Journal of neuroimaging : official journal of the American Society of Neuroimaging, 1994
Transcranial Doppler ultrasound provides a useful adjunct to extracranial ultrasound in the diagn... more Transcranial Doppler ultrasound provides a useful adjunct to extracranial ultrasound in the diagnosis of carotid bifurcation disease. Previous studies have shown that collateral flow patterns and diminished flow velocities in the ipsilateral middle cerebral artery correlate with hemodynamically significant carotid disease. In a series of 7,054 carotid duplex and transcranial Doppler examinations, 12.5% (95% confidence interval [CI]: 8.7, 16.4) of 287 ophthalmic arteries ipsilateral to an apparent carotid occlusion had no detectable flow signal, compared with 0.5% (95% CI: 0.3, 0.7) of 6,767 ophthalmic arteries ipsilateral to a non-occluded carotid artery (p < 0.001). Carotid siphon signals were not detectable in 24.4% (95% CI: 19.4, 29.4) of arteries ipsilateral to the carotid occlusion, versus 1.0% (95% CI: 0.8, 1.3) ipsilateral to nonoccluded carotid arteries (p < 0.001). A significant number of absent ophthalmic artery and carotid siphon signals (5.7 and 8.7%, respectively)...
The aim of this study was to assess the specific influence of age on basal functional status and ... more The aim of this study was to assess the specific influence of age on basal functional status and rehabilitation results. We conducted a case-comparison study on 150 stroke inpatients. They were enrolled in homogeneous subgroups, matched for severity of stroke (measured by Canadian Neurological Scale - CNS) and onset admission interval (within 3 days) and divided into five subgroups according to age: <or=50; 51-64; 65-74; 75-84; and >or=85 years. Even when severity of stroke was the same, increasing age was associated with greater disability in activities of daily living (ADL) and mobility, minor results of rehabilitation treatment and shorter length of stay. Patients >or=85 years were nearly ten times as likely to show a low response in ADL (OR = 9.28, 95% CI = 2.89-29.76) and nearly six times in mobility (OR = 6.13, 95% CI = 2.18-17.25) than younger patients. However, rehabilitation treatment was efficacious also in patients >or=85 years, with effectiveness of treatment...
Background and Purpose—We sought to assess the specific influence of sex on rehabilitation result... more Background and Purpose—We sought to assess the specific influence of sex on rehabilitation results. Methods—A case-control study in 440 consecutive patients with sequelae of first ischemic stroke were enrolled in 2 subgroups (males and females) and matched for severity of stroke (evaluated by means of the Canadian Neurological Scale), age (within 1 year), and onset-admission interval (within 3 days). Functional
Transcranial direct current stimulation (tDCS) of the motor cortex seems to be effective in impro... more Transcranial direct current stimulation (tDCS) of the motor cortex seems to be effective in improving motor performance in patients with chronic stroke, while some recent findings have reported conflicting results for the subacute phase. We aimed to verify whether upper extremity motor rehabilitation could be enhanced by treatment with tDCS administered before a rehabilitative session. Hand dexterity and force in 16 individuals with subacute stroke were assessed before (T0) and after anodal stimulation (T1) and after a successive session of motor rehabilitation (T2) in a double-blind, randomized, sham-controlled, crossover trial. To confirm the value of the device as a specific effector, behavioral tests were also administered. Anodal and sham stimulation plus rehabilitation significantly improved manual dexterity (repeated-measure Anova: A-tDCS: p = 0.005; S-tDCS: p = 0.042). Post hoc analysis revealed a significant stimulation effect only for A-tDCS (p = 0.013 between T0 and T1) a...
Control of gait is usually altered following stroke, and it may be further compromised by overexe... more Control of gait is usually altered following stroke, and it may be further compromised by overexertion and fatigue. This study aims to quantitatively assess patients' gait stability during six-minute walking, measuring upper body accelerations of twenty patients with stroke (64 ± 13 years old) and ten age-matched healthy subjects (63 ± 10 years old). Healthy subjects showed a steady gait in terms of speed and accelerations over the six minutes. Conversely, the patients unable to complete the test (n = 8) progressively reduced their walking speed (−22±11%, confidence interval CI 95% : −13, −29%, P = 0.046). Patients able to complete the test (n = 12) did not vary their walking speed over time (P = 0.493). However, this ability was not supported by an adequate capacity to maintain their gait stability, as shown by a progressive increase of their upper body accelerations (+5 ± 11%, CI 95% : −1; +12%, P = 0.010). Walking endurance and gait stability should be both quantitatively assessed and carefully improved during the rehabilitation of patients with stroke.
Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study ... more Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study was to establish whether PCI is a valid indicator in subacute stroke patients of energy cost of walking in different walking conditions, that is, over ground and on the Gait Trainer (GT) with body weight support (BWS). The study tested if correlations exist between PCI and ECW, indicating validity of the measure and, by implication, validity of PCI. Six patients (patient group (PG)) with subacute stroke and 6 healthy age- and size-matched subjects as control group (CG) performed, in a random sequence in different days, walking tests overground and on the GT with 0, 30, and 50% BWS. There was a good to excellent correlation between PCI and ECW in the observed walking conditions: in PG Pearson correlation was 0.919 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001); in CG Pearson correlation was 0.852 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In conclusion, the high significant correlations between PCI and ECW, in all the observed walking conditions, suggest that PCI is a valid outcome measure in subacute stroke patients.
Transcranial direct current stimulation (tDCS) is a noninvasive technique that is emerging as a p... more Transcranial direct current stimulation (tDCS) is a noninvasive technique that is emerging as a prospective therapy for different neurologic disorders. Previous studies have demonstrated that anodal and cathodal stimulation can improve motor performance in terms of dexterity and manual force. The objective of this study was to determine whether different electrodes' setups (anodal, cathodal, and simultaneous bilateral tDCS) provide different motor performance and which montage was more effective. As secondary outcome, we have asked to the patients about their satisfaction, and to determine if the bilateral tDCS was more uncomfortable than unilateral tDCS. Nine patients with stroke in subacute phase were enrolled in this study and randomly divided in three groups. Our results showed that tDCS was an effective treatment if compared to Sham stimulation (P = 0.022). In particular, anodal stimulation provided the higher improvement in terms of manual dexterity. Cathodal stimulation s...
Le malattie cerebrovascolari rappresentano un'emergenza sanitaria in prevedibile espansione nei p... more Le malattie cerebrovascolari rappresentano un'emergenza sanitaria in prevedibile espansione nei paesi occidentali, tanto che vengono considerate come una vera e propria "pandemia" 1 , sia per l'aumento di incidenza strettamente legato al progressivo invecchiamento della popolazione, sia per la presenza di minore mortalità associata alla fase acuta, rispetto al passato. In ogni caso, questa patologia rappresenta una condizione morbosa di primaria importanza, non solo in considerazione della elevata incidenza e della complessità assistenziale che richiede, ma anche a causa delle importanti conseguenze che ne derivano, in termini di disabilità residua, principale causa di disabilità nella popolazione generale 2 .
Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehab... more Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehabilitation's efforts are tended to avoid long-term impairments, but, actually, the rehabilitative outcomes are still poor. Novel tools based on new technologies have been developed to improve the motor recovery. In this paper, we have taken into account seven promising technologies that can improve rehabilitation of patients with stroke in the early future: (1) robotic devices for lower and upper limb recovery, (2) brain computer interfaces, (3) noninvasive brain stimulators, (4) neuroprostheses, (5) wearable devices for quantitative human movement analysis, (6) virtual reality, and (7) tablet-pc used for neurorehabilitation.
