Medicine and Health Sciences Commons^™

The Relationship Of Plantar Sensation With Standing Balance And Gait Post-Stroke, Stephen Parsons

Electronic Thesis and Dissertation Repository

Gait and balance dysfunction after stroke limit independence and quality of life. Numerous contributing factors have been investigated but the role of sensation deficits has received little attention. This thesis investigated the relationship between plantar cutaneous sensation and 1) standing balance, 2) gait, and 3) use of vision to compensate for sensory loss with a secondary analysis of data from individuals with subacute stroke. Associations between standing balance, gait and sensation were investigated with Spearman correlations. Individuals classified as impaired or intact sensation were compared on gait and standing balance measures. This thesis found plantar sensation is related to standing …

Protective Role Of Homoeopathic Medicines On Cerebral Ischaemia In Animals, Gulrana Khuwaja, Tauheed Ishrat, M Khan, Syed Raza, M Ahmad Khan, Ajmal Ahmad, Kumar Vaibhav, Anil Khurana, Fakhrul Islam

Indian Journal of Research in Homoeopathy

Objective: Cerebral ischaemia is the third leading cause of death after cancer and myocardial infarction. The protective effect of some homoeopathic drugs has been studied in the Middle Cerebral Artery Occlusion (MCAO) model of rat. Materials and Methods: The rats were pretreated with 200C potency once daily for 5 days orally (1 drop or 21 μl) and post treated after 24 hr of MCAO with 30C potency three times a day for 5 days orally (1 drop or 21 μl) with homoeopathic medicines Crotalus, Phosphorus, Arnica and Crocus. Results: The content of antioxidants, Thiobarbituric Acid Reactive Substances (TBARS) was elevated …

Serum Ferritin And Its Usefulness In Detecting Iron Deficiency Anaemia Among Children With Protein Energy Malnutrition: A Case-Control Study In North Central Nigeria, Ahmad Mohammad El Shereef, Enas Attef Al Naggar, Mohammad Ezzat Elwan, Rasha Ali El Kapany, Wafik Mahmoud El Sheikh

Menoufia Medical Journal

Objective The aim of the present study was to investigate the traditional and nontraditional risk factors in chronic kidney disease (CKD) patients with stroke and the role of renal function in the short-term outcome of stroke. Background Over the past decade, considerable evidence has accumulated on the increased incidence of stroke and mortality associated with CKD. Patients and methods A total of 67 patients with first ever stroke, either ischemic or hemorrhagic, with CKD were compared with 30 first ever stroke patients who were free from the signs and symptoms of CKD. All patients were assessed on admission (day 0) …

Non Communicable Diseases In Pakistan: Burden, Challenges And Way Forward For Health Care Authorities, Mohammad Wasay, Shehla Zaidi, Maria Khan, Rashid Jooma

Section of Neurology

No abstract provided.

Interrater Reliability Of The Wolf Motor Function Test–Functional Ability Scale: Why It Matters, Susan V. Duff, Jiaxue He, Monica A. Nelsen, Christianne J. Lane, Veronica T. Rowe, Steve L. Wolf, Alexander W. Dromerick, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background. One important objective for clinical trialists in rehabilitation is determining efficacy of interventions to enhance motor behavior. In part, limitation in the precision of measurement presents a challenge. The few valid, low-cost observational tools available to assess motor behavior cannot escape the variability inherent in test administration and scoring. This is especially true when there are multiple evaluators and raters, as in the case of multisite randomized controlled trials (RCTs). One way to enhance reliability and reduce variability is to implement rigorous quality control (QC) procedures. Objective. This article describes a systematic QC process used to refine …

Home-Based Constraint Induced Movement Therapy Poststroke, Stephen Isbel, Christine Chapparo, David Mcconnell, Judy Ranka

The Open Journal of Occupational Therapy

Background: This study examined the efficacy of a home-based Constraint Induced Movement Therapy (CI Therapy) protocol with eight poststroke survivors.

Method: Eight ABA, single case experiments were conducted in the homes of poststroke survivors. The intervention comprised restraint of the intact upper limb in a mitt for 21 days combined with a home-based and self-directed daily activity regime. Motor changes were measured using The Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL).

