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عضویت

جستجوی مقالات مرتبط با کلیدواژه "Stroke" در نشریات گروه "پزشکی"

  • ساناز امیری، حسن امیری*، پیمان حسنی ابهریان، محمد ناصحی، آزیتا چهری
    مقدمه

    بازماندگان سکته مغزی با آسیب به شبکه های نیمکره راست نقص های مشخصی در ظرفیت حافظه کاری نشان می دهند که معمولا با نقص کلی در توانایی تشخیص اهداف بینایی در هنگام نظارت مشخص می شود.

    هدف

    این مطالعه با هدف بررسی اثربخشی تحریک مغناطیسی مکرر مغزی (rTMS) بر حافظه فعال در بیماران سکته مغزی مبتلا به همی نگلکت صورت گرفته است.

    مواد و روش ها

    این مطالعه از نوع آزمایشی با گروه آزمایش و شم بود. در این مطالعه 60 نفر از بیماران مبتلا به سکته ی مغزی مبتلا به همی نگلکت مراجعه کننده به کلینیک درمانی تبسم شهر تهران به صورت هدفمند انتخاب و طور تصادفی ساده به دو گروه (30 نفر گروه دریافت کننده rTMS یا آزمایش و 30 نفر گروه شم) تخصیص یافته اند. در گام بعد هر دو گروه 3 بار در هفته، هر بار 10 دقیقه به مدت 15 جلسه تحت درمان با rTMS  با فرکانس 0/9 در جهت تقویت عملکرد حافظه کاری قرار گرفتند. در گروه شم پس از 30 ثانیه دستگاه  rTMS خاموش شده است ولی مشارکت کننده تصور می کرد که تحت مداخله توان بخشی حافظه کاری با rTMS با قرار دارد.  

    یافته ها

    یافته ها نشان داد میان پس آزمون زیر مولفه های حافظه کاری گروه های آزمایش و شم تفاوت معناداری وجود دارد (0/05≥P). تفاوت میان پس آزمون گروه آزمایش و گروه شم در مولفه های تعداد پاسخ های صحیح، موارد بدون پاسخ و زمان پاسخ معنادار بوده است (0/05≥P). همچنین تفاوت میان پس و پیش آزمون گروه آزمایش در مولفه های تعداد پاسخ های صحیح و تعداد خطاها معنادار بوده  است (0/05≥P).

    نتیجه گیری

    یافته های این مطالعه شواهد اولیه ای برای اثربخشی  rTMS در بهبود حافظه کاری در بیماران سکته مغزی مبتلا به همی نگلکت ارائه می دهد. این نتایج به حجم فزاینده تحقیقات در مورد پتانسیل تکنیک های غیرتهاجمی تحریک مغز در توا نبخشی عصبی کمک می کند و نیاز به تحقیقات بیشتر در این زمینه را برجسته می کند.

    کلید واژگان: سکته مغزی, همی نگلکت, حافظه کاری, Rtms
    Sanaz Amiri, Hassan Amiri*, Peyman Hassani-Abharian, Mohammad Nashi, Azita Chehri
    Introduction

    Stroke survivors with right hemisphere damage exhibit specific working memory deficits, often manifested as difficulty recognizing visual targets during monitoring.

    Objective

    This study aims to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on working memory in stroke patients with
    hemineglect.

    Materials and Methods

    This experimental study involved 60 stroke patients with hemiplegia, who were randomly divided into two groups: 30 in the rTMS (experimental) group and 30 in the sham group. Both groups received treatment with rTMS at 0.9 frequency, three times a week for 10 minutes over 15 sessions. In the sham group, the rTMS device was turned off after 30 seconds, leading participants to believe they were receiving real treatment.

    Results

    The results indicated a significant difference between the pre-test and post-test working memory components for both the experimental and sham groups (P≥0.05). Additionally, the post-test comparisons revealed significant differences between the experimental and sham groups in terms of correct answers, unanswered cases, and response time (P≥0.05). Moreover, within the experimental group, the difference between post-test and pre-test scores for correct answers and errors was also significant (P≥0.05).

    Conclusion

    This study provides preliminary evidence that rTMS effectively enhances working memory in stroke patients with hemineglect, contributing to the expanding research on non-invasive brain stimulation in neurorehabilitation and underscoring the necessity for further investigation.

