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Stroke
NIH - Medical Encyclopedia: Stroke
"The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began."
Highlighted ArticleTransient Ischemic Attack: A Dangerous Harbinger and an Opportunity to Intervene. (Semin Neurol. 2005)
"Transient ischemic attack (TIA) and ischemic stroke are both characterized by sudden onset of neurological symptoms due to focal cerebral ischemia, but they are distinguished by the duration of neurological symptoms, with TIA traditionally defined by resolution of symptoms within 24 hours and stroke reserved for symptoms of longer duration. ... The short-term risk of ischemic stroke after TIA is very high ..."
Stroke
Rehabilitation
NEWS:
Age should not be a factor in stroke rehab "People over 80 recover as well from a stroke as younger patients do and should not be excluded from intensive rehabilitation programmes, a study in Hong Kong has found. … It is commonly believed, even among medical staff, that the older a stroke victim, the less he or she will benefit from post-stroke rehabilitation. But the study by researchers at the University of Hong Kong has found no basis for this belief."
American Heart and American Stroke Associations Endorse New Stroke Rehabilitation Guidelines
Magnetic Therapy May Help Stroke Recovery "Using powerful magnetic fields to slow activity on the undamaged side of the brain after a stroke may improve patients' motor function … "
MDs: Make Stroke Victims Use Weak Arm
Restraining good arm aids stroke recovery
ARTICLES:
JOURNAL ARTICLES:
A comparison of stroke rehabilitation practice and outcomes between new zealand and United States facilities. (Arch Phys Med Rehabil. 2005) "U.S. participants with acute stroke who were selected for rehabilitation had better outcomes than NZ participants, despite shorter stays in the rehabilitation facility. U.S. participants had more intensive input from physiotherapists and occupational therapists, which may explain some of the larger increases in FIM scores."
A Placebo-Controlled Trial of Constraint-Induced Movement Therapy for Upper Extremity After Stroke. (Stroke. 2006) "CONCLUSIONS: The results support the efficacy of CI therapy for rehabilitating upper extremity motor function in patients with chronic stroke."
A Randomized Controlled Trial of Supervised Versus Unsupervised Exercise Programs for Ambulatory Stroke Survivors. (Stroke. 2006)
Assessing the outcome of stroke: a comparison between MRI and clinical stroke scales (Acta Neurologica Scandinavica 2006)
Attention rehabilitation following stroke and traumatic brain injury. A review. (Eura Medicophys. 2006)
Bilateral movement training and stroke rehabilitation: A systematic review and meta-analysis. (J Neurol Sci. 2006)"CONCLUSION: These meta-analysis findings indicate that bilateral movements alone or in combination with auxiliary sensory feedback are effective stroke rehabilitation protocols during the sub-acute and chronic phases of recovery."
Characterizing speech and language pathology outcomes in stroke rehabilitation. (Arch Phys Med Rehabil. 2005) "OBJECTIVES: To describe how occupational therapy (OT) activities during stroke inpatient rehabilitation vary by admission functional status and over time and how time spent in these various activities relates to functional status at discharge. … CONCLUSIONS: OT activities focused on a combination of remediating impairments and retraining specific functional tasks, at the ability level of each individual patient, and provided higher-level activities as patients improved their function. More time in higher-level activities was related to greater success in rehabilitation. However, higher-level activities remain the least common activities provided during inpatient rehabilitation."
Counselling increases physical activity behaviour nine weeks after rehabilitation. (Br J Sports Med. 2006)
Does age predict outcome in stroke rehabilitation? A study of 878 Chinese subjects. (Cerebrovasc Dis. 2006)
Dynamics of language reorganization after stroke. (Brain. 2006) "The data suggest that brain reorganization during language recovery proceeds in three phases: a strongly reduced activation of remaining left language areas in the acute phase is followed by an upregulation with recruitment of homologue language zones, which correlates with language improvement. Thereafter, a normalization of activation is observed, possibly reflecting consolidation in the language system."
Early prediction of functional outcome after stroke (Brain Injury 2006) "The best model predicting functional outcome and independence in activities of daily living of stroke patients after 6 months was that including NIH-SS, grip strength, age and previous stroke explaining 79% of the variance. These parameters assessed on day 7 post-stroke are more predictive than the difference between stroke onset and day 7 post-stroke."
