The rehabilitation of motor and cognitive disorders after stroke

Following a stroke there can be a large range of different deficits, with poor motor function and cognition being particularly important for outcome. Rehabilitation of these deficits is thus an important priority for clinicians. In this thesis, I present 5 experimental chapters aiming to generate cognitive and motor benefits for the stroke survivor. In Chapter 2, prolonged Mirror Therapy was applied to chronic stroke survivors. In Chapter 3, Mirror Therapy was applied in a home based for chronic stroke survivors. In both these Chapters 2 and 3 benefits in unimanual performance of the affected limb and functional improvements of daily activities are being reported. Chapter 4 considered the application of Mirror Therapy to early subacute stroke participants and tested the neural correlates behind any effect. Changes in brain activation within both the ipsi- and contralesional hemispheres were noted. Functional Electrical Stimulation was applied to chronic stroke patients in Chapter 5. Improvements in motor performance were noted, along with the amelioration of visuomotor neglect. Linked changes in activity in the ipsi- and contralesional hemispheres were again noted. Finally, in Chapter 6, Computer Progressive Attention Training was applied in early subacute stroke patients, comparing performance with patients who received no extra intervention. Importantly, the training not only improved the tested functions but also other cognitive processes not targeted in training (e.g., long-term memory). Taken together, the experimental work provides evidence of strategies that can be followed by clinicians to improve functional ability after stroke. In the final chapter the above findings are being discussed together with clinical implications of motor and cognitive rehabilitation approaches

Motor Development and Motor Resonance Difficulties in Autism: Relevance to Early Intervention for Language and Communication Skills

Research suggests that a sub-set of children with autism experience notable difficulties and delays in motor skills development, and that a large percentage of children with autism experience deficits in motor resonance. These motor-related deficiencies, which evidence suggests are present from a very early age, are likely to negatively affect social-communicative and language development in this population. Here, we review evidence for delayed, impaired, and atypical motor development in infants and children with autism. We then carefully review and examine the current language and communication-based intervention research that is relevant to motor and motor resonance (i.e., neural mirroring mechanisms activated when we observe the actions of others) deficits in children with autism. Finally, we describe research needs and future directions and developments for early interventions aimed at addressing the speech/language and social-communication development difficulties in autism from a motor-related perspective

A Greek registry of current type 2 diabetes management, aiming to determine core clinical approaches, patterns and strategies

Background: To analyze data in terms of the glycaemic control and therapeutic regimens used for Type-2 Diabetes Mellitus (T2DM) management in Greece, identify factors that influence clinical decisions and determine the level of compliance of T2DM management with the latest international and local guidelines. Methods: 'AGREEMENT' was a national-multicenter, non-interventional, cross-sectional disease registry. A total of 1191 adult T2DM patients were enrolled consecutively from 59 sites of the National Health System (NHS) or University Hospitals, representing the majority of Diabetes centers or Diabetes outpatient clinics in Greece with a broad geographic distribution. Patients were stratified by gender and analysis was done according to 3 treatment strategies: A (lifestyle changes or use of one oral antidiabetic agent), B (up to 3 antidiabetic agents including injectables but not insulin) and C (any regimens with insulin). Results: Mean (±SD) HbA1c % of the total population was 7.1 (±1.2) while mean (±SD) FPG (mg/dl) was measured at 136 (±42). The proportion of patients who achieved HbA1c < 7% was 53% and ranged from 74.2% for group A, to 60.6% for group B and 35.5% for group C. Median age of the studied population was 65.0 year old (Interquartile Range-IQR 14.0) with an equal distribution of genders between groups. Patients on insulin therapy (treatment strategy C) were older (median age: 67 years vs 63 or 65 for A and B, respectively) with longer diabetes duration (mean duration: 15.3 years vs 5.2 and 10.1 for A and B, respectively). Patients who received insulin presented poor compliance. There was a consensus for a series of decision criteria and factors that potentially influence clinical decisions, used by physicians for selection of the therapeutic strategy among the three groups. Compliance with international and Greek guidelines received a high score among groups A, B and C. No significant differences were presented as per sites' geographic areas, NHS or University centers and physicians' specialty (endocrinologists, diabetologists and internists). Conclusions: The presented findings suggest the need for improvement of the glycaemic control rate, especially among insulin treated patients as this group seems to achieve low glycaemic control, by setting appropriate HbA1c targets along with timely and individualised intensification of treatment as well as post-therapy evaluation of the compliance with the proposed treatment. © 2019 The Author(s)