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Frontiers of Neurology and Neuroscience 2018Henrik Ibsen (1828-1906) is a Norwegian playwright and poet who is known as the father of modern drama. Ibsen was in good health when he announced at his 70th birthday...
Henrik Ibsen (1828-1906) is a Norwegian playwright and poet who is known as the father of modern drama. Ibsen was in good health when he announced at his 70th birthday celebration that he intended to continue writing. His last play, When We Dead Awaken, was published in 1899. Why did Ibsen's dramatic writing come to an end? This chapter presents a medical account of Ibsen's health condition during the last 6 years of his life. It is based on a review of a document written by one of his doctors, Edvard Bull (1845-1925), letters, biographic information, and Ibsen's death certificate. The historical material suggests that he suffered from arteriosclerosis and cerebrovascular disease, and that he suffered several strokes, in 1900, 1901, and 1903. He suffered a paresis in his left foot, expressive aphasia, and a right hemiparesis, and he lost the ability to write. There is no evidence that Ibsen was hospitalised. He received medical treatment and care at his home and at a recreational spa. His health condition was unstable, and it is likely that he suffered from a series of smaller strokes in the last years of his life. Ibsen developed signs of heart failure, and he died peacefully from "paralysis cordis" at his home on May 23rd, 1906.
Topics: Cerebrovascular Disorders; Drama; History, 19th Century; History, 20th Century; Hospitalization; Humans; Norway; Paresis; Physicians; Stroke; Writing
PubMed: 30336461
DOI: 10.1159/000490444 -
Annals of Medicine Dec 2023Motor recovery following a stroke is related to the initial stroke severity and corticospinal tract integrity. One of the outcomes representing corticospinal tract...
BACKGROUND
Motor recovery following a stroke is related to the initial stroke severity and corticospinal tract integrity. One of the outcomes representing corticospinal tract integrity is the motor evoked potential (MEP). This study aimed to investigate the predictive value of MEP for motor recovery in patients with acute ischemic stroke.
PATIENTS AND METHODS
Patients with hemiparesis secondary to initial acute ischemic stroke were enrolled. MEPs of the upper limb were assessed as preserved (MEP+) or absent (MEP-) response ≤10 days post-stroke. Fugl-Meyer assessment (FMA) was performed at baseline and post-stroke at 30 and 90 days. A modified Rankin scale (mRS) was conducted at 90 days post-stroke. Patients were divided into two groups according to the highest FMA score of MEP- patients. Generalized estimating equations and logistic regression were used for our study analysis.
RESULTS
Sixty-one participants were included in this study. The highest FMA score of MEP- patients ≤10 days after stroke was 38. Among patients with an initial FMA score ≤38, FMA scores at 30 and 90 days post-stroke were significantly higher in MEP + patients than in MEP- patients. Proportional recovery at 30 and 90 days post-stroke was significantly higher in MEP + patients than in MEP- patients. MEP + patients had a higher percentage of good functional outcomes than MEP- patients, without statistical difference. Among patients with initial FMA score >38, FMA scores were 60.4 ± 4.8 and 63.9 ± 2.9 and proportional recovery was 65.2 ± 27.0% and 83.7 ± 24.6% at 30 and 90 days post-stroke, respectively.
CONCLUSIONS
Among patients with moderate-to-severe ischemic stroke, MEP + patients had better motor recoveries (approximately 70%) than MEP- patients at 90 days post-stroke. MEP + patients had better functional outcomes than MEP- patients.
Topics: Humans; Ischemic Stroke; Evoked Potentials, Motor; Stroke; Paresis
PubMed: 37345693
DOI: 10.1080/07853890.2023.2225144 -
Journal of Neuroengineering and... Oct 2020Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired... (Review)
Review
Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration.
Topics: Biomechanical Phenomena; Female; Gait Disorders, Neurologic; Humans; Leg; Locomotion; Male; Middle Aged; Paresis; Stroke; Stroke Rehabilitation; Walking
PubMed: 33087137
DOI: 10.1186/s12984-020-00747-6 -
Annual International Conference of the... Jul 2023Stroke is the leading cause of disability worldwide, and nearly 80% of stroke survivors suffer from upper-limb hemiparesis. Myoelectric exoskeletons can restore...
