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Effectiveness of physiotherapy interventions in brain plasticity, balance and functional ability in stroke survivors: A randomized controlled trial

Rahayu UB, Wibowo S, Setyopranoto I, Hibatullah Romli M

NeuroRehabilitation, 2020;47(4):463-470.
PMID: 33164953 DOI: 10.3233/NRE-203210

BACKGROUND: Brain injuries such as strokes cause damage and death of the neuron cells. Physiotherapy interventions help to improve patient's performance and ability. However, this is only theorized but the impact of the physiotherapy intervention on brain plasticity is not known.
OBJECTIVE: The present study aimed to investigate the effect of physiotherapy interventions on brain neuroplasticity by evaluating the brain plasticity regeneration, balance and functional ability.
METHODS: A randomized controlled trial was conducted with 64 stroke patients from three hospitals in the Surakarta region, Indonesia. Control groups (n = 32) received conventional physiotherapy and intervention groups (n = 32) received neurorestoration protocol, which both lasted for seven days. Efficacy of the interventions were measured on brain-derived neurotropic factor serum analysis, Berg Balance Scale and Barthel Index, respectively.
RESULTS: Both groups showed improvements in all parameters but only balance and functional performance had a statistically significant outcome.
CONCLUSION: Neurorestoration protocol that combined several established physiotherapy interventions was effective in improving balance and functional ability of stroke patients in only a seven days period.

Matched MeSH terms: Stroke/diagnosis; Stroke/epidemiology; Stroke/physiopathology*; Stroke Rehabilitation/methods*
Fulltext Test-retest reliability, internal consistency and concurrent validity of Fatigue Severity Scale in measuring post-stroke fatigue

Nadarajah M, Mazlan M, Abdul-Latif L, Goh HT

Eur J Phys Rehabil Med, 2017 Oct;53(5):703-709.
PMID: 27768012 DOI: 10.23736/S1973-9087.16.04388-4

BACKGROUND: Post-stroke fatigue (PSF) is a common complaint among stroke survivors and has significant impacts on recovery and quality of life. Limited tools that measure fatigue have been validated in stroke.
AIM: The purpose of this study was to determine the psychometric properties of Fatigue Severity Scale (FSS) in patients with stroke.
DESIGN: Cross-sectional study.
SETTING: Teaching hospital outpatient setting.
POPULATION: Fifty healthy controls (mean age 61.1±7.4 years; 22 males) and 50 patients with stroke (mean age 63.6±10.3 years; 34 males).
METHODS: FSS was administered twice approximately a week apart through face-to-face interview. In addition, we measured fatigue with Visual Analogue Scale - Fatigue (VAS-F) and Short-Form Health Survey 36 version 2 vitality scale. We used Cronbach alpha to determine internal consistency of FSS. Reliability and validity of FSS were determined by intraclass correlation coefficient (ICC) and Spearman correlation coefficient (r).
RESULTS: FSS showed excellent internal consistency for both stroke and healthy groups (Cronbach's alpha >0.90). FSS had excellent test-retest reliability for stroke patients and healthy controls (ICC=0.93 and ICC=0.90, respectively). The scale demonstrated good concurrent validity with VAS-Fatigue (all r>.60) and a moderate validity with the SF36-vitality scale. Furthermore, FSS was sensitive to distinguish fatigue in stroke from the healthy controls (P<0.01).
CONCLUSIONS: FSS has excellent internal consistency, test-retest reliability and good concurrent validity with VAS-F for both groups.
CLINICAL REHABILITATION IMPACT: This study provides evidence that FSS is a reliable and valid tool to measure post-stroke fatigue and is readily to be used in clinical settings.

Study site: Teaching hospital outpatient setting

Matched MeSH terms: Stroke/complications; Stroke/diagnosis*; Stroke/therapy; Stroke Rehabilitation/methods*
Fulltext A Review of Risk Factors for Cognitive Impairment in Stroke Survivors

Mohd Zulkifly MF, Ghazali SE, Che Din N, Singh DK, Subramaniam P

ScientificWorldJournal, 2016;2016:3456943.
PMID: 27340686 DOI: 10.1155/2016/3456943

