Walking is an essential task important to recovery after stroke. However, there is a limited understanding regarding the characteristics of walking in in-patients with stroke. The objectives of this thesis were to: 1) develop an instrument capable of acquiring temporal characteristics of everyday walking; 2) investigate the quantity and control of everyday walking; and 3) profile the task-specific link between walking and cardiorespiratory response. In study 1 we developed and validated a wireless monitoring system (ABLE system). Study 2 revealed low quantities of everyday walking (4816 steps; SD 3247) characterized by short bout durations (59.8s; SD 23.4) and asymmetric walking. In study 3 we observed a modest task-related response in HR(19.4% HRR); however, the intensity and duration of everyday walking did not approach the guidelines for aerobic benefit. Monitoring in-patient walking can help guide clinical decision making in developing methods to maximize recovery after stroke.

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Damage to motor areas of the brain, caused by stroke, can produce devastating motor deficits, including aberrant control of force. After stroke, reorganization of the brain’s motor system has been identified as one of the fundamental mechanisms involved in recovery of motor control after stroke. Yet, few studies have investigated how force production and modulation are encoded in the brain after stroke and how this relates to motor outcome. Thus, the purpose of this study was to (1) understand how past neuroimaging literature has contributed to establishing common patterns of brain reorganization during both relative and absolute force production after stroke, (2) examine how brain function is reorganized during force production and modulation in individuals with stroke, and (3) relate this task-related reorganization of brain function to the amount of paretic arm use after stroke. In the second chapter, we systematically reviewed all relevant literature examining brain activation during force production after stroke. The following chapters (chapters 3 and 4) applied functional magnetic resonance imaging (fMRI) to examine the neural correlates of force production and modulation after stroke. Chapter 2 supports differences in task-related brain activation dependent on features of stroke, such as severity and chronicity, as well as influence of rehabilitation. In addition, results suggest that activation of common motor areas of the brain during force production can be identified in relation to functional outcome after stroke. Results from the subsequent two chapters (3 and 4), demonstrate that brain function reorganizes in terms of absolute, and not relative force production after stroke. Specifically, stroke participants exhibit greater activation of motor areas than healthy controls when matched for absolute force production. Moreover, there is a relationship between paretic arm usage and brain activation, where stroke participants having less paretic arm use, as measured using wrist accelerometers, exhibit higher brain activation. Results of this thesis suggest that during absolute force production, brain activation may approach near maximal levels in stroke participants at lower forces than healthy controls. Furthermore, this effect may be amplified even further in subjects with less paretic arm usage, as increased activation in motor areas occurs in participants with less arm use after stroke. Ultimately, the results from this thesis will contribute to research relevant to brain reorganization in individuals with stroke and may lead to the development of new, beneficial therapeutic interventions that optimize brain reorganization and improve functional recovery after stroke.

The influence of physiotherapy for patients quality of life after stroke ABSTRACT Key words: stroke, quality of life, physiotherapy, Bobath technique. The influence of rehabilitation for patients after stroke helps to recover loss of functional disorder and the activities of daily living. There are created many physiotherapy techniques, which are used for the patients after stroke for the maximum recovery of the functions. Mostly clinical researches analyze the improvement of functional system. Though there are not many researches which analysis the influence of physiotherapy for the quality of life and they are not comprehensive. The purpose of the work: to evaluate patients quality of life after stroke using traditional physiotherapy methods and Bobath technique. The problems of the work: 1) To find out which components of the quality of life physiotherapy has the greater influence. 2) To find out which factors – age, gender, neurological lesion, has the influence for physiotherapy efficiency or for the quality of life. 3) To evaluate which physiotherapy methods has better influence using the traditional physiotherapy or using Bobath technique. The object of the work: 1) Patients quality of life who had stroke and for which was used traditional physiotherapy. 2) Patients who had stroke quality of life and for which was used Bobath technique. The hypothesis of the work: Stroke negatively influences patients’ quality of life – patients’ physical condition, emotional... [to full text]

Cerebral ischemia and intracerebral hemorrhage (ICH) are both characterized by a prolonged inflammatory response and secondary injury phase, yet the spatial/temporal relationships between inflammation and white matter (WM) damage were largely unknown. Thus, I quantified the development of WM damage and inflammation over 7 days after ischemia, and 14 days after ICH. Following ischemia, myelin and axons were progressively damaged, and myelin damage coincided with neutrophil infiltration. Activated microglia/macrophages increased dramatically in the lesion core and edge, and selectively infiltrated damaged WM tracts while surrounding undamaged ones. To investigate the involvement of neutrophils in WM damage and inflammation after ICH, rats were rendered neutropenic before performing ICH. Neutrophil depletion reduced peri-hematomal axonal damage, BBB breakdown, and MMP-9 production at early times, and lessened microglia/macrophage and astrocyte responses at later times. Activated microglia/macrophages infiltrated peri-hematomal WM tracts, correlating with myelin fragmentation and axonal loss, and this was reduced with neutrophil depletion.