Stroke is the leading cause of disability worldwide, and nearly 80% of stroke survivors suffer from upper-limb hemiparesis. Myoelectric exoskeletons can restore dexterity and independence to stroke survivors with upper-limb hemiparesis. However, the ability of patients to dexterously control myoelectric exoskeletons is limited by an incomplete understanding of the electromyographic (EMG) hallmarks of hemiparesis, such as muscle weakness and spasticity. Here we show that stroke survivors with upper-limb hemiparesis suffer from delayed voluntary muscle contraction and delayed muscle relaxation. We quantified the time constants of EMG activity associated with initiating and terminating voluntary hand grasps and extensions for both the paretic and non-paretic hands of stroke survivors. We found that the initiation and termination time constants were greater on the paretic side for both hand grasps and hand extensions. Notably, the initiation time constant during hand extension was approximately three times longer for the paretic hand than for the contralateral non-paretic hand (0.618 vs 0.189 s). We also show a positive correlation between the initiation and termination time constants and clinical scores on the Modified Ashworth Scale. The difficulty stroke survivors have in efficiently modulating their EMG presents a challenge for appropriate control of assistive myoelectric devices, such as exoskeletons. This work constitutes an important step towards understanding EMG differences after stroke and how to accommodate these EMG differences in assistive myoelectric devices. Real-time quantitative biofeedback of EMG time constants may also have broad implications for guiding rehabilitation and monitoring patient recovery.Clinical Relevance- After a stroke, muscle activity changes, and these changes make it difficult to use muscle activity to drive assistive and rehabilitative technologies. We identified slower muscle contraction and muscle relaxation as a key difference in muscle activity after a stroke. This quantifiable difference in muscle activity can be used to develop better assistive technologies, guide rehabilitation, and monitor patient recovery.
Topics: Humans; Electromyography; Stroke; Upper Extremity; Paresis; Survivors; Muscles
PubMed: 38083023
DOI: 10.1109/EMBC40787.2023.10340726 -
PloS One 2022It is known that resistance exercise using one limb can affect motor function of both the exercised limb and the unexercised contralateral limb, a phenomenon termed... (Review)
Review
It is known that resistance exercise using one limb can affect motor function of both the exercised limb and the unexercised contralateral limb, a phenomenon termed cross-education. It has been suggested that cross-education has clinical implications, e.g. in rehabilitation for orthopaedic conditions or post-stroke paresis. Much of the research on the contralateral effect of unilateral intervention on motor output is based on voluntary exercise. This scoping review aimed to map the characteristics of current literature on the cross-education caused by three most frequently utilised peripheral neuromuscular stimulation modalities in this context: electrical stimulation, mechanical vibration and percutaneous needling, that may direct future research and translate to clinical practice. A systematic search of relevant databases (Ebsco, ProQuest, PubMed, Scopus, Web of Science) through to the end of 2020 was conducted following the PRISMA Extension for Scoping Review. Empirical studies on human participants that applied a unilateral peripheral neuromuscular stimulation and assessed neuromuscular function of the stimulated and/or the unstimulated side were selected. By reading the full text, the demographic characteristics, context, design, methods and major findings of the studies were synthesised. The results found that 83 studies were eligible for the review, with the majority (53) utilised electrical stimulation whilst those applied vibration (18) or needling (12) were emerging. Although the contralateral effects appeared to be robust, only 31 studies claimed to be in the context of cross-education, and 25 investigated on clinical patients. The underlying mechanism for the contralateral effects induced by unilateral peripheral stimulation remains unclear. The findings suggest a need to enhance the awareness of cross-education caused by peripheral stimulation, to help improve the translation of theoretical concepts to clinical practice, and aid in developing well-designed clinical trials to determine the efficacy of cross-education therapies.
Topics: Electric Stimulation Therapy; Humans; Musculoskeletal Physiological Phenomena; Neuromuscular Diseases; Paresis; Peripheral Nerves; Physical Therapy Modalities; Stroke; Stroke Rehabilitation
PubMed: 35139128
DOI: 10.1371/journal.pone.0263662 -
Topics in Stroke Rehabilitation Jul 2024Ataxic hemiparesis (AH) is a well-recognized clinical lacunar stroke syndrome, characterized by paresis with ataxia on the same side of the body. It affects patients... (Review)
Review
BACKGROUND
Ataxic hemiparesis (AH) is a well-recognized clinical lacunar stroke syndrome, characterized by paresis with ataxia on the same side of the body. It affects patients with stroke involving the basal ganglia, pons, internal capsule, corona radiata, and thalamus. In the past, lacunar syndrome denotes good functional recovery with low mortality and morbidity rate. However, recent evidence suggests AH has an association with more debilitating outcomes in the long term.
