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1.
Int J Neurosci ; : 1-8, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38618966

RESUMO

OBJECTIVE: To investigate the impact of the combination of CICARE (C - Connect, I - Introduce, C - Communicate, A - Ask, R - Respond, E - Exit) communication model and traditional Chinese medicine (TCM) poultice on muscle strength and depression levels in patients. METHODS: Patients were divided into three groups: basic treatment group, basic treatment + TCM poultice group, and combined treatment group. Conventional rehabilitation therapy, TCM poultice external application, and the combination of both with the CICARE communication model were applied in the respective groups. Muscle strength (AMA muscle strength grading scale), self-care abilities (Barthel Index), depression symptoms (Hamilton Depression Rating Scale), neurological deficit status (NIHSS score) and serum inflammatory factor levels were assessed at admission, 3 weeks, and 8 weeks of treatment. RESULTS: After 3 and 8 weeks of treatment, the combined treatment group had higher AMA muscle strength scores and improved Barthel Index scores compared to other groups (p < 0.05). Depressive symptoms also improved significantly in the combined treatment group, with lower HDRS scores at 3 and 8 weeks (p < 0.05). After 8 weeks, IL-1, IL-6, and hs-CRP levels decreased in all groups, with the combined treatment group showing the lowest levels (p < 0.05). NIHSS scores decreased significantly in all groups post-intervention, with the combined treatment group showing the greatest improvement (p < 0.05). CONCLUSION: The integration of CICARE communication model with TCM poultice shows notable benefits in enhancing muscle strength, daily living self-care abilities, reducing depression, neurological impairment, and inflammatory factors in post-stroke hemiplegia patients.

2.
Phys Med Rehabil Clin N Am ; 35(2): 445-462, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38514229

RESUMO

Pain can be a significant barrier to a stroke survivors' functional recovery and can also lead to a decreased quality of life. Common pain conditions after stroke include headache, musculoskeletal pain, spasticity-related pain, complex regional pain syndrome, and central poststroke pain. This review investigates the evidence of diagnostic and management guidelines for various pain syndromes after stroke and identifies opportunities for future research to advance the field of poststroke pain.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Qualidade de Vida , Dor , Acidente Vascular Cerebral/complicações , Cefaleia , Espasticidade Muscular/etiologia
3.
Front Neurol ; 14: 1234205, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37789885

RESUMO

Background: Stroke is a main cause of disability worldwide and its neuro-rehabilitative management is not limited to the acute phase but requires continuity in the rehabilitation approach especially in the chronic phase. The aim of this scoping review was to highlight the different treatment opportunities available in neurorehabilitation, effective for patients with chronic stroke sequelae, not only in terms of maintaining motor function but also improving it. Methods: The literature search was conducted using the following databases: MEDLINE (PubMed), PEDro, Scopus, Web of Science (WOS), Cochrane from 2012 to February 2023. We selected Randomized Clinical Trials in English dealing with neurorehabilitation strategies in chronic hemiplegic patients after stroke focusing on motor function, muscular strength, gait, postural balance, spasticity, and quality of life. Results: According to the inclusion criteria, 47 articles were selected for our review. All of them were analyzed following the primary outcome and the rehabilitation technique used. Despite the different protocols used within the same technique and despite the chronicity of the disease, all studies report an improvement after the rehabilitation treatment of motor function and quality of life. Conclusion: The literature analyzed invites us to reflect respect to neurorehabilitation approach to the patient with chronic stroke sequelae often considered to have as its objective the maintenance of the present motor function and contain disability: instead, the review reports how, even in chronicity, the patient always reports margins of statistically and clinically significant improvement. The chronic stroke rehabilitation over 6 months has been proved effective in obtaining recovery in different settings.

