Reflections on mirror therapy in stroke: Mechanisms and effectiveness for improving hand function

Stroke is currently the second cause of death in the western world; one year following stroke, half of all patients have died. From the surviving half, a large part remains disabled and 55% to 75% of them have a paretic arm. This makes stroke the main cause of acquired adult disability. Deficits after a stroke consist, amongst other things, of motor problems, sensory problems and spasticity, and can range from complete paralysis of the upper-extremity towards relatively minor coordination deficits. Such impairments affect an individual’s ability to complete everyday activities (disability) and affect participation in everyday life situations. As there is no cure for stroke, rehabilitation is the primary means of increasing upper limb functioning

What do stroke survivors think about evidence based care they receive? Learning from insights at the periphery

Permission to archive the publisher pdf of this article was granted by the publisher in February 2012Rationale and aim of study: While exploring the experience of stroke survivors of secondary stroke prevention as part of a wider patient and public involvement service initiative, study participants willingly shared insights on other aspects of care that mattered to them. This is important as little is known about patients’ preferences for care. Methods: Data was generated from focus groups and semi-structured interviews that were held with 38 stroke survivors or their proxy respondents as part of an action research study. A framework analysis was used to examine data. Results: Our findings largely support current knowledge about the benefits of receiving evidence based stroke care. Although patients broadly appreciated being on a specialist unit, unexpectedly and contrary to best practice some expressed the wish to be treated elsewhere as they found the experience of being on a stroke unit difficult. Other findings included the need for more local peer support and difficulties surrounding transfer from hospital to home. Resultant actions included awareness training for staff about sensitively managing people’s perceptions about being on the stroke unit; development of shared computer based (IT) resources, and the establishment of a volunteer peer support system. Conclusion: The evidence base for the benefits of stroke unit care is unequivocal; however this model of care presents challenges for some. Involving patients in service development can inform small but key changes in practice that can help address inherent tensions in delivering evidence based services that are sensitive to patient preference.This project was funded by a grant from the Peninsula Primary Care Research Networ

No influence of dabigatran anticoagulation on hemorrhagic transformation in an experimental model of ischemic stroke

Background: Dabigatran etexilate (DE) is a new oral direct thrombin inhibitor. Clinical trials point towards a favourable risk-to-benefit profile of DE compared to warfarin. In this study, we evaluated whether hemorrhagic transformation (HT) occurs after experimental stroke under DE treatment as we have shown for warfarin. Methods: 44 male C57BL/6 mice were pretreated orally with 37.5 mg/kg DE, 75 mg/kg DE or saline and diluted thrombin time (dTT) and DE plasma concentrations were monitored. Ischemic stroke was induced by transient middle cerebral artery occlusion (tMCAO) for 1 h or 3 h. We assessed functional outcome and HT blood volume 24 h and 72 h after tMCAO. Results: After 1 h tMCAO, HT blood volume did not differ significantly between mice pretreated with DE 37.5 mg/kg and controls (1.5±0.5 µl vs. 1.8±0.5 µl, p>0.05). After 3 h tMCAO, DE-anticoagulated mice did also not show an increase in HT, neither at the dose of 37.5 mg/kg equivalent to anticoagulant treatment in the therapeutic range (1.3±0.9 µl vs. control 2.3±0.5 µl, p>0.05) nor at 75 mg/kg, clearly representing supratherapeutic anticoagulation (1.8±0.8 µl, p>0.05). Furthermore, no significant increase in HT under continued anticoagulation with DE 75 mg/kg could be found at 72 h after tMCAO for 1 h (1.7±0.9 µl vs. control 1.6±0.4 µl, p>0.05). Conclusion: Our experimental data suggest that DE does not significantly increase hemorrhagic transformation after transient focal cerebral ischemia in mice. From a translational viewpoint, this indicates that a continuation of DE anticoagulation in case of an ischemic stroke might be safe, but clearly, clinical data on this question are warranted

Dynamic balance training with sensory electrical stimulation in chronic stroke patients

A case study investigating the impact of sensory electrical stimulation during perturbed stance in one chronic stroke patient is presented. A special apparatus called the BalanceTrainer was used. It allows the application of perturbations to neurologically impaired people during standing, while protecting the subject from falling. The subject underwent two different periods of perturbation training, each lasting ten days. During the first period the subject was perturbed in eight different directions. During the second period the subject was also perturbed, but was assisted by sensory electrical stimulation of the soleus, tibialis anterior, tensor fascia latae, and vastus muscles in the impaired leg. After each period of training an assessment was carried out to measure the forces the subject applied on the ground via two force plates. The subject improved his ability to balance throughout the training, with the largest improvements during the final period when electrical stimulation was used

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

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

Treatments to Promote Neural Repair after Stroke.

