Factors Influencing Depression In Patients Of Cerebrovascular Accidents-A Study

Background: Post Stroke Depression (PSD) is one of the most frequent Neuropsychiatric consequences of stroke. It affects almost 29%-70% of Stroke Survivors (SS). There is paucity of research data in determining the risk factors and especially severity and associa?on of depression with site of lesion loca?on in Indian community. Aim and Objec?ves: To determine factors associated with PSD and associa?on between Socio-demographic profiles, Stroke symptoms, Site of lesion with depression. Materials and Methods: It’s a cross-sec?onal study including par?cipants from the outpa?ents sec?on of Department of Neurology at Prathima Ins?tute of Medical Sciences. A predetermined sample size of 60 pa?ents with CVA pa?ents was enrolled in the study and their socio demographic details are collected along with administering Beck’s Depression Inventory for Depression. Neuro-imaging provided informa?on on lesion loca?on. Collected data was analysed using SPSS version 19 and using descrip?ve and inferen?al sta?s?cs. Results: In this study 18 out of 60 subjects with stroke were diagnosed with PSD. Risk factors found to be mainly associated with PSD are lack of family support, Joint family types, Stroke with Aphasia, Cranial Nerve involvement and Motor System weakness whereas, Substance use is found to be a protec?ve factor. Significant numbers of subjects were found to have le?-anterior-sub-cor?cal lesions associated with PSD. Conclusion: This study highlights the variables which are to be considered in the recogni?on of PSD for Neurologists and Mental health care workers for early interven?on and a be?er outcome in view of stroke recovery

Assessment of quality of life among stroke survivors: a longitudinal study

Background: Quality of life (QoL) among stroke survivors is a concern which has not received sufficient attention in India. The objective of the study was to assess the quality of life of stroke survivors in rural population of Chikkaballapur district, Karnataka.Methods: A community based longitudinal study was done amongst the 150 incident stroke cases registered during the period from March 2013 to November 2014 and who survived beyond 28 days. The cases were enrolled and interviewed using a semi-structured questionnaire and were followed up for 6th month period. QoL was assessed at baseline (at 28 days), at 3rd month and 6th Month using Stroke Specific QoL scale (SSQoL) and Barthel index (BI).Results: The mean age of the persons with stroke was 61.3±15 years with a majority being males (69.3%). Baseline median score (IQR) of SSQoL at 28th day was poor i.e. 131 (77-183). Among the 150 cases, 136 (91%) survived until the end of 6th month. The overall QOL gradually improved to 182 (133-213) and 185 (147-213) at 3rd and 6th month respectively and similar improvement was seen individually in physical, psychological and social domains as well and on multivariate logistic regression age <60 years and few disturbed consciousness among the stroke survivors during the 6th month follow up were found to be predictors for improved quality of life.Conclusions: QoL showed significant improvements in all physical, psychological and social domains by the end of the 6th month of follow up.

Factors Associated with Health-related Quality of Life of Ambulatory Stroke Survivors in Jamaica / Factores Asociados con la Calidad de Vida Relacionada con la Salud de los Sobrevivientes de Apoplejía en Jamaica

ABSTRACT Objective: The study aimed to determine the factors associated with health-related quality of life (HRQL) in ambulatory chronic stroke survivors. Methods: Baseline data from a randomized controlled trial (RCT) done to determine the effects of aerobic exercise on HRQL were analysed. The Medical Outcomes 36-Item Short Form Health Survey (SF-36) was used to assess HRQL. Other measures included: functional status (the Barthel Index) and the Older American Resource and Services Questionnaire (OARS), grip strength measured with a dynamometer, lower extremity strength (the Motricity Index), depression (the Geriatric Depression Scale-GDS) and endurance assessed through the six-minute walk test. Data were analysed using the t-test, correlation coefficient and multiple linear regression. Results: One hundred and twenty-eight persons participated (mean age: 64 years, mean time post stroke: 12 months). The Physical Component of the SF-36 was associated with distance walked in six minutes (r = 0.395; p < 0.000), grip strength on the affected side (r = 0.309; p < 0.000) lower limb strength on the affected side (r = 0.287; p = 0.001), Barthel Index (r = 0.253; p = 0.004), OARS (r = 0.378; p < 0.000) and depressive symptoms (p = −0.353; p = 0.000). The independent predictors were: distance walked in six minutes and depressive symptoms. The mental component was significantly related to GDS (r = − 0.391; p = 0.000) and unaffected side lower limb strength (r = 0.251; p = 0.004). Male gender and less depressive symptoms were independently associated with this component. Conclusion: In Jamaican stroke survivors, motor impairment, activity limitation, depression and female gender are associated with poor health-related quality of life long after stroke onset.