    Keywords: Hemineglect, Rtms, Stroke, Working Memory
  • Zoofa Zayani, Etrat Hooshmandi, Afshin Borhani-Haghighi, Mousa Rahimi, Vahid Reza Ostovan, Nima Fadakar, Reza Tabrizi, Mahnaz Bayat, Seyedeh Shamim Hojati, Negin Gharbi, Hamideh Mahmoudinasab *
    Background
    Long non-coding ribonucleic acids (lncRNAs) have been implicated as possible circulating stroke indicators. This study focused on the expression status of antisense non-coding ribonucleic acid in the INK4 locus (ANRIL) and myocardial infarction associated transcript (MIAT) in patients with cerebral venous thrombosis (CVT).
    Methods
    In this study, fifty patients with CVT and one hundred age/gender-matched individuals as controls were included. The circulating levels of ANRIL and MIAT in the first 24 hours after admission were evaluated using the quantitative real-time polymerase chain reaction (RT-PCR) method. We compared the expression levels of ANRIL and MIAT between patients and controls using the independent two-sample t-test. Subgroup analysis was used to investigate the association of lncRNAs with clinical characteristics in patients with CVT. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the diagnostic value of two lncRNAs in patient assessment.
    Results
    The relative expression of lncRNAs ANRIL and MIAT significantly decreased in patients compared to the control. ANRIL and MIAT were shown as potential markers for discriminating patients with CVT from the healthy controls with an area under the curve (AUC) of 0.98 and 0.99, respectively.
    Conclusion
    For the first time, we found down-regulation and diagnostic potential of lncRNAs-ANRIL and MIAT in the blood of patients with CVT.
    Keywords: Venous Thrombosis, Stroke, Long Non-Coding RNA, Myocardial Infarction Associated Transcript, Gene Expression
  • Peyman Bakhshi, Sara Fakhri, Khadijeh Heidarizadeh, Parastou Kordestani-Moghadam *, Yaser Mokhayeri
    Valid indices and optimal models in predicting mortality rates among patients hospitalized in the emergency department have attracted much attention due to the wide use of mortality prediction instruments and the differences in the prediction result and hospitalization outcome for patients with stroke with disease severity tools. The present study aims to determine the relationship between APACHE II mean score and mortality among patients with stroke admitted to the emergency department in Shohadaye Ashayer Hospital in 2022. To conduct this prospective descriptive cross-sectional study, the information related to 273 patients with stroke admitted to the emergency department of the specialized neurology center in Shohadaye Ashayer Hospital in Khorramabad was utilized non-randomly, sequentially, and conveniently by applying the data collection tools during 2022. Demographic data, laboratory values, vital signs, and hospitalization outcomes in the emergency department during the first 24 hours were employed to calculate the APACHE II score. Based on univariate logistic regression model analysis, a significant relationship was observed between the APACHE II score with mortality among patients with stroke (P<0.001). In other words, the APACHE II predicted the mortality rate among patients with stroke accurately. The results revealed that the APACHE II accurately predicts the mortality rate and prioritizes patients with stroke for allocating treatment resources.
    Keywords: Stroke, APACHE II, Emergency Department, Mortality
  • زهرا سوکی، زهرا سادات سیروسی نژاد*، منصور دیانتی
    زمینه و هدف

    پاندمی کووید-19 بر روند درمان و مراقبت از بسیاری از بیماران تاثیر گذار بود. مطالعه حاضر با هدف مقایسه زمان تاخیرهای پیش بیمارستانی (بروز علائم تا رسیدن به بیمارستان) و داخل بیمارستانی (رسیدن به بیمارستان تا تزریق آلتپلاز) در بیماران مبتلا به سکته مغزی ایسکمیک حاد، قبل و حین پاندمی کووید-19 در کاشان انجام شد.

    روش ها

    در این پژوهش مقطعی، 202 بیمار مبتلا به سکته مغزی حاد مراجعه کننده به بیمارستان شهید بهشتی کاشان، با توجه به معیارهای ورود با روش سرشماری، در دو فاصله زمانی یکساله قبل (100 بیمار) و حین (102 بیمار) پاندمی کووید-19 وارد مطالعه شدند. اطلاعات دموگرافیک و بالینی موردنظر توسط پژوهشگر با استفاده از پرسشنامه محقق ساخته، از طریق پرونده پزشکی بیمار، سامانه اطلاعات مرکز فوریت های پزشکی کاشان و تماس با بیمار یا همراه وی تکمیل شد.

    یافته ها

    تفاوت معنی داری بین بیماران قبل (100 بیمار) و حین (102 بیمار) پاندمی کووید-19 از نظر فاصله های زمانی بروز علائم تا رسیدن به بیمارستان (تاخیرپیش بیمارستانی) و رسیدن به بیمارستان تا انجام سی تی اسکن گزارش نشد (0/05≤P). فاصله زمانی رسیدن به بیمارستان تا تزریق آلتپلاز (تاخیر داخل بیمارستانی) در حین پاندمی کووید-19 به طور معنی داری نسبت به قبل از پاندمی کووید-19 کوتاه تر بود (0/05>P).

    نتیجه گیری

    فاصله زمانی رسیدن به بیمارستان تا تزریق آلتپلاز به طور معنی داری در زمان پاندمی کووید-19 کاهش یافته است. در حالی که فواصل زمانی رسیدن به بیمارستان تا انجام سی تی اسکن و شروع علائم تا رسیدن به بیمارستان تفاوت معنی داری نداشت.

    کلید واژگان: کووید 19, تاخیر در درمان, سکته مغزی, خدمات فوریت های پزشکی
    Zahra Sooki, Zahra Sadat Sirousi Nejad*, Mansour Dianati
    Background and Aim

    The COVID-19 pandemic significantly affected the treatment and care of many patients. This study aimed to compare pre-hospital delays (the time from symptom onset until hospital arrival) and in-hospital delays (the time from hospital arrival until alteplase injection) in patients with acute ischemic stroke, both before and during the COVID-19 pandemic in Kashan, Iran.

    Methods

    In this cross-sectional study, 202 patients with acute strokes who were referred to Shahid Beheshti Hospital in Kashan, Iran, were included based on inclusion criteria using a census method. The data were collected over two one-year intervals: before (n=100) and during (n=102) the COVID-19 pandemic. The researcher compiled demographic and clinical information using a researcher-designed questionnaire, which was completed through patient medical files, the information system of the Kashan Emergency Medical Center, and communication with patients or their companions.

    Results

    No significant differences were observed between patients before (n=100) and during (n=102) the COVID-19 pandemic regarding the time intervals between symptom onset and hospital arrival (pre-hospital delay), as well as the time from hospital arrival to CT scan (P≥0.05). However, the interval from hospital arrival to alteplase injection (in-hospital delay) during the COVID-19 pandemic was significantly shorter than that observed prior to the pandemic (P<0.05).

