XVII. European Stroke Conference
Nice, France
XVII. European Stroke Conference
Nice, France
Poster Session: Recovery and rehabilitation
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
CATHODAL TRANSCRANIAL DC STIMULATION OF THE RIGHT FRONTO-TEMPORAL CORTEX ALTER REGIONAL METABOLIC ACTIVITY IN THE BRAIN OF POST-STROKE APHASIA
E.K.Kang
Y.K.Kim
Seoul National University Bundang Hospital
SOUTH KOREA
Background and Purpose: Transcranial direct current stimulation (tDCS) has potential to modulate the excitability of a targeted brain region by changing the neuronal membrane potentials. Behavioral study demonstrated that application of down-regulating cathodal tDCS to the right fronto-temporal area can facilitate picture naming task in post-stroke aphasia. The purpose of this study was to demonstrate the changes of regional neuronal metabolic activity in tDCS conditioned brain. Methods: Nine post-stroke aphasia patients due to a single stroke event participated in the series of Fludeoxyglucose F18 (18F-FDG) positron emission tomography (PET) studies of three conditions (baseline, no stimulation; sham stimulation with 2 mA for 1 min; tDCS stimulation with 2 mA for 20 min) during retrieval of picture names. Cathodal tDCS was given through electrodes placed over the right fronto-temporal Broca’s homologue. Results: When compared to sham tDCS, cathodal tDCS induced more metabolic activation of the cortical network of right fronto-temporo-occipital cortex, and lesser activation of the adjacent of Broca’s area. Relative increases in regional metabolism after cathodal tDCS compared to sham tDCS were found in the right primary motor and premotor area, visual association area, posterior cingulate gyrus, speech comprehension area, primary auditory area, right basal ganglia, and relative decrease in metabolism were found in the left visuo-auditory association area, temporal association area, pons and right anterior cingulated gyrus. Conclusions: These results document a beneficial effect of tDCS on post-stroke aphasia, and suggest that this interventional therapy may play an adjuvant strategy in post-stroke speech rehabilitation in combination with conventional speech therapy.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Lesion localisation predicts response to Bilateral Arm Training (BATRAC) in chronic stroke survivors
C. Globas
J.M.Lam
B. Hertler
C. Becker
J. Whitall
S. McCombe-Waller
D. Hanley
A.R.Luft
Centre of Neurology and Hertie Institute of Brain Research University Tübingen
GERMANY
Background and Purpose: In recent years several therapeutic approaches have been developed to improve motor function in stroke survivors with chronic disability. Bilateral Arm Training with Rhythmic Auditory Cueing (BATRAC) is an effective therapy to improve the arm function. But, not all individuals respond to this intervention. Here, the xobjective was to investigate the influence of lesion location on therapy response. Data collected as part of a randomized controlled trial conducted between 2001 and 2006 comparing BATRAC against standardized Bobath exercises, were analyzed. Methods: 17 chronic stroke survivors (first ever stroke> 6 months prior to enrollment) were BATRAC trained in 18 hourlong sessions 3x/week for 6 weeks. Upon rhythmic auditory cues, participants pushed and pulled bilaterally, in synchrony or alternation, 2 T-bar handles sliding in the transverse plane. The control group (18 patients) received standardized stretching exercises over the same time period 3x/week. Before and after the training period arm function was assessed through Fugl-Meyer Motor Performance Test (FM), and Wolf Motor Function scores (WMFT). For each patient anatomical MRI-scans (T1-weighted, 3D-MPRAGE sequence; 1x1x1 mm3) were collected. Voxel Based Lesion-Symptom Mapping (VLSM) was used to analyze the relationship between lesion morphology, arm motor function and therapy response (change in functional scores) on a voxel-by-voxel basis. Results: VLSM showed that lesions in premotor and frontal cortical areas were associated with poor improvement in FM score (p<0.01). There was a trend for a negative correlation lesion size and FM and WMFT improvement. Additionally, premotor cortex lesions were also associated with greater arm function deficit at baseline (n=42 subjects, BATRAC, control and dropouts combined; p<0.05). Conclusion: Lesions in frontal, especially premotor, cortical areas predict worse clinical outcome of arm function after stroke as well as poorer therapy response to BATRAC. This finding corresponds to the observation that responders to BATRAC show increased recruitment premotor cortex after threapy (Luft et al. JAMA 2004).
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Patient understanding of secondary prevention therapy : The effect of a specific pharmacy care plan.
