Ayçe Atalay

Predictors of functional outcome in first-ever ischemic stroke: A special interest to ischemic subtypes, comorbidity and age

OBJECTIVES Most cardiovascular abnormalities are associated not only with increased risk of certain ischemic stroke subtypes but also with markedly greater disability in stroke patients. We aimed to investigate the associations between age, comorbidity, cardiovascular problems, site and size of ischemic lesions and functional outcome in inpatient first-ever ischemic stroke patients. SUBJECTS A total of 129 first-ever ischemic stroke admissions to a university affiliated rehabilitation centre were involved. METHODS Demographic data, brain computerized tomography or magnetic resonance imaging reports of the patients were recorded. Cardiovascular parameters consisted of electrocardiographic, echocardiographic and carotid Doppler ultrasonographic findings. Location and size of ischemic lesions was determined by using the Oxfordshire Community Stroke Project classification. Charlson Comorbidity index adjusted for ischemic stroke was used to assess associated health problems. Functional recovery was defined as the improvements made on Functional Independence Measure. RESULTS Our data indicated that the presence of chronic atrial fibrillation and carotid stenosis had significant associations with total anterior circulation infarcts. Multivariate analyses revealed that age, Charlson Comorbidity index adjusted for ischemic stroke, total anterior circulation infarcts, Functional Independence Measure on admission were associated with rehabilitation outcomes. CONCLUSIONS Advanced age, high comorbidity, large anterior circulation infarcts and poor functional level on admission were independent indicators of unfavorable functional outcome. Hemodynamic comorbidities had significant impact on localization and extend of ischemic lesions.

Association of ideomotor apraxia with lesion site, etiology, neglect, and functional independence in patients with first ever stroke.

Abstract Background: Ideomotor apraxia (IMA) is characterized by the inability to correctly imitate hand gestures and voluntarily pantomime tool use. The relationship between IMA and characteristics of stroke has not been totally elucidated. Objective: This study aimed to find out associations between presence of IMA and stroke etiology, site of the lesions, neglect, and temporal and functional parameters of stroke in patients with first ever stroke. Methods: Thirty-nine patients with first ever stroke were included. Patients with severe cognitive deficits were excluded. Assessment tools included Ideomotor Apraxia Test, Functional Independence Measure (FIM), Brunnstrom recovery stages, Mini Mental Test (MMT), and star cancellation test. Etiology (hemorrhagic or ischemic) and site of stroke was assessed through brain imaging methods. Location and size of ischemic lesion was determined by using the Oxfordshire Community Stroke Project system. Results: IMA was identified in 35.9% of the patients. Patients with IMA had significantly lower FIM scores both on admission and discharge (P = 0.001, P = 0.001). Presence of IMA was significantly associated with the presence of neglect (P = 0.004), total anterior circulation ischemia (TACI) (P < 0.001), and lower MMT scores (P < 0.001). Lesion site, patient age, time since onset, and stroke etiology had no impact on the presence of IMA. Conclusion: IMA was in concordance with poor cognitive and functional state and was not limited to left hemisphere lesions. The study revealed strong associations between IMA, neglect, and TACI. Every patient with stroke should be evaluated for the presence of IMA on admission to rehabilitation unit.

Health-related Quality of Life in Patients with Myofascial Pain Syndrome

Health-related quality of life is being emphasized because people who are living with a chronic illness are demanding that the qualities of their lives are enhanced. Health-related quality of life defines the effects of diseases or symptoms including musculoskeletal conditions on functioning and a sense of well being. This review highlights the results of quality-of-life measurements in patients with myofascial pain syndrome while providing a comparison with various musculoskeletal disorders, emphasizing the domains that are affected for each specific disease. Also, myofascial pain studies that included quality-of-life measurement as an outcome variable are considered.

Comparison of the long-term effectiveness of progressive neuromuscular facilitation and continuous passive motion therapies after total knee arthroplasty.

[Purpose] The aim of this longitudinal study was to examine the long term functional effectiveness of proprioceptive neuromuscular facilitation (PNF) after total knee arthroplasty. [Subjects and Methods] We included 30 patients and they were randomly assigned to two groups. In addition to the standard rehabilitation program the PNF group received proprioceptive neuromuscular facilitation therapy and the CPM group received continuous passive motion therapy. The outcome measures included range of motion using a goniometer, pain scores using a numeric pain rating scale, days to reach functional benchmarks, the Beck depression scale and isokinetic torque and isometric strength measurements. [Results] There were no significant differences between the two groups in terms of baseline demographic data, clinical findings and length of stay. Days to reach range of motion benchmarks were similar in the two groups. Pain at the 8th week was slightly higher in the PNF group. With the exception of walking with a walker, days to reach functional benchmarks were statistically significantly fewer in patients of the PNF group despite similar isokinetic measurements. Administration of PNF resulted in earlier functional gains in patients after total knee arthroplasty. These functional accomplishments were more pronounced in the PNF group despite it having isokinetic torque measurements similar to those of the CPM group. [Conclusion] PNF techniques can positively affect functional outcomes over the long term.

Preoperative Motor Mapping

Neurosurgery must always carefully balance the benefit of surgical therapy against the risk of causing or increasing neurological symptoms. Preoperative risk assessment on the basis of standard anatomical imaging alone is often insufficient because of inherent variations in motor representation from one patient to the next and because pathology can obscure or alter the anatomy. Several sophisticated new technologies have been developed in the past 30 years: PET, fMRI, MEG, TMS, DTI, which substantially improve the capabilities of the neurosurgical team to assess cortical function and improve their surgical planning. Neurosurgeons need to understand and use this modern technology to create patient-specific cortical maps and management plans, in order to improve therapeutic effectiveness and reduce morbidity. This chapter presents the current technologies in use for preoperative mapping of the motor system.

Medical complications experienced by first-time ischemic stroke patients during inpatient, tertiary level stroke rehabilitation

[Purpose] The aim of this study was to assess the medical complications in first-time ischemic stroke patients, to identify the factors related to occurrence of complications. [Subjects and Methods] First-time ischemic stroke patients (n=81) admitted to a tertiary level inpatient rehabilitation center during a 5 year period were included in the study. The attending physiatrist noted the presence of specific medical complications and complications that required transfer to the acute care facility from patient records. The Oxfordshire Community Stroke Project classification was used to define the clinical subtypes of the ischemic stroke patients. The Charlson comorbidity index was used to evaluate co-morbid conditions. Functional disability was assessed using the Functional Independence Measure at admission and discharge. [Results] We found that 88.9% of the patients had at least one complication. The five most common complications were urinary tract infection (48.1%), shoulder pain (37.0%), insomnia (37.0%), depression (32.1%), and musculoskeletal pain other than shoulder pain (32.1%) and 11.1% of patients were transferred to acute care facility during rehabilitation period. Functional Independence Measure scores both at admission and discharge were significantly lower in patients with at least one complication than in patients with no complications. [Conclusion] Medical complications are common among patients undergoing stroke rehabilitation. Close interdisciplinary collaboration between physiatrists and other medical specialities is necessary for optimal management.