59 research outputs found
Role of walking-exercise therapy after stroke
Stroke commonly leads to reduced mobility, which leads to deconditioning and a worsening of vascular risk factors, such as diabetes. The worsened risk profile leads to further strokes and disability--a vicious cycle for the stroke survivor. Exercise (walking) therapy may break this cycle by providing adequate stimuli for improving gait through plastic adaptation in the brain and through increasing fitness. Randomized, controlled data demonstrate the efficacy for gains in fitness and walking speed, the latter being related to lasting changes in activation patterns of the brainstem and cerebellum. Diabetes and muscle inflammation can also be improved by aerobic exercise training. The scope of this review summarizes these data and identifies unresolved issues related to optimization, intensity and maintenance of therapy effects. Exercise should be an integral part of every rehabilitation program
Spinocerebellar ataxia types 1, 2, 3, and 6: disease severity and nonataxia symptoms.
OBJECTIVE: To identify factors that determine disease severity and clinical
phenotype of the most common spinocerebellar ataxias (SCAs), we studied 526
patients with SCA1, SCA2, SCA3. or SCA6.
METHODS: To measure the severity of ataxia we used the Scale for the Assessment
and Rating of Ataxia (SARA). In addition, nonataxia symptoms were assessed with
the Inventory of Non-Ataxia Symptoms (INAS). The INAS count denotes the number of
nonataxia symptoms in each patient.
RESULTS: An analysis of covariance with SARA score as dependent variable and
repeat lengths of the expanded and normal allele, age at onset, and disease
duration as independent variables led to multivariate models that explained 60.4%
of the SARA score variance in SCA1, 45.4% in SCA2, 46.8% in SCA3, and 33.7% in
SCA6. In SCA1, SCA2, and SCA3, SARA was mainly determined by repeat length of the
expanded allele, age at onset, and disease duration. The only factors determining
the SARA score in SCA6 were age at onset and disease duration. The INAS count was
5.0 +/- 2.3 in SCA1, 4.6 +/- 2.2 in SCA2, 5.2 +/- 2.5 in SCA3, and 2.0 +/- 1.7 in
SCA6. In SCA1, SCA2, and SCA3, SARA score and disease duration were the strongest
predictors of the INAS count. In SCA6, only age at onset and disease duration had
an effect on the INAS count.
CONCLUSIONS: Our study suggests that spinocerebellar ataxia (SCA) 1, SCA2, and
SCA3 share a number of common biologic properties, whereas SCA6 is distinct in
that its phenotype is more determined by age than by disease-related factors
Early symptoms in spinocerebellar ataxia type 1, 2, 3, and 6.
Abstract: Onset of genetically determined neurodegenerative
diseases is difficult to specify because of their insidious and
slowly progressive nature. This is especially true for spinocerebellar
ataxia (SCA) because of varying affection of many
parts of the nervous system and huge variability of symptoms.
We investigated early symptoms in 287 patients with
SCA1, SCA2, SCA3, or SCA6 and calculated the influence
of CAG repeat length on age of onset depending on (1) the
definition of disease onset, (2) people defining onset, and (3)
duration of symptoms. Gait difficulty was the initial symptom
in two-thirds of patients. Double vision, dysarthria, impaired
hand writing, and episodic vertigo preceded ataxia in 4% of
patients, respectively. Frequency of other early symptoms did
not differ from controls and was regarded unspecific. Data
about disease onset varied between patients and relatives for
1 year or more in 44% of cases. Influence of repeat length
on age of onset was maximum when onset was defined as
beginning of permanent gait disturbance and cases with
symptoms for more than 10 years were excluded. Under
these conditions, CAG repeat length determined 64% of
onset variability in SCA1, 67% in SCA2, 46% in SCA3, and
41% in SCA6 demonstrating substantial influence of nonrepeat
factors on disease onset in all SCA subtypes. Identification
of these factors is of interest as potential targets for
disease modifying compounds. In this respect, recognition of
early symptoms that develop before onset of ataxia is mandatory
to determine the shift from presymptomatic to affected
status in SCA
Motor Decline in Clinically Presymptomatic Spinocerebellar Ataxia Type 2 Gene Carriers
BACKGROUND: Motor deficits are a critical component of the clinical characteristics of patients with spinocerebellar ataxia type 2. However, there is no current information on the preclinical manifestation of those motor deficits in presymptomatic gene carriers. To further understand and characterize the onset of the clinical manifestation in this disease, we tested presymptomatic spinocerebellar ataxia type 2 gene carriers, and volunteers, in a task that evaluates their motor performance and their motor learning capabilities. METHODS AND FINDINGS: 28 presymptomatic spinocerebellar ataxia type 2 gene carriers and an equal number of control volunteers matched for age and gender participated in the study. Both groups were tested in a prism adaptation task known to be sensible to both motor performance and visuomotor learning deficits. Our results clearly show that although motor learning capabilities are intact, motor performance deficits are present even years before the clinical manifestation of the disease start. CONCLUSIONS: The results show a clear deficit in motor performance that can be detected years before the clinical onset of the disease. This motor performance deficit appears before any motor learning or clinical manifestations of the disease. These observations identify the performance coefficient as an objective and quantitative physiological biomarker that could be useful to assess the efficiency of different therapeutic agents
Effect of Exercise Interventions on Health-Related Quality of Life After Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis
Exercise interventions have been shown to help physical fitness, walking and balance after stroke, but data is lacking on whether such interventions lead to improvements in health-related quality of life (HRQoL). In this systematic review and meta-analysis, thirty randomised controlled trials (n=1,836 patients) were found from PubMed, OVID MEDLINE, Web of Science, CINAHL, SCOPUS, The Cochrane Library and TRIP databases when searched from 1966 to Feb 2020, that examine the effects of exercise interventions on HRQoL after strokem or transient ischaemic attack (TIA). Exercise interventions resulted in small to moderate beneficial effects on HRQoL at intervention end (standardised mean difference (SMD) -0.23; 95% CI -0.40 to -0.07) that appeared to diminish at longer term follow up (SMD -0.11; 95%CI -0.26 to 0.04). Exercise was associated with moderate improvements in physical health (SMD -0.33; 95% CI -0.61 to -0.04) and mental health (SMD -0.29; 95% CI -0.49 to -0.09) domains of HRQoL while effects on social or cognitive composites showed little difference. Interventions that were initiated within 6 months, lasted at least 12 weeks in duration, involved at least 150 minutes per week, and included resistance training appeared most effective. Exercise can lead to moderate beneficial effects on HRQoL and should be considered an integral part of stroke rehabilitatio
- …