Somatosensory and nociceptive changes in chronic post-stroke shoulder pain

Preliminary results from a cross-sectional study that investigated the relation between the presence of post-stroke shoulder pain and somatosensory and nociceptive changes are presented. The main finding is that both abnormal somatosensation and nociception are more frequently observed in stroke patients with pain as compared to pain-free stroke patients and healthy controls

Design and evaluation of the gait rehabilitation robot LOPES

The goal of the work presented in this thesis was to realize a robotic device that is able provide suitable gait training to stroke patients.\ud It is believed that motor training in general, but specifically for stroke patients should be intensive and task-specific in order to reach optimal outcome. Meanwhile, the training of severe stroke patients has proven to be physically very demanding to therapists. For this reason it is believed that robotic aids can be useful alternative for physical therapists to provide gait training. In this research we supposed a training setting in which a therapist is in control of the training, while the robot carries out the physical labor in guiding, assisting and correcting the patient

PENGARUH DEPRESI PADA AWAL STROKE (MINGGU I) TERHADAP WAKTU PERBAIKAN DEFISIT NEUROLOGIS PENDERITA STROKE NON HEMORAGIK

Introduction : Depression is the most common type of psychiatric disorder among stroke patients. It is considered as a usual reaction that frequently ignored by family and paramedic. It had been agreed that depression will hampered the neurological deficits recovery of stroke patients. The research was aimed to examine the influence of depression to the recovery time of neurological deficits in infarct stroke patient. Methods : An observation research with prospective study of 70 infarct stroke subjects. The subjects were infact stroke patients hospitalized in B1 neurology ward Dr. Kariadi hospital, January 2005 until December 2005. Neurological deficits were examined with National Institute of Health Stroke Scale (NIHSS) and the depression was diagnosed with Hamilton Depression Rating Scale (HDRS) . Neurological deficits recovery was examine in II, III, IV, V and VI with NIHSS. The patient has recovered if the score of NIHSS is 5 and not recovered if not reach the score of NIHSS 5. The result of the research is shown as graphics and survival analysis tables to know the difference of time recovery. The confounding factor was controlled with logistic regression analysis. The level of significant used this research is with p < 0.05). Results : Subjects without depressed mental state recovered in 3.88 weeks (95% CI 3.37; 4.39) and subjects with depressed mental state recovered in 5.78 weeks (95% CI 5.05; 6.06). Confounding factors that influence to recovery time of improve neurological deficits were age with p = 0.021 and course result of neurological deficit examination at first week with p = 0.001. Conclusions : Stroke patients with depression require more time to recover from neurological deficits compared with non depression stroke patients. Key Words : Post stroke depression – NIHSS – survival analysi

Clinical characteristics of unknown symptom onset stroke patients with and without diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch

Background: Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch was suggested to identify stroke patients with unknown time of symptom onset likely to be within the time window for thrombolysis. Aims: We aimed to study clinical characteristics associated with DWI-FLAIR mismatch in patients with unknown onset stroke. Methods: We analyzed baseline MRI and clinical data from patients with acute ischemic stroke proven by DWI from WAKE-UP, an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset. Clinical characteristics were compared between patients with and without DWI-FLAIR mismatch. Results: Of 699 patients included, 418 (59.8%) presented with DWI-FLAIR mismatch. A shorter delay between last seen well and symptom recognition (p = 0.0063), a shorter delay between symptom recognition and arrival at hospital (p = 0.0025), and history of atrial fibrillation (p = 0.19) were predictors of DWI-FLAIR mismatch in multivariate analysis. All other characteristics were comparable between groups. Conclusions: There are only minor differences in measured clinical characteristics between unknown symptom onset stroke patients with and without DWI-FLAIR mismatch. DWI-FLAIR mismatch as an indicator of stroke onset within 4.5 h shows no relevant association with commonly collected clinical characteristics of stroke patients

Short-term effects of focal muscle vibration on motor recovery after acute stroke: a pilot randomized sham-controlled study