D. Walsh
B. Carr
V. Treacy
J. Harbison
St James'S Hospital, Dublin
IRELAND
Introduction: Patient understanding of their secondary prevention therapy following stroke has been found to be limited. We performed a study of the effect of a pharmacy care plan in increasing patients understanding of secondary prevention therapy. Methods: Patients were recruited from rehabilitation wards, neurovascular clinics and day hospital. They underwent a brief (10-20 minute) one-to-one education session with a hospital pharmacist and were given specifically developed information leaflet for patients with stroke and TIA briefly describing the characteristics of typical secondary prevention medications in simple language. Level of understanding of therapy was determined before and 2 months after the intervention. Results: 62 patients were recruited to the study (Median age 72.5, 40 (65%) female). Prior to the intervention 10 patients (16.9%) could identify all their secondary prevention therapies and 23 (39%) could identify none. On reassessment, 44 (74.6%) could identify all their therapies and only 3 (5.1) could identify none. Prior to the intervention 33 (56%)subjects agreed that they knew what each medicine did, this increased to 54 patients (92%) 2 months after the intervention. Pre-intervention 40 (68%) did not feel they knew the principal side effects of the medications this fell to 15 (24%) post intervention. 50 patients (81%) reported finding the information provided useful. Conclusion: Implementation of the pharmacy care plan was associated with significant improvement in patients’ knowledge and understanding of their secondary prevention therapy.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Visual contrast sensitivity deficits following stroke - spatial differences and persistence in "recovered" visual field
P.L.Clatworthy
P.L.Warburton
J.-C.Baron
D.J.Tolhurst
Department of Clinical Neurosciences, University of Cambridge
UNITED KINGDOM
Visual field defects are common after stroke. Visual field may recover, perhaps by neural plasticity, but it is not known whether deficits persist in “recovered” visual field. Visual contrast sensitivity (CS) loss has been found after stroke, but this has not been localised within the visual field. We aimed to characterise CS loss in visual field which had recovered on perimetry, and to find out whether patients retain normal central visual field CS. CS functions (CSFs) were acquired in six patients (median age 62 years) with established visual field defects due to ischaemic stroke, and eight age-matched controls (median age 60.5 years). Subjects had no history of eye disease. In each subject, three sets of CSFs were obtained using an ascending contrast detection method. The first experiment used full screen sinusoidal grating stimuli of various spatial frequencies, the second central Gabor patches, and the third pairs of Gabor patches, one in “recovered” visual field, the other in the corresponding point in the opposite hemifield. Fixation was monitored. For the central patch stimulus, patient and control CSFs were similar. When the stimulus was close to the scotoma, however, CS for the spatial frequency of 1 cycle per degree was reduced in patients’ affected hemifields; the difference in CS between the 2 hemifields was significantly greater in patients than controls (Mann-Whitney U test). The form of the CSF was similar in all patients, and in all controls. This study demonstrates that contrast sensitivity deficits persist in visual field that has recovered on perimetry, and that this is reflected in full field contrast sensitivity, even though central field contrast sensitivity may be normal. How this is reflected in underlying neural processes requires investigation.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Brain-derived neurotrophic factor production by peripheral blood mononuclear cells during multidisciplinary poststroke rehabilitation
M. Caggiula
V. Nociti
A.K.Patanella
G. Frisullo
R. Iorio
V. Di Lazzaro
V.R.Barba
P. Tonali
M. Mirabella
A.P.Batocchi
Fondazione Don Carlo Gnocchi - Rome
ITALY
Background: In the last decade it became clear that regular exercise beneficially affects brain function and can play an important preventive and therapeutic role in stroke. The effects of exercise appear to be very complex and only partially understood. A characteristic finding for the effects of exercise in the brain and spinal cord has been the up-regulation of the brain-derived neurotrophic factor (BDNF). In this study, we determined serum BDNF levels and BDNF production by peripheral blood mononuclear cells (PBMCs) in patients with acute stroke before and after an individualized rehabilitation program and we correlated neurotrophin levels with clinical outcome of patients. Methods: We studied 15 consecutive patients with acute ischemic stroke, admitted to our centre for rehabilitation treatment. The severity of stroke was assessed through the National Institutes of Health Stroke Scale while the Barthel Index was used to measure functional independence level. All patients