There is a clinical imperative for noninvasive tests for carotid disease that have high sensitivi... more There is a clinical imperative for noninvasive tests for carotid disease that have high sensitivity. Previous studies have shown that transcranial Doppler ultrasound (TCD) can identify intracranial collateral flow patterns and other hemodynamic consequences of carotid occlusion. We hypothesized that a battery of such TCD findings would have a greater sensitivity than any one TCD finding alone and would have clinical utility in identifying carotid disease. We determined the prevalence of seven TCD findings in patients with various degrees of carotid stenosis as measured by a blinded observer on 138 cerebral angiograms. We further determined the sensitivity and specificity of any one finding or any single abnormality in the TCD battery (the combination of all seven findings) for identifying severe (&gt; or = 70%) carotid stenosis by angiography. The following four individual TCD findings were associated (P &lt; .001) with &gt; or = 70% carotid stenosis on cerebral angiography: ophthalmic and anterior cerebral artery flow reversal and low middle cerebral artery flow acceleration and pulsatility. The presence of any single abnormality in the TCD battery had a similar association (P &lt; .001) with &gt; or = 70% carotid stenosis. The individual TCD findings had sensitivities of 3% to 83% and specificities of 60% to 100% for identifying &gt; or = 70% carotid stenosis. The TCD battery had a sensitivity of 95% and specificity of 42% for identifying &gt; or = 70% carotid stenosis. A battery of TCD findings that can be routinely measured reliably identified patients with &gt; or = 70% angiographic internal carotid artery stenosis with high sensitivity.
Background and Purpose-The goal of this study was to assess the specific influence of stroke etio... more Background and Purpose-The goal of this study was to assess the specific influence of stroke etiology on rehabilitation results. Methods-This was a case-control study of 270 inpatients with sequelae of first stroke who were enrolled in homogeneous subgroups and matched for stroke severity, basal disability, age (within 1 year), sex, and onset admission interval (within 3 days) who were different only in terms of stroke origin, infarction versus hemorrhage. We compared the groups' length of stay, efficiency and effectiveness of treatment, and percentage of low and high responder patients. Odds ratios of dropouts and of low and high therapeutic response were also quantified.
Robotic-assisted walking training after stroke aims to enhance the odd of regaining independent g... more Robotic-assisted walking training after stroke aims to enhance the odd of regaining independent gait. Recent studies have suggested that this approach is more effective than conventional therapy alone only in severely affected patients. We determined whether these results persist at long-term follow-up. Forty-eight nonambulant participants after subacute stroke were stratified by motricity index into high (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;29) and low (≥29) motor impairment groups. Each arm was randomized to a robotic or control group at a mean of 20 days after stroke. All patients underwent 2 therapy sessions per day, 5 days per week, for 3 months. Robotic group subjects underwent 20 sessions of robotic-assisted gait training in the first 4 weeks of inpatient therapy and abbreviated conventional therapy, whereas control group patients received only conventional gait training. The primary outcome was Functional Ambulation Category, and secondary measures were the Rivermead Mobility Index and Barthel Index scores. The scales were administered before and after the inpatient stay and 2 years after discharge. At follow-up, as at discharge, the low motricity robotic group improved more than the control group counterpart with regard to functional ambulation category (4.7±0.5 versus 3.1±1.5, P=0.002), Barthel Index (76.9±11.5 versus 64.7±14.0, P=0.024), and Rivermead Mobility Index (11.8±3.5 versus 7.0±3.6, P=0.010), whereas conventional and robotic therapies were equally effective in the high motricity groups. The higher efficacy of the combination of robotic therapy and conventional therapy versus conventional therapy alone that was observed at discharge only in patients with greater motor impairments was sustained after 2 years.
We describe a young woman who presented with minor stroke as a first clinical symptom of Sjögren&... more We describe a young woman who presented with minor stroke as a first clinical symptom of Sjögren&#39;s syndrome (SS) in the absence of well-known risk factors for cerebrovascular disease. The medical history included recurrent miscarriages and sun rashes, which directed the diagnosis toward immunologic disorders such as systemic lupus erythematosus and antiphospholipid antibody syndrome, which are often associated with stroke. Only complete laboratory testing, including SSB antibody studies, and ophthalmologic and salivary gland evaluation revealed the correct diagnosis. Sjögren&#39;s syndrome should be considered among the causes of stroke, especially in a young female patient.
Alert me when this article is cited Alert me if a correction is posted Citation Map Abstract Top ... more Alert me when this article is cited Alert me if a correction is posted Citation Map Abstract Top Abstract Introduction Subjects and Methods Results Discussion References
We would like to thank Dr Tsuda for his interest in our recent publication which showed a differe... more We would like to thank Dr Tsuda for his interest in our recent publication which showed a difference in the effect of preadmission statins on ischemic stroke outcomes between blacks and whites. 1 Dr Tsuda provides a good summary for the role that statins may play in affecting ...