In this review, we aimed to identify the risk factors that may influence cognitive impairment among stroke survivors, namely, demographic, clinical, psychological, and physical determinants. A search from Medline, Scopus, and ISI Web of Science databases was conducted for papers published from year 2004 to 2015 related to risk factors of cognitive impairment among adult stroke survivors. A total of 1931 articles were retrieved, but only 27 articles met the criteria and were reviewed. In more than half of the articles it was found that demographical variables that include age, education level, and history of stroke were significant risk factors of cognitive impairment among stroke survivors. The review also indicated that diabetes mellitus, hypertension, types of stroke and affected region of brain, and stroke characteristics (e.g., size and location of infarctions) were clinical determinants that affected cognitive status. In addition, the presence of emotional disturbances mainly depressive symptoms showed significant effects on cognition. Independent relationships between cognition and functional impairment were also identified as determinants in a few studies. This review provided information on the possible risk factors of cognitive impairment in stroke survivors. This information may be beneficial in the prevention and management strategy of cognitive impairments among stroke survivors.

Matched MeSH terms: Stroke/complications*
Axial Segmental Coordination During Turning: Effects of Stroke and Attentional Loadings

Manaf H, Justine M, Goh HT

Motor Control, 2017 Jan;21(1):42-57.
PMID: 26595318 DOI: 10.1123/mc.2015-0040

Attentional loadings deteriorate straight walking performance for individuals poststroke, but its effects on turning while walking remain to be determined. Here we compared turning kinematics under three attentional loading conditions (single, dual-motor, and dual-cognitive task) between stroke survivors and healthy controls. Nine chronic stroke survivors and 10 healthy controls performed the Timed Upand- Go test while their full-body kinematics were recorded. Onset times of yaw rotation of the head, thorax and pelvis segments and head anticipation distance were used to quantify turning coordination. Results showed that stroke survivors reoriented their body segments much earlier than the controls, but they preserved the similar segmental reorientation sequence under the single-task condition. For the healthy controls, attentional loading led to an earlier axial segment reorientation, but the reorientation sequence was preserved. In contrast, the dual-cognitive task condition led to a disrupted reorientation sequence in stroke. The results indicate that turning coordination was altered in individuals poststroke, especially under the dual-task interference.

Matched MeSH terms: Stroke/physiopathology*
Fulltext Reliability and validity of the Nigerian (Hausa) version of the Stroke Impact Scale (SIS) 3.0 index

Mohammad AH, Al-Sadat N, Siew Yim L, Chinna K

Biomed Res Int, 2014;2014:302097.
PMID: 25276774 DOI: 10.1155/2014/302097

This study aims to test the translated Hausa version of the stroke impact scale SIS (3.0) and further evaluate its psychometric properties. The SIS 3.0 was translated from English into Hausa and was tested for its reliability and validity on a stratified random sample adult stroke survivors attending rehabilitation services at stroke referral hospitals in Kano, Nigeria. Psychometric analysis of the Hausa-SIS 3.0 involved face, content, criterion, and construct validity tests as well as internal and test-retest reliability. In reliability analyses, the Cronbach's alpha values for the items in Strength, Hand function, Mobility, ADL/IADL, Memory and thinking, Communication, Emotion, and Social participation domains were 0.80, 0.92, 0.90, 0.78, 0.84, 0.89, 0.58, and 0.74, respectively. There are 8 domains in stroke impact scale 3.0 in confirmatory factory analysis; some of the items in the Hausa-SIS questionnaire have to be dropped due to lack of discriminate validity. In the final analysis, a parsimonious model was obtained with two items per construct for the 8 constructs (Chi-square/df < 3, TLI and CFI > 0.9, and RMSEA < 0.08). Cross validation with 1000 bootstrap samples gave a satisfactory result (P = 0.011). In conclusion, the shorter 16-item Hausa-SIS seems to measure adequately the QOL outcomes in the 8 domains.

Matched MeSH terms: Stroke/physiopathology*
Fulltext Review of emotion recognition in stroke patients

Yuvaraj R, Murugappan M, Norlinah MI, Sundaraj K, Khairiyah M

Dement Geriatr Cogn Disord, 2013;36(3-4):179-96.
PMID: 23899462 DOI: 10.1159/000353440

