The complaints regarding sleep problems have not been well identified after a stroke. The aim of this study was to investigate the predictive factors of sleep quality and insomnia complaints in patients with stroke. A total of 70 subjects, 40 patients (57 ± 7 years) and 30 healthy controls (52 ± 6 years) assessed by the Pittsburgh Sleep Quality Index (PSQI) and the Sleep Habits Questionnaire took part in the study. The data were analyzed using the chi-square test, the Student's t-test and logistic regression analysis. On average, the patients showed poor sleep quality (patients: 6.3 ± 3.5; controls: 3.9 ± 2.2; p= 0.002) and insomnia complaint was the most prevalent (patients: 37.5%; controls: 6.7%; p= 0.007). The absence of insomnia complaint (OR= 0.120; 95%CI= 0.017-0.873; p= 0.036) and the decreased latency of sleep (OR= 0.120; 95%CI= 0.017-0.873; p= 0.036) were the protective factors of sleep quality. Female sex (OR= 11.098;; p= 0.036) and fragmented sleep (OR= 32.040;; p= 0.003) were the risk factors for insomnia complaint. We suggest that complaints of poor sleep quality and insomnia should be given priority assessment during clinical diagnosis of sleep disorders in stroke.

Various studies have been performed using the Social Rhythm Metric (SRM), though none has been developed with stroke patients. Stroke is a pathology that provokes a strong physical and social impact caused by an abnormality in cerebral circulation. Consequently, we performed two studies to validate the SRM and translate it into Portuguese, and to evaluate the regularity of the daily activities of stroke patients. Both healthy individuals and patients with unilateral cerebral lesions were evaluated. Subjects were of both sexes and between 45 and 65 yrs of age. Participants underwent clinical evaluation and recorded the time of 17 daily activities on the SRM for two weeks. Data were analyzed by the Pearson correlation and Fisher tests. After conceptual translation into Portuguese, corrections were made to arrive at the final version. Normative SRM scores varied from 3.2 to 7.0, suggesting that the activities presented in SRM adequately represented the daily routines of the patients. A correlation was found in SRM between the weeks (r=0.84; p=0.0001), indicating instrument reliability. The mean (+/-SD) score of the stoke patients was 4.8 (+/-1.0), and the correlation between the SRM and level of neurological damage showed that patients with lower SRM values were more physically compromised (r=-0.29; p=0.04), suggesting that SRM may be a clinical predictor. Activities related to eating and the sleep-wake cycle were rated by most patients. In all, 71% of the patients did not work, while 84% of healthy individuals did (p=0.001). Only 64% of patients left home compared to 90% of the healthy subjects (p=0.001), and 59% of patients recorded the activity of going home compared to 82% of healthy individuals (p=0.001). According to the results, there is evidence of the validity and reliability of the SRM, enabling it to be reliably used in chronobiological studies of stroke patients. Given that a less regular lifestyle may be associated with neurological compromise and a decrease in social activities, we suggest new studies with the repeated application of this instrument over the clinical evolution of the disease to better define improvement or worsening of the patient's condition in terms of their social and health aspects.

This study intended to evaluate the influence of stroke on memory processes (encoding, storage and retrieval) of visual and verbal stimuli and its implications to the motor practice. Twelve patients (6 with right and 6 with left brain lesions; 6-36 months post-lesion) and 12 healthy subjects, 45-65 years old from both sexes were studied. The encoding and storage processes were evaluated during test sessions where each subject had three attempts to identify two lists with 10 stimuli each (10 figures and 10 words referring to animals and objects). The retrieval process was evaluated by immediate free retrieval and by recognition tests. Data were analyzed by Mann-Whitney test. Performance was worse in patients (encoding -visual: p = 0.0001 and verbal: p = 0.0001; storage -verbal: p = 0.0001) and those with right lesions had worse performance in visual encoding (p = 0.0005) and those with left lesions had in verbal storage (p = 0.0246) and retrieval (p = 0.0001). According to results it is suggested that the patients were not able to adequately codify and store the information, however, they were adequately able to recover by recognition and this implicates the necessity to make a observational, distributed and varied practice in cerebrovascular disease patients therapy.

ABStRAct:In clinical practice, the physical therapist often evaluates and programs the patient's treatment without taking into account the temporal variation of functions and behaviors. The aim of this study was to analyze the influence of the chronotype (morning type -evening type), sleep-wake state (sleep quality and excessive sleepiness) and lifestyle regularity in determining the preferred time of day for physical and mental activities following stroke. Participants responded to the MorningnessEveningness Questionnaire (MEQ), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Social Rhythm Metric (SRM). The subjects were asked at what time of day they preferred to perform physical (exercises) and mental (tasks of reasoning) activities, considering only their well-being. A total of 42 patients (61±9 years) in the chronic stage after stroke (18±21 months) and 12 healthy individuals took part in the study. The data were analyzed using the χ 2 test and multiple regression. Among the patients evaluated, 64% had poor sleep quality, 43% excessive sleepiness and 57% an irregular daily routine. Regression analysis showed that chronotype was the only factor studied that influenced the preferred time of day for the activities. The results indicate the need for the physical therapist to analyze how chronotype can affect patient performance before establishing time of day of the physical therapy sessions.

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