Robotic-assisted walking training after stroke aims to enable highly impaired patients to walk in... more Robotic-assisted walking training after stroke aims to enable highly impaired patients to walk independently, but results have been mixed. The authors aimed to identify the characteristics of patients who may be most likely to benefit. A total of 48 participants with motor and gait dysfunction following subacute stroke were stratified by the motricity index into high (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;29) and low (≥ 29) motor impairment groups. Each arm was randomized to a robotic or control group (RG or CG) at a mean of 20 days after stroke. All patients underwent 2 therapy sessions per day, 5 days per week for 3 months. Those in the RG underwent 20 sessions of robotic-assisted gait training in the first 4 weeks of inpatient therapy using controlled endpoint trajectories and abbreviated conventional therapy, whereas the CG received only conventional gait training. The primary outcome was the functional ambulation category (FAC), and secondary measures were the Rivermead mobility index (RMI) and 6-minute walking distance, all evaluated at hospital admission and at discharge. The lower motricity group assigned to an electromechanical device significantly improved in the FAC (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), RMI (P = .001), and walking distance (P = .029). Conventional and robotic therapies were equivalent in the higher motricity arm. Robotic therapy combined with conventional therapy may be more effective than conventional therapy alone in patients with greater motor impairment during inpatient stroke rehabilitation.
To investigate the correlation between changes in cerebral functional activity during mental enga... more To investigate the correlation between changes in cerebral functional activity during mental engagement and the potential for neurologic recovery after stroke. Transcranial Doppler ultrasonography (TCD) makes it possible to detect the dynamic adjustment of cerebral perfusion related to functional neuronal changes. TCD monitoring of flow velocity changes in the middle cerebral artery of 29 ischemic stroke patients was performed during an object recognition task. The study took place within 4 weeks from stroke onset. Based on recovery occurring after 2 months, the patients were divided into four groups depending on the side of hemispheric lesion and the presence or absence of neurologic recovery. Ten healthy subjects served as control subjects. During the recognition task, control subjects showed a bilateral increase in flow velocity with respect to the rest phase (right side, 7.02 +/- 1.3%; left side, 6.65 +/- 1. 1%), with no side-to-side difference. In patients who experienced recovery, a similar pattern of bilateral activation was observed, irrespective of the side of the lesion. Conversely, in patients with no recovery, the increase of flow velocity was significantly higher on the side contralateral to the brain lesion (p &lt; 0.0001) with respect to the lesion side. Performance during the recognition task was comparable in the four groups of patients. These findings suggest that satisfactory recovery from a neurologic deficit requires the persistence of functional activity in the damaged hemisphere despite the presence of an anatomic lesion. The possibility of obtaining early prognostic indications with TCD may be relevant for an early selection of patients with the best probability of benefiting from rehabilitation therapy.
The Italian Journal of Neurological Sciences, 1997
The genetic anticipation phenomenon has been described in several neurological disorders, often a... more The genetic anticipation phenomenon has been described in several neurological disorders, often associated with unstable trinucleotide repeats in the affected genes. The occurrence of this phenomenon in hereditary essential tremor is still debated. We describe a family in which three male members with essential tremor showed a progressive anticipation in onset age and an increased severity of clinical symptomatology.
The objectives of this study were to investigate the efficacy of bromocriptine (BR) combined with... more The objectives of this study were to investigate the efficacy of bromocriptine (BR) combined with speech therapy (ST) to improve a late recovery in non-fluent aphasic stroke patients. We performed a double-blind study with high dosage of BR, prescribed according to a dose-escalating protocol, comprehensive of clinical data, relatives&#39; impression, and language evaluations. The study was divided into the following phases: t-0, inclusion; t-30, language re-test to evaluate the stability of aphasia; t-90, placebo (PL) and ST; t-150, BR and ST; t-210, BR; t-270, wash-out. With respect to the baseline assessment, a significant improvement was observed in the following tests: dictation (F, 4.8; p &lt; .004), reading-comprehension (F, 8.1; p &lt; .0003), repetition (F, 3.8; p &lt; .01) and verbal latency (F, 4.9; p &lt; .01). High dosage of BR promoted a late recovery in stable chronic non-fluent aphasia and this improvement was enhanced by combination with ST.