    Conclusion

    The interval from hospital arrival to alteplase injection significantly decreased during the COVID-19 pandemic. In contrast, the time intervals from hospital arrival to CT scan and from symptom onset to hospital arrival did not show significant differences.

    Keywords: COVID-19, Treatment Delay, Stroke, Emergency Medical Services
  • Saeideh Farahmand, Majid Ghasemi, Keivan Basiri, Ehsan Ghasemi
    Background

    Stroke is one of the most common causes of disability. Spasticity is a common clinical impairment that occurs after a stroke. Spasticity occurs due to changes in the mechanical properties of the muscle and the neural properties following a stroke.

    Objectives

    This study aimed to investigate the effect of Nintendo Wii games on ankle spasticity outcomes in stroke patients.

    Methods

    In this parallel single-blind clinical trial study, 30 patients with stroke were randomly assigned to one of the experimental and control groups. The subjects of both groups received conventional physiotherapy, including stretching of ankle plantar flexor muscles and walking exercises on parallel bars. In addition, the experimental group also received Nintendo Wii games for 30 minutes three times a week for a total of 12 sessions. Clinical outcomes of spasticity and neural properties were evaluated using the Modified Modified Ashworth Scale and H-reflex latency and Hmax/Mmax ratio. All statistical analyses were performed using SPSS version 20.

    Results

    The intragroup results showed that the clinical outcome of spasticity was significantly reduced in the experimental group (P = 0.001). The comparison between the two groups showed no statistically significant difference in clinical outcome and neural properties between the experimental and control groups (P > 0.05).

    Conclusions

    Based on the results, the clinical outcome of spasticity was significantly reduced after the end of the treatment in the Nintendo Wii group. The use of Nintendo Wii can be suggested as a treatment modality alongside the usual treatments to achieve greater and faster effectiveness in patients with stroke.

    Keywords: Stroke, Ankle Spasticity, Therapeutic Exercise, Virtual Reality
  • Nina Farzan, Amir Khanmirzaei, Marzieh Ghodrati, Haniye Mahmodi, Gelareh Azarinoush
    Background

    Hemorrhagic transformation (HT) is a serious complication of thrombolytic therapy with recombinant tissue plasminogen activator (r-tPA) in patients with acute ischemic stroke (AIS).

    Objectives

    This study aimed to investigate the prevalence of HT and associated risk factors in AIS patients treated with r-tPA.

    Methods

    We conducted a descriptive-analytical cross-sectional study on AIS patients at Shahid Beheshti Hospital, Qom, Iran, from April 2019 to March 2020. A total of 175 patients treated with r-tPA within 4.5 hours of stroke onset were included. Data on demographic and clinical factors, including underlying diseases, medication history, laboratory results, and occurrence of HT, were collected and analyzed using SPSS version 22. Statistical tests such as chi-square, t -test, and logistic regression were applied, with a significance level of P < 0.05.

    Results

    Hemorrhagic transformation was observed in 28 patients (16.0%) within 24 hours post-r-tPA administration. A significant association was found between HT and histories of diabetes, hypertension, hyperlipidemia, previous cerebrovascular accidents (CVA), and cardiovascular disease (P < 0.05). Antiplatelet and anticoagulant use were also significantly associated with HT (P < 0.05). The neutrophil-to-lymphocyte ratio (NLR) post-r-tPA showed increased predictive accuracy for HT (AUC = 0.768) compared to pre-treatment levels, indicating its potential as a reliable biomarker.

    Conclusions

    Patients with comorbid conditions such as diabetes, hypertension, and prior antithrombotic therapy exhibited an elevated risk of HT following r-tPA treatment. Post-treatment NLR was identified as a potential biomarker for predicting HT, supporting its use in assessing patient risk after thrombolysis. These findings underscore the importance of individualized risk assessment in AIS management.

    Keywords: Prevalence, Intracranial Hemorrhage, Stroke, Recombinant Tissue Plasminogen Activator, Hemorrhagic Stroke, Cerebral Ischemic Stroke, Thrombolysis, Neurology Emergency
  • Elham Mehdizadehfar, Elyar Sadeghi Hokmabadi, Aliakbar Taheraghdam, Yalda Sadeghpour, Aytak Khabbaz, Naeimeh Hosseinzadeh, Robab Mehdizadeh, Alireza Ala, Samad Shams Vahdati, Asghar Jafari-Rouhi, Niloufar Mohammadzadeh, Roya Rostami, Mehdi Farhoudi, Sama Rahnemayan
    Background

    Stroke remains a significant global health challenge, contributing to mortality and disability burdens. Optimizing stroke care involves understanding the complexities of in-hospital management, especially in regions like East Azerbaijan Province, where stroke incidence is high.

    Objectives

    This study evaluates the effectiveness of Emergency Stroke Code (ESC) activation and thrombolytic therapy in acute ischemic stroke care at Imam Reza Hospital, Tabriz, a referral center.

    Methods

    A cross-sectional study was carried out between April 2021 and March 2022, including patients with activated ESC or receiving thrombolysis at Imam Reza Hospital, Tabriz. Data on patient demographics, risk factors, time intervals, thrombolysis administration, adverse events, and outcomes were collected and analyzed using SPSS software.

    Results

    Among 748 acute stroke patients, 165 received thrombolysis, with 117 having ESC activation. The main reasons for not administering tissue plasminogen activator (tPA) in patients with ESC code activation included mild symptoms (23.6%), exceeding thrombolysis time (14.8%), and hemorrhagic stroke (10.4%). Pre-hospital ESC activation significantly reduced time intervals from hospital arrival to CT-scan and tPA injection (P < 0.001). The incidence of intracranial hemorrhage was 6.7% overall, with rare systemic bleeding (0.6%). Pre-hospital notification did not show significant changes in the National Institutes of Health Stroke Scale (NIHSS) or Modified Rankin Scale (MRS) scores.