performed one 55 minute session of motor rehabilitation every day. Patients with language deficits carried out speech therapy associated with their motor program. The programme was regularly monitored and reviewed by a multidisciplinary team. All subjects performed rehabilitative intervention for two months. Patients were assessed at the beginning of the rehabilitation treatment and at the end of the training program. BDNF levels were measured in duplicate by enzyme-linked immunoabsorbent assay (ELISA) in sera and supernatants of unstimulated PBMCs. Results: We found a significant improvement in patient functional independence and a consistent disability reduction after rehabilitation therapy. We also found a significant increase in BDNF levels after rehabilitation therapy as compared with pre-treatment values. Discussion: We found that rehabilitation treatment determines a significant increase of BDNF, a key mediator of neuronal plasticity. This increment probably mediates the beneficial effects of rehabilitation in patients with acute ischemic stroke.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Visual Field Defects following stroke - assessment and treatment
O.M.Duffy
D. Brand
S.K.Ghosh
Ayr Hospital Stroke Unit
UNITED KINGDOM
BACKGROUND Visual field defects (VFD) are a known complication of stroke, and if persistent can reduce likelihood of returning to independent living. As yet, however, we know little about rehabilitaion options and prognosis. METHODS Within three clinical sites in Ayrshire, patients with suspected VFD after stroke were identified and referred to a dedicated senior orthoptist. These patients have been followed up for a year and information collected on the first hundred. RESULTS 100 patients referred with possible VFD, the majority by medical staff and occupational therapy (OT). 99 patients were found to have some kind of visual defect, but only 66 of these were confirmed field defects. Of the remainder 46 had reduced visual acuity, 23 neglect,10 diplpopia, 3 gaze palsy, 2 saccadic/smooth pursuit defect. Medical staff were found to be 54% accurate diagnostically, OT 59% accurate. 35 patients were actively treated, of these 15 improved, in 20 there was no change.We found good cognition improved chances of recovery. No correlation was found in relation to CT brain changes and chances of recovery. Patients waited on average 10 days following stroke for assessment. There was no difference in recovery rate with regard to time to assessment. CONCLUSION VFD is a recognised complication following sroke. Other defects can only be found after assessment by orthoptist. Involvment of an orhtoptist can improve chances of recovery and therefore returning to independent living. In this small study time of referral did not influence recovery. We hope larger studies may be able to give further prognostic indicators.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Lesion morphology predicts response to aerobic treadmill exercise in chronic stroke survivors
J.M.Lam
C. Globas
B. Hertler
R.F.Macko
L.V.Forrester
D.F.Hanley
C. Becker
A.R.Luft
University Tübingen, Hertie-Institute of Clinical Brain Research;
Clinic of Geriatric Rehabilitation, Robert-Bosch-Krankenhaus Stuttgart
GERMANY
Background and purpose. Stroke is the most common cause of adult disability. Novel rehabilitation therapies can provide substantial improvement even long after a stroke. Response to these therapies, however, is variable and the predictors of response are unknown. For walking treadmill aerobic exercise training (T-EX) has been shown to enhance gait function and cardiovascular fitness. We hypothesized that lesion location and lesion size are such predictors of response to T-EX therapy. Methods. 20 subjects underwent a progressive graded aerobic treadmill exercise program (T-EX, 6 months, 3x/week, 10-45 min per session) at 50% to 60% of heart rate reserve. Before and after 6 months of T-EX, ambulation was assessed by 10 m and 6 min walks and cardiovascular fitness was measured by peak VO2 capacity. For each patient structural (T1-weighted, 3D-MPRAGE sequence; 1x1x1 mm3) and functional MRI scans were collected (BOLD fMRI of paretic knee movement before and after training). Voxel-Based Lesion-Symptom Mapping (VLSM) was used to analyze the relationship between lesion morphology and therapy response (change in functional scores) on a voxel-by-voxel basis. Results. VLSM analysis showed that lesions involving the core MCA territory (p<0.05, highest p=0.00584) were associated to poor gains in gait velocity. Relating gains to lesion size indicated separation of subjects into two groups: one with a clear negative correlation (r=-0.8748; p=0.004) and one that was unrelated (r=0.3219; p=0.224). For the latter group, no parameter that was collected here predicted therapy response. But, there was a significant correlation between poor response and recruitment of contralesional sensorimotor cortex (r=-0.6159; p=0.033) in fMRI after therapy. Discussion. Large hemispheric lesions poorly respond to T-EX rehabilitation therapy. Poor responders with small lesions seem to have an inefficient plasticity response in which the contralesional motor cortex is reactivated by therapy.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Stroke patient rehabilitation on rehabilitation departments in Poland - preliminary data from POLKARD
