Effect of whole body vibration on spasticity in hemiplegic legs of patients with stroke

Background: Several reports have focused on the effects of whole body vibration (WBV) on spasticity with differing results. Most studies used modified Ashworth scale (MAS) for qualitative measurements, but the effect was small.

Objective: To investigate the effect of WBV on spasticity in hemiplegic legs of patients with stroke using F-wave parameters.

Methods: Sixteen patients with stroke (mean age, 54.7 ± 13.5 years: time after stroke, 28.0 ± 26.3 months) were enrolled in a comparative before-and-after intervention trial. WBV was applied at 30 Hz (4–8 mm amplitude) for 5 min on the hamstrings, gastrocnemius, and soleus muscles in a sitting position. Spasticity was assessed according to the F-wave parameters, MAS, and active and passive range of motion (A-ROM and P-ROM, respectively). These assessments were obtained before, immediately after, and 20 min after each intervention.

Results: The F-wave parameters, MAS score, and P-ROM improved significantly after the WBV and remained below the baseline level, even after 20 min; no such change was noted in the unaffected limb via the F-wave parameters. The WBV also improved volitional movement immediately after intervention, as indicated by the A-ROM.

Conclusions: These results confirmed a significant reduction of motor neuron excitability until 20 min after the WBV, as indicated by F-wave parameters.     

Muscle architecture and torque production in stroke survivors: an observational study

Objective: Spasticity poststroke leads to muscle weakness and soft tissue contracture, however, it is not clear how muscle properties change due this motor neural disorder. The purpose was to compare medial gastrocnemius muscle architecture and mechanical properties of the plantarflexor muscles between stroke survivors with spasticity and healthy subjects.

Methods: The study included 15 stroke survivors with ankle spasticity and 15 healthy subjects. An isokinetic dynamometer was used for the evaluation of maximal isometric plantarflexor torque and images of the medial gastrocnemius muscle were obtained using ultrasonography. Images were collected at rest and during a maximum voluntary contraction.

Results: The affected limb showed reduced fascicle excursion (0.9 ± 0.7 cm), shorter fascicle length, and reduced muscle thickness (0.095 ± 0.010% of leg length and 1.18 ± 0.20 cm, at rest) compared to contralateral (1.6 ± 0.4 cm, 0.106 ± 0.015% of leg length and 1.29 ± 0.24 cm, respectively) and to healthy participants (1.8 ± 0.7 cm, 0.121 ± 0.019% of leg length and 1.43 ± 0.22 cm, respectively). The contralateral limb showed lower force (between 32 and 40%) and similar architecture parameters compared to healthy participants.

Conclusion: The affected limb had a different muscle architecture that appears to result in lower force production. The contralateral limb showed a decrease in force compared to healthy participants due to the other neural impairments than muscle morphology. Spasticity likely leds to adaptations of muscle architecture in the affected limb and in force reductions in both limbs of stroke survivors.     

Reduction in spasticity in stroke patient with paraffin therapy

Purpose: The aim of the study was to confirm whether paraffin therapy offer clinical value in the treatment of spasticity due to stroke.

Methods: Fifty-two patients with spasticity in the upper limb were included. The patients were randomized into the experimental group with paraffin therapy (n = 27) and the control group with placebo therapy (n = 25). The outcome measures besides temperature examination were undertaken at time points of 0 (T0), 2 (T1) and 4 weeks (T2) following therapy treatment. The extent of spasticity was measured using Modified Ashworth Score (MAS) during passive movement at the shoulder, elbow, wrist and finger joints. Visual analogue scale (VAS) was used to evaluate the hemiplegic upper limb pain and functional activity of the upper limb motor function was evaluated by Brunnstrom recovery stage. All adverse events were recorded.