    Conclusions

    While ESC activation streamlines in-hospital processes, it alone may not improve clinical outcomes without efficient out-of-hospital systems. Pre-hospital communication systems like ESC can aid in reducing in-hospital processing time for thrombolysis but must be coupled with efforts to enhance early diagnosis and efficient dispatch systems to optimize stroke care.

    Keywords: Stroke, Clinical Coding, Thrombolytic Therapy, Treatment Outcome
  • Ali Erfani, Seyed Hossein Aghamiri, Roya Karimi
    Background

    Intravenous alteplase is a drug treatment administered as an emergency measure within the early hours of patient admission.

    Objectives

    This study aimed to determine the role of hyperdense signal length in the middle cerebral artery on the degree of disability in patients with arterial ischemic stroke who exhibit evidence of vascular involvement.

    Methods

    In this cross-sectional study, patients with stroke who were referred to the emergency department of Imam Hossein Hospital in Tehran were included. The tools used were the demographic profile form and the Modified Rankin Scale (mRS). At the time of admission, the demographic profile form and the mRS tool were completed. The mRS tool was then administered again at discharge and 3 months after discharge. Following data collection, the patients' information was entered into SPSS version 16 software for analysis.

    Results

    The results showed that there was no relationship between the patient's age and the disability score at admission (P = 0.11). However, at discharge and 3 months after discharge, the level of disability had a significant relationship with the patient's age, with younger patients reporting less disability. Additionally, after admission and thrombectomy, the patient's disability status significantly improved compared to the status at admission (P = 0.000). The mean ± SD mRS score at admission was 4.78 ± 0.44, while at discharge it was 3.94 ± 1.84. The mean ± SD disability score 3 months after discharge decreased from 4.78 ± 0.44 to 3.72 ± 2.25. This reduction compared to the discharge score was not statistically significant (P = 0.06).

    Conclusions

    Older patients and those with higher middle cerebral artery (MCA) levels reported greater disability. Therefore, it is necessary to implement preventive measures to address this issue.

    Keywords: Modified Rankin Scale, Stroke, Disability
  • Zahra Ahmadizadeh, Seyed Afshin Samaei, Hossein Alibakhshi, Aliakbar Pahlevanian, Maryam Binesh*
    Objectives

    Occupational performance occurs in a dynamic interaction between the people, their occupations, and context. Stroke could affect the individual’s occupational performance, which is the basis of social life.
    This study aimed to investigate the factors affecting stroke patients’ occupational performance.

    Methods

    In this descriptive-analytic study, 55 people with stroke participated. The patients completed the Canadian occupational performance measure (COPM), Barthel index, Brunnstrom stage, Montreal cognitive assessment, and a demographic questionnaire.

    Results

    The results showed a significant correlation between occupational satisfaction and performance with cognition, the activities of daily living (ADL), and the severity of impairment in the upper and lower extremities (P <0.01). The results of linear regression show that cognition level could significantly predict occupational performance (R= 0.83, P <0.01) and satisfaction (R= 0.81, P <0.01) after stroke. 

    Discussion

    Results show that the cognitive level could predict occupational performance in patients with stroke. Performing daily living activities and lower limb impairment could predict satisfaction with occupational performance. Therefore, it is recommended that therapists consider the cognition in stroke patients through a proper therapeutic plan to prevent participation restrictions.

    Keywords: Stroke, Occupational Performance, Cognition, Participation, Activity Of Daily Living (ADL)
  • Mojtaba Azimian, Morteza Farazi*, Reza Nilipour, Mohammad Sayad Nasiri, Marzieh Amrevani, Samaneh Hosseinzadeh, Zahra Valitabar Kerati
    Objectives

    This study aimed to investigate neuropsychological rehabilitation’s effectiveness on stroke patients’ cognitive status.

    Methods

    This quasi-experimental study examined 22 adults with ischemic stroke of the left hemisphere (with an average age of 64.31 years) before and after the intervention. The patients had fluent aphasia (10 people) and non-fluent aphasia (12 people), along with cognitive disorders such as memory or attention disorder. Medical examination and para-clinical diagnosis of magnetic resonance imaging (MRI) with different causes, along with the Persian diagnostic aphasia battery bedside version (P-DAB-AQ1, 2016), were conducted. The severity of language disorder and type of aphasia were investigated using the Persian diagnostic aphasia battery (P-DAB-1) and Persian picture naming battery tests. Also, the mini-mental state examination (MMSE) test checked the cognitive dimensions. Verb network strengthening therapy, treatment of underlying forms, Persian verb, and sentence production protocol, and semantic feature analysis (SFA) for patients were also used.

    Results

    Findings show that the participants’ average aphasia quotient (AQ1) score increased from 74.80 to 80.12, and the average MMSE score increased from 17 to 22.59. The main variables do not follow a normal distribution (P<0.05), but the difference between scores before and after the intervention follows a normal distribution (P<0.05). Both the AQ1 and MMSE variables significantly differ before and after the intervention, according to the Wilcoxon test. The non-fluent aphasia group has a higher increase in MMSE scores than the fluent aphasia group.

    Discussion

    Neuropsychological rehabilitation interventions can effectively improve AQ1 and MMSE. In addition, further research on neuropsychological rehabilitation interventions with two intervention and control groups and the treatment methods used during this study can be suggested for the treatment of stroke patients.