Stroke remains a major cause of human disability worldwide. In parallel with advances in acute stroke interventions, new therapies are under development that target restorative processes. Such therapies have a treatment time window measured in days, weeks, or longer and so have the advantage that they may be accessible by a majority of patients. Several categories of restorative therapy have been studied and are reviewed herein, including drugs, growth factors, monoclonal antibodies, activity-related therapies including telerehabilitation, and a host of devices such as those related to brain stimulation or robotics. Many patients with stroke do not receive acute stroke therapies or receive them and do not derive benefit, often surviving for years thereafter. Therapies based on neural repair hold the promise of providing additional treatment options to a majority of patients with stroke

Preditores de fibrilação atrial de novo em unidade de cuidados intensivos não cardíaca

OBJECTIVE: To assess the predictors of de novo atrial fibrillation in patients in a non-cardiac intensive care unit. METHODS: A total of 418 hospitalized patients were analyzed between January and September 2016 in a non-cardiac intensive care unit. Clinical characteristics, interventions, and biochemical markers were recorded during hospitalization. In-hospital mortality and length of hospital stay in the intensive care unit were also evaluated. RESULTS: A total of 310 patients were included. The mean age of the patients was 61.0 ± 18.3 years, 49.4% were male, and 23.5% presented de novo atrial fibrillation. The multivariate model identified previous stroke (OR = 10.09; p = 0.016) and elevated levels of pro-B type natriuretic peptide (proBNP, OR = 1.28 for each 1,000pg/mL increment; p = 0.004) as independent predictors of de novo atrial fibrillation. Analysis of the proBNP receiver operating characteristic curve for prediction of de novo atrial fibrillation revealed an area under the curve of 0.816 (p 5,666pg/mL. There were no differences in mortality (p = 0.370), but the lengths of hospital stay (p = 0.002) and stay in the intensive care unit (p = 0.031) were higher in patients with de novo atrial fibrillation. CONCLUSIONS: A history of previous stroke and elevated proBNP during hospitalization were independent predictors of de novo atrial fibrillation in the polyvalent intensive care unit. The proBNP is a useful and easy- and quick-access tool in the stratification of atrial fibrillation risk.Objetivo: Avaliar quais os preditores de fibrilação atrial de novo em doentes de uma unidade de cuidados intensivos não cardíaca. Métodos: Foram analisados 418 doentes internados entre janeiro e setembro de 2016 em uma unidade de cuidados intensivos não cardíaca. Registaram-se as características clínicas, as intervenções efetuadas e os marcadores bioquímicos durante a internação. Avaliaram-se ainda a mortalidade hospitalar e o tempo de internação hospitalar e na unidade de cuidados intensivos. Resultados: Foram incluídos 310 doentes, com média de idades de 61,0 ± 18,3 anos, 49,4% do sexo masculino, 23,5% com fibrilação atrial de novo. O modelo multivariável identificou acidente vascular cerebral prévio (OR de 10,09; p = 0,016) e valores aumentados de proBNP (OR de 1,28 por cada aumento em 1.000pg/mL; p = 0,004) como preditores independentes de fibrilação atrial de novo. A análise por curva Característica de Operação do Receptor do proBNP para predição de fibrilação atrial de novo revelou área sob a curva de 0,816 (p 5.666pg/mL. Não se verificaram diferenças na mortalidade (p = 0,370), porém a duração da internação hospitalar (p = 0,002) e na unidade de cuidados intensivos (p = 0,031) foi superior nos doentes com fibrilação atrial de novo. Conclusões: História de acidente vascular cerebral prévio e proBNP elevado em internação constituíram preditores independentes de fibrilação atrial de novo na unidade de cuidados intensivos polivalente. O proBNP pode constituir ferramenta útil, de fácil e rápido acesso na estratificação do risco de fibrilação atrial.info:eu-repo/semantics/publishedVersio

Mechanosensing in myosin filament solves a 60 years old conflict in skeletal muscle modeling between high power output and slow rise in tension

Almost 60 years ago Andrew Huxley with his seminal paper \cite{Huxley1957} laid the foundation of modern muscle modeling, linking chemical events to mechanical performance. He described mechanics and energetics of muscle contraction through the cyclical attachment and detachment of myosin motors to the actin filament with ad hoc assumptions on the dependence of the rate constants on the strain of the myosin motors. That relatively simple hypothesis is still present in recent models, even though with several modifications to adapt the model to the different experimental constraints which became subsequently available. However, already in that paper, one controversial aspect of the model became clear. Relatively high attachment and detachment rates of myosin to the actin filament were needed to simulate the high power output at intermediate velocity of contraction. However, these rates were incompatible with the relatively slow rise in tension after activation, despite the rise should be generated by the same rate functions. This discrepancy has not been fully solved till today, despite several hypotheses have been forwarded to reconcile the two aspects. Here, using a conventional muscle model, we show that the recently revealed mechanosensing mechanism of recruitment of myosin motors \cite{Linarietal2015} can solve this long standing problem without any further ad-hoc hypotheses