I. Sarzynska-Dlugosz
A. Czlonkowska
M. Krawczyk
Institute of Psychiatry and Neurology / 2nd Department of Neurology
POLAND
Background: Every stroke patient should undergo rehabilitation. We aimed to evaluate factors improving efficiency of stroke in-patient rehabilitation in selected rehabilitation departments in Poland. Materials and methods: The web-based questionnaire evaluating rehabilitation departments in Poland was used to collect data on post-stroke patients admitted to participating centers between October the 1st 2006 and September 30th 2007. To ensure the quality only centers reported at least 50 patients were analyzed. Results: There were 15 centers that met criteria and 2990 patients (mean age: 67 years) were included in the final analyses. At the time of admission the modified Rankin scale distribution was: 0 - 0.2%, 1 - 1.7, 2 - 9.3%, 3 - 23.3%, 4 - 25.3%, 5 - 40.2%. Time from onset of stroke to admission varied: form below 3 week (39,5%) to over than year after stroke (17,7%). Rehabilitation procedures such as: kinesitherapy, group kinesitherapy, physical therapy, speech therapy, rehabilitation of other cognitive impairments, occupational therapy were conducted in 99.1%, 31.9%, 51.1%, 35.9%, 23%, 30.1%, respectively. We found that: longer overall time of any type of therapy and shorter time from the stroke onset to admission on rehabilitation department is connected with more frequent improvement in Rankin scale and activities of daily living. Conclusions: Post-stroke rehabilitation represents significant clinical matter and needs further monitoring in Poland.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Stroke patient attitudes to their secondary prevention therapy.
D. Walsh
B. Carr
V. Treacy
J. Harbison
St James's Hospital Dublin
IRELAND
Introduction: Studies have reported high levels (>90%) of adherence to secondary prevention therapy following stroke and TIA despite increasing numbers of medications prescribed. As part of a study to determine levels of patient understanding of theirtherapy, subjects were interviewed as to their attitudes to their therapy. Methodology: Patients were recruited from rehabilitation wards, clinics and day hospital. They were interviewed by a pharmacist carried and completed a questionnaire. Results/Conclusions : 67 patients completed questionnaires (41 (61% female), median 72 years (range 42-88)). Median number of medications was 7 (range 2-13) median number of secondary prevention medications was 4 (range 1-6). 37 (55%) felt they knew what their medicines did, 12 (18%) felt they new the main side effects of the medicines. 23 (34%) attributed unpleasant side effects to their medicines. 54 patients (81%) felt that their health depended on taking their medicines. 57 (85%) agreed that they were happy to take the medicines, even if they didn’t cure them. Three (5%) admitted to difficulties taking their medication as directed and, 4 (7%) admitted to occasionally deliberately not taking a dose. The subjects studied had a high degree of faith in the efficacy of their therapy and a high level of adherence despite a high level of perceived side effects and a low level of knowledge of understanding of the purpose and side effects of therapy.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
The effect of FES over the trunk on balance improvement in early hemiparetic stroke patients
K.G.Lee
Y.M.Kim
W.H.Ahn
Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine
SOUTH KOREA
Background and Purpose: The effectiveness of functional electrical stimulation (FES) over the trunk has been investigated in spinal cord injury, spastic diplegic cerebral palsy and scoliosis. This study was designed to determine the effectiveness of electrical stimulation over the trunk in improving balance during early stroke rehabilitation. Methods: Sixteen subjects (mean age = 61.5 +/- 11.8) who are hemiparetic stroke within 3 months of onset, inpatient of our rehabilitation hospital, were assigned randomly to two groups. Both group had physical therapy for 3 weeks. FES group received additional electrical stimulation over the hemiparetic back muscles. FES was applied for 20 minutes, 5 days per week for 3 weeks. Outcome measurements included Berg balance scale (BBS), Postural assessment scale for stroke patients (PASS) and Modified Bathel index (MBI). They were recorded before treatment and after treatment. Results: There was no difference of these values at initial evaluation between the two groups. Following 3 weeks of therapy, BBS, PASS and MBI were significantly increased when compared with initial evaluation in both group. Comparing the change of measurements before and after treatment, the changes of PASS were significantly higher in FES group (9.3 +/- 8.9) than those of the control group (5.8 +/- 5.7, P<0.05). The change of Berg balance scale, Modified Bathel index was improved in FES group, but not statistically significant. Conclusion: This study suggests that FES over the trunk become a beneficial therapeutic technique in improving the balance in early hemiparetic stroke patients.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Balance and Walking the First Week after a First Event of Stroke