Results: Grouped results showed statistically and clinically significant differences on the WMFT (WMFT [timed items]): Mean 7.28 seconds, SEM 1.41, 95% CI 4.40 – 10.18, …

“I Think Relax, Relax And It Flows A Lot Easier”: Exploring Client-Generated Relax Strategies, Dianne Cirone, Sara E. Mcewen

The Open Journal of Occupational Therapy

Background. Some adult stroke survivors participating in Cognitive Orientation to daily Occupational Performance (CO-OP) treatment programs self-generated relax strategies that have not been explored in previous CO-OP publications. The objective of this study was to describe the process by which adults with stroke used relax strategies and to explore the outcomes associated with their use.

Methods. Secondary analysis of transcripts of intervention sessions from five participants was conducted.

Results. All five participants applied relax strategies after initially observing a breakdown in performance that was attributed to increased fatigue or tension. The relax strategies used by the participants during their occupations …

Epigenetics And Social Context: Implications For Disparity In Cardiovascular Disease, Karen L. Saban, Herbert L. Matthews, Holli A. Devon, Linda W. Janusek

Nursing: School of Nursing Faculty Publications and Other Works

BACKGROUND:

Although it is well established that African Americans (AA) experience greater social stressors than non-Hispanic Whites (NHW), the extent to which early life adversity and cumulative social stressors such as perceived discrimination, neighborhood violence, subjective social status, and socioeconomic status contribute to disparity in coronary heart disease (CHD) and stroke between AA and NHW are not well understood.

PURPOSE:

The purpose of this paper is to propose a conceptual model based upon McEwen’s Allostatic Load Model suggesting how the relationships among social context, early life adversity, psychological stress, inflammation, adaptation, and epigenetic signature may contribute to the development of …

The Association Of The Vanin-1 N131s Variant With Blood Pressure Is Mediated By Endoplasmic Reticulum-Associated Degradation And Loss Of Function, Ya-Juan Wang, Bamidele O. Tayo, Anupam Bandyopadhyay, Heming Wang, Tao Feng, Nora Franceschini, Hua Tang, Jianmin Gao, Yun Ju Sung, The Cogent Bp Consortium, Robert C. Elston, Scott M. Williams, Richard S. Cooper, Ting-Wei Mu, Xiaofeng Zhu

Dartmouth Scholarship

High blood pressure (BP) is the most common cardiovascular risk factor worldwide and a major contributor to heart disease and stroke. We previously discovered a BP-associated missense SNP (single nucleotide polymorphism)–rs2272996–in the gene encoding vanin-1, a glycosylphosphatidylinositol (GPI)-anchored membrane pantetheinase. In the present study, we first replicated the association of rs2272996 and BP traits with a total sample size of nearly 30,000 individuals from the Continental Origins and Genetic Epidemiology Network (COGENT) of African Americans (P = 0.01). This association was further validated using patient plasma samples; we observed that the N131S mutation is associated with significantly lower plasma vanin-1 …

Return To Work After Stroke: A Nursing State Of The Science., Catherine Harris, Phd, Mba, Crnp

College of Nursing Faculty Papers & Presentations

There is a lack of research related to return to work (RTW) after acute ischemic stroke. Historically considered a disease of the elderly, acute ischemic stroke studies have not routinely used return to work as an outcome. Major stroke trials have not routinely collected this data as an endpoint. However, the mean age for acute ischemic stroke (AIS) has declined to 69 years of age, while the incidence in patients under the age of 55 has increased to 19%^1-3. Changes in retirement age have also affected RTW as a consideration in stroke patients. Failure to RTW after recovery …

Clinical Use Of Rivaroxaban: Pharmacokinetic And Pharmacodynamic Rationale For Dosing Regimens In Different Indications., Toby Trujillo, Paul P. Dobesh

