Longitudinal measurement of physical activity using a novel automated system to explore early stage functional recovery after stroke

Introduction There is emphasis on increasing patients’ Physical Activity (PA) to reduce disability and promote independent living. Therefore a new computerised system based on real time location technology called the Rehabilitation Mobility Measurement System (RMMS) was developed to overcome limitations of the current activity monitoring methods and measure PA continuously and unobtrusively. The study objectives were to evaluate the psychometric properties of RMMS and to explore early stage functional recovery after stroke in a rehabilitation unit and at home. Methods Each participant wore a radio-frequency identification tag with an in-built motion sensor on their unaffected wrist. Walking-aids and transport equipment were also fitted with tags. All areas accessed by patients were fitted with infra-red room locators. The tags transmitted movement and location signals to a computer having customised software programs for data processing. Descriptive statistics and graphs were used for analysis. Results The RMMS was very reliable (all ICC>0.90) and demonstrated high level of agreement on validation with observational methods. Longitudinal PA was measured successfully in the rehabilitation unit for 52 patients over 64±53 days. Outside of therapy sessions, patients spent 85% of the waking day in their own rooms undertaking limited high level activities (15%).The average mobility (walking or moving around) was 15 minutes per day only and was strongly correlated with Barthel Index and modified Rivermead Index scores on discharge (spearman’s rho=.-70, p=0.00) accounting for ≥ 43% of variation in these scores. Conclusion RMMS was a reliable and valid tool for measuring mobility; a key factor influencing early stroke recovery. The small amount of time spent active strongly suggests that better organisation of time outside therapy sessions is warranted to maximise daily PA of in-patients. RMMS could be used for motivational feedback for patients and clinicians to ultimately enhance functional activity during rehabilitation in a stroke unit

Effect of calcium against salinity-induced inhibition in growth, ion accumulation and proline contents in Cichorium intybus L

Abstract: This study assesses the effect of NaCl (80 and 160 mM) and CaCl 2 (10 mM) solutions, alone and in combination, to 30-day-old seedlings of Cichorium intybus L. Observations were made at 30 day intervals from the time of treatment till harvest (180 days after sowing). Application of NaCl resulted in significant decreases in lengths of root and stem, in dry weights of root, stem and leaves and in the leaf area, as compared with control. The reduction was less with the combined application of NaCl and CaCl 2 than with the NaCl treatment alone. On the contrary, treatment of CaCl 2 alone promoted the above variables. Proline content in the leaves was enhanced with NaCl and CaCl 2 alone as well as with the NaCl + CaCl 2 treatments; the maximum (six-fold) enhancement was observed with the combined treatments, compared with NaCl (four-fold increase) and CaCl 2 (two-fold increase) alone. The sodium (Na + ) and Chloride (Cl) contents in different plant parts increased both with NaCl and with NaCl + CaCl 2 treatments. The maximum accumulation was observed in leaves, followed by that in stem and root. The potassium (K + ) and calcium (Ca 2+ ) contents decreased under NaCl stress, but increased with CaCl 2 treatment. Thus, calcium ameliorated the deleterious effects of NaCl stress and stimulated the plant metabolism and growth

Measuring functional activities of patients in a stroke unit: Comparison of a sensor based Real Time Location System with the Observational Behaviour Mapping Technique [Poster Abstract]