Repetitive focal muscle vibration (rMV) is known to promote neural plasticity and long-lasting motor recovery in chronic stroke patients. Those structural and functional changes within the motor network underlying motor recovery occur in the very first hours after stroke. Nonetheless, to our knowledge, no rMV-based studies have been carried out in acute stroke patients so far, and the clinical benefit of rMV in this phase of stroke is yet to be determined. The aim of this randomized double-blind sham-controlled study is to investigate the short-term effect of rMV on motor recovery in acute stroke patients. Out of 22 acute stroke patients, 10 were treated with the rMV (vibration group–VG), while 12 underwent the sham treatment (control group–CG). Both treatments were carried out for 3 consecutive days, starting within 72 h of stroke onset; each daily session consisted of three 10-min treatments (for each treated limb), interspersed with a 1-min interval. rMV was delivered using a specific device (Cro®System, NEMOCO srl, Italy). The transducer was applied perpendicular to the target muscle's belly, near its distal tendon insertion, generating a 0.2–0.5 mm peak-to-peak sinusoidal displacement at a frequency of 100 Hz. All participants also underwent a daily standard rehabilitation program. The study protocol underwent local ethics committee approval (ClinicalTrial.gov NCT03697525) and written informed consent was obtained from all of the participants. With regard to the different pre-treatment clinical statuses, VG patients showed significant clinical improvement with respect to CG-treated patients among the NIHSS (p &lt; 0.001), Fugl-Meyer (p = 0.001), and Motricity Index (p &lt; 0.001) scores. In addition, when the upper and lower limb scales scores were compared between the two groups, VG patients were found to have a better clinical improvement at all the clinical end points. This study provides the first evidence that rMV is able to improve the motor outcome in a cohort of acute stroke patients, regardless of the pretreatment clinical status. Being a safe and well-tolerated intervention, which is easy to perform at the bedside, rMV may represent a valid complementary non-pharmacological therapy to promote motor recovery in acute stroke patients

The Use of Antihypertensive and Antiplatelet Drugs on Hospital Stroke Patients

Medicine is one of the most important part of the healing process, the restoration of health and prevention of disease. This study aims to describe the use of drugs, particularly antihypertensive and antiplatelet drugs in stroke patients hospitalized in PKU Muhammadiyah Hospital Bantul during December 2014-April 2015. This research is observational descriptive study. Data collection was done prospectively with a survey of stroke patients in inpatient Al-Insan and al-A'raaf wards in PKU Muhammadiyah Hospital Bantul during the specified period. During the study there were 61 stroke patients sampled in the study, of which 41 (67.2%) were geriatrics and 20 (32.8%) were not geriatrc. From the data, 28 (45.9%) patients did not receive antihypertensive drugs, only 33 (54,1%) patients received antihypertensive drug.The antihypertensive drugs type were given to patients were ACEI 9 (14.8%) and CCB 6 (9.8%), as well as combinations ACEI and CCB 7 (11.5%). Most patients did not receive antiplatelet 43 (70.5%), whereas patients receiving antiplatelet drugs most was the kind of aspirin 17 (27.9%). From the above data it can be concluded that the use of antihypertensive drugs in stroke patients in the inpatient ward in PKU Muhamaddiyah Hospital Bantul quite frequently used, while the use of antiplatelet drugs in these cases rarely used

Training emergency services’ dispatchers to recognise stroke: an interrupted time-series analysis

Background: Stroke is a time-dependent medical emergency in which early presentation to specialist care reduces death and dependency. Up to 70% of all stroke patients obtain first medical contact from the Emergency Medical Services (EMS). Identifying ‘true stroke’ from an EMS call is challenging, with over 50% of strokes being misclassified. The aim of this study was to evaluate the impact of the training package on the recognition of stroke by Emergency Medical Dispatchers (EMDs). Methods: This study took place in an ambulance service and a hospital in England using an interrupted time-series design. Suspected stroke patients were identified in one week blocks, every three weeks over an 18 month period, during which time the training was implemented. Patients were included if they had a diagnosis of stroke (EMS or hospital). The effect of the intervention on the accuracy of dispatch diagnosis was investigated using binomial (grouped) logistic regression. Results: In the Pre-implementation period EMDs correctly identified 63% of stroke patients; this increased to 80% Post-implementation. This change was significant (p=0.003), reflecting an improvement in identifying stroke patients relative to the Pre-implementation period both the During-implementation (OR=4.10 [95% CI 1.58 to 10.66]) and Post-implementation (OR=2.30 [95% CI 1.07 to 4.92]) periods. For patients with a final diagnosis of stroke who had been dispatched as stroke there was a marginally non-significant 2.8 minutes (95% CI −0.2 to 5.9 minutes, p=0.068)reduction between Pre- and Post-implementation periods from call to arrival of the ambulance at scene. Conclusions: This is the first study to develop, implement and evaluate the impact of a training package for EMDs with the aim of improving the recognition of stroke. Training led to a significant increase in the proportion of stroke patients dispatched as such by EMDs; a small reduction in time from call to arrival at scene by the ambulance also appeared likely. The training package has been endorsed by the UK Stroke Forum Education and Training, and is free to access on-line