Results: MAS decreased significantly in Exp group compared with Con group, at the time points of T1 and T2, both before and immediately after paraffin therapy. Paraffin treatment failed to show remarkable improvement in pain compared with placebo-treated patient at movement at any time point. But VAS in Exp exhibited a tendency to decrease over time in shoulder, elbow, wrist and hand. With regard to the Brunnstrom score, patients in Exp showed significant improvement at the end of trial compared to the beginning. The values of temperature showed significant increment immediately after paraffin therapy at each time point in Exp group.

Conclusion: Paraffin therapy may be a kind of noninvasive, promising method to reduce spasticity of stroke patients.     

Home-based hand rehabilitation with a robotic glove in hemiplegic patients after stroke: a pilot feasibility study

Objective: To evaluate the feasibility and safety of home rehabilitation of the hand using a robotic glove, and, in addition, its effectiveness, in hemiplegic patients after stroke.

Methods: In this non-randomized pilot study, 21 hemiplegic stroke patients (Ashworth spasticity index ≤ 3) were prescribed, after in-hospital rehabilitation, a 2-month home-program of intensive hand training using the Gloreha Lite glove that provides computer-controlled passive mobilization of the fingers. Feasibility was measured by: number of patients who completed the home-program, minutes of exercise and number of sessions/patient performed. Safety was assessed by: hand pain with a visual analog scale (VAS), Ashworth spasticity index for finger flexors, opponents of the thumb and wrist flexors, and hand edema (circumference of forearm, wrist and fingers), measured at start (T0) and end (T1) of rehabilitation. Hand motor function (Motricity Index, MI), fine manual dexterity (Nine Hole Peg Test, NHPT) and strength (Grip test) were also measured at T0 and T1.

Results: Patients performed, over a mean period 56 (49–63) days, a total of 1699 (1353–2045) min/patient of exercise with Gloreha Lite, 5.1 (4.3–5.8) days/week. Seventeen patients (81%) completed the full program. The mean VAS score of hand pain, Ashworth spasticity index and hand edema did not change significantly at T1 compared to T0. The MI, NHPT and Grip test improved significantly (p = 0.0020, 0.0156 and 0.0024, respectively) compared to baseline.

Conclusion: Gloreha Lite is feasible and safe for use in home rehabilitation. The efficacy data show a therapeutic effect which need to be confirmed by a randomized controlled study.     

Effects of constraint-induced movement therapy for lower limbs on measurements of functional mobility and postural balance in subjects with stroke: a randomized controlled trial*

Background: Constraint-induced movement therapy (CIMT) is suggested to reduce functional asymmetry between the upper limbs after stroke. However, there are few studies about CIMT for lower limbs.

Objective: To examine the effects of CIMT for lower limbs on functional mobility and postural balance in subjects with stroke.

Methods: A 40-day follow-up, single-blind randomized controlled trial was performed with 38 subacute stroke patients (mean of 4.5 months post-stroke). Participants were randomized into: treadmill training with load to restraint the non-paretic ankle (experimental group) or treadmill training without load (control group). Both groups performing daily training for two consecutive weeks (nine sessions) and performed home-based exercises during this period. As outcome measures, postural balance (Berg Balance Scale – BBS) and functional mobility (Timed Up and Go test – TUG and kinematic parameters of turning – Qualisys System of movement analysis) were obtained at baseline, mid-training, post-training and follow-up.

Results: Repeated-measures ANOVA showed improvements after training in postural balance (BBS: F = 39.39, P < .001) and functional mobility, showed by TUG (F = 18.33, P < .001) and by kinematic turning parameters (turn speed: F = 35.13, P < .001; stride length: F = 29.71, P < .001; stride time: F = 13.42, P < .001). All these improvements were observed in both groups and maintained in follow-up.

Conclusions: These results suggest that two weeks of treadmill gait training associated to home-based exercises can be effective to improve postural balance and functional mobility in subacute stroke patients. However, the load addition was not a differential factor in intervention.     