Effect of Constraint-Induced Movement Therapy on Upper Extremity Function 3 to 9 Months After Stroke (JAMA. 2006) "Conclusion Among patients who had a stroke within the previous 3 to 9 months, CIMT produced statistically significant and clinically relevant improvements in arm motor function that persisted for at least 1 year."
Effects of Day Hospital Rehabilitation After Stroke (Journal of Stroke and Cerebrovascular Diseases 2006) "Conclusion: During the 6 to 8 weeks of DHR, there is significant improvement in physical and cognitive functions and self-rated health and health-related quality of life, which are not related significantly to each other. Improvements are greater in patients with more severe impairment of physical and cognitive functions and self-rated health and health-related quality of life at baseline."
Effects of treadmill exercise on transcranial magnetic stimulation-induced excitability to quadriceps after stroke. (Arch Phys Med Rehabil. 2006)
Electrostimulation for promoting recovery of movement or functional ability after stroke. (Cochrane Database Syst Rev. 2006) ”AUTHORS' CONCLUSIONS: At present, there are insufficient robust data to inform clinical use of electrostimulation for neuromuscular re-training. Research is needed to address specific questions about the type of electrostimulation that might be most effective, in what dose and at what time after stroke."
Emotional symptoms in acute ischemic stroke. (Int J Geriatr Psychiatry. 2006) "CONCLUSION: The present study indicates that anxiety symptoms are more frequent than depressive symptoms in the acute stage of ischemic stroke. It is important to focus on both anxiety and depressive symptoms throughout the rehabilitation phase in order to ease the patients' personal anguish and improve neurological outcome after stroke."
Exercise Rehabilitation After Stroke. (NeuroRx. 2006)
Feedback and Cognition in Arm Motor Skill Reacquisition After Stroke (Stroke. 2006)
Fluoxetine Treatment in Poststroke Depression, Emotional Incontinence, and Anger Proneness (Stroke. 2006)
Guidelines Abstracted From the Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Stroke Rehabilitation (J Am Geriatr Soc. 2006)
Identifying the determinants of 1-year post-stroke outcomes in elderly patients (Acta Neurologica Scandinavica 2006) "Predictive models showed that age, not living at home pre-stroke, pre-stroke FIM < 108, inability to walk on admission, dysphasia, visual field loss and haemorrhagic stroke were associated with worse outcome."
Impact of comorbidity on ischemic stroke outcome (Acta Neurologica Scandinavica 2006)
Impact of Time on Improvement of Outcome After Stroke. (Stroke. 2006) "CONCLUSIONS: Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining approximately 16% to 42% of the observed improvements in the first 6 to 10 weeks after stroke onset."
Is Sex a Prognostic Factor in Stroke Rehabilitation?. A Matched Comparison. (Stroke. 2006) "CONCLUSIONS: Female sex is a mildly unfavorable prognostic factor in rehabilitation results after stroke."
Language Rehabilitation in Chronic Aphasia and Time Postonset (Stroke. 2006) "Conclusions— Time postonset is not related to response to treatment for aphasia in patients >1 year postonset of aphasia."
Long-Term Outcome After Stroke. Evaluating Health-Related Quality of Life Using Utility Measurements. (Stroke. 2005) "BACKGROUND AND PURPOSE: As stroke mortality rates decline, individuals are increasingly likely to live with their residual impairments and disabilities. Therefore, the quality of poststroke life is 1 of the pivotal topics that have to be considered beneath the functional outcome. However, data on health-related quality of life (HRQoL) have been infrequently used in stroke trials. The purpose of this study was to examine the long-term outcome (4 years after stroke) of HRQoL and to identify the determinants of HRQoL in stroke survivors. … RESULTS: Four years after stroke, besides physical functioning, neuropsychological sequelae such as depression and cognitive impairment contributed to a reduced HRQoL. In addition, the incidence of incontinence proved to be an important factor for HRQoL."