Journal Articles: Pharmacy Practice

Target-specific oral anticoagulants have become increasingly available as alternatives to traditional agents for the management of a number of thromboembolic disorders. To date, the direct Factor Xa inhibitor rivaroxaban is the most widely approved of the new agents. The dosing of rivaroxaban varies and adheres to specific schedules in each of the clinical settings in which it has been investigated. These regimens were devised based on the results of phase II dose-finding studies and/or pharmacokinetic modeling, and were demonstrated to be successful in randomized, phase III studies. In most cases, the pharmacodynamic profile of rivaroxaban permits once-daily dosing. A once-daily …

Investigation Of Sox9 Ablation On Neuroplasticity And Recovery After Ischemic Stroke, Bethany Robin Lenore Bass

Electronic Thesis and Dissertation Repository

Neuroplasticity is a key factor in post-stroke functional recovery. A chief inhibitor of post-stroke neuroplasticity is the expression of chondroitin sulfate proteoglycans (CSPGs). Recent research has shown that the transcription factor SOX9 is responsible for upregulating the expression of CSPGs in the injured central nervous system. Accordingly, CSPG levels are significantly lower in mice with the Sox9 gene conditionally knocked out. The purpose of this study was to determine how Sox9 ablation affects neuroplasticity and recovery after stroke. Behavioural test results revealed that Sox9 KO mice exhibited significantly improved functional recovery after stroke compared to controls. This correlated with increased …

A Multiple Degree Of Freedom Lower Extremity Isometric Device To Simultaneously Quantify Hip, Knee, And Ankle Torques, Natalia Sánchez, Ana Maria Acosta, Arno H. A. Stienen, Julius P. A. Dewald

Physical Therapy Faculty Articles and Research

Characterization of the joint torque coupling strategies used in the lower extremity to generate maximal and submaximal levels of torque at either the hip, knee, or ankle is lacking. Currently, there are no available isometric devices that quantify all concurrent joint torques in the hip, knee, and ankle of a single leg during maximum voluntary torque generation. Thus, joint-torque coupling strategies in the hip, knee, and concurrent torques at ankle and/or coupling patterns at the hip and knee driven by the ankle have yet to be quantified. This manuscript describes the design, implementation, and validation of a multiple degree of …

Reduction In Overall Occurrences Of Ischemic Events With Vorapaxar: Results From Tracer, Harvey D. White, Zhen Huang, Pierluigi Tricoci, Frans Van De Werf, Lars Wallentin, Yuliya Lokhnygina, David J. Moliterno, Philip E. Aylward, Kenneth W. Mahaffey, Paul W. Armstrong

Internal Medicine Faculty Publications

BACKGROUND: Clinical trials traditionally use time-to-first-event analysis embedded within the composite endpoint of cardiovascular death (CVD), myocardial infarction (MI), or stroke. However, many patients have >1 event, and this approach may not reflect overall experience. We addressed this by analyzing all cardiovascular events in TRACER.

METHODS AND RESULTS: TRACER randomized 12 944 patients with non-ST-segment elevation acute coronary syndromes to placebo or to protease-activated receptor 1 antagonist vorapaxar with a median follow-up of 502 days (interquartile range, 349 to 667). Analysis of vorapaxar's effect on recurrent CVD, MI, or stroke was prespecified using the Wei, Lin, and Weissfeld approach. Vorapaxar …

A Peek Behind The Courtain: Peer Review And Editorial Decisions, Gustavo Saposnik

Gustavo Saposnik

No abstract provided.

Characterization Of The Vascular Pathology In The Acta2 R258c Mouse Model And Cerebrovascular Characterization Of The Acta2 Null Mouse, Carlos A. Villamizar

Dissertations & Theses (Open Access)

Mutations in ACTA2, the gene encoding for smooth muscle α-actin, predispose patients to a wide range of vascular diseases and is most commonly associated with thoracic aortic aneurysms (TAAD) and dissections (TAAD) and strokes. TAAD in patients is characterized by aortic media degeneration and loss in contractile force generation followed by aortic enlargement and subsequent rupture. Most stroke cases associated with ACTA2 are described as moyamoya-like cerebrovascular incidents characterized by distal occlusion of the internal carotid artery, stenosis of arteries in the Circle of Willis, and straightening of cerebral arteries. Patient samples are scarcely available for analysis, and the few …