OBJECTIVE: Patients suffering from stroke have a diminished ability to recognize emotions. This paper presents a review of neuropsychological studies that investigated the basic emotion processing deficits involved in individuals with interhemispheric brain (right, left) damage and normal controls, including processing mode (perception) and communication channels (facial, prosodic-intonational, lexical-verbal).
METHODS: An electronic search was conducted using specific keywords for studies investigating emotion recognition in brain damage patients. The PubMed database was searched until March 2012 as well as citations and reference lists. 92 potential articles were identified.
RESULTS: The findings showed that deficits in emotion perception were more frequently observed in individuals with right brain damage than those with left brain damage when processing facial, prosodic and lexical emotional stimuli.
CONCLUSION: These findings suggest that the right hemisphere has a unique contribution in emotional processing and provide support for the right hemisphere emotion hypothesis.
SIGNIFICANCE:
This robust deficit in emotion recognition has clinical significance. The extent of emotion recognition deficit in brain damage patients appears to be correlated with a variety of interpersonal difficulties such as complaints of frustration in social relations, feelings of social discomfort, desire to connect with others, feelings of social disconnection and use of controlling behaviors.

Matched MeSH terms: Stroke/psychology*
A young lady with thalamic stroke mimicking acute Miller Fisher syndrome

Hasan S, Stanslas J, Hin LP, Basri HB

Neurosciences (Riyadh), 2012 Oct;17(4):380-1.
PMID: 23022907
Matched MeSH terms: Stroke/diagnosis*
Stroke mortality variations in South-East Asia: empirical evidence from the field

Hoy DG, Rao C, Hoa NP, Suhardi S, Lwin AM

Int J Stroke, 2013 Oct;8 Suppl A100:21-7.
PMID: 23013164 DOI: 10.1111/j.1747-4949.2012.00903.x

Stroke is a leading cause of death in Asia; however, many estimates of stroke mortality are based on epidemiological models rather than empirical data. Since 2005, initiatives have been undertaken in a number of Asian countries to strengthen and analyse vital registration data. This has increased the availability of empirical data on stroke mortality.

Matched MeSH terms: Stroke/mortality*
The ideal measurement of the quality of life in post stroke patients: an urban study

Samsiah M, Das S, Chee SY, Rashidah R, Siti H, Ruth P, et al.

Clin Ter, 2011;162(3):209-15.
PMID: 21717044

There is paucity of literature on the measurement of the quality of life in post stroke patients in the developing countries. The main objective of this study was to determine the quality of life (QOL) of post stroke patients.

Matched MeSH terms: Stroke*
Fulltext Acute stroke patients with high BMI are less likely to have severe disability at initial presentation

Choo WS, Foo S, Tan E, Thayaparan FS, Chung YY, Raman S, et al.

Med J Malaysia, 2009 Mar;64(1):34-6.
PMID: 19852318 MyJurnal

This is a prospective study to determine the severity of disability and prognosis of acute stroke patients related to their Body Mass index (BMI). A total of 79 consecutive CT-scan-proven acute stroke patients who were admitted to Hospital Tuanku Ja'afar, Seremban between November 2006 and April 2007 were recruited (male:female 49:30; mean age 62.7 years; ischemic stroke 70, intracerebral bleed 9). The patients were divided according to BMI less than 25 (Group A) and equal or greater than 25 (Group B). Severity of disability was measured between 24-48 hours by modified Rankin's score. Patients were followed up after one month. Thirty-seven patients had severe disability (Rankin Score 5). Twenty-nine patients had adverse outcomes including 11 deaths and 18 rehospitalizations or prolonged hospital/nursing home stay. 34.3% of Group B had severe disability compared to 56.8% of Group A (chi2 P = 0.046). Conversely 42.9% of Group B had adverse events at one month compared to 31.8% of Group A (chi2 P = 0.312). There were no statistical differences between high- and low-BMI groups for gender ratio, smoking, hypertension, diabetes, prior cardiovascular disease, mean age, mean lipid profile and blood pressure. When comparing patients with Rankin Score 1-4 versus 5, age and BMI were statistically significant between the two groups. By multivariate analysis only age is independent predictor for severe disability (P < 0.05). The results of this pilot study should be confirmed in larger prospective multicentre trial.