OBJECTIVE
To provide a comprehensive narrative review of published literatures on the topics related with AH and update clinical practice including rehabilitation.
METHODS
Literature review was performed by using the keywords "Subcortical Ataxia," "Lacunar Stroke," "Diaschisis", and "Ataxic Hemiparesis" on PubMed and Google Scholar Engines from 1978 to 2022. All papers published in English were reviewed and manual search of references from retrieved literature was performed for other relevant articles.
RESULTS
A comprehensive review was carried out on the following topics: neuroanatomical localization, pathogenesis, clinical features and clinical assessment scales, pharmacological and non-pharmacological modalities for ataxia treatment, prognosis, and outcome.
CONCLUSION
AH imposes significant challenges on stroke survivors when it comes to remediation of balance and coordination. It is associated with increased risk of mortality, stroke recurrence, and dementia. Though application of the concept of neuroplasticity and the utilization of repetitive transcranial magnetic stimulation have shown early promising results, further research is needed to establish the practice guidelines for rehabilitation of patients with AH.
Topics: Humans; Ataxia; Paresis; Stroke Rehabilitation; Stroke, Lacunar
PubMed: 37965878
DOI: 10.1080/10749357.2023.2281722 -
Clinical Rehabilitation Nov 2015To determine how motor imagery is being delivered in upper limb rehabilitation to guide practice and research. (Review)
Review
OBJECTIVE
To determine how motor imagery is being delivered in upper limb rehabilitation to guide practice and research.
DATA SOURCE
MEDLINE, PubMed, CINAHL, EMBASE, PsychINFO databases were searched from 1987 to November 2014 STUDY SELECTION: English, adults, any clinical population or diagnosis, intervention for upper limb with an outcome measure used. All types of studies were included. Two authors independently selected studies for review using consensus.
DATA EXTRACTION
Seven motor imagery elements were extracted using a model implemented in sport research: PETTLEP model (Physical, Environment, Task, Timing, Learning, Emotion, and Perspective).
RESULTS
The search yielded 1107 articles with 1059 excluded leaving 48 articles for full review. A total of 38 articles involved individuals with stroke, five articles involved individuals with complex regional pain syndrome, and five articles for other conditions. Motor imagery elements most commonly described were physical, environment, task, and perspective. Elements less commonly described were timing, learning, and emotional aspects. There were significant differences between study populations (e.g. stroke and complex regional pain syndrome) and within populations on how motor imagery was delivered.
CONCLUSION
Many of the imagery elements reviewed are not being considered or reported on in the selected studies. How motor imagery is being delivered within and between populations is inconsistent, which may lead to difficulties in determining key elements of effectiveness.
Topics: Adult; Case-Control Studies; Female; Humans; Imagery, Psychotherapy; Male; Motor Skills; Paresis; Prognosis; Randomized Controlled Trials as Topic; Recovery of Function; Risk Factors; Stroke; Treatment Outcome
PubMed: 25604911
DOI: 10.1177/0269215514566248 -
Brain Stimulation 2016Non-invasive brain stimulation (NIBS) facilitates motor improvements post stroke. Transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Non-invasive brain stimulation (NIBS) facilitates motor improvements post stroke. Transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are representative NIBS techniques frequently used in stroke motor rehabilitation. Our primary question is: Do these two techniques improve force production capability in paretic limbs?
OBJECTIVE
The current systematic review and meta-analysis investigated the effects of tDCS and rTMS on paretic limb force production in stroke survivors.
METHODS
Our comprehensive search identified 23 studies that reported changes in force production following tDCS or rTMS interventions. Each used random assignment and a sham control group. The 23 qualified studies in our meta-analysis generated 29 comparisons: 14 tDCS and 15 rTMS comparisons.