4.
Zhen Ci Yan Jiu ; 48(5): 508-14, 2023 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-37247866

RESUMO

OBJECTIVE: To analyze the optimum stimulating parameters and acupoint combination law of electroacupuncture (EA) treatment of post-stroke sequelae (PSS) through the network visual data mining and analysis of the literature,so as to provide reference for clinical application. METHODS: The related articles of acupuncture treatment of PSS patients published from January 1, 2005 to December 31, 2021 were collected from databases of CNKI, Wanfang, Weipu(VIP), SinoMed, CHAOXING, DUXIU, PubMed, Ovid, Embase and Cochrane Library. After the articles were screened according to our formulated inclusion and exclusion criteria, a "Clinical Literature Database of EA Treatment of PSS" was established. The SPSS Modeler14.1 software was used for modeling (by using the parameters of EA, types of apoplexy sequelae, names of acupoints, methods of acupoint matching, acupoint-attributed meridians, etc.) and association rule analysis, and the Cytoscape 3.6.0 software was used for data network visualization analysis. RESULTS: A total of 354 articles were collected, including 13 types of PSS, among which the hemi-plegia accounts for the highest proportion (51.13%), followed by depression (17.51%) and dysphagia (14.97%). A total of 228 acupoints are used, with a total frequency-time of 1 690. Among the 8 PSS (hemiplegia, depression, dysphagia, cognitive impairment, urinary incontinence, urinary retention, speech disorders, constipation) with the frequency of application of acupoints greater than or equal to 3, 275 articles are involved, with the frequency of dense wave being the highest (123 times), followed by continuous waves (95 times). The stimulation frequency of EA appears 275 times, with the low frequency being the highest (188 times). For hemiplegia type of PSS, low frequency and continuous waves or dense waves are mostly used, and the high correlation acupoint groups are Zusanli(ST36)/Hegu(LI4), LI4/Quchi(LI11) and ST36/LI11. For depression, low frequency and dense waves are mostly used, and the high correlation acupoint groups are Baihui(GV20)/Yintang(EX-HN3), GV20/Shenting(GV24) and GV20/Neiguan(PC6). For swallowing disorder, the mostly used stimulation parameter is low frequency, and the high correlation acupoint groups are Lianquan(CV23)/ST36/Fenglong(ST40), Tongli(HT5)/Yifeng(TE17)/PC6/ST40, and TE17/HT5/PC6/LI4. CONCLUSION: EA therapy is frequently used in the treatment of PSS, for which ST36, LI4 and LI11 are most frequently used in the treatment of hemiplegia, with the stimulation parameters being low-frequency and continuous waves or dense waves. For depression, GV20, EX-HN3, GV24 and PC6 are used, with the stimulation parameters being low frequency and dense waves. For dysphagia, CV23, HT5, TE17, PC6, ST36, ST40 and LI4 are employed, with low frequency electrical stimulation.


Assuntos
Terapia por Acupuntura , Transtornos de Deglutição , Eletroacupuntura , Meridianos , Acidente Vascular Cerebral , Humanos , Pontos de Acupuntura , Mineração de Dados , Hemiplegia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia
5.
Trials ; 24(1): 324, 2023 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-37170159

RESUMO

BACKGROUND: Stroke's prevalence and morbidity are increasing (Guano, et al. Neuro 89:53-61, 2017), and limb motor dysfunction is left in most patients (Gittler, et al. JAMA 319:820-821, 2018). Particularly, the rehabilitation of upper limbs is more difficult and time-consuming (Borges, et al. The Cochrane database of systematic reviews 10:CD011887, 2018). METHODS: A double-blind randomized controlled trial (RCT) will be conducted to investigate whether a new functional electrical stimulation (FES) combined with acupoint therapy is more effective in the rehabilitation of upper limb motor dysfunction after stroke. Patients who meet the inclusion criteria will be randomly divided into two groups: programmed flexor-extensor alternating electrical acupoint stimulation group (PES group) and conventional flexor-extensor alternating electrical acupoint stimulation group (CES group), which will be treated for 3 weeks. The primary outcome measures are electroencephalogram (EEG) and surface electromyogram (sEMG). The secondary outcome variables include MBI (modified Barthel index), China Stroke Scale (CSS), FMA-U (Fugl-Meyer assessment upper limb), MMT (manual muscle testing), and Brunnstrom. DISCUSSION: The results of this study are expected to verify the efficacy of PES therapy in the rehabilitation of upper limb motor function after stroke. This may promote the widespread use of the therapy in hospitals, communities, and homes for early and continuous treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT05333497. Registered on April 11, 2022.