Matched MeSH terms: Stroke/complications*
Fulltext Stroke audit

Chen RYT, Lim JKH, Chuo AML

Med J Malaysia, 2003 Aug;58(3):330-6.
PMID: 14750371

Medical audit is vital to ensure continuous quality assurance and quality improvements. We did a retrospective study to ascertain the adequacy of clinical documentation and the factors hindering early discharge after an acute stroke in a restructured hospital. The medical records of all patients with acute stroke who died or were discharged from a restructured hospital in Singapore in January and February 1999 were reviewed retrospectively. Demographic data and the presence or absence of clinical documentation were noted. Factors hindering the discharge of patients at Day 5, Day 10 of stroke and at final discharge were noted and classified into: stroke-related, complications of stroke, medical-related and social factors. There were 101 patients in the study cohort, 55 males (54.5%) and 46 females (45.5%). The mean age was 67.9 years (SD 12.3). Documentation in Barthel scores (0%), presence of depression (0%), mental scores (1.0%), visual problems (10.0%), bladder continence (39.6%), admission functional status (37.6%) and dysphagia (52.5%) were deficient. The mean length of stay (LOS) was 13.0 (SD 14.2) days. The main factor hindering discharge at Day 5 (90.4%), Day 10 (95.2%) and at final discharge (82.1%) was stroke-related problems. Poor function (60.3%) and dysphagia (15.8%) were the 2 most common stroke-related problems hindering final discharge. Complications of stroke, medical-related problems and social reasons hindered final discharge in 10.8%, 17.8% and 2.9% of patients respectively. This audit revealed inadequacy in clinical documentation in patients with acute stroke. The main hindrance to final discharge of patients was stroke-related problems. The 2 most important stroke-related problems were poor function and dysphagia.

Matched MeSH terms: Stroke/therapy*
Fulltext Heterotopic ossification in stroke is not that rare: lesson from rehabilitation standpoint

Fatimah Ahmedy, Nurul Diyanah Zenian, Wan Juhaini Paizi, Teh Yong Guang, Khin Nyein Yin, D. Maryama Ag Daud, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):71-71.
MyJurnal

Introduction:Stroke is a major public health concern and treating its complications is important for functional recov-ery. Heterotopic ossification (HO), a condition where bone is developed in non-skeletal tissue, is not an uncommon stroke-related complication with reported occurrence up to 12%. It typically presents with joint range of motion (ROM) limitation, pain and swelling. Detecting HO is important to prevent forceful joint manipulation during reha-bilitation that can cause pain and fracture. Two cases of diagnosing HO during the course of stroke rehabilitation are presented. Case description: First case was a subacute stroke in 25 year-old male with right-sided hemiparesis and right hip joint ROM limitation. He did not consent to have passive ROM exercise and refused to be seated due to severe right hip pain. Second case was a 41 year-old male with chronic right-sided hemiparetic stroke exhibiting ipsilateral lower limb neurological recovery but inability to perform bed mobility and walking despite regaining motor function. The right hip joint ROM was limited in the absence of pain. Radiographs demonstrated presence of HO in the affected hip of both patients. Gentle hip ROM exercise was prescribed and noted improvement in ROM with subsequent ability for sitting (first case) and short-distance ambulation (second case). Conclusion: HO should be considered as a differential diagnosis in stroke patients having limited ROM, hence the importance of thorough physical examination. Presence of HO would guide rehabilitation process by encouraging gentle ROM exercise in the attempt to reduce public health burden from halted functional recovery in stroke.

Matched MeSH terms: Stroke; Stroke Rehabilitation
Fulltext Incidence and multidimensional predictors of occasional and recurrent falls among Malaysian community-dwelling older persons

Ooi TC, Singh DKA, Shahar S, Rajab NF, Vanoh D, Sharif R, et al.

BMC Geriatr, 2021 03 02;21(1):154.
PMID: 33653312 DOI: 10.1186/s12877-021-02103-2

BACKGROUND: Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. In this study, we aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls. This was done in the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians.
METHODS: Data from 1,763 Malaysian community-dwelling older persons aged ≥ 60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up.
RESULTS: Three hundred and nine (17.53 %) participants reported fall occurrences at an 18-month follow-up, of whom 85 (27.51 %) had two or more falls. The incidence rate for occasional and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being female (OR: 1.57; 95 % CI: 1.04-2.36), being single (OR: 5.31; 95 % CI: 3.36-37.48), having history of fall (OR: 1.86; 95 % CI: 1.19-2.92) higher depression scale score (OR: 1.10; 95 % CI: 1.02-1.20), lower hemoglobin levels (OR: 0.90; 95 % CI: 0.81-1.00) and lower chair stand test score (OR: 0.93; 95 % CI: 0.87-1.00) remained independent predictors of occasional falls. While, having history of falls (OR: 2.74; 95 % CI: 1.45-5.19), being a stroke survivor (OR: 8.57; 95 % CI: 2.12-34.65), higher percentage of body fat (OR: 1.04; 95 % CI: 1.01-1.08) and lower chair stand test score (OR: 0.87; 95 % CI: 0.77-0.97) appeared as recurrent falls predictors.
CONCLUSIONS: Having history of falls and lower muscle strength were predictors for both occasional and recurrent falls among Malaysian community-dwelling older persons. Modifying these predictors may be beneficial in falls prevention and management strategies among older persons.