RESUMEN Objetivo: El presente estudio estuvo dirigido a determinar los factores asociados con la calidad de vida relacionada con la salud (CVRS) en sobrevivientes de apoplejía crónicos ambulatorios. Métodos: Se analizaron los datos de base de un ensayo controlado aleatorio (ECA) para determinar los efectos del ejercicio aeróbico en la CVRS. La calidad de vida relacionada con la salud se evaluó utilizando los resultados médicos del Cuestionario de Salud de Formulario Breve de 36 Preguntas (SF-36). Otras mediciones incluyeron: el estado funcional (índice de Barthel) y el Cuestionario de Recursos y Servicios para Personas de Edad Avanzada (OARS, en inglés), la fuerza de prensión medida con un dinamómetro, la fuerza de las extremidades inferiores (índice de motricidad), la depresión (Escala de Depresión Geriátrica - EDG), y la resistencia evaluada mediante la prueba de una caminata de seis minutos. Los datos fueron analizados mediante la Prueba t, el coeficiente de correlación, y la regresión lineal múltiple. Resultados: Ciento veintiocho personas participaron (edad promedio: 64 años; tiempo promedio después del accidente cerebrovascular: 12 meses). El componente físico del Cuestionario SF-36 se asoció con la distancia recorrida en seis minutos (r = 0.395; p < 0.000), fuerza de prensión en el lado afectado (r = 0.309; p < 0.000, la fuerza de la extremidad inferior en el lado afectado (r = 0.287; p = 0.001), el índice de Barthel (r = 0.253; p = 0.004), la escala de OARS (r = 0.378; p < 0.000), y los síntomas depresivos (p = −0.353; p = 0.000). Los predictores independientes fueron: la distancia recorrida en seis minutos y los síntomas depresivos. El componente mental estuvo relacionado significativamente con la EDG (r = − 0.391; p = 0.000) y la fuerza del miembro inferior del lado no afectado (r = 0.251; p = 0.004). El género masculino y síntomas menos depresivos estuvieron independientemente asociados con este componente. Conclusión: En los sobrevivientes jamaicanos de apoplejía, el deterioro motor, la limitación de la actividad, la depresión, y el género femenino están asociados con una pobre calidad de vida mucho después del inicio del accidente cerebrovascular.

Muscle Thickness and Echo Intensity of the Abdominal and Lower Extremity Muscles in Stroke Survivors

BACKGROUND AND PURPOSE: This study compared the muscle thickness (MT) and echo intensity (EI) of the abdominal, thigh, and lower leg muscles between the paretic and nonparetic sides in chronic stroke survivors. METHODS: Thirty-two stroke survivors living in the community participated in this study. The MT and EI, which are indicators of muscle mass and intramuscular fat or connective tissue, were assessed in the rectus abdominis, external oblique, internal oblique, transversus abdominis, rectus femoris, vastus intermedius, vastus lateralis, vastus medialis, tibialis anterior, gastrocnemius, and soleus via transverse ultrasound imaging. In addition, a possible indicator of physical activity—the frequency of going out per week—was evaluated. RESULTS: All quadriceps muscles and the tibialis anterior were significantly thinner and the EI values of the vastus intermedius, vastus lateralis, vastus medialis, and soleus were significantly higher in the paretic limb than the nonparetic limb. The MT and EI values of abdominal muscles did not differ significantly between the two sides. The MT values of the paretic rectus femoris, vastus lateralis, and vastus medialis were significantly associated with the frequency of going out after adjusting confounding factors. The MT of the nonparetic vastus lateralis was significantly associated with latency from stroke onset after adjusting confounding factors. CONCLUSIONS: Our results indicate that quantitative and qualitative changes on the paretic side in stroke survivors were the most robust in the thigh muscles, whereas such changes might not occur in the abdominal muscles.

