Stroke is a common and frequently-occurring disease, which seriously endangers human health. Rehabilitation treatment can effectively reduce the disability rate of stroke and improve the quality of life. The tertiary rehabilitation treatment system for stroke can effectively improve the motor function of stroke patients and improve the quality of life. This paper focuses on the choices and methods of physical therapy and occupational therapy at all levels of the hospitals and in different periods of the disease. It also aims to summarize the tertiary rehabilitation strategy for motor dysfunction in stroke patients, to provide references for all levels of hospitals and communities, achieve standardization and unification of rehabilitation treatment, as well as the rehabilitation efficacy of homogeneity.
In order to accurately evaluate the similarity of motions during daily rehabilitation training for stroke patients, this paper proposed a novel quantitative assessment method based on dynamic time warping (DTW) algorithm. Firstly, the raw accelerometer signals were preprocessed to eliminate the noise. Secondly, the similarity between the accelerometer signals and four standard task templates was calculated respectively, and then the motion was recognized based on the similarity measurements. Finally, the corresponding quantitative assessment model was used to compute the result. The clinical experimental results showed that there were significant differences in the shortest path distance (R value) of DTW between different tasks, and the classification accuracy could be up to 91% when the R value was selected as the classification feature. Additionally, with the process of rehabilitation, the R value decreased gradually, which means that the R value can be taken as the assessment index to evaluate the quality of designated tasks for stroke patients. It also indicated that the R value could be applied into the scene of automatic prescription generation and interactive gaming to determine whether it is needed to change the rehabilitation plan or adjust the game difficulty level, so as to implement the individualized rehabilitation services.
Objective To systematically review the rehabilitation effect of isokinetic muscle training on knee muscle strength, functional walking ability and dynamic balance in post-stroke patients. Methods PubMed, Ovid Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang databases were searched online for randomized controlled trials on isokinetic muscle training of lower limbs in post-stroke patients. The retrieval time was from inception to October, 2022. Endnote X9 software was used to manage the literature. Cochrane Manual 5.1.0 was used for quality assessment, and RevMan 5.4 software was used for meta-analysis. Results A total of 20 randomized controlled trials were included in the study, with the intervention group using isokinetic muscle training of the lower extremities or combined with conventional rehabilitation training and the control group using conventional rehabilitation training and/or other intervention, with a total of 1448 study subjects. Meta-analysis results showed that the differences in knee flexion peak torque [mean difference (MD)=5.85 N·m, 95% confidence interval (CI) (4.84, 6.85) N·m, P<0.00001], knee extension peak torque [MD=9.09 N·m, 95%CI (4.83, 13.36) N·m, P<0.0001], Time Up Go test [MD=–4.70 s, 95%CI (–6.68, –2.72) s, P<0.00001], 10-meter walking test [MD=–4.71 s, 95%CI (–9.12, –0.31) s, P=0.04], Fugl-Meyer Lower Extremity Motor Function Assessment score [MD=6.61, 95%CI (3.52, 9.70), P<0.0001], and Berg Balance Scale score [MD=5.61, 95%CI (0.91, 10.31), P=0.02] were statistically significant. Conclusion Isokinetic training may improve knee strength and functional walking ability in post-stroke patients, but there is still no strong evidence of improvement in motor function and balance.
ObjectiveTo explore the association of elongase of very long chain fatty acids family member 6 (ELOVL6) gene with increased risk of large-artery atherosclerosis stroke (LAA) in Han Chinese population in Chengdu.MethodsHan Chinese populations in Chengdu, Sichuan were chosen for this study using the case-control design between January 2015 and December 2017. The genotypes and haplotypes of six single nucleotides polymorphisms (SNPs) of ELOVL6 gene (rs3813825, rs17041272, rs4141123, rs9997926, rs6824447, and rs12504538) were analyzed in different genetic models in entire samples, and gene-enviromental interaction analyses were also carried out to get an insight of the risk factors for LAA. At the same time, we also analyzed the gene expression profile in peripheral blood mononuclear cells between groups.ResultsA total of 240 LAA cases and 211 healthy controls were enrolled in this study. All the enrolled subjects presented CC genotype of rs9997926, while the other five SNPs (rs3813825, rs17041272, rs4141123, rs6824447, and rs12504538) were genotyped successfully in all the enrolled subjects. rs17041272 polymorphism and TGTTG haplotype were significantly associated with LAA risk in studied population [CC/(CG+GG): odds ratio (OR)=0.640, 95% confidence interval (CI) (0.423, 0.968), P=0.034; TGTTG: OR=1.776, 95%CI (1.069, 2.951), P=0.024], and the interaction among rs17041272, rs6824447 SNPs and dyslipidemia increased susceptibility to LAA [OR=2.737, 95%CI (1.715, 4.368), P<0.001]. The ELOVL6 gene expression level was higher in LAA subjects (t=−3.167, P=0.003).ConclusionsELOVL6 gene is associated with LAA risk in Han nationality of Chinese population in Chengdu, and the interaction of gene-environmental risk factors could be of great importance in pathophysiology of LAA.