Assuntos
Doenças Musculoesqueléticas , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Pontos de Acupuntura , Estimulação Elétrica , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Extremidade Superior
6.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-1003892

RESUMO

This parer summarized the clinical experience of Professor ZHANG Zhiyuan in treating stroke sequelae from the perspective of regulating qi and blood. It is believed that the basic pathogenesis of stroke sequelae is disharmony of qi and blood, and it is advocated that the basic treatment method is to regulate qi and blood. For the three major symptoms of stroke sequelae, including hemiplegia, cognitive dysfunction, and sluggish speech, the effective formulas have been summarized. Hemiplegia is often treated with Chongsu Qiju Decoction (重塑起居汤) to tonify the center and replenish qi, activate blood and dredge collaterals. Cognitive dysfunction is often treated with modified San Hua Decoction (三化汤) to resolve phlegm and purge heat, regulate qi and tonify blood. And sluggish speech is often treated with Zishou Jieyu Decoction (资寿解语汤) to warm and tonify yang qi, expel wind and remove phlegm. Meanwhile, the self-made Zhinao Huayu Decoction (治脑化瘀汤) is used to prevent the occurrence of stroke sequelae, and to regulate the blood and qi by using wind medicinals and the method of relaxing and purging bowels to cure the disease.

7.
Front Pharmacol ; 13: 868662, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35548368

RESUMO

Objectives: We developed a Korean medicine core outcome set for stroke sequelae (COS-SS-KM) to evaluate the effectiveness and safety of herbal medicine (HM) for stroke sequelae, especially for elderly stroke patients in primary clinics. Methods: We identified previously reported outcomes from a literature review and defined the list of outcomes and effect modifiers for the core outcome set (COS) questionnaire. Three rounds of modified Delphi consensus exercises with experts were conducted online for suitability assessment, and one round of a modified Delphi consensus exercise with primary clinicians was conducted for feasibility assessment. Results: The review identified 17 outcomes and 16 effect modifiers; moreover, six outcomes and one effect modifier were suggested by the experts. The final COS comprised 8 outcomes and 12 effect modifiers for history taking, and experts listed 13 major symptoms of stroke sequelae for symptom assessment. The clinicians agreed on the feasibility of the COS. Conclusion: This COS will help primary care researchers assess the effectiveness of pharmacotherapy, including HM, for elderly patients with stroke sequelae. Future studies should focus on reflecting the opinions of all stakeholders.

8.
J Neurol Sci ; 430: 120007, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34624794

RESUMO

There are a plethora of cognitive sequelae in addition to neglect and extinction that arise with unilateral right hemispheric stroke (RHS). Cognitive deficits following non-dominant (right) hemisphere stroke are common with unilateral neglect and extinction being the most recognized examples. The severity of RHS is usually underestimated by the National Institutes of Health Stroke Scale (NIHSS), which in terms of lateralized right hemisphere cognitive deficits, tests only for visual inattention/extinction. They account for 2 out of 42 total possible points. Additional neuropsychiatric sequelae include but are not limited to deficiencies in affective prosody comprehension and production (aprosodias), understanding and expressing facial emotions, empathy, recognition of familiar faces, anxiety, mania, apathy, and psychosis. These sequelae have a profound impact on patients' quality of life; affecting communication, interpersonal relationships, and the ability to fulfill social roles. They also pose additional challenges to recovery. There is presently a gap in the literature regarding a cohesive overview of the significant cognitive sequelae following RHS. This paper serves as a narrative survey of the current understanding of the subject, with particular emphasis on neuropsychiatric poststroke syndromes not predominantly associated with left hemisphere lesions (LHL), bilateral lesions, hemiplegia, or paralysis. A more comprehensive understanding of the neuropsychological consequences of RHS extending beyond the typical associations of unilateral neglect and extinction may have important implications for clinical practice, including the ways in which clinicians approach diagnostics, treatment, and rehabilitation.