Gambaran Kekuatan Otot Pasien Stroke Non Hemoragik Setelah Diberikan Latihan Bola Karet Dan Thera Band Hand Di Rumah Sakit Rk. Charitas Palembang

Background: Non-hemoragic stroke patients has upper extermity muscle weakness resulting in decreased muscle strength. Exercise done on non-hemoragic stroke patients to with simple movement and beneficial exercises to increase muscle strength. Objective: To description rubber ball and thera band hand training on the muscle strength of non-hemoragic stroke patients in the RS.RK. Charitas Palembang. The aim of this study to determine of muscle strength non-hemoragic stroke patients before and after being given a rubber ball training and thera band hand exercises. Muscle strength measured with hand dynamometer. Method: This study used a two group pretest and posttest pre-experiment design of 6 respondents with consecutive sampling technique. Respondents were divided into 2 groups, group 1 was given rubber ball training and group 2 was given thera band hand training. Both groups were given exercise during for 5 days and each exercise was carried out for 15 minutes. Results: 6 respondents with non-hemoragic stroke had weakness in upper extermity muscle strength. Respondents with rubber ball training had increase muscle strength about 66,7% and respondents given thera band hand 100% did not increased. Non- hemoragic stroke patient at RS.RK. Charitas with low upper extermity had the rubber ball training continously because the rubber ball training can increase the strength of the upper extermity muscles. Suggestion: It is necessary to practice regular and continuous rubber balls and hand band thera to increase the upper exterm muscle strength. Further research is suggestesd to be able to continue this research with more number of respondents

Stroke with unknown time of symptom onset: baseline clinical and magnetic resonance imaging data of the first thousand patients in WAKE-UP (efficacy and safety of mri-based thrombolysis in wake-up stroke: a randomized, doubleblind, placebo-controlled trial)

Background and Purpose—We describe clinical and magnetic resonance imaging (MRI) characteristics of stroke patients with unknown time of symptom onset potentially eligible for thrombolysis from a large prospective cohort. Methods—We analyzed baseline data from WAKE-UP (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke: A Randomized, Doubleblind, Placebo-Controlled Trial), an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset. MRI judgment included assessment of the mismatch between visibility of the acute ischemic lesion on diffusion-weighted imaging and fluid-attenuated inversion recovery. Results—Of 1005 patients included, diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch was present in 479 patients (48.0%). Patients with daytime-unwitnessed stroke (n=138, 13.7%) had a shorter delay between symptom recognition and hospital arrival (1.5 versus 1.8 hours; P=0.002), a higher National Institutes of Stroke Scale score on admission (8 versus 6; P&lt;0.001), and more often aphasia (72.5% versus 34.0%; P&lt;0.001) when compared with stroke patients waking up from nighttime sleep. Frequency of diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch was comparable between both groups (43.7% versus 48.7%; P=0.30). Conclusions—Almost half of the patients with unknown time of symptom onset stroke otherwise eligible for thrombolysis had MRI findings making them likely to be within a time window for safe and effective thrombolysis. Patients with daytime onset unwitnessed stroke differ from wake-up stroke patients with regards to clinical characteristics but are comparable in terms of MRI characteristics of lesion age. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT01525290. URL: https://www.clinicaltrialsregister.eu. Unique identifier: 2011-005906-32