Clinical characteristics and functional outcome after rehabilitation of middle cerebral artery stroke

To describe the clinical profile of MCA stroke. Also, to describe the functional outcome and to identify factors associated with functional changes after rehabilitation of MCA stroke. Sixty five hemiplegic patients due to MCA stroke were studied. Patients underwent complete neurological and functional evaluation on admission. Evaluation included stroke type, cardiovascular risk factors for stroke, associated neurological deficits, total motricity index [MI] of upper and lower extremities, motor function of the trunk assessed by Trunk Control Test [TCT], and Functional Independence Measure [FIM]. All patients were enrolled in an inpatient rehabilitation program. Patients were re-evaluated at discharge. Statistical analyses were carried out to determine factors associated with functional outcome after rehabilitation of MCA stroke. The total MI and TCT improved significantly after rehabilitation. In addition, discharge total FIM score was statistically higher than admission total FIM score. Patients with hemineglect, impaired cognition, dysphagia, hemihypoesthesia incontinence or multiple neurological deficits had significantly lower discharge total FIM score than patients without such variables. The discharge FIM score correlated strongly with admission total FIM score [r= 0.88, p<0.001] moderately with admission TCT score [r= 0.69, p<0.001], fairly with admission total MI [r=0.37, P=0.002] and negatively with age [r= -0.2, p=0.01]. On multiple linear regression analysis, admission total FiM and TCT scores score were the only significant predictors of discharge FIM scores. Rehabilitation improved the functional outcome of MCA stroke patients. The initial functional status was the most important factor associated with functional improvement

Plasma polymorphonuclear neutrophil elastase in systemic sclerosis: clinical correlative study

To measure the plasma level, of polymorphonuclear neutrophil [PMN] elastase in patients with systemic sclerosis [SSc] and to study its relation to interstitial pulmonary fibrosis, extent of skin sclerosis, and other clinical manifestations of the disease. Seventeen patients with SSc [7 diffuse SSc [dSSc] and 10 limited SSc [lSSc]] and 13 controls were included. The degree of skin involvement was quantified by modified Rodnan skin thickness score [mRSS]. Pulmonary involvement was assessed in all patients by high resolution computerized tomography [HRCT] and pulmonary function tests [PET]. Plasma PMN elastase was measured in all patients and controls. There was a significant increase of plasma PMN elastase levels in SSc patients compared to controls. Elevated plasma PMN elastase levels were observed in 47.05% of all SSc patients especially in dSSc subtype and were significantly associated with the more frequent presence of arthritis [P=0.049]. Pulmonary fibrosis was detected in 82.35% of SSc patients by HRCT and restrictive lung disease, defined by FVC <80%, was detected in 70.58% of patients. Ground glass opacification [GGO] was detected more frequently in SSc patients with elevated PMN elastase levels compared to patients with normal levels. The presence elevated plasma PMN elastase in SSc patients had a positive predictive value PV] of 83.3% in detecting early interstitial lung fibrosis. Plasma PMN elastase correlated with CRP but not with the extent of skin involvement or PFT results. Elevated PMN elastase may be used as a simple screening test to predict early interstitial pulmonary fibrosis in patients with SSc

efficacy of bilateral arm training with rhythmic auditory cueing in stroke rehabilitation: clinical and electrophysiological study

To study the efficacy of repetitive bilateral arm training with rhythmic auditory cueing [BATRAC] on motor recovery in stroke patients clinically and electrophysiologically. Forty patients with chronic hemiplegia were included in the study. All patients participated in BATRAC [3 sessions/week] for six weeks. The upper extremity functional performance was evaluated by the Fugl-Meyer Upper Extremity Motor Performance [FMUEMP] and grip strength. Transcranial magnetic stimulation [TMS] was used to elicit MEP to the abductor digiti minimi. Functional performance and MEP were recorded before and after BATRAC. Following BATRAC there were improvement in functional performance [FMUEMP and grip strength], decrease in TMS threshold, decrease in the central motor conduction time and increase in MEP amplitude. These changes were significant [p<0.01]. Besides, there was a significant positive correlation between pre-rehabilitation MEP amplitudes and the improvement in FMUEMP. BATRAC for 6 consecutive weeks has been proven effective in improving both functional performance [of the paretic upper extremity] and MEP parameters in chronic stroke patients suggesting that functional improvement might has been secondary to central motor excitability changes