Individuals with Higher Levels of Physical Activity after Stroke Show Comparable Patterns of Myelin to Healthy Older Adults

Higher levels is not a scientific term, the mentors and senior researchers need remedial training in research in general.  Useless.

Individuals with Higher Levels of Physical Activity after Stroke Show Comparable Patterns of Myelin to Healthy Older Adults

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Brian Greeley, PhD, Cristina Rubino, MSc, Ronan Denyer, MSc, ...

First Published May 9, 2022 Research Article Find in PubMed 

https://doi.org/10.1177/15459683221100497

Article information

Abstract

Background

Myelin asymmetry ratios (MARs) relate and contribute to motor impairment and function after stroke. Physical activity (PA) may induce myelin plasticity, potentially mitigating hemispheric myelin asymmetries that can occur after a stroke.

Objective

The aim of this study was to determine whether individuals with higher levels of PA showed lower MAR compared to individuals with lower levels of PA.

Methods

Myelin water fraction was obtained from 5 bilateral motor regions in 22 individuals with chronic stroke and 26 healthy older adults. Activity levels were quantified with wrist accelerometers worn for a period of 72 hours (3 days). Higher and lower PA levels were defined by a cluster analysis within each group.

Results

MAR was similar regardless of PA level within the older adult group. Compared to the higher PA stroke group, lower PA stroke participants displayed greater MAR. There was no difference in MAR between the stroke and older adult higher PA groups. Within the lower PA groups, individuals with stroke showed greater MAR compared to the older adults. Arm impairment, lesion volume, age, time since stroke, and preferential arm use were not different between the PA stroke groups, suggesting that motor impairment severity and extent of brain damage did not drive differences in PA.

Conclusion

Individuals who have had a stroke and are also physically active display lower MAR (i.e., similar myelin in both hemispheres) in motor regions. High levels of PA may be neuroprotective and mitigate myelin asymmetries once a neurological insult, such as a stroke, occurs. Alternately, it is possible that promoting high levels of PA after a stroke may reduce myelin asymmetries.

Keywords

Chronic stroke, myelin water fraction, physical activity, asymmetry ratios, older adults

Introduction

Due to a reduction in mortality rates, there are an increasing number of individuals living with long-term disabilities post-stroke. Consequently, people with stroke have the highest need for rehabilitation among neurological disorders worldwide.¹ Identifying effective interventions that optimize recovery of motor function represents an important challenge to improve quality of life after stroke.

Inducing myelin plasticity has become a viable therapeutic target for improving recovery after stroke.^2,3 White matter plays a crucial role in the formation and function of neural circuits^4,5 and undergoes use-dependent plasticity in young^6,7 and older⁸ adults. However, following a stroke, there is considerable loss of myelin in both the contra- and ipsilesional hemispheres,^9-11 which contributes to sensorimotor deficits.^2,9,12 Specifically, myelin asymmetry ratios (MARs), calculated as a ratio of contralesional to ipsilesional myelin water fraction, in the posterior limb of the internal capsule are greater (e.g., >1 and therefore less symmetrical) in individuals who have had a stroke compared with older adults.¹¹ Additionally, there is a negative relationship between MAR in the precentral gyrus⁹ and corticospinal tract^13,14 and upper-extremity motor impairment. Approaches that target and reduce MAR may also improve function after stroke.

Physical activity (PA) induces white matter plasticity. In animal models, exercise increased myelin debris removal and enhanced remyelination in chronic cerebral hypoperfusion rats,¹⁵ and increased the rate of remyelination after a demyelinating injury.¹⁶ In older adults, there is a positive relationship between white matter structure in the fornix, temporal, and frontal brain regions and amount of PA.^17,18 Further, aerobic exercise and resistance training increases white matter volume in the prefrontal cortex¹⁹ and decreases white matter lesion volume,²⁰ respectively. Taken together, PA appears to be a promising, cost-effective approach to promote white matter plasticity in older adults. An open question, however, is whether individuals who are more physically active have more symmetrical MAR (i.e., values close to 1). Yet, PA is often obtained through self-report questionnaires, which are subjective and may not accurately reflect real-world activity.²¹

