Mihai Berteanu

Dynamic of oxidative and nitrosative stress markers during the convalescent period of stroke patients undergoing rehabilitation

Background Stroke patients have a redox imbalance, a consequence of both the cerebrovascular event and the associated pathological conditions. Our study was aimed to investigate the dynamic of some oxidative and nitrosative markers during the convalescent phase of postacute stroke patients undergoing rehabilitation. Methods We assessed thiol, advanced oxidation protein product, protein carbonyl, 3-nitro-l-tyrosine, ceruloplasmin and oxidized LDL concentrations, as well as gamma-glutamyltranspeptidase (GGT) activity in 20 patients at the beginning of the hospitalization and at the discharge moment, respectively, and 24 apparently healthy controls. Results We found significantly increased values for GGT (P = 0.04), ceruloplasmin (P = 0.01) and protein carbonyl (P = 0.04) in stroke patients at the hospitalization moment when compared with healthy controls, while total thiols were significantly decreased (P = 0.002). Rehabilitation was associated with a significant decrease of protein carbonyl (P = 0.03) and oxidized LDL particle concentrations (P = 0.03), as well as GGT activity (P = 0.02). At the hospitalization moment, both GGT and ceruloplasmin were significantly negatively correlated with non-proteic thiols (r = −0.44, P = 0.049, and r = −0.53, P = 0.015, respectively) and significantly positively with protein carbonyls (r = +0.80, P < 0.001, and r = +0.69, P < 0.001, respectively) suggesting putative roles of GGT and ceruloplasmin in the redox imbalance. Conclusions These results highlight the existence of a redox imbalance in postacute stroke patients, and the possible benefits of an antioxidant-based therapy for the recovery of these patients.

Dynamics of Inflammatory Markers in Post-Acute Stroke Patients Undergoing Rehabilitation

Stroke is a pathological condition associated with an enhanced inflammatory response that has a multifactorial etiology. We evaluated the dynamic of plasma concentrations of IL-1α, IL-6, IL-8, TNF-α, soluble form of intercellular adhesion molecule 1, and lipoprotein (a) [Lp(a)] during the rehabilitation of post-acute stroke patients (n = 20), in parallel with control subjects (n = 24). Stroke patients had significantly increased concentrations of IL-6, TNF-α, and Lp(a) when compared to healthy controls. It was found that the changes in the IL-6, IL-8, and TNF-α concentrations associated with the pathological condition were statistically significant (χ2 = 4.81, p = 0.028, χ2 = 10.40, p = 0.005 and χ2 = 6.73, p = 0.034, respectively). The decrease of Lp(a) during the rehabilitation had statistical significance (p = 0.043), while the decrease of IL-1α had marginal significance (p = 0.071). IL-1α, TNF-α, and Lp(a) concentrations were significantly negatively correlated with the Barthel index values, suggesting that the decrease of these inflammatory markers was beneficial for patients’ recovery.

The role of physical and rehabilitation medicine specialist in lymphoedema.

V. Fialka-Moser , M. Korpan , E. Varela , A. Ward , C. Gutenbrunner , J.M. Casillas , A. Delarque , M. Berteanu , N. Christodoulou h,* a Department of Physical Medicine and Rehabilitation, General Hospital Vienna, Medical University Vienna, Austria b Dpto. Medicina Fisica y Rehabilitación, Facultad de Medicina UCM, Spain c North Staffordshire Rehabilitation Centre, Haywood Hospital, United Kingdom d Department of Rehabilitation Medicine, Hannover Medical School, Germany e Institut national de la santé et de la recherche médicale, University Hospital of Dijon, France f Medecine Physique et de Readaptation, CHU Timone, France g Department Physical and Rehabilitation Medicine, University Hospital ELIAS, Romania h European University Cyprus, School of Sciences, Cyprus

Effect of the nutritional supplement ALAnerv® on the serum PON1 activity in post-acute stroke patients.