Introduction: To overcome the limitations of the current activity monitoring methods and to effectively investigate early stage functional activities post stroke, we are developing a new computerised Real Time Location System (RTLS).Having previously established excellent RTLS reliability (Intraclass Correlation Coefficients≥0.90), this study aims to determine its validity by comparing it to the Observational Behaviour Mapping Technique (OBMT). Methods: All rooms routinely accessed by patients are fitted with infra-red room locators which send their location codes to specialised Radio-Frequency Identification (RFID) tags. The RFID tags that have in-built motion sensors transmit their location and movement signals to a computer. All participating patients and staff members wear the tags and additional tags are attached to equipment like walking-aids and wheelchairs. Simultaneously, on various days, OBMT is being used to record patients’ location, interaction and activity every ten minutes. Descriptive statistics and Pearson’s Correlation Coefficients (PCCs) are being used for statistical analysis. Results: So far, we have analysed the results for the location category of three patients and have observed only small differences between the two systems for mean time spent in own room (diff=7min; OBMT=550, RTLS=557) and in therapy room (diff=4min; OBMT=90, RTLS=86). Further analysis will involve comparing the methods for time spent in categories like interacting with staff members, doing therapeutic and non therapeutic activities and using equipment. Conclusion: Based on results, we hope to determine that the RTLS is a valid system for continuous, unobtrusive patient activity measurement and can provide much needed quantifiable information about functional recovery post stroke

A new computerised system can continuously measure functional activities of patients in a stroke rehabilitation unit

Background: To be able to measure patient activity in a continuous and unobtrusive manner we are developing a new automated system based on Real Time Location Technology. This would also allow us to overcome limitations of the current activity monitoring methods. Having established excellent reliability of the system (Intraclass Correlation Coefficients≥0.90) we validated it against Observational Behaviour Mapping Techniques and obtained a high level of agreement between the two methods. The mean differences for time spent in own room and physiotherapy room were 1.1 and 1.5 minutes respectively. To date, the system has measured continuous activity of 43 patients from admission to discharge. Methods: Each participant wore a Radio Frequency identification tag with an in-built motion sensor. This tag, worn on the unaffected wrist receives infra-red location signals from room locators fitted in all rooms accessed by the patients. The tag transmits the location and movement signals to a computer. Bespoke software programmes were developed to collect and process data. Descriptive statistics and charts were used for analysis. Results: Here we report the individual activity profiles of 2 patients. Summary charts (emailed separately) illustrate some individual differences in the activity of these patients. Both patients spent the majority of their time in their own rooms (mean 88.6% and 77.5%) where patient 2 was less active. Patients were most active whilst in physiotherapy (mean 98% and 95%). Conclusion: With further development of the software we are aiming to build a comprehensive picture of functional recovery. Therefore, the analysis of other key aspects such as time spent sitting in the chair, lying in bed, transfers or walking in the corridor will be added. This may also give more insight into the kind of activity undertaken in their own rooms. Ultimately, the aim is to generate a better understanding of early rehabilitation post stroke

Measuring continuous patient activity post-stroke using a novel sensor-based computerised system

Introduction To be able to measure patient activity in a continuous and unobtrusive manner we have developed a new system based on Real Time Location Technology. Having previously established excellent reliability and validity of the system, it has been effectively used to measure patients’ walking ability and activity levels in a rehabilitation unit and at home. Method Fifty-two participants wore a Radio Frequency Identification tag on their unaffected wrist. This tag has an in-built motion sensor and continuously transmits the location and movement signals to a computer with bespoke software programmes to collect and process data. Descriptive statistics and graphs depicting average duration of walking were used for analysis. Results To date, activity levels of 25 patients during hospitalisation and of 9 patients at home have been analysed. From admission to discharge relatively small changes in activity level were observed. For instance the overall activity in own room increased by only 7% (Admission=60%; Discharge=67%). However, post-discharge activity at home decreased considerably by 54% (Discharge =73%; Home=19%). Similarly relatively low average duration of walking were observed when measured for 22 hospitalised patients; 10 minutes per day (Minimum=1minute; Maximum=90 minutes).The graphs gave in-depth information about gait recovery patterns of individual patients. Discussion So far interesting aspects of early, functional recovery post-stroke were revealed. Ultimately, the aim is to develop a comprehensive system that can provide activity feedback to patients, carers and clinicians. This could function as a motivational strategy to further improve patient activity levels in a rehabilitation unit and at home

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation