Multiple sclerosis (MS) is a chronic autoimmune disease that causes progressive functional impairment, mainly in walking tasks. Noninvasive brain stimulation (NIBS) could influence the motor function ...and improving gait ability of patients.
The aim was to analyze the effects of NIBS (transcranial direct current stimulation tDCS or transcranial magnetic stimulation TMS on functional locomotion in people with multiple sclerosis (PwMS).
A search was conducted for randomized controlled trials published up to November 2023 comparing the application of NIBS versus a sham or control group. The primary outcome were spatiotemporal gait parameters and functional mobility. Two review authors independently assessed the risk of bias in the included studies, and we used the Grading of Recommendations Assessment, Development, and Evaluation methodology to rate the certainty of the evidence for each outcome. A meta-analysis was performed by pooling the appropriate data using RevMan Web.
A total of four clinical trials were included for metanalysis. We observed that there is no statistically significant difference in overall effect in gait speed (MD = 0.08; 95% CI: −0.08–0.24; p = 0.32), and cadence (MD = 0.22; 95% CI: −11.54–11.98; p = 0.97%) between groups. But there was a statistically significant difference in overall effect in stride length between groups (MD:0.19; 95% CI: 0.07–0.31; p = 0.002), mainly when the intervention performed by multiple sessions and associated with motor rehabilitation (MD = 0.29; 95% CI: 0.14–0.44; p = 0.0002).
tDCS applied by multiple session and combined with motor rehabilitation (i.e., aerobic and/or resistance training) can improve stride length in PwMS.
Background: After the stroke, the development of the second motor neuron degeneration can reduce muscle strength and functional capacity.
Objective: The aim of this study was to describe the ...electro-myographic findings in the acute phase of stroke and to correlate them with the severity and muscle strength.
Material and Methods: Twenty patients were studied in the first 72 hours after stroke. The severity of the lesion was assessed using the National Institutes of Health Stroke Scale (NIHSS), and muscle strength was assessed using the Medical Research Council Scale (MRC). Sensory conduction and motor conduction were studied to exclude peripheral polyneuropathy, radiculopathies, or other neuro-muscular diseases, and electro-myography (EMG) was performed with co-axial needle electrodes in the deltoid, carpal radial extensor, vastus lateralis, and anterior tibialis at rest, slight effort and maximum effort. The associations between qualitative and quantitative variables were studied using the Chi-square test and Fisher's exact test.
Results: Among the patients, 40% had abnormal EMG positive sharp waves (PSWs), fibrillation, fasciculations, and abnormal patterns in maximum effort. Positive correlations were found between NIHSS and PSW (p = 0.005; r = 0.65) and abnormal EMG (p = 0.017; r = 0.72), and negative correlations were found between MRC and PSW (p = 0.041; r = -0.83) and abnormal EMG (p = 0.027; r = -0.81).
Conclusion: It was concluded that the main EMG findings in the acute phase of stroke were the presence of the denervation process and polyphasic motor unit potentials. These changes in EMG were correlated with stroke severity and lower muscle strength.
The coronavirus disease 2019 (COVID-19) can disrupt various brain functions. Over a one-year period, we aimed to assess brain activity and cognitive function in 53 COVID-19 patients and 30 ...individuals without COVID-19 (or asymptomatic). The Montreal Cognitive Assessment, Trail Making Test Parts A and B (TMT-A and B), and Digit Span Test were used to assess cognitive function. Cognitive variables and electroencephalography (EEG) data (activity, mobility, and complexity) were compared between the groups at rest and during cognitive demand (F3-F7, Fz-F3, Fz-F4, and F4-F8). There was a reduction in F3-F7 activity during the TMT-B in the COVID-19 group at 6-12 months compared to the controls (p = 0.01) at baseline (p = 0.03), a reduction in signal complexity at F3-F7 at rest in the COVID-19 group at baseline and 6-12 months compared to the controls (p < 0.001), and a reduction in Fz-F4 activity at rest from 6-12 months in the post-COVID group compared to baseline (p = 0.02) and 3-6 months (p = 0.04). At 6-12 months, there was a time increase in TMT-A in the COVID-19 group compared to that in the controls (p = 0.04). Some correlations were found between EEG data and cognitive test in both groups. In conclusion, there was a reduction in brain activity at rest in the Fz-F4 areas and during high cognitive demands in the F3-F7 areas. A reduction in signal complexity in F3-F7 at rest was found in the COVID-19 group at 6-12 months after acute infection. Furthermore, individuals with COVID-19 experience long-term changes in cognitive function.