Matched MeSH terms: Stroke*
Fulltext An overview of fractional anisotropy as a reliable quantitative measurement for the corticospinal tract (CST) integrity in correlation with a Fugl-Meyer assessment in stroke rehabilitation

Zolkefley MKI, Firwana YMS, Hatta HZM, Rowbin C, Nassir CMNCM, Hanafi MH, et al.

J Phys Ther Sci, 2021 Jan;33(1):75-83.
PMID: 33519079 DOI: 10.1589/jpts.33.75

[Purpose] Understanding the essential mechanisms in post-stroke recovery not only provides important basic insights into brain function and plasticity but can also guide the development of new therapeutic approaches for stroke patients. This review aims to give an overview of how various variables of Magnetic Resonance-Diffusion Tensor Imaging (MR-DTI) metrics of fractional anisotropy (FA) can be used as a reliable quantitative measurement and indicator of corticospinal tract (CST) changes, particularly in relation to functional motor outcome correlation with a Fugl-Meyer assessment in stroke rehabilitation. [Methods] PubMed electronic database was searched for the relevant literature, using key words of diffusion tensor imaging (dti), corticospinal tract, and stroke. [Results] We reviewed the role of FA in monitoring CST remodeling and its role of predicting motor recovery after stroke. We also discussed the mechanism of CST remodeling and its modulation from the value of FA and FMA-UE. [Conclusion] Heterogeneity of post-stroke brain disorganization and motor impairment is a recognized challenge in the development of accurate indicators of CST integrity. DTI-based FA measurements offer a reliable and evidence-based indicator for CST integrity that would aid in predicting motor recovery within the context of stroke rehabilitation.

Matched MeSH terms: Stroke; Stroke Rehabilitation
Concurrent stroke and ST-elevation myocardial infarction: Is it a contraindication for intravenous tenecteplase?

Wan Asyraf WZ, Elengoe S, Che Hassan HH, Abu Bakar A, Remli R

Med J Malaysia, 2020 03;75(2):169-170.
PMID: 32281601

Acute ischemic stroke (AIS) and acute ST-elevation myocardial infarction (STEMI) are leading causes of mortality worldwide. Concurrent AIS presentation with STEMI is rare and potentially fatal. Most importantly to date many centres in Malaysia are still not aware on how to treat this condition. We report a case of AIS, which was treated with intravenous tenecteplase (TNK) according to ischemic stroke dosage and lead to improvement of neurological deficit.

Matched MeSH terms: Stroke/drug therapy*
Fulltext Relationship between demographic and clinical factors with physical functioning of stroke patients. [Hubungan antara faktor demografik dan klinikal dengan kefungsian fizikal pesakit strok]

Ghazali SE, Mohd Zulkifly MF, Che Din N, Desa A, Ali RA

Jurnal Sains Kesihatan Malaysia, 2016;14(2):23-30.
MyJurnal

Stroke is a causal factor that commonly caused physical impairments and activity limitations among patients to perform daily activities until at certain level stroke patients will experience disability. The aim of this study is to examine the relationship of each demographic and clinical factors that is believed to associate with physical functioning of patients
those who experienced stroke. This present study also try to compare physical functioning of patients with associated factors and then examine the correlation between those factors with physical functioning. A total of 147 respondents that pass for cognitive screening test involved in this study. Barthel Index (ADL) was administered to the respondents after 6 weeks of stroke attack in order to measure their physical functioning status. Results found that there was a significant difference [F(3, 143) = 4.06; p < 0.01] between level of educations with physical functioning of patients. With respect to clinical factors also showed a significant difference (p < 0.01) was higher in physical functioning when stroke attack
occurred at right hemisphere of brain. There was a significant difference (p < 0.01) in physical functioning with respect to belief of recovery. Furthermore, number of stroke attack also showed a significant difference [F(1, 145) = 11.19; [p < 0.01] in physical functioning of patients. Correlation test that was carried out found a positive significant correlation
(r = 0.24; p < 0.01) between physical functioning with respect to the affected lesion side. In conclusion, demographic and clinical factors also played the roles to determine level of physical functioning among stroke patients and thus these factors should be considered in any studies that intended to enhance physical functioning of patients in future.
Keywords: stroke; physical functioning; disability; physical impairment