A novel hinged ankle foot orthosis for gait performance in chronic hemiplegic stroke survivors: a feasibility study

Stroke survivors with gait disturbances may use ankle foot orthoses (AFOs). However, most AFOs come in one-piece styles, which make it difficult for spasticity-affected stroke survivors to don. AFOs are also limited since they do not properly prevent ankle joint for foot drop by itself. Therefore, the present study developed a novel hinged AFO by adding a locking device to a hinged joint. We then tested its feasibility in 9 hemiplegic stroke survivors by investigating temporal–spatial gait parameters using the GAITRite in the following 3 conditions: no AFO, traditional AFO, and novel hinged AFO. There was no significant difference in spatiotemporal gait parameters among the different conditions. There were greater decreases in gait velocity, cadence, step length, and stride length in the novel hinged AFO group than in the no AFO and traditional AFO groups. This novel hinged AFO was developed to prevent foot drop. However, the AFO did not show significant differences in gait parameters because it consists of metal with extra weight and volume. Functionally, it prevented foot drop. It also improved convenience by its releasable design. Thus, further studies are needed to develop an AFO that improves gait and is convenient to use for hemiplegic stroke survivors.

Effects of a community-based exercise program on functional fitness status and APDL in post-discharge stroke survivors / 体力科学

The purpose of this study was to implement a community-based exercise program for postdischarge stroke survivors in the public health center. The subjects were fourteen male stroke survivors with chronic upper and lower limb paresis (63.0±5.9 years) . The study design was quasiexperimental, with each subject serving as his own control. All subjects have to meet following inclusion criteria: (1) first stroke resulting in hemiplegia, (2) at least 6 months post-stroke, (3) able to walk independently, and (4) free from grave aphasia, apraxia, agnosia, or disequilibrium. A 25-week (2 deek) training program consisted of a warm-up, lower and upper extremity muscle strengthening, recreational activities, walking training, and a cool down. The duration of this program is approximately 70 minutes a day. The outcome measure was the 12 functional fitness test items and questionnaire in activities parallel to daily living. Significant improvements (P<0.05) were found for handgrip strength, knee extension strength, tandem balance, standing and sitting, and timed up and go in the treatment period. However, the scores in activities parallel to daily living were not significant. These results suggest that they may attain significant functional improvements in response to implementation of a community-based exercise program. In conclusion, post-discharge stroke survivors can improve their functional fitness status by participating in a community-based exercise program.

Comparison of dementia in stroke survivors and patients with parkinson’s disease in Thai subjects.

Comparison of dementia in stroke survivors and patients with Parkinson’s disease was done at Siriraj Hospital during 1990-1994. Two hundred and twelve Thai stroke survivors and 132 patients with Parkinson’s disease were enrolled in this study. The mean age of the study groups were 62.78 (SD 11.12) years for stroke survival group and 67.72 (SD 9.12) years for Parkinson’s diseases group. The mean duration of stroke suffering was 2.09 (SD 2.74) years whereas the mean duration of suffering from Parkinson’s disease was 3.5 (SD 3.53) years. All patients of both groups were screened for depression by using Thai Geriatric Depression Scale and patients with Alzheimer’s disease were excluded from the study. Thai Mental State Examination (TMSE) is a standard test used in this study to identify dementia. Seventy stroke patients (33.02%) scored below 23 points (cut-off point for dementia) and 34 patients (25.76%) of Parkinson’s disease scored below 23 points which they were classified as definite dementia. Anyone who scored below 20 points was classified as severe dementia which there were 40 patients (18.88%) in stroke group and 24 patients (18.18%) in Parkinson’s disease group. Patient who scored between 20-22 points was classified as mild to moderate dementia which there were 30 patients (14.15%) in stroke group and 12 patients (9.09%) in Parkinson’s disease group. Fifty-eight patients (27.36%) in stroke group and 37 patients (28.03%) in Parkinson’s disease group scored between 23-25 points and they were classified as borderline dementia. Comparison of the subset of demenyia yesting in TMSE between stroke group and Parkinson's disease group revented no statistically significant difference in any degree of dementia. Subset tests of orientation, language and abstract thinking, and recall seemed to be more affected in Parkinson's disease group whereas subset test of registration was equally impaired in both groups. There were no difference in subset tests of dementia in mild to moderate dementia group of both patients with stroke and Parkinson's disease. In conclusion we could not differentiate pattern of dementia between stroke survivors and patients with Parkinson's disease even they were severely demented.