Association Between Serum Vitamin D Levels and Physical Outcomes of Patients Who Underwent Rehabilitation Following Ischemic Stroke.

BACKGROUND Ischemic stroke is the most common cause of disability in adults. Deficiency of vitamin D in patients with cardiovascular diseases is increasing. Only a few studies have assessed the relationship between serum vitamin D levels and functional capacity and degree of disability. This study aimed to evaluate the association between serum vitamin D levels and physical outcomes of 94 patients who underwent physical rehabilitation following ischemic stroke. MATERIAL AND METHODS A group of 94 patients was enrolled; however, 80 patients (61.8±6.9 years) were included. They underwent a 6-week rehabilitation using proprioceptive neuromuscular facilitation (PNF, 60 min daily), mirror therapy (MT, 30 min daily), and occupational therapy (OT, 45 min daily). The Barthel Index (BI) and modified Rankin scale (mRS) were used for functional assessments. Laboratory blood tests for serum vitamin D and insulin-like growth factor 1 (IGF-1) levels were conducted. RESULTS There was a significant increase in BI scores (median difference=2.0 points [pts]; P<0.001) and IGF levels (median difference=124.6 ng/ml; P<0.001) after rehabilitation. There was a significant decrease in mRS scores (median difference=7.0 pts; P<0.001), but there was no significant difference in vitamin D levels (P=0.40). The effect of age (B=-0.01, P=0.04) and serum vitamin D level (B=-0.02, P=0.01) on the BI score was demonstrated. The effect of body mass index (BMI) results (B=-0.07, P=0.02) on the mRS score was observed. CONCLUSIONS Lower serum vitamin D levels and more advanced age may be associated with worse functional outcomes in first-ever ischemic stroke patients.

Assessment of Changes in Serum C-Reactive Protein Levels in Patients after Ischemic Stroke Undergoing Rehabilitation-A Retrospective Observational Study.

Inflammation plays a key role in the pathogenesis and prognosis of ischemic stroke. C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect the progression of vascular disease. Using a biomarker such as CRP to predict recovery rather than mortality may present clinical value in providing rehabilitation. The primary aim of the study was to analyze changes in serum CRP levels in patients after ischemic stroke during the regenerative-compensatory period and to assess the usefulness of CRP as a potential biomarker during the rehabilitation period. The project was carried out as a retrospective analysis of prospectively collected data from post-stroke patients from the Department of Neurological Rehabilitation of the Regional Specialist Hospital in Wroclaw. A group of 52 patients, after their first-ever ischemic stroke with subsequent hemiplegia, was finally qualified to participate in the study. Serum CRP levels were determined during blood laboratory tests. The Modified Rankin Scale (mRS) and Barthel Index (BI) were used to assess functional outcomes. Rehabilitation using neurophysiological methods was applied five days a week (each session lasted 60 min, and the entire period was 42 days). At the first test, serum CRP levels were found to be above 5 mg/L in 19 patients, the second test in 12 patients, the third test in five patients, and the fourth test in 9 patients. Only three patients had values higher than 5 mg/L in all consecutive assessments (p > 0.05). There was a statistically significant increase in BI scores after therapy (p < 0.001) as well as a decrease in the mRS score by 2.2 points (p < 0.001), in CRP values by 5.02 mg/L (p = 0.019), and in cortisol levels by 2.5 nmol/L (p = 0.002). Statistically significant relationships were observed between the CRP levels after rehabilitation and the corresponding mRS scores (rs = 0.29, p = 0.038). Furthermore, the effect of BMI on CRP levels was demonstrated (B = 0.20, p = 0.038). In conclusion, despite demonstrating a significant relationship between CRP levels and corresponding mRS scores, CRP levels alone may not serve as an independent predictor of long-term functional outcomes in ischemic stroke patients undergoing rehabilitation.

Does Mental Health Affect the Decision to Vaccinate Against SARS-CoV-2? A Cross-Sectional Nationwide Study Before the Vaccine Campaign.