Journal of neuroimaging : official journal of the American Society of Neuroimaging, 1994
Transcranial Doppler ultrasound provides a useful adjunct to extracranial ultrasound in the diagn... more Transcranial Doppler ultrasound provides a useful adjunct to extracranial ultrasound in the diagnosis of carotid bifurcation disease. Previous studies have shown that collateral flow patterns and diminished flow velocities in the ipsilateral middle cerebral artery correlate with hemodynamically significant carotid disease. In a series of 7,054 carotid duplex and transcranial Doppler examinations, 12.5% (95% confidence interval [CI]: 8.7, 16.4) of 287 ophthalmic arteries ipsilateral to an apparent carotid occlusion had no detectable flow signal, compared with 0.5% (95% CI: 0.3, 0.7) of 6,767 ophthalmic arteries ipsilateral to a non-occluded carotid artery (p < 0.001). Carotid siphon signals were not detectable in 24.4% (95% CI: 19.4, 29.4) of arteries ipsilateral to the carotid occlusion, versus 1.0% (95% CI: 0.8, 1.3) ipsilateral to nonoccluded carotid arteries (p < 0.001). A significant number of absent ophthalmic artery and carotid siphon signals (5.7 and 8.7%, respectively)...
The aim of this study was to assess the specific influence of age on basal functional status and ... more The aim of this study was to assess the specific influence of age on basal functional status and rehabilitation results. We conducted a case-comparison study on 150 stroke inpatients. They were enrolled in homogeneous subgroups, matched for severity of stroke (measured by Canadian Neurological Scale - CNS) and onset admission interval (within 3 days) and divided into five subgroups according to age: <or=50; 51-64; 65-74; 75-84; and >or=85 years. Even when severity of stroke was the same, increasing age was associated with greater disability in activities of daily living (ADL) and mobility, minor results of rehabilitation treatment and shorter length of stay. Patients >or=85 years were nearly ten times as likely to show a low response in ADL (OR = 9.28, 95% CI = 2.89-29.76) and nearly six times in mobility (OR = 6.13, 95% CI = 2.18-17.25) than younger patients. However, rehabilitation treatment was efficacious also in patients >or=85 years, with effectiveness of treatment...
Background and Purpose—We sought to assess the specific influence of sex on rehabilitation result... more Background and Purpose—We sought to assess the specific influence of sex on rehabilitation results. Methods—A case-control study in 440 consecutive patients with sequelae of first ischemic stroke were enrolled in 2 subgroups (males and females) and matched for severity of stroke (evaluated by means of the Canadian Neurological Scale), age (within 1 year), and onset-admission interval (within 3 days). Functional
Transcranial direct current stimulation (tDCS) of the motor cortex seems to be effective in impro... more Transcranial direct current stimulation (tDCS) of the motor cortex seems to be effective in improving motor performance in patients with chronic stroke, while some recent findings have reported conflicting results for the subacute phase. We aimed to verify whether upper extremity motor rehabilitation could be enhanced by treatment with tDCS administered before a rehabilitative session. Hand dexterity and force in 16 individuals with subacute stroke were assessed before (T0) and after anodal stimulation (T1) and after a successive session of motor rehabilitation (T2) in a double-blind, randomized, sham-controlled, crossover trial. To confirm the value of the device as a specific effector, behavioral tests were also administered. Anodal and sham stimulation plus rehabilitation significantly improved manual dexterity (repeated-measure Anova: A-tDCS: p = 0.005; S-tDCS: p = 0.042). Post hoc analysis revealed a significant stimulation effect only for A-tDCS (p = 0.013 between T0 and T1) a...
Control of gait is usually altered following stroke, and it may be further compromised by overexe... more Control of gait is usually altered following stroke, and it may be further compromised by overexertion and fatigue. This study aims to quantitatively assess patients' gait stability during six-minute walking, measuring upper body accelerations of twenty patients with stroke (64 ± 13 years old) and ten age-matched healthy subjects (63 ± 10 years old). Healthy subjects showed a steady gait in terms of speed and accelerations over the six minutes. Conversely, the patients unable to complete the test (n = 8) progressively reduced their walking speed (−22±11%, confidence interval CI 95% : −13, −29%, P = 0.046). Patients able to complete the test (n = 12) did not vary their walking speed over time (P = 0.493). However, this ability was not supported by an adequate capacity to maintain their gait stability, as shown by a progressive increase of their upper body accelerations (+5 ± 11%, CI 95% : −1; +12%, P = 0.010). Walking endurance and gait stability should be both quantitatively assessed and carefully improved during the rehabilitation of patients with stroke.
Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study ... more Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study was to establish whether PCI is a valid indicator in subacute stroke patients of energy cost of walking in different walking conditions, that is, over ground and on the Gait Trainer (GT) with body weight support (BWS). The study tested if correlations exist between PCI and ECW, indicating validity of the measure and, by implication, validity of PCI. Six patients (patient group (PG)) with subacute stroke and 6 healthy age- and size-matched subjects as control group (CG) performed, in a random sequence in different days, walking tests overground and on the GT with 0, 30, and 50% BWS. There was a good to excellent correlation between PCI and ECW in the observed walking conditions: in PG Pearson correlation was 0.919 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001); in CG Pearson correlation was 0.852 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In conclusion, the high significant correlations between PCI and ECW, in all the observed walking conditions, suggest that PCI is a valid outcome measure in subacute stroke patients.
Transcranial direct current stimulation (tDCS) is a noninvasive technique that is emerging as a p... more Transcranial direct current stimulation (tDCS) is a noninvasive technique that is emerging as a prospective therapy for different neurologic disorders. Previous studies have demonstrated that anodal and cathodal stimulation can improve motor performance in terms of dexterity and manual force. The objective of this study was to determine whether different electrodes' setups (anodal, cathodal, and simultaneous bilateral tDCS) provide different motor performance and which montage was more effective. As secondary outcome, we have asked to the patients about their satisfaction, and to determine if the bilateral tDCS was more uncomfortable than unilateral tDCS. Nine patients with stroke in subacute phase were enrolled in this study and randomly divided in three groups. Our results showed that tDCS was an effective treatment if compared to Sham stimulation (P = 0.022). In particular, anodal stimulation provided the higher improvement in terms of manual dexterity. Cathodal stimulation s...
Le malattie cerebrovascolari rappresentano un'emergenza sanitaria in prevedibile espansione nei p... more Le malattie cerebrovascolari rappresentano un'emergenza sanitaria in prevedibile espansione nei paesi occidentali, tanto che vengono considerate come una vera e propria "pandemia" 1 , sia per l'aumento di incidenza strettamente legato al progressivo invecchiamento della popolazione, sia per la presenza di minore mortalità associata alla fase acuta, rispetto al passato. In ogni caso, questa patologia rappresenta una condizione morbosa di primaria importanza, non solo in considerazione della elevata incidenza e della complessità assistenziale che richiede, ma anche a causa delle importanti conseguenze che ne derivano, in termini di disabilità residua, principale causa di disabilità nella popolazione generale 2 .
Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehab... more Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehabilitation's efforts are tended to avoid long-term impairments, but, actually, the rehabilitative outcomes are still poor. Novel tools based on new technologies have been developed to improve the motor recovery. In this paper, we have taken into account seven promising technologies that can improve rehabilitation of patients with stroke in the early future: (1) robotic devices for lower and upper limb recovery, (2) brain computer interfaces, (3) noninvasive brain stimulators, (4) neuroprostheses, (5) wearable devices for quantitative human movement analysis, (6) virtual reality, and (7) tablet-pc used for neurorehabilitation.
