Brain & NeuroRehabilitation最新文献

Lyme disease is a multisystem infection that can affect the joints, heart, and nervous system when untreated. While it can present with cranial nerve palsy, dysphagia is rarely reported. This case highlights a rare instance of dysphagia in Lyme disease, typically known for neurological symptoms like facial nerve palsy. Despite the absence of erythema migrans or a documented tick bite, the patient's facial palsy, hearing loss, vocal cord paralysis, and dysphagia were attributed to Lyme disease. With the rising prevalence of Lyme disease, similar cases may increase, particularly in endemic regions of North America, Europe, and parts of Asia, emphasizing the need for early diagnosis and treatment in patients with unexplained dysphagia.

Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulatory technique with potential in stroke rehabilitation by modulating cortical excitability. However, the optimal parameters, including electrode placement, current intensity, stimulation duration, and electrode size, remain poorly understood, and the interactions among these factors contribute to mixed results in motor recovery post-stroke. This review explores the various stimulation parameters and their impact on enhancing corticospinal excitability (CSE) and motor function recovery. Different electrode placement (montages), such as anodal, cathodal, and bi-hemispheric stimulation, have demonstrated varying effectiveness in restoring motor function. Bihemispheric stimulation demonstrated a larger effect size compared to other unihemispheric (anodal or cathodal) stimulation; however, its relative superiority remains inconclusive. Inter-individual anatomical variations, such as skull thickness, lesion location, and cortical atrophy, can affect tDCS outcomes, highlighting the need for personalized electrode placement guided by computational modeling based on brain imaging. Furthermore, stimulation intensity, typically 1-2 mA, exhibited nonlinear effects on CSE, contrasting with the dose-response relationships observed in earlier studies. Stimulation duration is also critical, with evidence suggesting that prolonged stimulation may reverse excitability-enhancing effects beyond a certain threshold. While smaller electrodes enhance focality, an appropriately sized electrode is necessary to effectively modulate electrical activity in the target region, with evidence suggesting a dose-response relationship between electrode size and motor recovery. Overall, the interplay among these parameters underscores the need for personalized and optimized tDCS protocols to achieve consistent motor recovery in stroke patients. Future research should focus on refining these parameters to maximize the therapeutic benefits of tDCS.

Sarcopenia is characterized by the progressive loss of muscle mass and strength and can be categorized as either primary or secondary. Patients who have experienced a stroke may develop sarcopenia, which can adversely impact their functional recovery. The pathophysiology of sarcopenia related to stroke involves nutritional deficiency, disuse atrophy, denervation, and metabolic disturbance. Various evaluation tools are available to diagnose this condition, assessing skeletal muscle mass, muscle strength, and physical function. However, due to the limitations of traditional sarcopenia diagnostic criteria in the context of stroke, there is pressing need to establish diagnostic standards that accurately reflect the disabilities experienced by patients with stroke.

This study analyzed the impact of post-stroke fatigue (PSF) on functional recovery in acute and subacute stroke patients during inpatient rehabilitation. Medical records of 177 patients were retrospectively reviewed. PSF was assessed using the Fatigue Severity Scale (FSS)-9. Patients were classified into two groups: a PSF group (mean FSS ≥ 4) and a non-PSF group (mean FSS < 4). Stroke severity was measured with the National Institutes of Health Stroke Scale, and functional outcomes were evaluated using Functional Ambulation Category (FAC), Berg Balance Test, Korean version of the Modified Barthel Index (K-MBI), and Mini-Mental State Examination-Korean version (MMSE-K). Statistical significance was set at p < 0.05. The prevalence of PSF was 52.5%. The repeated measures of analysis of variance showed significant "time" effects on FAC (F = 29.726, p < 0.001) and K-MBI (F = 15.348, p < 0.001). A significant "group" effect was observed on MMSE-K (F = 4.571, p = 0.035), and a "time × group" interaction on only K-MBI (F = 4.284, p = 0.041). Multivariable logistic regression analysis showed that improvements in K-MBI scores were independent of initial severity, depression, and age (p = 0.043). PSF affects the recovery of activities of daily living (ADL) in stroke patients, suggesting that regulating early fatigue after stroke positively affects functional recovery.

Post-stroke cognitive impairment (PSCI) is a common and significant disorder affecting a considerable proportion of stroke patients. PSCI is a known factor that increases the risk of mortality, dependency, and institutionalization in stroke patients. The early prediction of PSCI and the implementation of cognitive rehabilitation could enhance the quality of life of stroke patients and reduce the burden on their families. It is therefore imperative to identify risk factors for PSCIs in the early stages of stroke and to implement early cognitive rehabilitation with an appropriate prognosis. A number of risk factors for PSCI can be identified in patient characteristics, clinical findings, and imaging findings. It is unfortunate that the majority of factors associated with PSCI are non-modifiable. However, the only modifiable factor that can be controlled is the management of stroke risk factors for secondary prevention. Further research is needed to elucidate the potential benefits of various cognitive rehabilitation programs for the prevention and improvement of PSCI.