    Keywords: Stroke, Aphasia, Neuropsychological Rehabilitation, Persian Speaking
  • Sadegh Abbasian, Mahsa Kargar Moghaddam, Amin Azimkhani, Fariborz Ramezani, Mohsen Ghotbi
    Background

    The neurological assessment plays a crucial role in evaluating stroke patients and is a skill that has been practiced by physicians for a long time, and further refined by practitioners. The purpose of the current study was to systematically review and synthesize the evidence-based neurological assessment of the different methods of treadmill-related training protocols in stroke patients.

    Evidence Acquisition:

     In this study, the appropriate studies were documented (N = 1270) using PubMed as the sole electronic database. Moreover, subgroup studies were provided based on training intensity and duration, categorized as low intensity-low duration, low intensity-high duration, high intensity-low duration, and high intensity-high duration. Training intensities were standardized to meters per second (m/s), and the training duration was calculated in terms of minutes per session, the number of sessions per week, and the total number of training weeks, which were then converted into minutes. The assessment of neurological recovery following stroke was conducted using standard neurological assessment scales.

    Results

    This meta-analysis in humans found a notably positive standardized mean difference in protocols with high intensity and high duration (1.792; 95% CI = 0.566 to 3.02).

    Conclusions

    In conclusion, the current meta-analysis suggests that practitioners using the high intensity-high duration protocol should regularly monitor the neurological outcomes, as they may be negatively impacted by the intensity and duration of the protocol.

    Keywords: Duration, Intensity, Neurological Deficits, Stroke, Training
  • Maryam Zolghadr, Shohreh Dehkordi, Javad Sarrafzadeh, Saeed Talebian, Hassan Haddadzade Niri, Marzieh Yassin
    Introduction

    Upper limb motor disability, with a prevalence of approximately 77%, is the most common complication after stroke. Despite advancements in rehabilitation, many patients face persistent upper limb discrepancies. Adopting top-down and bottom-up interventions may enhance neuroplasticity and improve upper limb function. This study aims to determine the effect of motor cortical transcranial direct-current stimulation (tDCS) as a top-down approach combined with task-oriented training (TOT) as a bottom-up intervention on changes in electroencephalography (EEG) spectral power in chronic stroke patients.

    Materials and Methods

    Thirty chronic hemiparetic stroke survivors were randomly assigned to receive real or sham stimulation targeting the primary motor cortex (C3/C4) at 2 mA for 20 minutes and TOT daily over 15 sessions. EEG was conducted before and after the intervention, with a 3-month follow-up and the relative powers of delta to gamma frequency bands were recorded during the movement task with each hand (healthy and involved).

    Results

    Significant differences in the theta (P=0.000), alpha (P=0.004), beta (P=0.000) and gamma (P=0.003) relative powers were observed between groups at follow-up. Additionally, the Friedman test revealed a significant decrease in alpha and beta bands’ relative powers in the healthy hand of the control group at follow-up (P=0.001). The experimental group displayed increased alpha and beta powers and decreased theta without statistical significance.

    Conclusion

    The increase in the relative power of low frequencies and the decrease in high frequencies in the sham group, which were more prominent than the increases in alpha and beta bands’ relative power and the decrease in theta in the experimental group, can indicate that the real-tDCS can prevent the recovery drop of relative powers. Due to the inconsistent effects of tDCS on the EEG power spectrum in stroke patients, conventional tDCS administration may require adjustments for optimal application to brain target points.

    Keywords: Electroencephalography, Stroke, Task, Transcranialdirect-Current Stimulation, Upper Extremity
  • فاطمه نصیری، محمد فتحی*، راضیه رضایی، مونا کدخدایی
    زمینه و هدف

    سکته مغزی به دنبال مختل شدن خون رسانی به ناحیه ای در مغز سبب آسیب در سیستم های حسی و حرکتی و ناتوانی های حرکتی و شناختی می شود. هدف از این مطالعه تعیین و بررسی تاثیر تمرینات در منزل با اضافه بار عملکردی بر بیماران سکته مغزی حاد بود.

    روش بررسی

    در این مطالعه نیمه تجربی که در سال 1403 به صورت پیش آزمون و پس آزمون با گروه های تجربی و کنترل انجام شد، جامعه آماری شامل بیماران سکته مغزی مراجعه کننده به کلینیک بیمارستان شهدای عشایر خرم آباد بود. نمونه آماری شامل 24 نفر بیمار سکته مغزی حاد بود که به صورت تصادفی در دو گروه (مداخله و کنترل) تقسیم شدند. در دو مرحله پیش آزمون و پس آزمون (پس از 12هفته تمرین)، آزمون تعادل برگ، اندازه گیری استقلال عملکردی، آزمون راه رفتن دالی و بررسی الکترومیوگرافی عضله تیبیالیس قدامی و چهارسر رانی در هر2 گروه اجرا شد. داده های جمع آوری شده با استفاده از آزمون های آماری تی مستقل و کولموگروف اسمیرنف تجزیه و تحلیل شدند.

    یافته ها

    در بررسی تعادل با سطح معنی داری (0001/0 =p)، در آزمون راه رفتن با سطح معنی داری (0001 /0=p) و در آزمون استقلال عملکردی با سطح معنی داری (0001/0=p) در گروه مداخله وضعیت بهتر بود. بررسی الکترومیوگرافی عصب عضله چهارسر رانی با سطح معنی داری (01/0=p) و عصب عضله تیبیالیس قدامی با سطح معنی داری (01/0=p) مشخص کرد آمپلیتود عضله گروه کنترل وضعیت بهتری داشت.