The current study investigated MAR (contralesional/ipsilesional or dominant/non-dominant hemispheres) from five motor regions of interest (ROIs) in low and high physically active individuals with chronic stroke (>6 months) and older adults. Physical activity levels were obtained using accelerometers which participants wore for 72 consecutive hours (3 days). We hypothesized that: (1) individuals with stroke would display greater MAR (i.e., >1) relative to older adults, and (2) individuals in the lower PA stroke group would display greater MAR in motor ROIs relative to individuals in the higher PA stroke group as well as the older adult group.

 

Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke

More reasons for YOU TO HAVE THE CORRECT STROKE, so your doctors can actually treat you. YOUR RESPONSIBILITY!

But the worst is researching cost rather than recovery.

Oh God, measuring cost rather than 100% recovery as a reason to do this research. The mentors and senior researchers need remedial training in patient stroke goals. THIS FUCKING STUPIDITY is why survivors need to be in charge. They would keep their eye on the only goal in stroke; 100% RECOVERY.

 

Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke

 

Lan Gao^1*, Andrew Bivard², Mark Parsons^2,3,4, Neil J. Spratt³, Christopher Levi³, Kenneth Butcher⁵, Timothy Kleinig⁶, Bernard Yan², Qiang Dong⁷, Xin Cheng⁷, Min Lou⁸, Congguo Yin⁹, Chushuang Chen³, Peng Wang¹⁰, Longting Lin¹¹, Philip Choi¹², Ferdinand Miteff³ and Marj Moodie¹

• ¹Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
• ²Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC, Australia
• ³Departments of Neurology, John Hunter Hospital, University of Newcastle, Callaghan, NSW, Australia
• ⁴Department of Neurology, UNSW South Western Clinical School, Liverpool Hospital, University of New South Wales, Kensington, NSW, Australia
• ⁵Department of Neurology, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
• ⁶Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
• ⁷Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
• ⁸Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
• ⁹Department of Neurology, Hangzhou First Hospital, Zhejiang University School of Medicine, Hangzhou, China
• ¹⁰Zhejiang Provincial People's Hospital, Zhejiang, China
• ¹¹School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
• ¹²Department of Neurology, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia

Background: To compare the cost-effectiveness of providing endovascular thrombectomy (EVT) for patients with ischemic stroke in the >4.5 h time window between patient groups who met and did not meet the perfusion imaging trial criteria.

Methods: A discrete event simulation (DES) model was developed to simulate the long-term outcome post EVT in patients meeting or not meeting the extended time window clinical trial perfusion imaging criteria at presentation, vs. medical treatment alone (including intravenous thrombolysis). The effectiveness of thrombectomy in patients meeting the landmark trial criteria (DEFUSE 3 and DAWN) was derived from a prospective cohort study of Australian patients who received EVT for ischemic stroke, between 2015 and 2019, in the extended time window (>4.5 h).

Results: Endovascular thrombectomy was shown to be a cost-effective treatment for patients satisfying the clinical trial criteria in our prospective cohort [incremental cost-effectiveness ratio (ICER) of $11,608/quality-adjusted life year (QALY) for DEFUSE 3-postive or $34,416/QALY for DAWN-positive]. However, offering EVT to patients outside of clinical trial criteria was associated with reduced benefit (−1.02 QALY for DEFUSE 3; −1.43 QALY for DAWN) and higher long-term patient costs ($8,955 for DEFUSE 3; $9,271 for DAWN), thereby making it unlikely to be cost-effective in Australia.

Conclusions: Treating patients not meeting the DAWN or DEFUSE 3 clinical trial criteria in the extended time window for EVT was associated with less gain in QALYs and higher cost. Caution should be exercised when considering this procedure for patients not satisfying the trial perfusion imaging criteria for EVT.

