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Human Brain Mapping Oct 2023Overlapping clinical presentations in primary progressive aphasia (PPA) variants present challenges for diagnosis and understanding pathophysiology, particularly in the...
Overlapping clinical presentations in primary progressive aphasia (PPA) variants present challenges for diagnosis and understanding pathophysiology, particularly in the early stages of the disease when behavioral (speech) symptoms are not clearly evident. Divergent atrophy patterns (temporoparietal degeneration in logopenic variant lvPPA, frontal degeneration in nonfluent variant nfvPPA) can partially account for differential speech production errors in the two groups in the later stages of the disease. While the existing dogma states that neurodegeneration is the root cause of compromised behavior and cortical activity in PPA, the extent to which neurophysiological signatures of speech dysfunction manifest independent of their divergent atrophy patterns remain unknown. We test the hypothesis that nonword deficits in lvPPA and nfvPPA arise from distinct patterns of neural oscillations that are unrelated to atrophy. We use a novel structure-function imaging approach integrating magnetoencephalographic imaging of neural oscillations during a non-word repetition task with voxel-based morphometry-derived measures of gray matter volume to isolate neural oscillation abnormalities independent of atrophy. We find reduced beta band neural activity in left temporal regions associated with the late stages of auditory encoding unique to patients with lvPPA and reduced high-gamma neural activity over left frontal regions associated with the early stages of motor preparation in patients with nfvPPA. Neither of these patterns of reduced cortical oscillations was explained by cortical atrophy in our statistical model. These findings highlight the importance of structure-function imaging in revealing neurophysiological sequelae in early stages of dementia when neither structural atrophy nor behavioral deficits are clinically distinct.
Topics: Humans; Aphasia, Primary Progressive; Neurophysiology; Magnetic Resonance Imaging; Gray Matter; Atrophy; Primary Progressive Nonfluent Aphasia
PubMed: 37516916
DOI: 10.1002/hbm.26408 -
JMIR Rehabilitation and Assistive... Jul 2023Rehabilitation improves poststroke recovery with greater effect for many when applied intensively within enriched environments. The failure of health care providers to...
BACKGROUND
Rehabilitation improves poststroke recovery with greater effect for many when applied intensively within enriched environments. The failure of health care providers to achieve minimum recommendations for rehabilitation motivated the development of a technology-enriched rehabilitation gym (TERG) that enables individuals under supervision to perform high-intensity self-managed exercises safely in an enriched environment.
OBJECTIVE
This study aimed to assess the feasibility of the TERG approach and gather preliminary evidence of its effect for future research.
METHODS
This feasibility study recruited people well enough to exercise but living with motor impairment following a stroke at least 12 months previously. Following assessment, an 8-week exercise program using a TERG (eg, virtual reality treadmills, power-assisted equipment, balance trainers, and upper limb training systems) was structured in partnership with participants. The feasibility was assessed through recruitment, retention, and adherence rates along with participant interviews. Effect sizes were calculated from the mean change in standard outcome measures.
RESULTS
In total, 70 individuals registered interest, the first 50 were invited for assessment, 39 attended, and 31 were eligible and consented. Following a pilot study (n=5), 26 individuals (mean age 60.4, SD 13.3 years; mean 39.0, SD 29.2 months post stroke; n=17 males; n=10 with aphasia) were recruited to a feasibility study, which 25 individuals completed. Participants attended an average of 18.7 (SD 6.2) sessions with an 82% attendance rate. Reasons for nonattendance related to personal life, illness, weather, care, and transport. In total, 19 adverse events were reported: muscle or joint pain, fatigue, dizziness, and viral illness, all resolved within a week. Participants found the TERG program to be a positive experience with the equipment highly usable albeit with some need for individual tailoring to accommodate body shape and impairment. The inclusion of performance feedback and gamification was well received. Mean improvements in outcome measures were recorded across all domains with low to medium effect sizes.
CONCLUSIONS
This study assessed the feasibility of a holistic technology-based solution to the gap between stroke rehabilitation recommendations and provision. The results clearly demonstrate a rehabilitation program delivered through a TERG is feasible in terms of recruitment, retention, adherence, and user acceptability and may lead to considerable improvement in function, even in a chronic stroke population.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-doi.org/10.3389/fresc.2021.820929.
PubMed: 37477954
DOI: 10.2196/46619 -
Radiology Case Reports Sep 2023Mechanical thrombectomy is the gold standard in treating acute ischemic stroke complicated by large vessel occlusion. However, there are limited studies on repeated...
Mechanical thrombectomy is the gold standard in treating acute ischemic stroke complicated by large vessel occlusion. However, there are limited studies on repeated mechanical thrombectomy in acute ischemic stroke. In this case, we report a 68-year-old male with atrial fibrillation who developed sudden left limb weakness and motor aphasia for 6 hours, and his National Institutes of Health Stroke Scale (NIHSS) score was 10. Computed tomography angiography (CTA) showed occlusion of the right internal carotid artery, and mechanical thrombectomy was performed immediately. The patient's neurologic disability was utterly relieved, and the NIHSS score returned to 0. At 30 hours postoperatively, he again developed left limb weakness with motor aphasia. The NHISS Score was 11, and the CTA showed that the right internal carotid artery was re-occluded. After computed tomography perfusion evaluation, the patient underwent mechanical thrombectomy again, and the etiological examination confirmed Cardioembolism. Anticoagulation therapy was commenced 1 week post-thrombectomy. The prognosis of the patients was good.