The COVID-19 pandemic generated a sense of threat in the society, leading to social isolation and mental health deterioration. A great deal of hope for the development of herd immunity was placed in preventive vaccinations. The survey, performed before vaccine campaign between September 26-October 27, 2020, during the second wave of the SARS-CoV-2 pandemic in Poland with the Computer Assisted Web Interviews method. The study was partly community based and partly open to the public. Participants were invited to complete the survey using Google forms via social media (Facebook, WhatsApp). The survey was also distributed 54 times at the request of interested persons via e-mail. Total 1,043 questionnaires were assessed for eligibility and 41 were excluded (13 because of the age under 18, and 28 due to refusal to participate: non-response after sending questionnaire via e-mail). Finally 1,001 questionnaires were included to the study and statistical analysis was performed on the basis of the 1,001 responses. The questionnaire consisted of three parts: a sociodemographic survey, a questionnaire assessing the knowledge of the SARS-CoV-2 and the General Health Questionnaire-28. Participants also determined their attitude toward being vaccinated against SARS-CoV-2. The questionnaire was completed by a total of 1,001 participants: 243 people declared that they will not get vaccinated against SARS-CoV-2. Majority of people declaring the willingness to vaccinate were representatives of medical professions, suffering from chronic diseases, with higher values on the total GHQ-28 scale and the subscales: anxiety and insomnia, social dysfunction and somatic dysfunction. Loss of income, difficult access to health care, recognizing the restrictions as excessive and knowledge about COVID-19 were found as significant positive determinants of the reluctance to vaccinate. Greater readiness to vaccinate can be associated with greater certainty about its effectiveness and a hypothetical collectivist attitude. Experiencing anxiety and psychopathological symptoms are risk factors for infection, but can also be conducive to reliance on information about vaccination presented in the media. Reluctance to vaccinate may result from greater awareness of the complexity of the disease, and thus less faith in the effectiveness of vaccines.

Influence of Physical Activity and Socio-Economic Status on Depression and Anxiety Symptoms in Patients after Stroke.

Stroke is a high-risk factor for depression. Neurological rehabilitation is greatly difficult and often does not include treatment of depression. The post-stroke depression plays an important role in the progress of treatment, health, and the life of the patient. The appropriate treatment of depression could improve the quality of life of the patient and their family. The study aimed to evaluate the impact of physical activity and socio-economic status of the patient on the effectiveness of recovery from depression and the severity of the symptoms of depression. The study was conducted with 40 patients after stroke aged 42-82 years, and included 10 women and 30 men who were hospitalized for two weeks. The severity of depression/anxiety (D/A) symptoms were evaluated two times; at admission and after two weeks of physical therapy. The hospital anxiety and depression scale (HADS) questionnaire was used for this purpose. Socio-economic status was evaluated by several simple questions. It was revealed that physical therapy has a positive influence on mental state. The severity of D/A symptoms after stroke is related to the financial status of the patients (χ2 = 11.198, p = 0.024). The state of health (χ2 = 20.57, p = 0.022) and physical fitness (χ2 = 12.95, p = 0.044) changed the severity of symptoms of anxiety and depressive disorders. The kinesiotherapy in the group of patients with post-stroke depression had positive effects; however, economic and health conditions may influence the prognosis of the disease.

BDNF Impact on Biological Markers of Depression-Role of Physical Exercise and Training.

Depression is the most common and devastating psychiatric disorder in the world. Its symptoms, especially during the pandemic, are observed in all age groups. Exercise training (ET) is well known as a non-pharmacological strategy to alleviate clinical depression. The brain-derived neurotrophic factor (BDNF) is one of the biological factors whose expression and secretion are intensified in response to ET. BDNF is also secreted by contracted skeletal muscle that likely exerts para-, auto- and endocrine effects, supporting the crosstalk between skeletal muscle and other distant organs/tissues, such as the nervous system. This finding suggests that they communicate and work together to induce improvements on mood, cognition, and learning processes as BDNF is the main player in the neurogenesis, growth, and survival of neurons. Therefore, BDNF has been recognized as a therapeutic factor in clinical depression, especially in response to ET. The underlying mechanisms through which ET impacts depression are varied. The aim of this review was to provide information of the biological markers of depression such as monoamines, tryptophan, endocannabinoids, markers of inflammatory processes (oxidative stress and cytokines) stress and sex hormones and their relationship to BDNF. In addition, we reviewed the effects of ET on BNDF expression and how it impacts depression as well as the potential mechanisms mediating this process, providing a better understanding of underlying ET-related mechanisms in depression.