Matched MeSH terms: Stroke*
Fulltext Interpretations of self-rated health in stroke survivors from a semi-rural community in South East Asia

Yap KH, Warren N, Reidpath DD, Allotey P

Int J Qual Stud Health Well-being, 2019 Dec;14(1):1613875.
PMID: 31120385 DOI: 10.1080/17482631.2019.1613875

Purpose: Stroke survivors report poorer self-rated health (SRH) compared to the general population but there is limited understanding on what contributes to SRH. This ethnographic study examined the individual and contextual factors that shape stroke survivors' SRH in a rural middle income country situated in South East Asia. Methods: Ethnographic methods which encompasses various data collection methods from different data sources were used in this study to describe the socio-cultural context of 16 stroke survivors living in a rural village. Within this context, the experiences of these participants were then interpreted in terms of what contributed to their perception of health and recovery, juxtaposed with objectively measure physical and cognitive states. Results: SRH reflected the post stroke adjustment of stroke survivors. Better SRH was influenced by good post-stroke adjustment that was achieved by a combination of physical functioning, cognitive functioning, emotional well-being and family support. Poorer SRH appear to reflect poor post-stroke adjustment regardless of the objective physical and cognitive states of the stroke survivors. It was also observed that cognitive deficits, though its presence was acknowledged by participants, were usually not taken into account when rating SRH. However, while physical functioning was perceived by participants to directly impact SRH, the presence of cognitive deficits (often in tandem with depressive symptoms) indirectly complicated the recovery of physical functions treasured by participants. Conclusion: Stroke survivors reporting poorer SRH warrant further attention and intervention from health practitioners supporting the longer-term needs of stroke survivors in similar settings.

Matched MeSH terms: Stroke*
Fulltext Virtual Reality Games as an Adjunct in Improving Upper Limb Function and General Health among Stroke Survivors

Ahmad MA, Singh DKA, Mohd Nordin NA, Hooi Nee K, Ibrahim N

Int J Environ Res Public Health, 2019 12 16;16(24).
PMID: 31888293 DOI: 10.3390/ijerph16245144

Virtual reality (VR) games has the potential to improve patient outcomes in stroke rehabilitation. However, there is limited information on VR games as an adjunct to standard physiotherapy in improving upper limb function. This study involved 36 participants in both experimental (n = 18) and control (n = 18) groups with a mean age (SD) of 57 (8.20) and 63 (10.54) years, respectively. Outcome measures were the Fugl-Meyer assessment for upper extremities (FMA-UE), Wolf motor function test (WMFT), intrinsic motivation inventory (IMI), Lawton of instrumental activities of daily living (IADL), and stroke impact scale (SIS) assessed at pre-post intervention. The experimental group had 0.5 h of upper limb (UL) VR games with 1.5 h of standard physiotherapy, and the control group received 2 h of standard physiotherapy. The intervention for both groups was performed once a week for eight consecutive weeks. The results showed a significant time-group interaction effect for IMI (p = 0.001), Lawton IADL (p = 0.01) and SIS domain of communication (p = 0.03). A significant time effect was found in FMA-UE (p = 0.001), WMFT (p = 0.001), Lawton IADL (p = 0.01), and SIS domains; strength, ADL and stroke recovery (p < 0.05). These results indicated an improvement in UL motor ability, sensory function, instrumental ADL, and quality of life in both groups after eight weeks of intervention. However, no significant (p > 0.05) group effect on all the outcome measures was demonstrated. Thus, replacing a portion of standard physiotherapy time with VR games was equally effective in improving UL function and general health compared to receiving only standard physiotherapy among stroke survivors.