Mental practice with motor imagery: evidence for motor recovery and cortical reorganization after stroke. (Arch Phys Med Rehabil. 2006)
Motor Imagery. A Backdoor to the Motor System After Stroke? (Stroke. 2006) " … the literature suggests the encouraging effect of motor imagery training on motor recovery after stroke. Based on the available literature in healthy volunteers, robust activation of the nonprimary motor structures, but only weak and inconsistent activation of M1, occurs during motor imagery. In patients with stroke, the cortical activation patterns are essentially unexplored as is the underlying mechanism of motor imagery training. Provided appropriate methodology is implemented, motor imagery may provide a valuable tool to access the motor network and improve outcome after stroke."
Motor learning: its relevance to stroke recovery and neurorehabilitation. (Curr Opin Neurol. 2006) "SUMMARY: Motor learning mechanisms are operative during spontaneous stroke recovery and interact with rehabilitative training. For optimal results, rehabilitation techniques should be geared towards patients' specific motor deficits and possibly combined, for example, CIMT with VR. Two critical questions that should always be asked of a rehabilitation technique are whether gains persist for a significant period after training and whether they generalize to untrained tasks."
Occupational therapy for patients with problems in activities of daily living after stroke. (Cochrane Database Syst Rev. 2006) "AUTHORS' CONCLUSIONS: Patients who receive occupational therapy interventions are less likely to deteriorate and are more likely to be independent in their ability to perform personal activities of daily living. However, the exact nature of the occupational therapy intervention to achieve maximum benefit needs to be defined."
Optimizing therapy of seizures in stroke patients. (Neurology. 2006)
Predicting Improvement in Gait After Stroke (Stroke. 2005)
Predicting mobility outcome one year after stroke: a prospective cohort study. (J Rehabil Med. 2006) "CONCLUSION: The present prospective study shows that outcome of mobility one year after stroke can be predicted validly by including functional status, sitting balance, moment of admission to the rehabilitation centre after stroke onset and age."
Predictors of disorientation among brain injury and stroke patients during rehabilitation. (Rehabil Nurs. 2005) " … risk of becoming disoriented after a period of orientation during the rehabilitation stay increased by 78% among patients who are disoriented on admission to rehabilitation, compared with those who are oriented on admission. These findings confirm that temporal orientation is unstable during the period of rehabilitation following a brain injury or stroke."
Screening patients with stroke for rehabilitation needs: validation of the post-stroke rehabilitation guidelines. (Neurorehabil Neural Repair. 2006) "CONCLUSION: . Many acute stroke patients had cognitive and perceptual deficits that were not documented in their charts. These data support the Post-Stroke Rehabilitation Guidelines for systematic assessment even when deficits are not immediately apparent. Systematic screening may improve discharge planning, rehabilitation treatment, and long-term outcome of persons with stroke."
Susceptibility to deterioration of mobility long-term after stroke: a prospective cohort study. (Stroke. 2006)
Testing a model of post-stroke exercise behavior. (Rehabil Nurs. 2006) "Interventions to strengthen self-efficacy and outcome expectations for exercise, along with reminders for clinicians to encourage regular exercise programs, may increase the likelihood of initiating and maintaining an exercise program, potentially improving physical function and cardiovascular fitness in this population."
The Effects of Mental Practice in Stroke Rehabilitation: A Systematic Review (Archives of Physical Medicine and Rehabilitation 2006) "There was some evidence that mental practice as an additional therapy intervention had positive effects on recovery of arm function after stroke. Two mental practice techniques appeared to be effective—tape instruction and self-regulation. Results from the single case studies indicate that mental practice is also promising for improvement of leg function."
Therapeutic exercise and depressive symptoms after stroke. (J Am Geriatr Soc. 2006) "CONCLUSION: Exercise may help reduce poststroke depressive symptoms. Depressive symptoms do not limit gains in physical function due to exercise. Exercise may contribute to improved quality of life in those with poststroke depressive symptoms."
Timing of initiation of rehabilitation after stroke. (Arch Phys Med Rehabil. 2005) "CONCLUSIONS: Fewer days from stroke symptom onset to rehabilitation admission is associated with better functional outcomes at discharge and shorter LOS [length of stay]."
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