Assuntos
Cérebro , Transtornos da Percepção , Acidente Vascular Cerebral , Lateralidade Funcional , Hemiplegia , Humanos , Testes Neuropsicológicos , Transtornos da Percepção/etiologia , Qualidade de Vida , Acidente Vascular Cerebral/complicações
9.
Am J Transl Res ; 13(8): 9639-9646, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34540090

RESUMO

OBJECTIVE: To study the effect of early systematic rehabilitation nursing on the quality of life and limb function in elderly patients with stroke sequelae. METHODS: This prospective study was conducted in 97 elderly patients with stroke sequelae. These patients were randomly allocated to the control group (n=49) and the experimental group (n=48). Patients in the control group received routine rehabilitation nursing, while those in the experimental group received early systematic rehabilitation nursing. Upper limb motor function (Fugl-Meyer assessment (FMA) score), upper limb sensory function (tactile threshold and two-point discrimination), physiological state (Hamilton anxiety (HAMA) scale and Hamilton depression (HAMD) scale score), ability of daily living (ADL) (the Barthel index score and ability of daily living score), and the quality of life (generic quality of life inventory-74 (GQOLI-74) score) before and 3 months after intervention were compared between the two groups. RESULTS: Compared with before intervention, FMA scores in the two groups after intervention were increased, while modified Ashworth scores were decreased (all P<0.05). The changes in the experimental group after intervention were more than those in the control group (both P<0.05). Tactile threshold and two-point discrimination in both groups after intervention were reduced when compared with before intervention (all P<0.05); tactile threshold and two-point discrimination in the experimental group after intervention group were smaller than those in the control group (both P<0.05). HAMA scale and HAMD scale scores in the two groups after intervention were lower than those before intervention (all P<0.05); HAMA scale and HAMD scale score in the experimental group after intervention were reduced when compared with the control group (both P<0.05). The Barthel index scores, ADL scores, and GQOLI-74 scores in both groups after intervention were increased when compared with before intervention (all P<0.05). The Barthel index score, ADL score, and GQOLI-74 score in the experimental group after intervention were higher than those in the control group (all P<0.05). CONCLUSION: For elderly patients with stroke sequelae, early systemic rehabilitation nursing is more beneficial for the improvement of upper limb motor and sensory function, alleviation of negative psychology, raise in ability of daily living, and increase of life quality. It is therefore worthy of clinical application.

10.
Cerebrovasc Dis ; 50(6): 729-737, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34284375

RESUMO

BACKGROUND: For outcome assessment in patients surviving subarachnoid hemorrhage (SAH), the modified Rankin scale (mRS) represents the mostly established outcome tool, whereas other dimensions of outcome such as mood disorders and impairments in social life remain unattended so far. OBJECTIVE: The aim of our study was to correlate 12-month functional and subjective health outcomes in SAH survivors. METHODS: All SAH patients treated over a 5-year period received outcome assessment at 12 months, including functional scores (mRS and Barthel Index [BI]), subjective health measurement (EQ-5D), and whether they returned to work. Analyses - including utility-weighted mRS - were conducted to detect associations and correlations among different outcome measures, especially in patients achieving good functional outcome (i.e., mRS 0-2) at 12 months. RESULTS: Of 351 SAH survivors, 287 (81.2%) achieved favorable functional outcome at 12 months. Contrary to the BI, the EQ-5D visual analog scale (VAS) showed a strong association with different mRS grades, accentuated in patients with favorable functional outcome. Despite favorable functional outcome, patients reported a high rate of impairments in activities (24.0%), pain (33.4%), and anxiety/depression (42.5%). Further, multivariable analysis revealed (i) impairments in activities (odds ratio [OR] [95% confidence interval {CI}]: 0.872 [0.817-0.930]), (ii) presence of depression or anxiety (OR [95% CI]: 0.836 [0.760-0.920]), and (iii) return to work (OR [95% CI]: 1.102 [0.1.013-1.198]) to be independently associated with self-reported subjective health. CONCLUSION: Established stroke scores mainly focusing on functional outcomes do poorly reflect the high rate of subjective impairments reported in SAH survivors, specifically in those achieving good functional outcome. Further studies are needed to investigate whether psychoeducational approaches aiming at improving coping mechanisms and perceived self-efficacy may result in higher subjective health in these patients.