    نتیجه گیری

    نتایج این مطالعه نشان داد علاوه بر تمرینات کلینیکی تمرینات مبتنی بر منزل با استفاده از یک وزنه یا ویت کاف موجب بهبود عملکرد مستقل، راه رفتن و وضعیت تعادلی بیماران سکته مغزی حاد می شود که این موضوع با تغییرات مثبت در الکترومیوگرافی عضلات درگیر همراه بود.

    کلید واژگان: تمرین مبتنی بر منزل, استقلال عملکردی, تعادل, راه رفتن, الکترومیوگرافی, سکته مغزی
    F. Nasiri, M .Fathi*, R .Rezaei, M. Kadkhodai
    Background & aim

    stroke causes damage to the sensory and motor systems and motor and cognitive disabilities due to impaired blood supply to an area in the brain. The aim of the present study was to investigate the effect of exercises at home with functional overload on acute stroke patients.

    Methods

    In the present semi-experimental study conducted in 2024, as a pre-test and post-test with intervention and control groups, the statistical population included stroke patients referred to the clinic of Shohdai Eshair Hospital in Khorramabad. The statistical sample included 24 acute stroke patients who were randomly divided into two groups (intervention and control). In two stages of pre-test and post-test (after 12 weeks of training), leaf balance test, measurement of functional independence, dolly walking test and electromyography examination of anterior tibialis muscle and quadriceps femoris were performed in both groups.The collected data were analyzed using independent t and Kolmogorov-Smirnov statistical tests.

    Results

    The balance examination with a significant level (p = 0.0001), in the walking test with a significant level (p = 0.0001) and in the functional independence test with a significant level (0.0001) p=0/) in the experimental group, the situation was better. Electromyography examination of quadriceps muscle nerve with a significant level (p=0.01) and anterior tibialis muscle nerve with a significant level (p=0.01) revealed that the muscle amplitude of the control group was better.

    Conclusion

    The results of the present study indicated that in addition to clinical exercises, home-based exercises using a weight or weight cuff improve independent performance, walking, and balance in acute stroke patients, which was associated with positive changes in muscle electromyography.

    Keywords: Home-Based Exercise, Functional Independence, Balance, Gait, Electromyography, Stroke
  • راضیه یوسفی، پیام ساسان نژاد، عیسی نظر، علی هادیانفر، محمدتقی شاکری، زهرا جعفری*
    زمینه و هدف

    شناسایی عوامل تاثیرگذار بر طول مدت بستری بیماران مشکوک به سکته مغزی، می تواند در بهینه سازی استفاده از منابع بیمارستانی موثر باشد. لذا این مطالعه با هدف تحلیل بقای عوامل مرتبط با زمان بستری بیماران مشکوک به سکته مغزی، که با اورژانس به بیمارستان قائم (عج) مشهد انتقال داده شده بودند، انجام شد.

    روش بررسی

    در این کوهورت تاریخی، اطلاعات کلیه بیماران مشکوک به سکته مغزی که از ابتدای فروردین تا آخر اسفند 1397 با اورژانس 115 مشهد تماس گرفته و به بخش اورژانس بیمارستان قائم (عج) مشهد منتقل شده بودند جمع آوری شد. داده های اورژانس پیش بیمارستانی با استفاده از شناسه ماموریت با سوابق بیمارستانی ادغام شدند. پیامد نهایی مطالعه، طول مدت بستری بیماران بود. برای تحلیل داده ها، از نرم افزار Stata استفاده شد.

    یافته ها

    میانه طول مدت بستری بیماران هفت روز بود. از بین 578 بیمار شرکت کننده 386 مورد (67%) بهبود یافته و 190 مورد (33%) سانسور شده بودند. در تحلیل چند متغیره، رگرسیون کاکس به دلیل عدم برقراری فرض خطرات متناسب، نامناسب شناخته شد. پس از برازش مدل های پارامتری لگ نرمال، لگ لجستیک، نمایی و وایبل، مدل لگ نرمال با کمترین مقادیر AIC و BIC به ترتیب برابر 909/1273و 740/1356 به عنوان بهترین مدل انتخاب شد. از بین متغیرهای مورد بررسی اولویت پذیرش بیماران، بیمه، فصل بستری و حاشیه نشینی به عنوان متغیرهای معنا دار شناخته شدند.

    نتیجه گیری

    نتایج نشان می دهد مدل های بقا می توانند به خوبی جهت تحلیل داده های طول عمر به کار گرفته شوند و براساس معناداری متغیرها، به نظر می رسد که با تمرکز بر آمادگی بیشتر مراکز و تخصیص منابع، برنامه ریزی های مفیدتری قابل اجرا باشد.

    کلید واژگان: خدمات فوریت های پزشکی, طول مدت اقامت, سکته مغزی, تحلیل بقا
    Razieh Yousefi, Payam Sasannejad, Eisa Nazar, Ali Hadianfar, Mohammadtaghi Shakeri., Zahra Jafari*
    Background

    Identifying factors that influence the length of hospital stay for suspected stroke patients is crucial for optimizing the utilization of hospital resources. This study aimed to determine the factors associated with the length of hospital stay for suspected stroke patients transferred to Qaem Hospital in Mashhad through emergency services using survival analysis.

    Methods

    In this historical cohort study, general information was gathered for all suspected stroke patients who sought emergency services in Mashhad, the largest city in northeast Iran, from March 21, 2018, to March 20, 2019, and were then transferred to the Emergency Department of Qaem Hospital. Pre-hospital emergency data were integrated with hospital records using the mission ID. The primary outcome assessed in the study was the length of hospital stay, with model implementation carried out using the statistical software Stata.