Promoting physical activity in hospitalized patients with mild ischemic stroke: a pilot study

Background: Patients with acute stroke spend most of their hospital day inactive. However, a method to promote physical activity (PA) in stroke has not been established.

Objective: To evaluate the effectiveness of promoting PA by enhancing self-efficacy in hospitalized patients with mild ischemic stroke.

Design: Pre–post interventional study.

Methods: Hospitalized patients with mild ischemic stroke who could walk without assistance were recruited. We measured the daily number of steps taken as the index of daily hospitalized PA using an accelerometer. At the baseline measurement, patients did not receive accelerometer-based feedback. To promote hospitalized PA, a physical therapist provided instruction on the self-monitoring approach and discussed PA targets, encouraged the patients to walk more, and instructed them on the importance of PA after stroke. We also measured self-efficacy for PA using an assessment tool at the baseline and during the intervention.

Results: Twenty-two patients (62.5 years old, 68.2% men) were included. PA during the intervention was higher than that at the baseline measurement (5709.4 ± 2236.1 vs. 2813.9 ± 1511.9 steps/day, p < 0.001). Self-efficacy for PA during the intervention was also higher than that at the baseline measurement (76.4 ± 18.8 vs. 58.9 ± 29.0 points, p < 0.001).

Conclusions: Promoting PA by enhancing self-efficacy may increase PA and self-efficacy for PA in hospitalized patients with mild ischemic stroke. The present results might provide new strategies of PA promotion in these hospitalized patients.     

The use of virtual reality for balance among individuals with chronic stroke: a systematic review and meta-analysis

Background: Virtual reality (VR) is becoming a popular alternative to traditional upper and lower limb rehabilitation following a stroke.

Objective: To conduct a systematic review and meta-analysis on the effectiveness of VR interventions for improving balance in a chronic stroke (≥6 months) population.

Data sources: A literature search of Pubmed, Scopus, CINAHL, Embase, Psycinfo, and Web of Science databases was conducted.

Study selection: English randomized controlled trials published up to September 2015 assessing balance with VR in chronic stroke participants.

Data extraction: Mean and standard deviations from outcome measures were extracted. Pooled standard mean differences ± standard error were calculated for the Berg Balance Scale (BBS) and the Timed Up and Go test (TUG).

Results: In total, 20 studies were selected which assessed the Nintendo^® Wii Fit balance board (n = 7), treadmill training and VR (n = 7), and postural training using VR (n = 6). Significant improvements were found for VR interventions evaluating the BBS (n = 12; MD = 2.94 ± 0.57; p < 0.001) and TUG (n = 13; MD = 2.49 ± 0.57; p < 0.001). Sub-analyses revealed postural VR interventions had a significant effect on BBS (n = 5) and TUG (n = 3) scores (BBS: MD = 3.82 ± 0.79; p < 0.001 and TUG: MD = 3.74 ± 0.97; p < 0.001). VR and treadmill training (n = 5) had a significant effect on TUG scores (MD = 2.15 ± 0.89, p = 0.016).

Conclusion: Overall, VR interventions compared to conventional rehabilitation had significant improvements. The meta-analyses also suggest that the Nintendo^® Wii Fit balance board may not be effective, although further confirmatory studies are necessary. Results should be interpreted with caution due to differences in therapy intensities and effect sizes within the included studies.     

Comparison of the Mini-Balance Evaluations Systems Test with the Berg Balance Scale in relationship to walking speed and motor recovery post stroke*

Background: The Mini-BESTest is a recently developed balance assessment tool that incorporates challenging dynamic balance tasks. Few studies have compared the psychometric properties of the Mini-BESTest to the commonly used Berg Balance Scale (BBS). However, the utility of these scales in relationship to post stroke walking speeds has not been explored.

Objectives: The purpose of this study was to compare the sensitivity and specificity of the Mini-BESTest and BBS to evaluate walking speeds in individuals with stroke.

Design: A retrospective exploratory design.