Assuntos
Hemorragia Subaracnóidea , Humanos , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
11.
J Pak Med Assoc ; 70 [Special Issue](9): 38-44, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33177726

RESUMO

OBJECTIVE: To explore the clinical effect of comprehensive rehabilitation nursing intervention on hemiplegia patients in the sequela stage of stroke. METHODS: Patients with knee reflex after stroke were divided into the treatment group and the control group. Patients in the control group received Activities of Daily Living (ADL) training. Patients in the treatment group received comprehensive rehabilitation training in addition to the ADL training of the control group, including joint flexion and extension training, active resistance training, low-frequency electrotherapy, and standing training. The knee reflex angle and ankle dorsiflexion angle of patients in both groups were measured before and after 4 weeks of treatment. Also, the Manual Muscle Testing (MMT) scale, the modified Ashworth scale, the Fugl-Meyer assessment (FMA), and Barthel index (lower limb) rating scale of patients in both groups were compared. RESULTS: It was found that there was significant difference between the two groups in the changes of knee and ankle joint angles after treatment (P < 0.05). In the Ashworth and MMT (Manual Muscle Testing) grading analysis of patients, it was found that the Ashworth grading of quadriceps femoris and triceps leg improved significantly before and after treatment (P < 0.01). There was significant difference in MMT grade between the two groups after treatment of quadriceps and hamstring muscles (P < 0.05). There was significant difference in satisfaction degree of pain control or relief methods (P < 0.05). In the analysis of Fugl-Meyer and Barthel integral effects of lower limbs for the patients with knee reflex before and after treatment, a significant difference (P < 0.05) was found in the Fugl-Meyer motor function and Barthel index scores of the two groups. CONCLUSIONS: Therefore, the results suggested that comprehensive rehabilitation nursing could promote the treatment of sequelae of hemiplegia. Although there were some shortcomings in the experimental process, it still provided a reliable basis for the clinical treatment of sequelae of stroke.


Assuntos
Enfermagem em Reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Hemiplegia/etiologia , Humanos , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
12.
Rinsho Shinkeigaku ; 60(1): 27-31, 2020 Jan 30.
Artigo em Japonês | MEDLINE | ID: mdl-31852871

RESUMO

BACKGROUND: Metabolic insult causing re-expression of old stroke (MICROS), one of the stroke mimics, is characterized by reappearance of impairment of past stroke and can be mistaken for a stroke recurrence. The aim of the present study was to identify the clinical characteristics of MICROS in emergency stroke care, and to investigate predictive factors for distinguishing MICROS from stroke recurrences. METHODS: In our Stroke Center, 519 consecutive patients admitted with suspected stroke in June 2016 to December 2017. MICROS was defined as an acute deterioration of neurological deficits of the previous stroke despite no evidence for stroke recurrences. Among the 70 patients with a past history of stroke, 14 were MICROS, 5 were transient ischemic attack, 15 were other stroke mimics, and 36 were stroke recurrences, respectively. We evaluated the clinical characteristics of MICROS and compared MICROS with stroke recurrences. RESULTS: The causes of MICROS were infectious disease (including influenza and pneumonia) in 4, transient somnolence after syncope in 4, hypo/hyperglycemia in 2, medication overdoses in 1, and anxiety in 3. Eight of the 14 MICROS patients were admitted within 4 hours after the symptom onset. In MICROS patients, fever (>37°C) was observed more frequently than those with stroke recurrences though the difference was not statistically significant. CONCLUSION: MICROS might be associated with fever, syncope, or serum glucose abnormality. MICROS patients sometimes visit the hospital emergency room within 4 hours, thus, distinction between MICROS and true stroke recurrences is important.