BACKGROUND Paraoxonase-1 (PON1) is one of the HDL-associated proteins which contributes to the antioxidant properties of these lipoproteins. The aim of this pilot study was to evaluate the effect of the nutritional supplement ALAnerv® on serum PON1 activity in post-acute stroke patients undergoing rehabilitation. METHODS We enrolled 28 post-acute stroke patients and randomly divided them into (-) ALA or (+) ALA study groups. All the patients underwent the same rehabilitation program and received comparable standard medications. Moreover, (+) ALA patients received ALAnerv® for two weeks (2 pills/day). The serum PON1 activity was assessed on blood samples taken at the admission and at the discharge moments, respectively. We used paraoxon (paraoxonase activity, PONA), phenyl acetate (arylesterase activity, ARYLA) and dihydrocoumarin (lactonase activity, LACTA) as substrates, the latter activity being regarded as physiologically relevant. A control group of 14 apparently healthy subjects was also created. RESULTS In the (+) ALA group, LACTA significantly increased during the study period (17.6 ± 3.2 vs. 27.6 ± 3.5, p = 0.002). Moreover, the percentage of LACTA variation between (-) ALA and (+) ALA groups during the study was also statistically different (-11.7 ± 6.9% vs. +95.1 ± 29.7%, p < 0.0001). CONCLUSIONS These preliminary results suggest that ALA nerv® could contribute to the improvement of the physiologically relevant LACTA of PON1 in post-acute stroke patients, enabling this enzyme to contribute to the redox correction. Also, this study raises the question about the effect of a longer treatment period over the other enzymatic activities of serum PON1.

New Mechatronic System for Gait Rehabilitation - Functional Requirements

Given the large variability of pathological gait and the high specificity of gait phenotypes, it is very difficult to design a gait rehabilitation system able to adapt to the functional requirements of every person with ambulation disabilities, in every stage of the complex process of gait rehabilitation. Another approach is that of ambiental gait rehabilitation, with focus on adaptability, not on adaptation, on synthetical training, not on analytical training, on integrative training, not on step by step training. Our focus is not on controlling the movement itself, but on controlling the environment that shapes human functionality and assuring the appropriate level of support, resistance and persuasion, with consequent stimulation of the explorative behavior and the active involvement of the person in gait training. A mechatronic system designed for such a therapeutical approach has specific functional requirements.

Rationale in Designing a New System for Gait Rehabilitation

Our multidisciplinary team decided to concentrate efforts in developing a new gait rehabilitation system, able to respond to most of the requirements of an ideal training system. Therefore, we identified the system’s necessary, we compared the costs and the benefits of the existing concepts and systems, and we developed the concept and the design of the system called RELIVE. Developing this system makes the object of a funded national research and development project.

The effect of the ALAnerv nutritional supplement on some oxidative stress markers in postacute stroke patients undergoing rehabilitation.

Stroke is a pathologic condition associated with redox imbalance. This pilot study was designed to evaluate the effect of the consumption of the nutritional supplement ALAnerv on some oxidative stress markers in postacute stroke patients undergoing rehabilitation. To achieve this goal, we assigned 28 patients to 2 study groups: (-)ALA and (+)ALA. Patients in both groups participated in the same rehabilitation program and received comparable standard medications; however, patients in the (+)ALA group received ALAnerv for 2 weeks (2 pills per day). We assessed total and nonproteic thiols, protein carbonyls, ceruloplasmin, oxidized low-density lipoprotein (LDL) particles, lipid hydroperoxide concentrations, gamma-glutamyl transpeptidase activity, and total antioxidant capacity. Regression analysis indicated that supplementation with ALAnerv was responsible for the significant decrease in glucose (p = 0.002) and oxidized LDL particles (p < 0.001) during the study period. For both parameters, the variation in the percent of concentration between the 2 groups during the study period reached statistical significance (p = 0.012 and p < 0.001, respectively). Moreover, Barthel Index values at discharge were significantly influenced by ALAnerv treatment. These preliminary results indicate that ALAnerv might be helpful because it rapidly corrects plasma fasting glucose and corrects serum oxidized LDL particle concentrations, suggesting the need for longer treatment with 2 pills or more per day.