C. Persson
P.O.Hansson
U. Svantesson
K. Stibrant Sunnerhagen
Department of Physiotherapy Sahlgrenska University Hospital/Östra Göteborg, Sweden
SWEDEN
Background: The aim of the study was to assess walking and balance in the acute phase after stroke. Methods: One hundred and sixteen patients with a first event of an acute stroke, consecutive admitted to a Stroke Unit, were assessed with the Modified Motor Assessment Scale (M-MAS UAS-95), the Berg balance scale (BBS), The Swedish Postural Assessment Scale for Stroke Patients (SwePASS), the 10 Meter Walking Test (10 MWT) and the Timed Up & Go (TUG) during four to seven days after stroke onset. Results: Nearly half of the population was identified by the BBS, the 10 MWT and the TUG as having a risk of falling and predicted non community ambulatory. The mean score for the M-MAS UAS-95 was 43, the mean speed with the 10 MWT was 0.58 m/s, the mean score for the BBS was 32, the mean time för TUG was 22 seconds and the mean score for SwePASS was 27. Results from cross tabulation with the 10 MWT when having the BBS as a golden standard indicates that none of the instruments are interchangeable, but when BBS shows a low risk of falling, the 10 MWT seems unnecessary to perform and the TUG when having the BBS. Discussion: Patients with a first event of an acute stroke, during the first week after onset, have impaired walking and balance ability and the most commonly used tests seem to measure different components and are not interchangeable.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Beneficial effects of the neurotrophic drug Cerebrolysin on the infarct volume after acute stroke
V.I.Skvortsova
N.A.Shamalov
H. Moessler
P.H.Novak
EBEWE Pharma, Unterach/Attersee
AUSTRIA
BACKGROUND Neurotrophic factors are thought to protect neurons against detrimental lesions in the penumbra area after stroke. Cerebrolysin is a peptide preparation which acts like naturally occurring neurotrophic factors. The aim of this trial was to assess the safety and efficacy of Cerebrolysin as an adjuvant therapy in patients suffering from acute ischemic stroke. METHODS In this prospective, randomized, placebo-controlled, double-blind trial, 47 patients suffering from a first acute ischemic stroke with clinical symptoms of middle cerebral artery occlusion, were enrolled within 12 hours after onset of symptoms. They received 10 IV infusions of 50 ml Cerebrolysin (n=24) or placebo (n=23) over a period of 10 days concomitant to basic stroke treatment. Primary efficacy analysis was percent change of the MRI infarct volume from day 3 to day 30. Secondary efficacy analysis included mRS, NIH SS, CGI and BI. Analysis of efficacy and safety was done from the ITT analysis set. RESULTS Baseline demographics and clinical characteristics were comparable between both treatment groups except for age (Cerebrolysin: 73.0y; placebo: 66.8y; p=0.05). A significant (p<0.05) reduction in the MRI volume was observed in the Cerebrolysin group over time compared to patients treated with placebo. There is descriptive evidence for a superiority of Cerebrolysin over placebo in the clinical outcome measures on day 30, particularly over the first ten days. Clinical data do not indicate any safety concerns, Cerebrolysin was well tolerated. DISCUSSION The present study confirmed previous findings in acute stroke and showed that Cerebrolysin has beneficial effects on infarct volume and clinical outcome with a better and faster performance compared to placebo suggesting a faster recovery under Cerebrolysin treatment. However, due to the small sample size, treatment effects of Cerebrolysin were not statistically significant. Cerebrolysin treatment with up to 50 ml per day is rated safe and well tolerated.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
The evaluation of effect after biofeedback training using Interactive Balance System in subacute stroke patients
K.G.Lee
M.H.Chun
S.H.Kang
B.R.Kim
Asan Medical Center
SOUTH KOREA
