Gait Measurements and Motor Recovery after Stroke

2000 Mathematics Subject Classification: 62P10, 92C20Gait analysis is one of the methods used for estimation of the degree of restoration of motor recovery after stroke. The purpose of the present study was to examine the diagnostic value of the footprint parameters and their relationship with the functional ambulation profile (FAP) scores provided automatically by the pressure sensor walkway system for gait examination. The patterns of walking were studied in a group of 23 patients with chronic unilateral stroke and 72 healthy subjects. Among the measured gait variables the peak times of the footprints were found as most informative parameters. Their predictive value was compared with some other gait indicators for motor recovery after stroke

Orthostatic Reactivity in Patients with Diabetic Neuropathy

AIM: The purpose of the study was to assess the effect of a structured physical therapy (PT) programme on the orthostatic reactivity in patients with diabetic neuropathy (DNP).MATERIAL AND METHODS: The study was performed in 90 patients with DNP (34 male and 56 female, mean ages 60.8 ± 7.8 years) of lower extremities. The orthostatic autoregulation was evaluated using an active orthostatic test. The arterial blood pressure and the heart rate were determined after 10 minutes of rest in lying position before and after 1, 5 and 10 minutes of active standing.RESULTS: At the start of the study a normotonic orthostatic reactivity (NOR) was observed in 32 patients. Abnormal sympathicotonic type of orthostatic reactivity (SOR) was found in 18 patients and asympaticotonic type of orthostatic reactivity (AOR) was established in the remaining 40 patients. After the PT treatment a significant improvement of the orthostatic autoregulation in the groups with SOR and AOR was not found – NOR was observed in 66 patients with DNP (80.3%) at 6 weeks after the start of PT.CONCLUSION: The applied structured PT, later continued as a home exercise programme, significantly improved the orthostatic reactivity in patients with orthostatic dysregulation due to DNP

Orthostatic Reactivity In Patients With Diabetic Neuropathy

The purpose of the study was to assess the effect of a structured physical therapy (PT) programme on the orthostatic reactivity in patients with diabetic neuropathy (DNP). The study was performed in 90 patients with DNP (34 male and 56 female, mean age 60.8±7.8 years) of lower extremities. The orthostatic autoregulation was evaluated using an active orthostatic test. The arterial blood pressure and the heart rate were determined after 10 minutes of rest in lying position before and after 1, 5 and 10 minutes of active standing. All patients had therapy with alpha-lipoic acid and a structured intensive 10 days PT program, later continued as a home exercise programme. The orthostatic autoregulation was evaluated three times – at the start of the study, at day 10 and at 6 weeks after the beginning of PT. The classification of Thulesius was used to divide the patients into 3 groups according to the type of their orthostatic reactivity. At the start of the study a normotonic orthostatic reactivity (NOR) was observed in 32 patients. Abnormal sympathicotonic type of orthostatic reactivity (SOR) was found in 18 patients and asympaticotonic type of orthostatic reactivity (AOR) was established in the remaining 40 patients. After the PT treatment a significant improvement of the orthostatic autoregulation in the groups with SOR and AOR was found – NOR was observed in 66 patients with DNP (80.3%) at 6 weeks after the start of PT. The applied structured PT, later continued as a home exercise programme, significantly improved the orthostatic reactivity in patients with orthostatic dysregulation due to DNP. Author Keywords: Exercise Therapy, Orthostatic Tolerance, Physical Therapy, Type II Diabete

Принципи на неврорехабилитация при мозъчен инсулт

Настоящото издание е посветено на болестите на нервната система и е продължение на учебника по обща неврология. То цели да обезпечи адекватен обем на теоретични и практически познания за диагноза, специфична терапия, поведение, интензивно лечение, профилактика, експертна оценка на трудоспособността и диспенсеризация на заболяванията на централната и периферната нервна система. Придобитите знания са съставна част от изискванията за амбулаторна и специализирана медицинска помощ по нервни болести и са насочени към формиране на практически умения за самостоятелна диагностично-лечебна, консултативна и експертна дейност по неврология. Учебникът е създаден като интердисциплинарно ръководство, предназначено за студенти по медицина, медицинска рехабилитация и кинезитерапия, общопрактикуващи лекари, специалисти в различни области на медицината, специализанти и докторанти, в чиято задължителна учебна програма са включени дисциплините „Нервни болести“ и „Кинезитерапия при нервни и психични болести“. Всеки обучаващ се трябва да усвои задължителен обем на теоретични и практически знания, определени като „Минимално изискуемо ниво на компетентност“ (МИНК). То е включено към всяка глава на учебника. Ръководството по клинична неврология е богато онагледено с учебни схеми, илюстрации и таблици. В него са отразени съвременните консенсуси за диагностика и поведение при различни неврологични заболявания и гранични с тях болести и синдроми, което го прави полезно помагало в ежедневната клинична практика. Учебникът завършва с преглед на Нобеловите награди в областта на невронауките, които са основа за прогресивното развитие на съвременната неврология

Grading carotid stenosis using ultrasonic methods

The controversy as to whether Doppler ultrasonic methods should play a role in clinical decision-making in the prevention of stroke is attributable to reported disagreement between angiographic and ultrasonic results and the lack of internationally accepted ultrasound criteria for describing the degree of stenosis. Foremost among the explanations for both is the broad scatter of peak systolic velocities in the stenosis, the criterion that has so far received most attention. Grading based on a set of main and additional criteria can overcome diagnostic errors. Morphological measurements (B-mode images and color flow imaging) are the main criteria for low and moderate degrees of stenosis. Increased velocities in the stenosis indicate narrowing, but the appearance of collateral flow and decreased poststenotic flow velocity prove a high degree stenosis (≥70%), additionally allowing the estimation of the hemodynamic effect in the category of high-degree stenosis. Additional criteria refer to the effect of a stenosis on prestenotic flow (common carotid artery), the extent of poststenotic flow disturbances, and derived velocity criteria (diastolic peak velocity and the carotid ratio). This multiparametric approach is intended to increase the reliability and the standard of reporting of ultrasonic results for arteriosclerotic disease of the carotid artery

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes)

Abstract: Background: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)\u2013defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. Results: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52\u20131.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Conclusions: Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720.Abstract: BACKGROUND: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). METHODS: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. RESULTS: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52-1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. CONCLUSIONS: Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes)

International audienc