Symmetry function in gait pattern analysis in patients after unilateral transfemoral amputation using a mechanical or microprocessor prosthetic knee.

BACKGROUND: Above-knee amputations (AKAs) contribute to gait asymmetry. The level of asymmetry is affected by the type of knee prosthetic module. There is limited evidence suggesting that more technically advanced solutions (microprocessor modules; MicPK) are superior to less advanced ones (mechanical modules; MechPK). The study aimed to evaluate the variable range of hip and pelvic joint movements during gait and look for differentiating areas with an increased level of asymmetry of the gait cycle in individuals who underwent an AKA and are equipped with MicPK or MechPK. METHODS: Twenty-eight individuals participated in the study; 14 were assigned to a study group of individuals who underwent a unilateral AKA, and the other 14 were healthy participants as a control group. The movement task was recorded using the optoelectronic SMART-E system following the standard Davis protocol (the Newington model). A new method of quantifying gait symmetry using the symmetry function (SF) is proposed. SF is an integral measure of absolute differences in time-standardized signals between sides throughout the whole cycle of motion variability. RESULTS: In the frontal plane, there were significant differences between groups in the asymmetry of the range of movement in the hip joint of the intact limb. In the middle of the support phase, the intact limb was more adducted in individuals with MicPK and less abducted in people with MechPK (differences in mean 180%, p < 0.000; max 63%, p < 0.000; min 65%, p < 0.000). In the sagittal plane, the range of asymmetry of the flexion and thigh extension of the intact limb was similar to and only slightly different from the physiological gait. In the transverse plane, higher asymmetry values were noted for individuals with MicPK. In the final stage of the swing phase, the thigh was more rotated both externally and internally. The size of the asymmetry, when compared to gait of healthy individuals, reached 50% (differences in mean 115%, p < 0.232; max 62% p < 0.26; min 50, p < 0.154). CONCLUSIONS: In the study group, the assessed ranges of pelvic and thigh movement in the hip joint differed only in the frontal plane. Individuals who underwent a unilateral above-knee amputation may gain less from using MicPK than anticipated.

Pelvic Symmetry Is Influenced by Asymmetrical Tonic Neck Reflex during Young Children's Gait.

Gait is one of the examined functions in child development. It should be economical and symmetrical. One test increasingly used by physiotherapists and pediatricians is asymmetrical tonic neck reflex (ATNR). Physiologically, it is observed from in utero up to six postnatal months. This reaction is inhibited with the growing maturation of the central nervous system (CNS). In some children, when the natural process of development is incorrect, ATNR manifests later in life, when it is observed as an automatic response of muscle tension to head rotation. Analysis of pelvis symmetry in the gait of children with active ATNR is important for better understanding their specific movements. In the gait of children with persistent ATNR, some variations are observed. The aim of the study was to investigate the gait symmetry of preschool children and the influence of persistent ATNR. Fifty preschool children with a trace form of ATNR were examined. The distribution of the gait parameters was determined using a BTS G-SENSOR measurement instrument. ATNR negatively influences pelvic obliquity and pelvic rotation (p < 0.01). Younger children have a statistically higher symmetry index of pelvis obliquity in the examined group (p = 0.015). Boys obtain a higher result of symmetry in pelvic tilt than girls in the group (p = 0.027). ATNR affects walking symmetry in preschool children, thus evaluation of the reflex activity and then proper therapy is required to support proper development.