Elderly Stroke Rehabilitation: Overcoming the Complications and Its Associated Challenges

Lui, Siew Kwaon; Nguyen, Minh Nguyet

doi:10.1155/2018/9853837

Cited by 125 publications

(106 citation statements)

References 110 publications

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“…Up to 95% of stroke patients develop systemic (medical) complications [10,11] and/or neurological complications, as well as stroke syndromes [12,13]. These complications are not only a leading cause of death in stroke patients, with a mortality rate between 23% and 50%, but also pose a major challenge for post-stroke treatment and recovery and may delay or prevent aggressive rehabilitation [10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Post-Ischaemic Immunological Response in the Brain: Targeting Microglia in Ischaemic Stroke Therapy

et al. 2020

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Microglia, the major endogenous immune cells of the central nervous system, mediate critical degenerative and regenerative responses in ischaemic stroke. Microglia become “activated”, proliferating, and undergoing changes in morphology, gene and protein expression over days and weeks post-ischaemia, with deleterious and beneficial effects. Pro-inflammatory microglia (commonly referred to as M1) exacerbate secondary neuronal injury through the release of reactive oxygen species, cytokines and proteases. In contrast, microglia may facilitate neuronal recovery via tissue and vascular remodelling, through the secretion of anti-inflammatory cytokines and growth factors (a profile often termed M2). This M1/M2 nomenclature does not fully account for the microglial heterogeneity in the ischaemic brain, with some simultaneous expression of both M1 and M2 markers at the single-cell level. Understanding and regulating microglial activation status, reducing detrimental and promoting repair behaviours, present the potential for therapeutic intervention, and open a longer window of opportunity than offered by acute neuroprotective strategies. Pharmacological modulation of microglial activation status to promote anti-inflammatory gene expression can increase neurogenesis and improve functional recovery post-stroke, based on promising preclinical data. Cell-based therapies, using preconditioned microglia, are of interest as a method of therapeutic modulation of the post-ischaemic inflammatory response. Currently, there are no clinically-approved pharmacological options targeting post-ischaemic inflammation. A major developmental challenge for clinical translation will be the selective suppression of the deleterious effects of microglial activity after stroke whilst retaining (or enhancing) the neurovascular repair and remodelling responses of microglia.

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Section: Introductionmentioning

confidence: 99%

Post-Ischaemic Immunological Response in the Brain: Targeting Microglia in Ischaemic Stroke Therapy

et al. 2020

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“…Neurorehabilitation units are the primary services used in the subacute phase after stroke to promote functional recovery and regain independence. 1 The prevalent old age of stroke survivors (about 50% aged >75 years and 30% >85 years) 2,3 and the high prevalence of comorbidities (stroke occurs in isolation in <6% of patients) 4 negatively influences the success rate of rehabilitation, 2,5 making the treatment and recovery for stroke increasingly complex. To maximize functional gains and shorten the length of hospital stays, it is generally recommended to start rehabilitation as soon as patients are clinically stable, no later than 30 days after stroke.…”

Section: Introductionmentioning

confidence: 99%

A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial

Ambrosini

Peri

Nava

et al. 2020

Eur J Phys Rehabil Med

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This provisional PDF corresponds to the article as it appeared upon acceptance.A copyedited and fully formatted version will be made available soon. The final version may contain major or minor changes. Subscription: Information about subscribing to Minerva Medica journals is online at:http://www.minervamedica.it/en/how-to-order-journals.php Reprints and permissions: For information about reprints and permissionssend an email to: journals.dept@minervamedica.it -journals2.dept@minervamedica.it -journals6.dept@minervamedica.it EDIZIONI MINERVA MEDICA ABSTRACT BACKGROUND: Early interventions maximizing patient's involvement are essential to promote gait restoration and motor recovery after stroke. AIM: To evaluate the effects of a multimodal biofeedback training involving cycling augmented by Functional Electrical Stimulation (FES) and balance exercises on walking ability and motor recovery. DESIGN: Randomized controlled trial (NCT02439515). SETTING: Inpatient rehabilitation facility. POPULATION: Subacute stroke survivors (less than 6 months from the first event) with an age of up to 90 years old. METHODS: 68 participants were randomly allocated to an experimental group, performing 15 sessions of biofeedback FES-cycling training followed by 15 sessions of biofeedback balance training (20 minutes each) in addition to usual care (70 minutes), and a control group performing 30 sessions (90 minutes) of usual care. Participants were evaluated before training, after 15 sessions, after 30 sessions, and at 6-month follow-up through: gait speed (primary outcome), spatio-temporal gait parameters, Six Minute Walking Test, Functional Independence Measure, Motricity Index, Trunk Control Test, Berg Balance Scale, and Fall Efficacy Scale. RESULTS: Both groups significantly improved over time, but no group and interaction effects were found for any outcomes. The 73% of the experimental group achieved a clinically meaningful change in gait speed compared to the 38% of the control group (p-value=0.048).These percentages were even more unbalanced for patients with a moderate to severe gait impairment at baseline (91% versus 36%; p-value=0.008). COPYRIGHT© EDIZIONI MINERVA MEDICAThis document is

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“…Stroke is a condition predominantly affecting older people, with a greater disability impact than any other chronic disease. With the aging population, the burden of stroke will increase greatly during the next few decades, especially in developing countries …”

Section: Introductionmentioning

confidence: 99%

Sexual dysfunction after stroke—A biopsychosocial perspective

Htwe

Rehman

et al. 2020

Int J Clin Pract

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Objectives Poststroke sexual dysfunction (PSSD) is widespread and underrecognised, affecting over half of stroke patients with significant effects on a patients' quality of life. We reviewed the postulated factors contributing to PSSD and explore the underrecognition by presenting a questionnaire study as well as examining existing literature. Methods A literature search between January 1980 and December 2019 in electronic databases such as EMBASE, MEDLINE and PubMed was conducted. The questionnaire study involved all adult stroke patients attending the outpatient clinic over a 6‐month period, containing multiple choice and open questions relating to prevalence, impact and provision provided for patients with PSSD. Findings Poststroke sexual dysfunction is unlikely attributed solely to the physical effects of stroke. We present a biopsychosocial model summarising the wide range of factors which can contribute to PSSD. Less than 10% of patients receive any advice despite 90% of patients hoping for advice relating to sexual dysfunction in stroke. Interpretation and implications A multidisciplinary, proactive involvement in screening and managing PSSD is required to successfully manage a commonly forgotten complication of stroke. As part of the wider theme of managing lifestyle factors poststroke (eg, smoking, driving advice, dietary advice, alcohol), the ‘sexual function aspect’ of patients’ lives must not be ignored.

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Elderly Stroke Rehabilitation: Overcoming the Complications and Its Associated Challenges

Cited by 125 publications

References 110 publications

Post-Ischaemic Immunological Response in the Brain: Targeting Microglia in Ischaemic Stroke Therapy

Post-Ischaemic Immunological Response in the Brain: Targeting Microglia in Ischaemic Stroke Therapy

A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial

Sexual dysfunction after stroke—A biopsychosocial perspective

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