Three-Dimensional Carotid Ultrasound Plaque Texture Predicts Vascular Events, Arna Van Engelen, Thapat Wannarong, Grace Parraga, Wiro J Niessen, Aaron Fenster, J David Spence, Marleen De Bruijne

Medical Biophysics Publications

BACKGROUND AND PURPOSE: Carotid ultrasound atherosclerosis measurements, including those of the arterial wall and plaque, provide a way to monitor patients at risk of vascular events. Our objective was to examine carotid ultrasound plaque texture measurements and the change in carotid plaque texture during 1 year in patients at risk of events and to compare these with measurements of plaque volume and other risk factors as predictors of vascular events.

METHODS: We evaluated 298 patients with carotid atherosclerosis using 3-dimensional (3D) ultrasound at baseline and after 1 year and measured carotid plaque volume and 376 measures of plaque texture. Patients …

The Disability Burden Associated With Stroke Emerges Before Stroke Onset And Differentially Affects Blacks: Results From The Health And Retirement Study Cohort, Benjamin D. Capistrant, Nicte I. Mejia, Sze Yan Liu, Qianyi Wang, M. Maria Glymour

Department of Public Health Scholarship and Creative Works

Background.

Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience a stroke. We contrast annual declines in IADL independence for older individuals who remain stroke-free to those for individuals who experienced a stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace. Methods.

Health and Retirement Study participants who were stroke-free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of …

A Prescription At Discharge Improve Short And Long Term Adherence, Gustavo Saposnik

Gustavo Saposnik

No abstract provided.

A Simple Risk Index And Thrombolytic Treatment Response In Acute Ischemic Stroke, Gustavo Saposnik

Gustavo Saposnik

No abstract provided.

Ihome: Ipad Application For Stoke Rehab At Home, Gustavo Saposnik

Gustavo Saposnik

No abstract provided.

Stroke Patient Rehabilitation: A Pilot Study Of An Android-Based Game, Ma. Mercedes T. Rodrigo

Department of Information Systems & Computer Science Faculty Publications

Background

Cerebral vascular accidents (strokes) are the primary cause of disability worldwide and the second leading cause of death both in the Philippines and internationally. In recent years, a number of computer-based applications have been developed to assist in the stroke recovery process.

Aim

This article discusses an Android-based tablet game, FINDEX, that aids in the rehabilitation process of stroke survivors with impaired fine motor skills.

Method

FINDEX was designed and developed in the Philippines. The game contains assessment and monitoring support for tracking the patient’s progress in terms of fine finger dexterity, for example, finger control, isolation and coordination, …

Predictors Of Health In Adult Child Caregivers Of Parent Stroke Survivors In China, Yuqin Pan

Loma Linda University Electronic Theses, Dissertations & Projects

Strokes are the leading cause of adult disability and death in China. The prevalence is 6 - 9% among adults over 65 in urban areas. It is estimated that currently there are more than 7.5 million stroke survivors with an annual increase of 2.5 million new cases. These stroke survivors are in great need of care during their rehabilitation. The tradition of filial piety involves adult children in caregiving to their parent stroke survivors; however, the caregiving responsibility becomes more challenging due to shrinking family size and modernization; thus caregiver health is often compromised. Data were collected by face-to-face interviews …

Volume Of Carotid Artery Ulceration As A Predictor Of Cardiovascular Events, Mariya Kuk, Thapat Wannarong, Vadim Beletsky, Grace Parraga, Aaron Fenster, J David Spence

Medical Biophysics Publications

BACKGROUND AND PURPOSE: Previous studies have shown the presence of ulceration in atherosclerotic plaque either by categorizing the plaque as complex (irregular morphology with ulcers) or smooth or by quantifying the number of ulcers observed in a specific region of interest. The aim of this study was to quantify carotid total ulcer volume by 3-dimensional ultrasound to investigate the relationship of total ulcer volume to vascular events (strokes, transient ischemic attack, myocardial infarction, revascularization, or death because of cardiovascular reasons).