There is a clinical imperative for noninvasive tests for carotid disease that have high sensitivi... more There is a clinical imperative for noninvasive tests for carotid disease that have high sensitivity. Previous studies have shown that transcranial Doppler ultrasound (TCD) can identify intracranial collateral flow patterns and other hemodynamic consequences of carotid occlusion. We hypothesized that a battery of such TCD findings would have a greater sensitivity than any one TCD finding alone and would have clinical utility in identifying carotid disease. We determined the prevalence of seven TCD findings in patients with various degrees of carotid stenosis as measured by a blinded observer on 138 cerebral angiograms. We further determined the sensitivity and specificity of any one finding or any single abnormality in the TCD battery (the combination of all seven findings) for identifying severe (&gt; or = 70%) carotid stenosis by angiography. The following four individual TCD findings were associated (P &lt; .001) with &gt; or = 70% carotid stenosis on cerebral angiography: ophthalmic and anterior cerebral artery flow reversal and low middle cerebral artery flow acceleration and pulsatility. The presence of any single abnormality in the TCD battery had a similar association (P &lt; .001) with &gt; or = 70% carotid stenosis. The individual TCD findings had sensitivities of 3% to 83% and specificities of 60% to 100% for identifying &gt; or = 70% carotid stenosis. The TCD battery had a sensitivity of 95% and specificity of 42% for identifying &gt; or = 70% carotid stenosis. A battery of TCD findings that can be routinely measured reliably identified patients with &gt; or = 70% angiographic internal carotid artery stenosis with high sensitivity.
Background and Purpose-The goal of this study was to assess the specific influence of stroke etio... more Background and Purpose-The goal of this study was to assess the specific influence of stroke etiology on rehabilitation results. Methods-This was a case-control study of 270 inpatients with sequelae of first stroke who were enrolled in homogeneous subgroups and matched for stroke severity, basal disability, age (within 1 year), sex, and onset admission interval (within 3 days) who were different only in terms of stroke origin, infarction versus hemorrhage. We compared the groups' length of stay, efficiency and effectiveness of treatment, and percentage of low and high responder patients. Odds ratios of dropouts and of low and high therapeutic response were also quantified.
Robotic-assisted walking training after stroke aims to enhance the odd of regaining independent g... more Robotic-assisted walking training after stroke aims to enhance the odd of regaining independent gait. Recent studies have suggested that this approach is more effective than conventional therapy alone only in severely affected patients. We determined whether these results persist at long-term follow-up. Forty-eight nonambulant participants after subacute stroke were stratified by motricity index into high (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;29) and low (≥29) motor impairment groups. Each arm was randomized to a robotic or control group at a mean of 20 days after stroke. All patients underwent 2 therapy sessions per day, 5 days per week, for 3 months. Robotic group subjects underwent 20 sessions of robotic-assisted gait training in the first 4 weeks of inpatient therapy and abbreviated conventional therapy, whereas control group patients received only conventional gait training. The primary outcome was Functional Ambulation Category, and secondary measures were the Rivermead Mobility Index and Barthel Index scores. The scales were administered before and after the inpatient stay and 2 years after discharge. At follow-up, as at discharge, the low motricity robotic group improved more than the control group counterpart with regard to functional ambulation category (4.7±0.5 versus 3.1±1.5, P=0.002), Barthel Index (76.9±11.5 versus 64.7±14.0, P=0.024), and Rivermead Mobility Index (11.8±3.5 versus 7.0±3.6, P=0.010), whereas conventional and robotic therapies were equally effective in the high motricity groups. The higher efficacy of the combination of robotic therapy and conventional therapy versus conventional therapy alone that was observed at discharge only in patients with greater motor impairments was sustained after 2 years.
We describe a young woman who presented with minor stroke as a first clinical symptom of Sjögren&... more We describe a young woman who presented with minor stroke as a first clinical symptom of Sjögren&#39;s syndrome (SS) in the absence of well-known risk factors for cerebrovascular disease. The medical history included recurrent miscarriages and sun rashes, which directed the diagnosis toward immunologic disorders such as systemic lupus erythematosus and antiphospholipid antibody syndrome, which are often associated with stroke. Only complete laboratory testing, including SSB antibody studies, and ophthalmologic and salivary gland evaluation revealed the correct diagnosis. Sjögren&#39;s syndrome should be considered among the causes of stroke, especially in a young female patient.
Alert me when this article is cited Alert me if a correction is posted Citation Map Abstract Top ... more Alert me when this article is cited Alert me if a correction is posted Citation Map Abstract Top Abstract Introduction Subjects and Methods Results Discussion References
We would like to thank Dr Tsuda for his interest in our recent publication which showed a differe... more We would like to thank Dr Tsuda for his interest in our recent publication which showed a difference in the effect of preadmission statins on ischemic stroke outcomes between blacks and whites. 1 Dr Tsuda provides a good summary for the role that statins may play in affecting ...