PubMed: 37441454
DOI: 10.1016/j.radcr.2023.06.026 -
Alternative Therapies in Health and... Sep 2023It is estimated that 25% of the patients in Pakistan experience stroke resulting in problems with language. Among many of the conditions, problem with verbal expressive... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
It is estimated that 25% of the patients in Pakistan experience stroke resulting in problems with language. Among many of the conditions, problem with verbal expressive production (Broca's Aphasia) is one of the main problem faced by people having stoke. Many traditional therapies are incorporated to treat symptoms of Aphasia including fluent and non- fluent Aphasia.
OBJECTIVES
The primary objective of the current study was to determine the effectiveness of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with convention speech therapy, Melodic Intonation therapy (MIT) in enhancing the verbal expressive skills in patients with severe Broca's Aphasia. Another objective of this study was to compare the efficacy of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with traditional therapy, as well as the quality of life of patients with severe Broca's Aphasia.
METHODS
A randomized control trial (NCT03699605, clinicaltrials.gov) was conducted from November 2018 - June 2019 in Pakistan railway Hospital (PRH). Patients having a three-month history of severe Broca's Aphasia, aged between 40-60 years, bilingual (Urdu and English language) and having the ability to use a smart phone were included in the study. Patients with cognitive impairments were excluded. Total of 77 patients were evaluated for eligibility criteria according to the G Power software for sample size. Out of 77, 54 individuals fulfilled the inclusion criteria. The participants were divided into 2 groups (27 each) through sealed envelope method. Patients of both groups were assessed pre and post intervention using the Boston Diagnostic Aphasia Examination (BADE) battery (Primary outcome measure). Experimental group n = 25 received VESMP-U therapy and control group n = 25 (2 drop out in each group) received MIT for 16 weeks i.e. 4 days per week having 64 sessions altogether. Each intervention session lasted up to 30-45 minutes for both groups.
RESULTS
Within and between group analysis after intervention showed that the VESMP-U group had significantly improved BDAE scores (P = .001; 95% CI) than the MIT group for all variables (articulatory intelligibility, phrase length, grammatical form, prosody/intonation, spontaneous speech, word finding, repetition, and auditory comprehension). The BDAE scores of participants in experimental group having VESMP-U therapy pre- and post-intervention were statistically significant (P = .001; 95% CI), which indicates that participant's communication skills were enhanced by use of VESMP-U.
CONCLUSION
Android based application VESMP-U has been found to be effective in improving expression and quality of life of patients with severe Broca's aphasia.
Topics: Adult; Humans; Middle Aged; Aphasia, Broca; Asian People; Pakistan; Quality of Life; Stroke
PubMed: 37295011
DOI: No ID Found -
Journal of Neurology Sep 2023Telemedicine has rapidly emerged as an important tool in emergency neurology. In particular, reliable biomarkers of large vessel occlusions (LVOs) are critically...
BACKGROUND
Telemedicine has rapidly emerged as an important tool in emergency neurology. In particular, reliable biomarkers of large vessel occlusions (LVOs) are critically necessary in order to identify the need for in-hospital mechanical thrombectomy (MT). Based on pathophysiological factors, we propose that the presence of head and/or gaze deviation alone signifies cortical hypoperfusion and is therefore a highly sensitive marker for the presence of LVO.
METHODS
We retrospectively analyzed a cohort of 160 patients, examined via telemedicine and suspected to have had an acute stroke; this included patients with ischemic or hemorrhagic stroke, transient ischemic attack, and stroke mimics. An assessment of head and gaze deviation and NIHSS score evaluation was performed. In a second analysis, patients who only had ischemia in the anterior circulation (n = 110) were evaluated.
RESULTS
Head and/or gaze deviation alone was found to be a reliable marker of LVO (sensitivity: 0.66/specificity: 0.92), as well as a sound indicator for MT (0.82/0.91), in patients with suspected ischemic stroke. The performance of this indicator further improved when patients with ischemia in the anterior circulation only were assessed (LVO: 0.70/0.93; MT: 0.86/0.90). In both analyses, head and/or gaze deviation served as a better indicator for LVO or MT compared to the prevalence of motor deficits or aphasia. Of note, in patients who had ischemia in the anterior circulation, head and/or gaze deviation performed better than the NIHSS score as an indicator for MT.
CONCLUSION
These findings confirm that the presence of head and/or gaze deviation serves as a reliable biomarker in stroke-based telemedicine for the diagnosis of LVO, as well as a strong indicator for MT. Furthermore, this marker is just as reliable as the NIHSS score but easier to assess. We therefore suggest that any stroke patient who displays head and/or gaze deviation should immediately be scheduled for vessel imaging and subsequently transported to a MT-competent center.
Topics: Humans; Retrospective Studies; Stroke; Telemedicine; Brain Ischemia; Thrombectomy
PubMed: 37202605
DOI: 10.1007/s00415-023-11775-2