    Results

    The median hospitalization time until patients' recovery was  seven days. Out of the 578 participants, 386 cases (66.8%) recovered, while the remaining 190 cases (33.2%) were censored (83 individuals had died during the study, and 107 individuals had exited the hospital for other reasons). The average age of patients at the time of hospitalization was 71.13±13.01 years. Statistical analysis employing Log-rank and Breslow tests identified a significant difference in hospitalization duration among patients receiving various levels of care and based on their insurance status. During multivariate analysis, the Cox regression model was considered unsuitable due to some variables not meeting the proportional hazards assumption, leading to the utilization of AFT models. Following the evaluation of AFT models, including Log-normal, Log-logistic, Exponential, and Weibull, the log-normal model emerged as the most suitable choice, exhibiting AIC and BIC values of 1273.909 and 1356.740, respectively. Significant variables influencing length of stay included patient admission priority, insurance status, season, and residency status.

    Conclusion

    The study suggests that parametric survival models are effective for analyzing lifetime data. Additionally, in light of the significant variables identified, enhancing facility readiness and resource allocation could facilitate more efficient planning and implementation.

    Keywords: Emergency Medical Services, Length Of Stay, Stroke, Survival Analysis
  • حمیدرضا مهریار، پیمان اتابکی*، عباس ریاحی، محمدرضا امیری نیک پور
    زمینه و هدف

    ظهور داروهای ترومبولیتیک افق های جدیدی را در درمان مبتلایان به سکته حاد ایسکمیک مغزی گشوده است و این مطالعه با هدف ارزیابی موانع دریافت فعال کننده پلاسمینوژن بافتی در بیماران مبتلا به سکته مغزی حاد ایسکمیک در بیمارستان امام خمینی ارومیه انجام شد.

    روش بررسی

    این مطالعه به صورت توصیفی-تحلیلی به شیوه مقطعی از اول فروردین الی 29 اسفند 1394 بر روی بیماران مبتلا به سکته حاد ایسکمیک مغزی مراجعه کننده به اورژانس بیمارستان امام خمینی ارومیه به روش نمونه گیری سرشماری انجام شد که برای جمع آوری داده ها از چک لیستی که شامل اطلاعات دموگرافیک بود استفاده شد که داده ها بعد جمع آوری وارد SPSS software, version 18 (SPSS Inc., Chicago, IL, USA) شده و با کمک آمار توصیفی تجزیه و تحلیل شد.

    یافته ها

    در این مطالعه نتایج نشان داد که از 100 بیمار مورد بررسی یک درصد بیماران حایز دریافت داروی rtPA بودند و شایعترین عامل ممانعت کننده در دریافت دارو به ترتیب مربوط به تاخیر در مراجعه به بیمارستان (69%)، تاخیر در رویت سی تی اسکن (49%)، تاخیر در ویزیت سرویس نورولوژی (40%)، تاخیر در آماده شدن آزمایشات (26%) و از میان کنترا اندیکاسیون های دریافت دارو، بهبود سریع علایم با 19% قرار داشتند. میانگین های زمانی بین شروع علایم تا ورود به اورژانس، ورود بیمار به اورژانس تا ویزیت پزشک، جوابدهی آزمایشات، انجام سی تی اسکن، مشاوره نورولوژی و تصمیم نهایی برای بیمار به ترتیب برابر با 1305، 13، 118، 151، 162، 1523 دقیقه به دست آمد.

    نتیجه گیری

    مهمترین مانع در شروع به موقع ترومبولیتیک تراپی تاخیر در مراجعه به اورژانس است. بنابراین آموزش همگانی در جهت ارتقاء سطح آگاهی عمومی جامعه می تواند در کاهش این تاخیر زمانی موثر باشد.

    کلید واژگان: حاد, ایسکمیک, پلاسمینوژن, سکته مغزی
    Hamidreza Mehryar, Payman Atabaki*, Abass Riyahi, Mohammadreza Amiri Nikpour
    Background

    The emergence of thrombolytic drugs has opened new horizons in the treatment of patients with acute ischemic stroke, and this study was conducted with the aim of evaluating the barriers of receiving tissue plasminogen activator in patients with acute ischemic stroke in Imam Khomeini Hospital of Urmia.

    Methods

    This descriptive-analytical, cross-sectional study was conducted from April 21, 2015 to March 19, 2016 on patients with acute ischemic stroke referred to the emergency department of Imam Khomeini Hospital in Urmia using census sampling method. To collect data, a checklist containing demographic information was used. After collecting the data, it was entered into SPSS 18 and analyzed with the help of descriptive statistics.

    Results

    In this study, the results showed that out of 100 patients, most of the participants were male (58%)58 and the rest were female, and the average age was 63.71±17.3 years, and 86% were in the age range of 18-80 years, which was the appropriate age to receive or thrombolytics. and the rest were over 80 years old. The fastest visit time was 25 minutes and the latest was 10080 minutes (168 hours). Among these 40 people, only four people (40%) were in the golden time period of thrombolytic drug, i.e. Three hours from the onset of symptoms to the final evaluation. Among the four people who were placed in the golden time, in 50% of the cases there was a history of taking anticoagulants, in 25% a history of head injury, in 50% of the blood sugar less than 50 and finally 1 person (25% of the people placed in the golden time) that is, 1% of all patients were eligible to receive rtPA. About 24% of patients had NIHSS<4 and 2% had NIHSS>25, and the average number obtained was 10.

    Conclusion

    The most important obstacle in the timely initiation of thrombolytic therapy is the delay in visiting the emergency room. Therefore, public education in order to improve the level of general awareness of the society can be effective in reducing this time delay.