RESULTS
Random effects models indicated improvements in paretic limb force after tDCS and rTMS rehabilitation. We found positive effects on force production in the two sets of stimulation protocols: (a) increasing cortical activity in the ipsilesional hemisphere and (b) decreasing cortical activity in the contralesional hemisphere. Moreover, across acute, subacute, and chronic phases, tDCS and rTMS improved force production.
CONCLUSION
Cumulative meta-analytic results revealed that tDCS and rTMS rehabilitation protocols successfully improved paretic limb force production capabilities.
Topics: Brain; Humans; Paresis; Stroke; Stroke Rehabilitation; Transcranial Direct Current Stimulation; Transcranial Magnetic Stimulation
PubMed: 27262725
DOI: 10.1016/j.brs.2016.05.005 -
Journal of Stroke and Cerebrovascular... Mar 2021The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST)... (Observational Study)
Observational Study
OBJECTIVES
The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST) proved to be highly efficient in the treatment of emergent large vessel occluding (ELVO) strokes in the anterior circulation. To achieve a timely diagnosis, a robust combination of few and simple signs to identify ELVOs in AIS patients applicable by paramedics in the prehospital triage is worthwhile.
MATERIALS AND METHODS
This retrospective single-center study included 904 AIS patients (324 ELVO, 580 non-ELVO) admitted between 2010 and 2015 in a tertiary stroke center. We re-evaluated two symptoms based on NIHSS items, gaze deviation and hemiparesis of the limbs ("Gaze deviation and Paresis Score, GPS") for the pre-hospital prediction of ELVO.
RESULTS
A positive GPS AIS in patients predicted ELVO with a sensitivity of 0.89, specificity = 0.97, positive predictive value (PPV) = 0.95, negative predictive value (NPV) = 0.94 and diagnostic odds ratio (DOR) = 34.25 (CI: 20.75-56.53). The positive Likelihood-ratio (LR) was 29.67, the negative Likelihood ratio (LR) 0.11. NIHSS of patients with positive GPS (gaze palsy NIHSS ≥ 0, Motor arm NIHSS ≥2 and Motor leg NIHSS ≥2) was markedly higher compared to negative GPS patients (p < 0.001).
CONCLUSIONS
The GPS proved to be similarly accurate in detecting ELVO in the anterior circulation of AIS patients and even more specific than other published clinical scores. Its simplicity and clarity might enable non-neurological medical staff to identify ELVO AIS patients with high certainty in a preclinical setting.
Topics: Aged; Aged, 80 and over; Clinical Decision-Making; Disability Evaluation; Emergency Medical Services; Endovascular Procedures; Female; Fixation, Ocular; Humans; Ischemic Stroke; Male; Middle Aged; Ocular Motility Disorders; Paresis; Predictive Value of Tests; Prognosis; Registries; Reproducibility of Results; Retrospective Studies; Triage
PubMed: 33388631
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105518 -
Neurological Sciences : Official... Sep 2017Technology-supported training is emerging as a solution to support therapists in their efforts providing high-intensity, repetitive, and task-specific treatment, in... (Meta-Analysis)
Meta-Analysis Review
Technology-supported training is emerging as a solution to support therapists in their efforts providing high-intensity, repetitive, and task-specific treatment, in order to enhance the recovery process. The aim of this review is to assess the effectiveness of different robotic devices (end-effector and exoskeleton robots) in comparison with any other type of intervention. Furthermore, we aim to assess whether or not better improvements are obtained in the sub-acute phase after stroke onset than in the chronic phase. A research was conducted in the electronic bibliographic databases Cochrane, MEDLINE, and EMBASE. A total of 17 studies were included: 14 randomized controlled trials, 2 systematic reviews, and one meta-analysis. Fugl-Meyer and modified Ashworth scale were selected to measure primary outcomes, i.e., motor function and muscle tone. Functional independence measure and motor activity log were selected to measure secondary outcomes, i.e., activities of daily living. In comparison with conventional therapy, the robot-assisted rehabilitation is more effective in improving upper limb motor function recovery, especially in chronic stroke patients. No significant improvements are observed in the reduction of muscle tone or daily living activities. The present systematic review shows that the use of robotic devices can positively affect the recovery of arm function in patients with stroke.
Topics: Humans; Paresis; Robotics; Stroke; Stroke Rehabilitation; Therapy, Computer-Assisted; Upper Extremity
PubMed: 28540536
DOI: 10.1007/s10072-017-2995-5