Objective To explore the awareness of thrombolytic therapy for acute ischemic stroke in inpatients with a history of stroke and with a high risk of stroke. Methods From January to August 2012, using self-designed questionnaire, trained neurologists conducted the face to face investigation in 500 inpatients with a high risk of stroke, including those with a history of stroke in Department of Neurology in the Second Affiliated Hospital of Chongqing Medical University. Results A total of 467 valid questionnaires were recovered. Only 16.1% (75/467) patients were aware of thrombolytic therapy for acute stroke, of whom 50.7% (38/75) knew the time window of thrombolytic therapy. Awareness of thrombolytic therapy was higher in patients aged 56-70 years, with a higher level of education and income, and in those who knew at least 3 stroke warning signs and those with a history of stroke. While awareness of the time window of thrombolytic therapy was higher in those unmarried or widowed and with a history of stroke. Multiple logistic regression analysis showed that awareness of thrombolytic therapy was independently associated with age, education level, knowledge of stroke warning signs and a history of stroke; awareness of the time window was associated with marital status and a history of stroke (P<0.05). Conclusions Inpatients with a history of stroke and with a high risk of stroke in the Department of Neurology have poor awareness of thrombolytic therapy for acute ischemic stroke. It is necessary to improve the level of patients’ knowledge about thrombolytic therapy for acute stroke by health education.
Objective To investigate the incidence of perioperative stroke in elderly patients (≥65 years) undergoing offpump coronary artery bypass grafting (OPCAB) versus onpump coronary artery bypass grafting (CABG). Methods WTBZ]We electronically searched PubMed (from 1966 to 2010), Cochrane Library (Issue 12, 2010), EMbase (from 1974 to 2010), CNKI (Chinese, from 1997 to 2010), CBM (Chinese, from 1989 to 2010), and manually searched some journals to collect published or grey literatures of clinical researches on comparison between OPCAB and CABG for elderly patients in the incidence of perioperative strokes. We assessed the methodology quality of included researches and extracted data to conduct metaanalysis by RevMan 5.0 software. Four subgroups (aged 65 to 70 years, 70 to 75 years, 75 to 80 years, and older than 80 years) according to the age of the patients, and subgroups according to the study design were analyzed respectively. Sensitivity analysis was conducted by deleting the studies of low quality. Results We finally identified 17 studies including 5 historical cohort studies and 12 case control studies. No randomized controlled trial was searched. A total of 7 275 patients including 2 521 (34.65%) in the OPCAB group and 4 754 (65.35%) in the CABG group were identified. The metaanalyses of historical cohort study subgroup and case control study subgroup showed statistical difference in stroke incidence between the OPCABG and CABG groups with OR 0.25 and 95%CI 0.10 to 0.62,and with OR 0.25 and 95%CI 0.15 to 0.41,respectively. Statistical difference was tested in three age subgroups (70 to 75 years, 75 to 80 years, and elder than 80 years) and the OR (95%CI) value was 0.35 (0.21, 0.59), 0.14 (0.04, 0.54), and 0.09 (0.02, 0.38),respectively. The difference of stroke incidence between OPCAB and CABG patients in all the three subgroups was significant, while there was no statistical difference in the subgroup aged 65 to 70 years with OR 0.10 and 95%CI 0.01 to 1.68. The sensitvity analysis showed that metaanalysis was stable in case control study subgroup, was not stable in historical cohort study subgroup. Conclusions OPCAB may reduce incidence of perioperative stroke in elderly patients. However, it still needs to be confirmed by more multicenter, largesample, and randomized doubleblind controlled trials in the future.