Assuntos
Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Diagnóstico Diferencial , Overdose de Drogas/complicações , Humanos , Hiperglicemia , Influenza Humana/complicações , Pneumonia/complicações , Recidiva , Síncope/complicações
13.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-695903

RESUMO

Objective To observe the clinical efficacy of heat-sensitive moxibustion in preventing bedsores after ischemic stroke. Method A hundred ischemic stroke patients were randomized into a treatment group and a control group, 50 cases each. The control group was intervened by ordinary nursing care, while the treatment group additionally received heat-sensitive moxibustion. Norton scale and hemodynamics [whole blood viscosity (low-shear, mid-shear and high-shear), hematocrit and erythrocyte sedimentation rate (ESR)] of the two groups were observed before and after the treatment, and the occurrences of bedsores in the two groups were compared. Result After the intervention, Norton scale and hemodynamic indexes were significantly changed in both groups (P<0.05). Norton scale and hemodynamic indexes in the treatment group were significantly different from those in the control group after the intervention (P<0.05). The occurrence rate of bedsores was 8.0% in the treatment group versus 24.0% in the control group, and the between-group difference was statistically significant (P<0.05). Conclusion Heat-sensitive moxibustion can effectively reduce the risk and occurrence of bedsores in ischemic stroke patients, and its mechanism is possibly related to the improvement of hemodynamics.

14.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-695902

RESUMO

Objective To observe the clinical efficacy of warm needling plus Chinese medication for external application in treating post-stroke shoulder pain. Method Two hundred patients with post-stroke shoulder pain were randomized into a treatment group and a control group, 100 cases each. The two groups both received rehabilitation training for shoulder joint. In addition, the treatment group was given warm needling plus Chinese medication for external application, while the control group was given warm needling. Visual Analogue Scale (VAS) for pain, upper-limb Fugl-Mayer Assessment (FMA) and Modified Barthel Index (MBI) were adopted to evaluate the two groups before and after the treatment. The clinical efficacies of the two groups were also compared. Result The total effective rate was 100.0% in the treatment group versus 87.0% in the control group, and the between-group difference was statistically significant (P<0.01). The VAS, FMA and MBI scores were significantly changed after the treatment in both groups (P<0.01). After the treatment, the VAS, FMA and MBI scores of the treatment group were significantly different from those of the control group (P<0.05, P<0.01). Conclusion Warm needling plus Chinese medication for external application and rehabilitation training can obviously reduce post-stroke shoulder pain, and enhance the upper-limb motor function and activities of daily living.

15.
BMC Health Serv Res ; 17(1): 35, 2017 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-28086871

RESUMO

BACKGROUND: Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking. METHODS: Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres. RESULTS: Indication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems. CONCLUSION: Coordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services. TRIAL REGISTRATION: No.: ACTRN12616001322426 (Registration Date: 21st September 2016).


Assuntos
Procedimentos Clínicos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Lista de Checagem , Cuidados Críticos/organização & administração , Técnica Delphi , Saúde da Família , Pessoal de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Malásia , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Medição de Risco , Especialização
16.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-512972

RESUMO

Objective To explore the optimal acupuncture scheme in intervening hypermyotonia of the affected limbs in stroke.Method Eighty eligible stroke patients were randomly grouped by using the orthogonal experimental design, by adopting electroacupuncture (A), daily acupuncture frequency (B), and acupoint (C) as three factors, and two levels. A total of 20 treatment sessions were conducted. Each group was scored by using the Modified Ashworth Scale (MAS) before and after the treatment, and the safety was also evaluated.Result There was a significant difference in comparing the MAS score between the two different levels of factor A (P<0.05), while there were no significant differences in comparing the MAS scores between different levels of factor B and factor C (P<0.05). Concerning the improvement of the MAS scores of wrist, elbow, knee, and ankle joints, A2B1C1(i.e. electroacupuncture twice a day with acupoints from yin meridians) was the optimal treatment scheme.Conclusion Electroacupuncture twice a day is the optimal treatment scheme for hypermyotonia of the affected limbs in stroke, as it can effectively ease the hypermyotonia, improve the function and symptoms of the limbs, and has a satisfactory security evaluation.