Background: The postural imbalance and instability is caused by multiple factors in stroke patients. The purpose of this study is to evaluate the effects of the biofeedback training using Interactive Balance System (Tetrax, Ramat Gan, Israel) by various indices in subacute stroke patients. Methods: This study was prospective randomized controlled case control study. We included 40 stroke patients who 1) consulted to rehabilitation medicine in subacute period, 2) could not ambulate but stand independently, 3) were scored above 20 in Korean Mini-Mental State Evaluation (K-MMSE) and 4) had not any orthopedic, vestibular problems and neurologic problem except stroke. Balance training was done by conventional method (control group, 20 patients) and using Interactive Balance System (training group, 20 patients) for about 2 weeks. The effects were evaluated by comparison before and after training using the scales of Interactive Balance System (1. general stability, 2. distribution of body’s center of pressure (COP) and 3. weight distribution) in position with opened eyes and scales of bedside evaluations (1. Modified Barthel Index, 2. Berg Balance Scale, and 3. Postural Assessment Scale For Stroke Patient) Results: There were no differences in age and sexual distribution, time to onset and duration of training between two groups. On the other hand, there were general improvements on all indices in Interactive Balance System and bedside evaluation, after training in two groups. But, in training group, the distribution of body’s COP was significantly improved than control group (p=0.018). Discussion: We know, doing the biofeedback training using Interactive Balance System was better stabilized the body’s COP than doing the conventional balance training in subacute stroke patients. In future, we will study for correlation location and lateralization with the effect of this training after adding more patients.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Correlation of Post Stroke Clinical Improvement with Oxidative Metabolism Alterations
E. Tataradze
N. Chabashvili
T. Sanikidze
M. Papava
Z. Sopromadze
T. Svanishvili
Tbilisi State Medical University
GEORGIA
The role of oxidative stress in clinical impairment caused by stroke has been studied extensively. There might be a relation between normalization of oxidative status and clinical improvement. We investigated 64 acute stroke patients. Motor functions, performance of Activities of Daily Living (ADL) and redox status were assessed at admission and at the end of acute stage. Motor functions were assessed by Motricity Index (MI) and by measuring Range of Motion (ROM); ADL - by Barthel Index (BI). For the assessment of redox status we studied alterations of blood paramagnetic centers [Mn2+, ceruloplazmin (CP), Fe3+ transferin (Fe3+tf)] by Electron Paramagnetic Resonance (EPR) spectroscopy, and activity of antoixidative enzyme superoxide dismutase (SOD). The mean values of MI, ROM and BI increased significantly during observational period. Intensive EPR signals of Mn2+ ions (promoters of free radical oxidation) were detected initially. Activity of antioxidant system was reduced: intensity of CP signal (reflecting its oxidation degree) was increased and intensity of Fe3+tf signal was decreased. At the follow-up we revealed decrease of concentration of Mn2+; decrease of CP oxidation degree; increase of Fe3+tf concentration. Mean value of SOD was decreased initially, then increased significantly. There was a positive correlation found between SOD activity and all clinical parameters. Intensity of Mn2+ signal was in negative correlation with all parameters. Fe3+tf signal correlated positively with MI and BI. CP signal was in negative correlation with MI and BI. Thus, redox parameters are in significant correlation with motor and ADL functions. We conclude that normalization of the redox balance positively influences clinical improvement of stroke patients.
Session:
Poster Session I
Date:
Wednesday 14 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Unlock the locked in
K.S.Sunnerhagen
Å. Schjoelberg
Rehabilitation medicine/Göteborg University
SWEDEN
Sometimes a stroke can lock in a person, which is a catastrophe. This happens with a stroke in the medulla oblongata and/or pons, resulting in tetrapareseses and paralyses of the lower cranial nerves (motion, respiration, communication and feeding). Other parts of the brain remain intact; rendering normal cognitive function. The locked in syndrome has spared eye/eyelid movement, locked in state also finger or toe movement. Luckily, this syndrome seems to be uncommon but the frequency after stroke is not known. Sunnaas University hospital has the responsibility for these rare persons in Norway. The aim of this study is to present cases which show the complexibility and the need (that requires the work) of different professions to work together towards a common goal. Material and method From a cohort we present 4 cases (2 men and 2 women with brain stem infarcts) to highlight the needs of the person and what is required from the team. Results: Communication at arrival: l eye movement for 3, weak voice for 1. At present (1-6 years later): computer assisted communication for 2, letter board for 1 and “normal” for one. The need of the person which is locked in requires a skilled team where different professional together can assess the person and help to find ways for alternative communication. Probably only one site per country can gather enough experience to give professional help. There is a need for follow up to re-assess skills and needs partly due to new techniques but also to see if the person need more assistance for adaptation with the alternative communication or extra information about communication for carers of the person