This meta-analysis aimed to evaluate the effect of constraint-induced movement therapy (CIMT) on arm function and daily living compared with conventional rehabilitation in stroke patients with hemiplegia. We searched three international electronic databases-MEDLINE, Embase, and the Cochrane Library-for relevant studies. The risk of bias was evaluated using Cochrane's Risk of Bias version 1.0, and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations method. A total of 34 randomized controlled trials (RCTs) were included herein. Specifically, 21 RCTs regarding arm motor function, 13 on upper limb motor impairment, and 12 on activities of daily living (ADL) performance were analyzed. The results of the meta-analysis demonstrated that CIMT was significantly more effective than conventional therapy in improving arm motor function, reducing upper limb motor impairment, and enhancing ADL performance. CIMT should be implemented and tailored to the strength of the affected upper limb to improve upper limb function and ADL performance in post-stroke patients with hemiplegia.

From the perspective of a Parkinson's patient, this paper aims to elucidate some of the unreasonable and difficult-to-understand realities in Korea, from diagnosis to treatment, with a view to improving the system and policies. Adequate procedures for furnishing information to patients following a diagnosis are lacking. To date, no websites have been established by doctors, public institutions, or the government to provide adequate information. This dearth of information creates a problematic situation that gives rise to patients receiving erroneous or misleading information, thereby wasting their time, financial resources, and ultimately, impacts their health. It is recommended that the government establish an authoritative organization to provide information about Parkinson's disease in order to prevent harm and promote non-motor and motor symptom treatments, such as psychotherapy, as demonstrated in the United States and the United Kingdom. In Korea, the Korea Parkinson Association, a nonprofit private organization, has initiated a campaign for understanding and consideration. With the support of the government and society, an environment can be created where people with Parkinson's disease can live with dignity as members of society.

Transcranial direct current stimulation (tDCS) has emerged as a valuable neuromodulation technique. Many clinical conditions are associated with brain damage, and in severe cases, structural changes such as skull defects are common. These clinical characteristics result in distinct electrical flow patterns during tDCS application compared to cases without brain damage. Recently, notable advancements have been made in both the medical and engineering fields pertaining to the use of in silico modelling and simulation with the aid of magnetic resonance imaging (MRI). As a result, it is now possible to conduct simulations tailored to the unique structural anatomy of an individual's brain, using their own MRI data, to provide targeted tDCS. We have developed software that performs both segmentation and simulation, and have conducted randomized controlled trials using optimized tDCS for stroke and disorders of consciousness. Additionally, we have carried out simulation-related research on stroke and burr hole surgery. This review examines various articles related to simulation and optimized tDCS, evaluating their clinical implications. We believe that these insights will provide valuable guidance for both current and future applications of tDCS.

Stroke frequently results in mobility impairments, contributing to an increased cardiovascular risk. Despite efforts to promote physical activity, stroke survivors fail to meet recommended levels. This secondary analysis of the 'Physical Fitness in Patients with Subacute Stroke' (Phys-Stroke) trial analyzes physical activity at 6 months post-stroke, and examines the effect of gains in walking capacity during the subacute phase on physical activity in the chronic stage. Phys-Stroke compared aerobic exercise vs relaxation in 200 stroke patients. Data from the 6-minute walk test (6MWT) pre and post intervention as well as accelerometry and questionnaire data at 6 months were used. Data was analyzed using mixed linear models and function-on-scalar regression. At 6 months after stroke, participants exhibited low daily step counts (5,623 ± 2,998 steps/day), with most activity occurring in the morning and midday. Per meter gained in the 6MWT during the intervention period, participants increased daily steps by 8.2 (95% confidence interval, 1.6 to 14.8, p = 0.017) at 6 months. Questionnaire data showed that engagement in sports activities was minimal, basic activities being the primary activity. Stroke survivors demonstrated suboptimal activity levels at 6 months but increases in walking capacity during the subacute stage did result in meaningful increases chronically.

Trial registration: ClinicalTrials.gov Identifier: NCT01953549.

To investigate the safety and efficacy of balance training for stroke patients with reduced balance ability by performing a meta-analysis of randomized controlled trials. The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to February 2022. Quality assessment was performed using the using the Cochrane risk of bias tool. Studies were included if: 1) patient allocation was randomized; 2) the participant was composed of stroke patients with reduced balance ability (Berg Balance Scale [BBS] ≤ 40, Timed-Up and Go ≥ 14 seconds, or Mini-Balance Evaluation Systems Test ≤ 17.5); and 3) intervention was additional balance training for the experimental group. Six studies including 466 patients were included in the final analysis. The meta-analysis showed a significant improvement in the BBS (mean difference [MD], 8.14; 95% confidence interval [CI], 4.65, 11.64) and Trunk Impairment Scale (MD, 4.71; 95% CI, 3.45, 5.96) after balance training relative to the comparison group. Ambulation function was significantly improved (standardized MD, 0.98; 95% CI, 0.46, 1.49) after balance training. There was one report of a femur fracture among 230 participants in the balance training group. Balance training in addition to conventional rehabilitation program in stroke patients with reduced balance ability appears to be effective and safe.