Magnetic resonance imaging (MRI) plays a crucial role in the diagnosis of ischemic stroke. Accurate segmentation of the infarct is of great significance for selecting intervention treatment methods and evaluating the prognosis of patients. To address the issue of poor segmentation accuracy of existing methods for multiscale stroke lesions, a novel encoder-decoder architecture network based on depthwise separable convolution is proposed. Firstly, this network replaces the convolutional layer modules of the U-Net with redesigned depthwise separable convolution modules. Secondly, an modified Atrous spatial pyramid pooling (MASPP) is introduced to enlarge the receptive field and enhance the extraction of multiscale features. Thirdly, an attention gate (AG) structure is incorporated at the skip connections of the network to further enhance the segmentation accuracy of multiscale targets. Finally, Experimental evaluations are conducted using the ischemic stroke lesion segmentation 2022 challenge (ISLES2022) dataset. The proposed algorithm in this paper achieves Dice similarity coefficient (DSC), Hausdorff distance (HD), sensitivity (SEN), and precision (PRE) scores of 0.816 5, 3.668 1, 0.889 2, and 0.894 6, respectively, outperforming other mainstream segmentation algorithms. The experimental results demonstrate that the method in this paper effectively improves the segmentation of infarct lesions, and is expected to provide a reliable support for clinical diagnosis and treatment.
Stroke is one of the most health-threatening diseases in the world, with high incidence and high morbidity. Despite the development of stroke therapy and improved systems to recognize stroke symptoms and deliver care promptly, only a minority of patients with acute stroke receive thrombolytic therapy, and many of them remain with residual functional deficits. Thus, the need for effective stroke rehabilitation is likely to remain an essential part of the continuum of stroke care for the foreseeable future. This review summarizes and analyzes the results of literatures on stroke rehabilitation in recent years, briefly describes the rehabilitation techniques and progress in dyskinesia, speech barrier, dysphagia, emotional disorder and spasticity after stroke, to provide some references for the optimization of rehabilitation treatment.
Objective To systematically review the efficacy of six cognitive interventions on cognitive function of patients with mild cognitive impairment after stroke. Methods The PubMed, EMbase, Cochrane Library, SinoMed, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials on the effects of non-drug interventions on the cognitive function of patients with mild cognitive impairment after stroke from inception to March 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using Openbugs 3.2.3 and Stata 16.0 software. Results A total of 72 studies involving 4 962 patients were included. The results of network meta-analysis showed that the following five cognitive interventions improved the cognitive function of stroke patients with mild cognitive impairment: cognitive control intervention (SMD=−1.28, 95%CI −1.686 to −0.90, P<0.05) had the most significant effect on the improvement of cognitive function, followed by computer cognitive training (SMD=−1.02, 95%CI −1.51 to −0.53, P<0.05), virtual reality cognitive training (SMD=−1.20, 95%CI −1.78 to −0.62, P<0.05), non-invasive neural regulation (SMD=−1.09, 95%CI −1.58 to −0.60, P<0.05), and cognitive stimulation (SMD=−0.94, 95%CI −1.82 to −0.07, P<0.05). Conclusion Five cognitive interventions are effective in improving cognitive function for stroke patients with mild cognitive impairment, among which cognitive control intervention is the most effective. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To discuss the feasibility of treating the brain ischemic stroke by the co-transplantation of the neural stem cells(NSCs) and the endothelial progenitor cells(EPCs). Methods The original biomedical articles concerned with the treatment of the brain ischemic therapy by the use of the NSCs and the EPCs were extensively reviewed as well as retrieved and analyzed. Results The review revealed that the NSCs and the EPCs could migrate to the injured area due to brain ischemic stroke, the environment of the local microcirculation could induce the neurogenesis and the vasculogenesis to repair the injury, and the neurogenesis and vasculogenesis could promote each other. Conclusion The co-transplantation of the NSCs and the EPCscan represent a new promising strategy formore effectively solving the two difficult problems of the neural cell loss andthe vascular obstruction caused by the brain ischemic stroke.