Methods: Forty-one individuals with chronic stroke were evaluated with the Mini-BESTest, BBS, and 10-meter self-selected walk test (10MWT). Based on their self-selected gait speeds (below or above 0.8 m/s), participants were classified as slow and fast walkers.

Results: Significant linear correlations were observed between the Mini-BESTest vs. BBS (r = 0.72, p ≤ 0.001), Mini-BESTest vs. 10MWT (r = 0.58, p ≤ 0.001), and BBS vs. 10MWT (r = 0.30, p = 0.05). Independent t-tests comparing the balance scores for the slow and fast walkers revealed significant group differences for the Mini-BESTest (p = 0.003), but not for the BBS (p = 0.09). The Mini-BESTest demonstrated higher sensitivity (93%) and specificity (64%) compared to the BBS (sensitivity 81%, specificity 56%) for discriminating participants into slow and fast walkers.

Conclusions: The Mini-BESTest has a greater discriminative ability than the BBS to categorize individuals with stroke into slow and fast walkers.     

Strain sonoelastographic evaluation of biceps muscle intrinsic stiffness after botulinum toxin-A injection

Background: The most commonly used clinical tools for measuring spasticity are modified Ashworth scale (MAS) and Tardieu scale but both yield subjective rather than objective results. Ultrasound elastography (EUS) provides information on tissue stiffness and allows the qualitative or quantitative measurements of the mechanical properties of tissues.

Objective: To assess the stiffness of biceps brachialis muscles in stroke patients by strain EUS and to investigate the sonoelastographic changes and its correlations with clinical evaluation parameters after botulinum toxin-A (BTA) injections.

Methods: This is a prospective study. A total of 48 chronic stroke patients requiring BTA injections to biceps brachialis muscles were included in the study. All patients received injections with BTA to biceps brachialis muscles under ultrasound guidance. MAS, goniometric measurements, and strain EUS assessments were performed at preintervention and at 4-week postintervention.

Results: Strain index values of biceps muscle on the affected side were significantly increased compared with those on the unaffected side (p < 0.01). At 4 weeks after BTA injection, significant improvements were observed in MAS grades and goniometric measurements (p < 0.05). Statistically significant differences were also found between the MAS grades and strain index values in both pre-/postintervention period (p < 0.01). No significant correlations were observed between clinical parameters and strain EUS findings.

Conclusions: Strain EUS is a promising diagnostic tool for assessing stiffness in spastic muscles, in establishing the treatment plan and monitoring the effectiveness of the therapeutic modality.     

Effects of botulinum toxin A therapy and multidisciplinary rehabilitation on lower limb spasticity classified by spastic muscle echo intensity in post-stroke patients

Objectives: The purpose of the present study was to investigate retrospectively the relationship between botulinum toxin type A plus multidisciplinary rehabilitation and muscle echo intensity in post-stroke patients with spasticity. The primary aim was to investigate whether the effects of the intervention on the improvement of spasticity depend on muscle echo intensity, and the secondary aim was to investigate whether the motor function of the lower limbs depends on muscle echo intensity.

Methods: A 12-day inpatient protocol was designed for 102 post-stroke patients with spasticity due to lower limb paralysis. Muscle echo intensity of the triceps surae muscle was measured by ultrasonography, and the patients were categorized into four groups based on Heckmatt scale grades (Grades I–IV).

Results: All four groups classified by the Heckmatt scale showed significant pre-to-post-intervention differences in the knee and ankle modified Ashworth scale scores (p < 0.05). Grades I–III patient groups showed a significant improvement in lower limb motor function following intervention. Grade IV patients did not show a significant improvement in lower limb motor function.

Conclusions: We observed significant improvements in the modified Ashworth scale scores after botulinum toxin type A and multidisciplinary rehabilitation therapy on post-stroke patients with spasticity. Although patients with lower muscle echo intensity demonstrated improvements in motor function, the improvement was poor in those with higher muscle echo intensity.     