Technologically-advanced assessment of upper-limb spasticity: a pilot study

BACKGROUND Spasticity is a muscle disorder associated with upper motor neuron syndrome occurring in neurological disorders, such as stroke, multiple sclerosis, spinal cord injury and others. It influences the patients rehabilitation, interfering with function, limiting independence, causing pain and producing secondary impairments, such as contractures or other complications. Due to the heterogeneity of clinical signs of spasticity, there is no agreement on the most appropriate assessment and measurement modality for the evaluation of treatment outcomes. AIM The aim of this article is to propose the use of new robotic devices for upper-limb spasticity assessment and describe the most relevant measures of spasticity which could be automatically assessed by using a technologically advanced device. DESIGN Observational pilot study. SETTING The treatment was provided in a Rehabilitation Centre where the device was located and the subjects were treated in an outpatients setting. POPULATION Five post-stroke patients, age range 19-79 years (mean age 61, standard deviation [SD]±25) in their chronic phase. METHODS A new robotic device able to automatically assess upper-limb spasticity during passive and active mobilization has been developed. The elbow spasticity of five post stroke patients has been assessed by using the new device and by means of the Modified Ashworth Scale (MAS). After the first assessment, subjects were treated with botulin toxin injections, and then underwent 10 sessions of robotic treatments. After the treatment, subjects spasticity was assessed by using the robotic device and the MAS Score. RESULTS In four out of five patients, the botulin toxin injection and robotic treatment resulted in the improvement of the MAS Score; in three patients the robotic measures were able to detect the MAS changes. In one subject botulin toxin was not effective and the robotic device was able to detect the lack of effectiveness. CONCLUSIONS By using the robotic device some spasticity parameters can be continuously recorded during the rehabilitation treatment in order to objectively measure the effectiveness of the interventions provided. CLINICAL REHABILITATION IMPACT The standardized evaluation parameters recorded using robotic devices may provide several advantages: 1) the measures for spasticity assessment can be monitored during every rehabilitation session (even during each movement); 2) these measurements are able to highlight even small changes; 3) the recovery plateau can be detected early thus avoiding further rehabilitation sessions; and 4) these measurements can reduce the assessment bias in multicenter studies.

Instrumented Gait Analysis for Assessing the Efficiency of a Complex Rehabilitation Program in Patients with Stroke – A Case Study

Annually, 15 million people worldwide suffer a stroke. Establishing the disability status after stroke is the key for the Physical and Rehabilitation Medicine point of view. 90% of those who have suffered a stroke show multiple impairments. The post stroke walking pattern has a major impact on the patient’s activity and participation capacity and to regain a functional gait is one of the most important goals of the rehabilitation intervention. The instrumented gait analysis is the key for accurately assessing the efficiency of a gait rehabilitation program and may be an important tool for designing personalized training. The aim of this study is to evaluate the effect of a complex rehabilitation program on the walking pattern in patients with after stroke hemiparesis.

Advanced technology for gait rehabilitation --- An overview

Most gait training systems are designed for acute and subacute neurological inpatients. Many systems are used for relearning gait movements (nonfunctional training) or gait cycle training (functional gait training). Each system presents its own advantages and disadvantages in terms of functional outcomes. However, training gait cycle movements is not sufficient for the rehabilitation of ambulation. There is a need for new solutions to overcome the limitations of existing systems in order to ensure individually tailored training conditions for each of the potential users, no matter the complexity of his or her condition. There is also a need for a new, integrative approach in gait rehabilitation, one that encompasses and addresses all aspects of physical as well as psychological aspects of ambulation in real-life multitasking situations. In this respect, a multidisciplinary multinational team performed an overview of the current technology for gait rehabilitation and reviewed the principles of ambulation training.