Matched MeSH terms: Stroke; Stroke Rehabilitation
Fulltext Prevalence of dementia in ischaemic or mixed stroke populations: systematic review and meta-analysis

Craig L, Hoo ZL, Yan TZ, Wardlaw J, Quinn TJ

J Neurol Neurosurg Psychiatry, 2022 02;93(2):180-187.
PMID: 34782389 DOI: 10.1136/jnnp-2020-325796

An understanding of the epidemiology of poststroke dementia (PSD) is necessary to inform research, practice and policy. With increasing primary studies, a contemporary review of PSD could allow for analyses of incidence and prevalence trends. Databases were searched using a prespecified search strategy. Eligible studies described an ischaemic or mixed stroke cohort with prospective clinical assessment for dementia. Pooled prevalence of dementia was calculated using random-effects models at any time after stroke (primary outcome) and at 1 year (range: 6-18 months), stratified for inclusion of prestroke dementia. Meta-regression explored the effect of year of study. Sensitivity analyses removed low-quality or outlier studies. Of 12 505 titles assessed, 44 studies were included in the quantitative analyses. At any time point after stroke, the prevalence of PSD was 16.5% (95% CI 10.4% to 25.1%) excluding prestroke dementia and 22.3% (95% CI 18.8% to 26.2%) including prestroke dementia. At 1 year, the prevalence of PSD was 18.4% (95% CI 7.4% to 38.7%) and 20.4% (95% CI 14.2% to 28.2%) with prestroke dementia included. In studies including prestroke dementia there was a negative association between dementia prevalence and year of study (slope coefficient=-0.05 (SD: 0.01), p<0.0001). Estimates were robust to sensitivity analyses. Dementia is common following stroke. At any point following stroke, more than one in five people will have dementia, although a proportion of this dementia predates the stroke. Declining prevalence of prestroke dementia may explain apparent reduction in PSD over time. Risk of dementia following stroke remains substantial and front-loaded, with high prevalence at 1 year post event.

Matched MeSH terms: Stroke/epidemiology*
Fulltext Does body mass index and height influence the incident risk of ischemic stroke in newly diagnosed type 2 diabetes subjects?

Duan D, Li H, Xu J, Wong L, Xu G, Kong F, et al.

J Diabetes Res, 2019;2019:2591709.
PMID: 30805371 DOI: 10.1155/2019/2591709

Objective: To estimate the incident risk of ischemic stroke (IS) in newly diagnosed type 2 diabetes (T2D) subjects according to different body mass index (BMI) and height categories.

Methods: A total of 25,130 newly diagnosed T2D subjects were included in this study. All T2D subjects were enrolled consecutively from the Chronic Disease Surveillance System (CDSS) of Ningbo. Standardized incidence ratio (SIR) and its 95% confidence interval (95% CI) stratified by BMI categories and height quartiles were used to estimate the incident risk of IS in T2D subjects.

Results: In total, 22,795 subjects completed the follow-up. Among them, 1268 newly diagnosed IS cases were identified, with 149,675 person-years. The SIRs of normal BMI (18.5-24.0 kg/m2), overweight (24.0-28.0 kg/m2), and obese (≥28.0 kg/m2) in overall subjects were 2.56 (95% CI 1.90-3.13), 2.13 (95% CI 1.90-3.13), and 1.87 (95% CI 1.29-2.43), respectively (Ptrend < 0.01), comparing to the general population of Ningbo. For each 1 kg/m2 increment in BMI, the SIR was 0.948 (95% CI 0.903-0.999). For height quartiles, the SIRs of male subjects in quartile 1 (<160 cm), quartile 2 (161-165 cm), quartile 3 (165-170 cm), and quartile 4 (≥171 cm) were 2.27 (95% CI 1.99-2.56), 2.01 (95% CI 1.67-2.45), 1.37 (95% CI 1.05-1.68), and 0.91 (95% CI 0.40-1.32), respectively (Ptrend < 0.01). While for female subjects, the SIRs in quartile 1 (<155 cm), quartile 2 (156-160 cm), quartile 3 (161-165 cm), and quartile 4 (≥166 cm) were 3.57 (95% CI 3.11-3.49), 2.96 (95% CI 2.61-3.31), 1.94 (95% CI 1.51-2.36), and 1.71 (95% CI 0.95-2.47), respectively (Ptrend < 0.01).

Conclusion: Compared to the general population of Ningbo, T2D subjects had a higher incident risk of IS. Furthermore, the IS incident risk was not only higher in newly diagnosed T2D subjects with normal BMI but also lower in taller newly diagnosed T2D subjects.

Matched MeSH terms: Stroke*

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