    Keywords: Acute, Ischemic, Plasminogen, Stroke
  • Somayeh Bahadoram, Narges Arsalani, Masoud Fallahi Khoshknab, Farahnaz Mohammadi-Shahbolaghi, Asghar Dalvandi
    Background

    Patients With Stroke (PWS), like patients with other chronic health conditions, need long‑term care in home settings. Patient transfer from hospital to home is associated with challenges such as care quality impairment and ineffective patient need fulfillment. The aim of this study was to assess the principles of Home Care (HC) for PWS.

    Materials and Methods

    This integrative review was conducted in 2023 using the method recommended by Whittemore and Knafl. The Web of Science, Google Scholar, ScienceDirect, ProQuest, Scopus, Cumulative Index to Nursing and Allied Health Literature, PubMed, and specific databases for stroke care guidelines were searched to find relevant articles published between 2010 and 2023. The Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) statement was used for document screening and selection. The data were analyzed using the constant comparison method.

    Results

    Primarily, 2608 documents were retrieved, and 22 of them were included in data analysis. The principles of HC for PWS were categorized into six main categories: principles of transition from hospital care to HC, principles of assessment for HC, principles of education for HC, principles of designing an HC plan, principles of HC measures, and principles of discharge from HC centers.

    Conclusions

    The present study provides a detailed overview of the principles of HC for PWS, which can be used to develop standard guidelines and improve the quality of HC for PWS.

    Keywords: Home Care Services, Practice Guideline, Review Literature, Stroke
  • Raya Al-Mamari, Eilean Rathinasamy Lazarus *, Maryam Alharrasi, Huda Al-Noumani, Omar Alzaabi
    Background
    Dysphagia is the most common and significant neuromuscular disorder following a massive stroke. Patients with dysphagia are at a higher risk of developing pneumonia, experiencing prolonged hospital stays, and requiring nasogastric tube placement, which can increase post-stroke morbidity and mortality.
    Objectives
    This study aimed to investigate the effects of post-stroke dysphagia on various clinical outcomes in acute stroke patients. These outcomes included the degree of impairment, mortality rate, presence of nasogastric tube (NGT), incidence of stroke-associated pneumonia, and duration of hospitalization.
    Methods
    The study employed a cross-sectional design, involving a sample of 274 patients with acute stroke admitted to two tertiary hospitals in Oman over a six-month period. The researcher utilized a non-probability convenience sampling technique from June 2 to November 21, 2021. The Modified Rankin Scale was used to assess the level of impairment, including death upon discharge. The Glasgow Coma Scale and Gugging Swallowing Screen were employed to evaluate dysphagia. Data analysis was conducted using SPSS version 23 software, which included descriptive analysis, correlations, and regression analysis, with statistical significance set at p<0.05.
    Results
    The study included 274 participants, comprising 170 males (62%), with a mean age of 61.14±14.83 years. A substantial proportion (70.1%) experienced dysphagia. Approximately 35% had a history of previous strokes, and comorbidities such as hypertension (71.9%) and diabetes mellitus (58.4%) were prevalent. Smoking, alcohol consumption, and obesity were noted in subsets of participants. Most had ischemic strokes (81.8%) with varied locations. Glasgow Coma Scale scores varied, with 42.3% scoring 15/15. Thrombolysis/ thrombectomy was performed in 14.9% of cases, and 9.5% experienced hemorrhagic transformation. A significant correlation was found between dysphagia and the prolonged use of NGT during hospitalization and upon discharge (p<0.001). Dysphagia was also linked to longer hospital stays and higher levels of impairment, including increased mortality rates and the incidence of stroke-related pneumonia (p<0.001).
    Conclusion
    Dysphagia is prevalent among acute stroke patients in Oman and significantly impacts post-stroke outcomes, including prolonged hospitalization, increased mortality rates, heightened levels of impairment, and the need for nasogastric tube placement, as well as the occurrence of stroke-related pneumonia. This study emphasizes the importance of implementing routine dysphagia screening and multidisciplinary management teams for acute stroke patients, along with establishing standardized protocols and ongoing training for healthcare providers in Oman.
    Keywords: Aspiration, Deglutition Disorders, Length Of Stay, Patient Discharge, Stroke
  • Saeideh Farahmand, Majid Ghasemi, Keivan Basiri, Ehsan Ghasemi
    Introduction

    Stroke is one of the most common causes of disability. Spasticity is a common clinical impairment that occurs after a stroke. This study investigates the effect of Nintendo Wii games on the outcomes of spasticity, functional mobility, and quality of life in patients with stroke.

    Materials and Methods

    In this single-blind clinical trial study, 30 patients with stroke were randomly assigned to one of the experimental and control groups. Subjects of both groups received conventional physiotherapy. In addition, the experimental group also received Nintendo Wii games for 30 min, three times a week for a total of 12 sessions. The primary outcomes spasticity and functional mobility that respectively evaluated using the modified modified Ashworth scale (MMAS) and the timed up-and-go test before and after the treatment. The assessor was blind about group assignment. Meanwhile, the secondary outcome included quality of life. All statistical analyses were performed using the SPSS software, version 20.

    Results

    The intragroup results showed that in the experimental group, spasticity was significantly reduced (P=0.001), functional mobility improved (P=0.001), and the quality of life increased significantly (P<0.001); however, in the control group, only a significant improvement in functional mobility (P=0.04) was observed. The comparison between the two groups showed that there is no statistically significant difference in the results between the experimental and control groups (P>0.05).

    Conclusion

    Considering these results, the use of Nintendo Wii can be suggested as a treatment modality alongside the usual treatments to achieve more and faster effectiveness in patients with stroke.

    Keywords: Stroke, Spasticity, Exercisetherapy, Virtual Reality
نکته
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