Introduction

Seven large clinical trials have demonstrated that endovascular thrombectomy (EVT) is highly effective in increasing disability-free survival compared to the previous standard care, intravenous thrombolysis (IVT), in strokes due to a large vessel occlusion (LVO) (1–7). Based on these foundational trials, DAWN and DEFUSE 3 trials also extended the treatment time window for patients screened with perfusion imaging to identify treatment responders from 6 h out to 24 h (8, 9). These ground-breaking trials were highly selective but demonstrated considerable patient benefits. Since its introduction as routine care in Australia, providing EVT to patients with an LVO has seen a significant amount of “scope creep,” where a large proportion of patients are now offered therapy outside of the trial criteria. Previous post-hoc analysis has shown that providing EVT to patients meeting the trial criteria is highly cost-effective within the normal and extended time window (10–16); however, it is not known if this cost-effectiveness is maintained when patients are treated outside of the trial criteria.

Patient outcomes after stroke and EVT are highly influenced by patient characteristics (17, 18), such as age, pre-morbid disability, co-morbidities, and imaging characteristics including the site of the vessel occlusion and the volume of core/penumbra (19). It is important to acknowledge that in clinical practice, which is distinct from controlled trials that are subject to strict selection criteria, the clinicians are more likely to treat patients who do not enroll into these trials, and not all these patients benefit from the treatment to the same extent, while some are even harmed due to hemorrhage, vessel perforation, or reperfusion injury. To investigate the effect of this scope creep on the likely cost of therapy, we undertook a discrete event simulation to assess the cost-effectiveness of EVT in the real world with respect to patients meeting/not meeting the clinical trial criteria, in comparison to the medical treatment alone.

More at link.

The comparison of clinical and computerized measurement of sitting balance in stroke patients and healthy individuals

So what the hell is the rehab needed to improve sitting balance? This was useless for that purpose. The purpose of stroke research is stroke rehab protocols. Or do your mentors and senior researchers need remedial training in that concept? 

The comparison of clinical and computerized measurement of sitting balance in stroke patients and healthy individuals

Neurorehabilitation , Volume 44(3) , Pgs. 361-368.

NARIC Accession Number: J81308.  What's this?
ISSN: 1053-8135.
Author(s): Ozdil, Aytul; Iyigun, Gozde; Kalyoncu, Cem.
Publication Year: 2019.
Number of Pages: 8.
Abstract: Study compared the results of computerized and clinical sitting balance measurements in stroke patients and healthy individuals and to identify the agreement and relationship between the two measurement methods in stroke patients. This study included 30 chronic stroke patients and 30 age-matched healthy individuals. A force platform chair was used for the computerized measurement and the Function in Sitting Test (FIST) was used for the clinical sitting balance measurement. The sitting balance of the stroke patients, measured with computerized and clinical measurements, were still affected in the chronic phase. The CoP deviation (eyes-open and eyes-closed) was higher whereas the FIST score was lower in the stroke group than the healthy group. The computerized sitting balance measurement CoP deviation was not correlated with the FIST scores. However, there was an excellent agreement (96.6 percent) between the methods. The results suggest that both the computerized and clinical sitting balance measurements can be used objectively for the assessment of sitting balance but the computerized methods might be preferable due to requiring shorter time with less intra-tester variability.
Descriptor Terms: CLINICAL MANAGEMENT, COMPUTER APPLICATIONS, EQUILIBRIUM, EVALUATION TECHNIQUES, MEASUREMENTS, MOBILITY, PERFORMANCE STANDARDS, POSTURE, STROKE, TESTS.


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Citation: Ozdil, Aytul, Iyigun, Gozde, Kalyoncu, Cem. (2019). The comparison of clinical and computerized measurement of sitting balance in stroke patients and healthy individuals.  Neurorehabilitation , 44(3), Pgs. 361-368. Retrieved 8/20/2019, from REHABDATA database.