17.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-659997

RESUMO

Objective To analyze the clinical effect and application value of Dahuoluo capsule combined with acupuncture therapy in treating stroke sequelae. Methods 80 patients with brain stroke sequelae were enrolled in this study from January 2016 to January 2017, and were randomly divided into the observation group (n= 40) and the control group (n=40). The control group was given Dahuoluo capsule, and the observation group was treated with Dahuoluo capsule combined with acupuncture therapy. The therapeutic effects of the two groups were compared and analyzed. Results The total effective rates in the observation group (97.5%) was significantly higher than the control group (75.0%) with significant difference (P<0.05); the daily activity ability scores of the observation group 15d, 30d after treatment were significantly higher than the control group with statistical significance (P<0.05). There was no statistical significance in the incidence of adverse reactions between the observation group (2.5%) and the control group (5.0%). Conclusion Dahuoluo capsule combined with acupuncture therapy has significant clinical effect on the treatment of patients with stroke sequelae, and the efficacy of which is safe and reliable.

18.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-657677

RESUMO

Objective To analyze the clinical effect and application value of Dahuoluo capsule combined with acupuncture therapy in treating stroke sequelae. Methods 80 patients with brain stroke sequelae were enrolled in this study from January 2016 to January 2017, and were randomly divided into the observation group (n= 40) and the control group (n=40). The control group was given Dahuoluo capsule, and the observation group was treated with Dahuoluo capsule combined with acupuncture therapy. The therapeutic effects of the two groups were compared and analyzed. Results The total effective rates in the observation group (97.5%) was significantly higher than the control group (75.0%) with significant difference (P<0.05); the daily activity ability scores of the observation group 15d, 30d after treatment were significantly higher than the control group with statistical significance (P<0.05). There was no statistical significance in the incidence of adverse reactions between the observation group (2.5%) and the control group (5.0%). Conclusion Dahuoluo capsule combined with acupuncture therapy has significant clinical effect on the treatment of patients with stroke sequelae, and the efficacy of which is safe and reliable.

19.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-613575

RESUMO

Objective To investigate the effect of acupuncture at Huatuo jiaji points plus virtual balancing game on balance function in stroke patients.Methods Fifty patients with poststroke balance dysfunction were randomly allocated: 25 cases to the treatment group and 25 cases to the control groups. The treatment group received acupuncture at Huatuo jiaji points plus virtual balancing game-based rehabilitation training and the control group, virtual balancing game-based rehabilitation training alone. The Berg Balance Scale (BBS) score, the Timed Up and Go Test (TUGT) score, the COP offset distance indices (EO2, EC2, EOTS and EO1) and the modified Barthel Index (MBI) score were recorded in the two groups before and after treatment.Results There were statistically significant pre-/post-treatment differences in the BBS score, the TUGT score, the COP offset distance indices and the MBI score in the two groups of patients (P<0.05). There were statistically significant post-treatment differences in the BBS score, the TUGT score, the COP offset distance indices and the MBI score between the treatment and control groups (P<0.05).Conclusion Acupuncture at Huatuo jiaji points plus virtual balancing game is an effective way to treat poststroke balance dysfunction.

20.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-613571

RESUMO

Objective To investigate the clinical therapeutic effect of different frequency electroacupuncture on poststroke hemidysesthesia.Methods Sixty patients with poststroke hemidysesthesia were randomly allocated to treatment and control groups, 30 cases each. Both groups received electroacupuncture at the same points. The electroacupuncture frequency was 100 Hz in the treatment group and 1 Hz in the control group. The clinical therapeutic effects were evaluated in the two groups at 30 days after treatment.Results The total efficacy rate and the cure and marked efficacy rate were 93.3 and 80.0, respectively, in the treatment group and 86.0% and 43.3%, respectively, in the control group. There was no significant difference in the total efficacy rate between the two groups (P<0.05).There was a statistically significant difference in the cure and marked efficacy rate between the two groups (P<0.05). There was a statistically significant pre-/post-treatment difference in the limb dysesthesia score in the two groups (P<0.05). There was a statistically significant post-treatment difference in the limb dysesthesia score between the treatment and control groups (P<0.05).Conclusions Electroacupuncture is an effective way to treat poststroke hemidyse- sthesia. High frequency electroacupuncture is more effective than low frequency electroacupuncture.

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