The improvement in respiratory function by inspiratory muscle training is due to structural muscle changes in patients with stroke: a randomized controlled pilot trial

Background: The changes effected by the inspiratory muscle training (IMT) on the structure of inspiratory muscles such as on the diaphragm, in patients with stroke, is unclear.

Objective: To investigate the effect of IMT on inspiratory function, diaphragm thickness, walking endurance, and fatigue in patients with stroke.

Methods: A total of 30 patients with stroke were randomized to either the experimental group or the control group. The experimental group (n = 15) underwent inspiratory muscle training with resistance adjusted to 30% of maximal inspiratory pressure, 90 breaths a day, 5 times a week for 6 weeks. Both groups received regular physical therapy for the same amount of time. The primary outcome measure was the diaphragm thickness ratio. The secondary outcomes were inspiratory function; maximal inspiratory pressure and inspiratory muscle endurance; and gait endurance and fatigue.

Results: There were significant differences between the two groups in the thickness ratio on the affected diaphragm thickness (medium effect size), maximal inspiratory pressure (medium effect size), and inspiratory muscle endurance (large effect size; Bonferroni correction p < 0.005). The gait endurance (medium effect size) and fatigue (small effect size) showed no significant differences in the between group comparison.

Conclusion: Inspiratory muscle training was effective in improving respiratory function and inducing structural changes, especially in the affected diaphragm.     

Pilot randomized controlled trial to assess a physical therapy program on upper extremity function to counteract inactivity in chronic stroke

Background: In chronic stroke, feasible physical therapy (PT) programs are needed to promote function throughout life.

Objective: This randomized controlled pilot trial investigated the feasibility and effect of a PT program composed of strengthening exercises with elastic bands and bimanual functional training, with clearly defined doses based on the rate of perceived exertion (Borg scale), to counteract inactivity in chronic stroke.

Methods: Fifteen subjects > 6 month post-stroke were randomized to three-month of UE function training (UE group), or to lower extremity function training (LE group). At baseline (T0), post-intervention (T1) and three-month follow-up (T2) assessment included the Fugl-Meyer Assessment scale (FMA), Wolf Motor Function test (WMFT), grip strength, and muscle tone. Feasibility was also evaluated.

Results: The mixed-model ANOVAs revealed a significant interaction between the time and group factors for FMA (p < .001) and WMFT (p = .009). The UE group improved upper extremity function and motor recovery significantly more than the LE group. There was no significant interaction between treatment group and change in grip strength over time (p = .217). No between-group differences (p > .05) were found in muscle tone. In the UE group, the attendance rate was ≥85% for 71.4% of subjects and 85.7% showed high satisfaction. No adverse events were recorded. After treatment, adherence to the program was higher in the UE group.

Conclusions: The suggested PT program may be useful to improve the paretic UE function and motor recovery in chronic stroke. Moreover, it may be helpful to facilitate lifelong active involvement of stroke subjects in exercise.     

Cognitive and affective functions associated with insomnia: a population-based study

Objectives: The number of patients with insomnia is rapidly increasing as society ages. The influence of insomnia on cognitive, affective, and activities of daily living (ADL) functions has not been fully studied.

Methods: Participants were 142 residents of a local super-aged community who underwent health check-ups provided by the local government. Participants completed cognitive, affective and ADL function tests including the MMSE. We divided participants into two subgroups based on Athens Insomnia Scale (AIS) scores (AIS ≤3 and AIS ≥4) and compared cognitive, affective, and ADL functions by sex and age.

Results: Subjective insomnia (AIS ≥4) was found in 36.2% of participants and was more frequent in females than males. No differences were found in cognitive function between the AIS subgroups. For both sexes, Geriatric Depression Scale scores were significantly higher in the AIS ≥4 subgroup than the AIS ≤3 subgroup. Apathy Scale scores were significantly higher in males in the AIS ≥4 subgroup. Of the AIS subscales, ‘sleepiness during the day’ was significantly higher in females than males (**p < 0.01), especially in those aged ≥75 years (**p < 0.01). This group of older females also showed a significantly lower Trail Making Test scores (*p < 0.05).