METHODS: In total, 349 at-risk subjects provided written informed consent to carotid 3-dimensional ultrasound and were analyzed for ulcerations. Ulcer …

The Stroke-Related Effects Of Hip Flexion Fatigue On Over Ground Walking, Megan M. Rybar, Eric R. Walker, Henry Kuhnen, Daniel R. Ouellette, Reivian Berrios, Sandra K. Hunter, Allison Hyngstrom

Exercise Science Faculty Research and Publications

Individuals post stroke often rely more on hip flexors for limb advancement during walking due to distal weakness but the effects of muscle fatigue in this group is not known. The purpose of this study was to quantify how stroke affects the influence of hip flexor fatigue on over ground walking kinematics and performance and muscle activation. Ten individuals with chronic stroke and 10 without stroke (controls) participated in the study. Maximal walking speed, walking distance, muscle electromyograms (EMG), and lower extremity joint kinematics were compared before and after dynamic, submaximal fatiguing contractions of the hip flexors (30% maximal load) …

Sensory Electrical Stimulation Improves Foot Placement During Targeted Stepping Post-Stroke, Eric R. Walker, Allison Hyngstrom, Brian D. Schmit

Physical Therapy Faculty Research and Publications

Proper foot placement is vital for maintaining balance during walking, requiring the integration of multiple sensory signals with motor commands. Disruption of brain structures post-stroke likely alters the processing of sensory information by motor centers, interfering with precision control of foot placement and walking function for stroke survivors. In this study, we examined whether somatosensory stimulation, which improves functional movements of the paretic hand, could be used to improve foot placement of the paretic limb. Foot placement was evaluated before, during, and after application of somatosensory electrical stimulation to the paretic foot during a targeted stepping task. Starting from standing, …

Current Pathophysiological Concepts In Cerebral Small Vessel Disease., Fred Rincon, Clinton B Wright

Department of Neurology Faculty Papers

The association between cerebral small vessel disease (SVD) - in the form of white matter lesions, infarctions, and hemorrhages - with vascular cognitive impairment (VCI), has mostly been deduced from observational studies. Pathological conditions affecting the small vessels of the brain and leading to SVD have suggested plausible molecular mechanisms involved in vascular damage and their impact on brain function. However, much still needs to be clarified in understanding the pathophysiology of VCI, the role of neurodegenerative processes such as Alzheimer's disease, and the impact of aging itself. In addition, both genetic predispositions and environmental exposures may potentiate the development …

The Art Of Estimating Outcomes And Treating Patients With Stroke In The 21st Century., Gustavo Saposnik

Gustavo Saposnik

No abstract provided.

Addressing The Controversy Of Rate-Versus-Rhythm Control In Atrial Fibrillation, Tahmeed Contractor, Vadim Levin, Ravi Desai, Francis E Marchlinski

Vadim A Levin MD

Atrial fibrillation is the most common sustained cardiac arrhythmia and significantly increases patient risk of stroke, cardiomyopathy, and mortality. Rate versus rhythm control as the "best" treatment strategy remains an issue of considerable, ongoing debate. A multitude of clinical trials have compared the 2 strategies and have not shown any benefit of one approach over the other. However, the trials were conducted in specific subgroups of patients and demonstrated low success rates with antiarrhythmic drug (AAD) therapy and a high incidence of adverse AAD effects. Sub-analyses of the trials have confirmed that successful rhythm control with sinus rhythm restoration is …

Addressing The Controversy Of Rate-Versus-Rhythm Control In Atrial Fibrillation, Tahmeed Contractor, Vadim Levin, Ravi Desai, Francis E Marchlinski

Ravi V Desai MD

Atrial fibrillation is the most common sustained cardiac arrhythmia and significantly increases patient risk of stroke, cardiomyopathy, and mortality. Rate versus rhythm control as the "best" treatment strategy remains an issue of considerable, ongoing debate. A multitude of clinical trials have compared the 2 strategies and have not shown any benefit of one approach over the other. However, the trials were conducted in specific subgroups of patients and demonstrated low success rates with antiarrhythmic drug (AAD) therapy and a high incidence of adverse AAD effects. Sub-analyses of the trials have confirmed that successful rhythm control with sinus rhythm restoration is …