A 53-year-old right-handed man developed left hemiparesis (of grade 2 in the Medical Research Council Scale) and right head deviation due to ischemic stroke. When instructed to clap his hands, he ...brought his right hand to the midline and searched for the other hand. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) scans, the unilateral spatial neglect (USN) test, and the blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) study are presented in · The Eastchester clapping sign provides evidence of USN phenomena.- Frequently, patients with USN can ignore problems with the affected limb. This patient presented bilateral activation in the networks related to spatial attention (mainly parietal posterior lobes), and fMRI patterns indicated maladaptive plasticity.·
Extraparenchymal neurocysticercosis has an aggressive course because cysts in the cerebrospinal fluid compartments induce acute inflammatory reactions. The relationships between symptoms, imaging ...findings, lesion type and location remain poorly understood. In this retrospective clinical records-based study, we describe the clinical symptoms, magnetic resonance imaging features, and cyst distribution in the CSF compartments of 36 patients with extraparenchymal neurocysticercosis. Patients were recruited between 1995 and 2010 and median follow up was 38 months. During all the follow up time we found that 75% (27/36) of the patients had symptoms related to raised intracranial pressure sometime, 72.2% (26/36) cysticercotic meningitis, 61.1% (22/36) seizures, and 50.0% (18/36) headaches unrelated to intracranial pressure. Regarding lesion types, 77.8% (28/36) of patients presented with grape-like cysts, 22.2% (8/36) giant cysts, and 61.1% (22/36) contrast-enhancing lesions. Hydrocephalus occurred in 72.2% (26/36) of patients during the follow-up period. All patients had cysts in the subarachnoid space and 41.7% (15/36) had at least one cyst in some ventricle. Cysts were predominantly located in the posterior fossa (31 patients) and supratentorial basal cisterns (19 patients). The fourth ventricle was the main compromised ventricle (10 patients). Spinal cysts were more frequent than previously reported (11.1%, 4/36). Our findings are useful for both diagnosis and treatment selection in patients with neurocysticercosis.
Older adults are benefited from the continuous tactile information to enhance postural control. Therefore, the aim was to evaluate the effect of the haptic anchors during balancing and walking tasks ...in older adults.
The search strategy (up to January 2023) was based on the PICOT (older adults; anchor system during balance and walking tasks; any control group; postural control measurements; short and/or long-term effect). Two pairs of reviewers independently examined all titles and abstracts for eligibility. The reviewers independently extracted data from the included studies, assessed the risk of bias, and certainty of the evidence.
Six studies were included in the qualitative synthesis. All studies used a 125-g haptic anchor system. Four studies used anchors when standing in a semi-tandem position, two in tandem walking on different surfaces, and one in an upright position after plantar flexor muscle fatigue. Two studies showed that the anchor system reduced body sway. One study showed that the ellipse area was significantly lower for the 50% group (reduced frequency) in the post-practice phase. One study showed that the reduction in the ellipse area was independent of the fatigue condition. Two studies observed reduced trunk acceleration in the frontal plane during tandem waking tasks. The studies had low to moderate certainty of evidence.
Haptic anchors can reduce postural sway during balance and walking tasks in older adults. Also, positive effects were seen during the delayed post-practice phase after the removal of anchors only in individuals who used a reduced anchor frequency.
Abstract
The Brazilian Practice Guidelines for Stroke Rehabilitation – Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia ...Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
The assistive device chair has a low manufacturing cost, and allow an easy handling and storage
The assistive device chair has been adapted to facilitate sitting posture;
The assistive device chair ...can be used as an auxiliary tool in early mobilizations protocols and contemporary rehabilitation approaches;
The early mobilization protocol associated with the assistive device chair can generate clinical improvements in acute stroke.
The mobilization protocol associated with the assistive device chair can promote improvement in International Classification of Functioning, Disability, and Health domains in acute stroke.
This report presents the adaptation of an assistive device chair for bedside sitting and its application in two patients with trunk control impairment in the acute stroke phase.
The device was built with polyvinylchloride (PVC) pipes and designed by a team of mechanical engineers and physiotherapists to maintain a prolonged sitting position with less demand from therapists. To test the device, two patients were followed up during the acute phase of stroke. Both patients underwent an early mobilization program (30 min, twice a day, for three days) with an assistive device chair for bedside sitting. Patients were evaluated using the National Institutes of Health Stroke Scale (NIHSS), Trunk Impairment Scale (TIS), and International Classification of Functioning, Disability, and Health (ICF) checklist (b: body function; d: activity and participation).
The adaptations generated the following equipment: 1) foldable, 2) three levels of backrest inclination, and 3) a safety anterior support or an activity table. Both patients showed clinical improvement after the intervention period, with NIHSS score reduction, TIS improvement, and greater functionality and independence on the ICF framework.
The equipment with adaptations seems to be functional, easy to handle, and can potentially contribute to clinical and functional improvements in patients with trunk control deficits after stroke.
To understand the current practices in stroke evaluation, the main clinical decision support system and artificial intelligence (AI) technologies need to be understood to assist the therapist in ...obtaining better insights about impairments and level of activity and participation in persons with stroke during rehabilitation.
This scoping review maps the use of AI for the functional evaluation of persons with stroke; the context involves any setting of rehabilitation. Data were extracted from CENTRAL, MEDLINE, EMBASE, LILACS, CINAHL, PEDRO Web of Science, IEEE Xplore, AAAI Publications, ACM Digital Library, MathSciNet, and arXiv up to January 2021. The data obtained from the literature review were summarized in a single dataset in which each reference paper was considered as an instance, and the study characteristics were considered as attributes. The attributes used for the multiple correspondence analysis were publication year, study type, sample size, age, stroke phase, stroke type, functional status, AI type, and AI function.
Forty-four studies were included. The analysis showed that spasticity analysis based on ML techniques was used for the cases of stroke with moderate functional status. The techniques of deep learning and pressure sensors were used for gait analysis. Machine learning techniques and algorithms were used for upper limb and reaching analyses. The inertial measurement unit technique was applied in studies where the functional status was between mild and severe. The fuzzy logic technique was used for activity classifiers.
The prevailing research themes demonstrated the growing utility of AI algorithms for stroke evaluation.
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