). Complete continence increased significantly (<i>p</i> &#x3c; 0.001) from 39.0% at T1 to 58.9% at T2. The median urine volume increased significantly (<i>p</i> &#x3c; 0.001) from 161 mL at T1 to 230 mL at T2. Often, distress is higher in younger patients, whereas incontinence is higher in older patients. Multivariate logistic regression analysis identified age ≤69 years (<i>p</i> = 0.001) and tumor stage ≥pT3 (<i>p</i> = 0.006) as independent predictors of high distress. <b><i>Conclusions:</i></b> Distress and incontinence decreased significantly during the 3 weeks of inpatient rehabilitation after RP. Patient age ≤69 years and tumor stage ≥pT3 are independent predictors of high psychosocial distress.


2021 ◽  
Vol 22 (3) ◽  
pp. 257-264
Author(s):  
Sergey V. Kotov ◽  
Alexander I. Romanov ◽  
Ekaterina V. Silina ◽  
Victor A. Stupin ◽  
Elena V. Isakova ◽  
...  

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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