Discussion: Insomnia was present in 36.2% of the population in a Japanese super-aged community. Those with insomnia showed more depressive symptoms (both sexes) and males showed more apathy. The most distinct characteristic of females aged ≥75 years was a high frequency of daytime sleepiness, possibly related to a decline in attention and executive function.     

RAB7L1 promoter polymorphism and risk of Parkinson’s disease; a case-control study

Introduction: Recent genome-wide association studies have explored some new loci in association with Parkinson’s disease (PD). RAB7L1 is an important gene involved in one of the important neurological pathways, located in PARK16 locus. We performed a case-control study to examine the association between rs823144 SNP located in the promoter region of the RAB7L1 gene and PD risk in Iranian population.

Methods: A total of 960 samples including 480 PD patients and 480 healthy controls were collected for analysis of the RAB7L1 rs823144 polymorphism using polymerase chain reaction-restriction fragment length polymorphism (PCR – RFLP) method.

Results: We found significant differences in genotypic and allelic frequencies between patients and controls. Significant association was found between presence of minor allele (C) and decreased risk of PD development (p = 0.008, OR = 0.74 (0.605–0.924)). Also another significant association was observed between the CC genotype and PD (p = 0.004, OR = 0.441 (0.252–0.772)).

Conclusion: Our data support the association between rs823144 and decreased risk of PD.     

Skeletal muscle changes following stroke: a systematic review and comparison to healthy individuals

Background: Despite extensive study of the impact of stroke on muscle and functional performance, questions remain regarding the extent to which changes are due to the neurological injury vs. age-related loss of morphology and force production.

Objectives: To synthesize available evidence describing post-stroke changes in lower extremity muscle size and strength compared to healthy adults.

Methods: Scientific literature was searched up to April 2016 to identify studies that included lower extremity muscle size and strength measures in individuals with chronic stroke. Lower extremity muscle size and strength data from healthy controls were sought for comparison. Relative differences were calculated between paretic, nonparetic, and control limbs.

Results: Fifteen studies with 375 participants (61% male; age = 62 ± 5 years; time since stroke = 60 ± 42 months) were included. The paretic limb exhibited deficits of ~13% in thigh muscle size, ~5% in lower leg muscle size, and ~8% in lean leg mass compared to the nonparetic limb. Paretic plantarflexor and knee extensor strength were 52 and 36% lower, respectively, compared to the nonparetic limb. When compared to age-matched control data, both paretic and nonparetic limbs showed deficits in muscle size and strength.

Conclusions: Age-related differences support the impact of stroke-related sarcopenia as a contributor to hemiparetic muscle dysfunction. Understanding these muscular changes is necessary for designing appropriate exercise interventions aimed at restoring muscle function.     

Dl-3-n-butylphthalide can improve the cognitive function of patients with acute ischemic stroke: a prospective intervention study

Objectives: The present study investigated the effects of dl-3-n-butylphthalide on cognitive function of patients with acute ischemic stroke (AIS).

Methods: A total of 104 patients with AIS admitted between October 2012 and June 2013 were assigned to either the Treatment (standardized treatment plus dl-3-n-butylphthalide) or Control (standardized treatment alone) groups. Cognitive function was assessed by the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) and Mini-Mental State Examination (MMSE) before and 1 month after treatment, when high-sensitivity C-reactive protein (hs-CRP) and homocysteine (Hcy) were also detected. A multivariate logistic regression analysis was done for explore the independent risk factors for vascular dementia (VD).