Robotic-assisted walking training after stroke aims to enable highly impaired patients to walk in... more Robotic-assisted walking training after stroke aims to enable highly impaired patients to walk independently, but results have been mixed. The authors aimed to identify the characteristics of patients who may be most likely to benefit. A total of 48 participants with motor and gait dysfunction following subacute stroke were stratified by the motricity index into high (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;29) and low (≥ 29) motor impairment groups. Each arm was randomized to a robotic or control group (RG or CG) at a mean of 20 days after stroke. All patients underwent 2 therapy sessions per day, 5 days per week for 3 months. Those in the RG underwent 20 sessions of robotic-assisted gait training in the first 4 weeks of inpatient therapy using controlled endpoint trajectories and abbreviated conventional therapy, whereas the CG received only conventional gait training. The primary outcome was the functional ambulation category (FAC), and secondary measures were the Rivermead mobility index (RMI) and 6-minute walking distance, all evaluated at hospital admission and at discharge. The lower motricity group assigned to an electromechanical device significantly improved in the FAC (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), RMI (P = .001), and walking distance (P = .029). Conventional and robotic therapies were equivalent in the higher motricity arm. Robotic therapy combined with conventional therapy may be more effective than conventional therapy alone in patients with greater motor impairment during inpatient stroke rehabilitation.
To investigate the correlation between changes in cerebral functional activity during mental enga... more To investigate the correlation between changes in cerebral functional activity during mental engagement and the potential for neurologic recovery after stroke. Transcranial Doppler ultrasonography (TCD) makes it possible to detect the dynamic adjustment of cerebral perfusion related to functional neuronal changes. TCD monitoring of flow velocity changes in the middle cerebral artery of 29 ischemic stroke patients was performed during an object recognition task. The study took place within 4 weeks from stroke onset. Based on recovery occurring after 2 months, the patients were divided into four groups depending on the side of hemispheric lesion and the presence or absence of neurologic recovery. Ten healthy subjects served as control subjects. During the recognition task, control subjects showed a bilateral increase in flow velocity with respect to the rest phase (right side, 7.02 +/- 1.3%; left side, 6.65 +/- 1. 1%), with no side-to-side difference. In patients who experienced recovery, a similar pattern of bilateral activation was observed, irrespective of the side of the lesion. Conversely, in patients with no recovery, the increase of flow velocity was significantly higher on the side contralateral to the brain lesion (p &lt; 0.0001) with respect to the lesion side. Performance during the recognition task was comparable in the four groups of patients. These findings suggest that satisfactory recovery from a neurologic deficit requires the persistence of functional activity in the damaged hemisphere despite the presence of an anatomic lesion. The possibility of obtaining early prognostic indications with TCD may be relevant for an early selection of patients with the best probability of benefiting from rehabilitation therapy.
The Italian Journal of Neurological Sciences, 1997
The genetic anticipation phenomenon has been described in several neurological disorders, often a... more The genetic anticipation phenomenon has been described in several neurological disorders, often associated with unstable trinucleotide repeats in the affected genes. The occurrence of this phenomenon in hereditary essential tremor is still debated. We describe a family in which three male members with essential tremor showed a progressive anticipation in onset age and an increased severity of clinical symptomatology.
The objectives of this study were to investigate the efficacy of bromocriptine (BR) combined with... more The objectives of this study were to investigate the efficacy of bromocriptine (BR) combined with speech therapy (ST) to improve a late recovery in non-fluent aphasic stroke patients. We performed a double-blind study with high dosage of BR, prescribed according to a dose-escalating protocol, comprehensive of clinical data, relatives&#39; impression, and language evaluations. The study was divided into the following phases: t-0, inclusion; t-30, language re-test to evaluate the stability of aphasia; t-90, placebo (PL) and ST; t-150, BR and ST; t-210, BR; t-270, wash-out. With respect to the baseline assessment, a significant improvement was observed in the following tests: dictation (F, 4.8; p &lt; .004), reading-comprehension (F, 8.1; p &lt; .0003), repetition (F, 3.8; p &lt; .01) and verbal latency (F, 4.9; p &lt; .01). High dosage of BR promoted a late recovery in stable chronic non-fluent aphasia and this improvement was enhanced by combination with ST.
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