Results: The proportion of cognitive impairment was significantly lower after treatment than before in both the Treatment (88% vs. 64%, P = 0.023) and Control (87% vs. 70%, P = 0.047) groups. Vascular dementia dropped from 30 to 10% in the Treatment (P = 0.035) and from 25.9 to 16.7% in the Control (P = 0.027) groups. Total cognitive improvement was more significant in the Treatment Group (P = 0.018); naming, memory, attention, and linguistic abilities were significantly improved (all P < 0.05). Serum Hcy and hs-CRP levels were significantly lower in the Treatment Group than in the Control Group 1 month after treatment (P < 0.05).

Discussion: Dl-3-n-butylphthalide could significantly improve the cognitive function of AIS patients 1 month after stroke. Hcy was involved in the incidence of VD 1 month after AIS. However, further studies are necessary because of differences between groups at baseline.     

Benign paroxysmal positional vertigo in spontaneous intracranial hypotension

Objectives: To assess the prevalence and related factors of benign paroxysmal positional vertigo (BPPV) in patients with spontaneous intracranial hypotension (SIH).

Methods: We retrospectively reviewed 156 consecutive inpatients with SIH, and collected the clinical and radiological data. These patients were divided into BPPV group and non-BPPV group according to the clinical manifestation and the results of Dix-Hallpike or supine roll tests during hospitalization period. We performed a univariate analysis and a further multiple logistic regression analysis to identify the related factors of the development of BPPV in SIH patients.

Results: BPPV was detected in 18 patients among the total 156 SIH patients (11.54%). The univariate analysis showed a low cerebrospinal fluid (CSF) pressure (P = 0.018), a small pontomesencephalic angle (P = 0.012) and a positive venous distension sign (VDS) (P = 0.045) were associated with the presence of BPPV. But the multivariate analysis only demonstrated a low CSF pressure was related to the presence of BPPV (OR = 1.022, 95% CI: 1.001–1.043, P = 0.044).

Conclusion: BPPV is common in SIH patients. SIH patients with low CSF pressure may be prone to develop BPPV.     

Neuroprotective effect of G14-humanin on global cerebral ischemia/reperfusion by activation of SOCS3 – STAT3 – MCL–1 signal transduction pathway in rats

Objective: Humanin (HN) has been identified to suppress neuron death. Gly¹⁴-HN (HNG), as a variant of HN, can decrease infarct volume after ischemia/reperfusion (I/R) injury. This study aimed to investigate the neuroprotective mechanism of HNG on global cerebral I/R (GI) in rats.

Methods: Rats were randomly divided into 13 groups: Sham group, GI groups and HNG groups. Both GI group and HNG groups included six time points (1, 3, 6, 12, 24, and 72 h). At 24 h after reperfusion, Nissl staining was used to observe positive neurons, and p-STAT3, MCL-1, SOCS3, Bax and Caspase-3 in different groups were detected by immunohistochemistry. qRT-PCR and western blot were used to evaluate the expression of STAT3, p-STAT3, MCL–1, and SOCS3.

Results: The immunohistochemistry also showed a significant increase in Bax (0.29 ± 0.007 vs. 0.22 ± 0.007, P < 0.01) and Caspase-3 (0.24 ± 0.02 vs. 0.18 ± 0.006, P < 0.01) in GI group compared with Sham group, while Bax (0.26 ± 0.01 vs. 0.29 ± 0.008, P < 0.01) and Caspase-3 (0.20 ± 0.008 vs. 0.24 ± 0.02, P < 0.01) were significantly decreased by HNG-treatment compared with GI group. Along with immunohistochemistry, western blot and qRT-PCR indicated that the protein and mRNA levels of STAT3, MCL-1, and SOCS3 were up-regulated after administration of HNG at six time points after global cerebral I/R in rat.

Conclusion: HNG might exert neuroprotective effects through alleviating apoptosis and activating of SOCS3 – STAT3 – MCL-1 signal transduction pathway.

Highlights

(1) Cerebral ischemia led to neuronal loss in hippocampal CA1 region of rats.

(2) HNG had neuroprotective effects on ischemia/reperfusion rats.

(3) The protective effect of HNG might be related to the SOCS3 – STAT3 – MCL-1 pathway.

     

A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios

Background: In walking rehabilitation trials, self-selected walking speed (SSWS) has emerged as the dominant outcome measure to assess walking ability. However, this measure cannot differentiate between recovery of impaired movement and compensation strategies. Spatiotemporal variables and asymmetry ratios are frequently used to quantify gait deviations and are hypothesized markers of recovery.

Objectives: The purpose of this review is to investigate spatiotemporal variables and asymmetry ratios as mechanistic recovery measures in physical therapy intervention studies post-stroke.

Methods: A systematic literature search was performed to identify physical therapy intervention studies with a statistically significant change in SSWS post intervention and concurrently collected spatiotemporal variables. Methodological quality was assessed using the Cochrane Collaboration’s tool. Walking speed, spatiotemporal, and intervention data were extracted.

Results: 46 studies met the inclusion criteria, 41 of which reported raw spatiotemporal measures and 19 reported asymmetry ratio calculations. Study interventions included: aerobic training (n = 2), functional electrical stimulation (n = 5), hippotherapy (n = 2), motor dual task training (n = 2), multidimensional rehabilitation (n = 4), robotics (n = 4), sensory stimulation training (n = 8), strength/resistance training (n = 4), task specific locomotor rehabilitation (n = 9), and visually guided training (n = 6).

Conclusions: Spatiotemporal variables help describe gait deviations, but scale to speed, so consequently, may not be an independent factor in describing functional recovery and gains. Therefore, these variables are limited in explaining mechanistic changes involved in improving gait speed. Use of asymmetry measures provides additional information regarding the coordinative requirements for gait and can potentially indicate recovery. Additional laboratory-based mechanistic measures may be required to truly understand how walking speed improves.     

Higher ambulatory systolic blood pressure independently associated with enlarged perivascular spaces in basal ganglia

Backgrounds: Enlarged perivascular spaces (EPVS) have been identified as a marker of cerebral small vessel diseases (CSVD). Ambulatory blood pressure (ABP) is the strongest predictor of hypertension-related brain damage. However, the relationship between ABP levels and EPVS is unclear.

Objectives: This study aimed to investigate the association between ABP levels and EPVS by 24-hour ambulatory blood pressure monitoring (ABPM).

Methods: We prospectively recruited inpatients for physical examinations in our hospital from May 2013 to Jun 2016. 24-hour ABPM data and cranial magnetic resonance imaging information were collected. EPVS in basal ganglia (BG) and centrum semiovale (CSO) were identified and classified into three categories by the severity. White matter hyperintensities were scored by Fazekas scale. Spearman correlation analysis and multiple logistic regression analysis were used to determine the relationship between ABP levels and EPVS.

Results: A total of 573 subjects were enrolled in this study. 24-hour, day and night systolic blood pressure (SBP) levels were positively related to higher numbers of EPVS in BG (24-hour SBP: r = 0.23, p < 0.01; day SBP: r = 0.25, p < 0.01; night SBP: r = 0.30, p < 0.01). The association was unchanged after controlling for confounders by multiple logistic regression analysis. 24-hour and day diastolic blood pressure (DBP) levels increased with an increasing degree of EPVS in CSO (p = 0.04 and 0.049, respectively). But the association disappeared after adjusting for confounders. Spearman correlation analysis indicated that ABP levels were not associated with higher numbers of EPVS in CSO (p > 0.05). DBP levels were not independently associated with the severity of EPVS in BG and CSO.

Conclusion: Higher SBP levels were independently associated with EPVS in BG, but not in CSO, which supported EPVS in BG to be a marker of CSVD. Pathogenesis of EPVS in BG and CSO might be different.