Cerebral ischemia and intracerebral hemorrhage (ICH) are both characterized by a prolonged inflammatory response and secondary injury phase, yet the spatial/temporal relationships between inflammation and white matter (WM) damage were largely unknown. Thus, I quantified the development of WM damage and inflammation over 7 days after ischemia, and 14 days after ICH. Following ischemia, myelin and axons were progressively damaged, and myelin damage coincided with neutrophil infiltration. Activated microglia/macrophages increased dramatically in the lesion core and edge, and selectively infiltrated damaged WM tracts while surrounding undamaged ones. To investigate the involvement of neutrophils in WM damage and inflammation after ICH, rats were rendered neutropenic before performing ICH. Neutrophil depletion reduced peri-hematomal axonal damage, BBB breakdown, and MMP-9 production at early times, and lessened microglia/macrophage and astrocyte responses at later times. Activated microglia/macrophages infiltrated peri-hematomal WM tracts, correlating with myelin fragmentation and axonal loss, and this was reduced with neutrophil depletion.

Die systemische Thrombolyse mit rekombinantem Gewebeplasminogenaktivator (rtPA) stellt das einzige pharmakologisch evidente und kausale Therapiekonzept für die Behandlung der akuten zerebralen Ischämie dar. Dieses Be-handlungskonzept ist nur in einem kurzen therapeutischen Zeitfenster anwendbar und birgt das Risiko unerwünschter zum Teil lebensbedrohlicher Nebenwirkungen. Darüber hinaus ist rtPA potenziell neurotoxisch. In der vorliegenden Arbeit sollten am thrombembolischen Schlaganfallmodell der Ratte die Effekte der hyperbaren Sauerstofftherapie (HBO) nach induzierter fokaler zerebraler Ischämie in Kombination mit rtPA erstmals im Langzeitverlauf von 4 Wochen untersucht werden. Grundlage hierfür waren die in früheren Studien nachgewiesenen potenziell neuroprotektiven Effekte der HBO. In 4 verschiedenen Infarkt-assoziierten Arealen wurden durch Immunperoxidasemarkierung Neuronale Nuklei (NeuN) im Gehirn von Ratten detektiert und durch den Vergleich mit der kontralateralen Hemisphäre der Neuronenverlust erfasst. Mithilfe einer Dreifach-immunfluoreszenzfärbung und konfokaler Laserscanningmikroskopie wurden neben dem Neuronenverlust sowohl Astrogliose als auch Mikrogliaaktivierung, als wesentliche Bestandteile der neurovaskulären Einheit (NVU), qualitativ analysiert. Für die Ischämie-assoziierten Gebiete ergab sich ein über den gesamten Beobachtungszeitraum konstantes und mit dem Penumbramodell korres-pondierendes schalenförmiges Muster des Neuronenverlusts. Die Hypothese einer Neuroprotektion durch HBO in Kombination mit rtPA konnte im Vergleich zu früheren experimentellen Studienergebnissen nicht bestätigt werden.

The neuroprotective effects of AF4, a flavonoid-enriched extract derived from the peel of Northern Spy apples (containing quercetin-3-O-glucoside, quercetin-3-O-galactoside, quercetin-3-O-rhamnoside, quercetin-3-O-rutinoside, epicatechin, and cyanidin-3-O-galactoside) were examined by assessing neuronal loss and motor impairment resulting from hypoxic-ischemic (HI) brain injury in adult C57BL/6 mice. Relative to vehicle treatment (water, 10mL/kg/day), oral administration of AF4 (50 mg/kg/day) for 3 days reduces HI-induced neuronal loss in the striatum and hippocampus, motor impairments, and reduces the ability of LPS to stimulate the production of TNF-alpha in whole blood. Pretreatment with AF4 (1 ug/mL) decreased the death of mouse primary cortical neurons subjected to oxygen glucose deprivation (12 hours) in comparison to vehicle (DMSO) or the same concentration of quercetin or its metabolites. Taken together these findings indicate that AF4 reduces HI-induced brain injury and motor deficits by increasing the resistance of vulnerable neurons to ischemic cell death and decreasing the production of inflammatory cytokines.

Excessive muscle tone or stiffness secondary to stroke frequently involves the ankle plantarflexors and has been associated with decreased mobility and reduced function. Although becoming more common in clinical practice, the effectiveness of botulinum toxin A (BTX-A) injected in the ankle plantarflexors on gait biomechanics is not well established. The primary objective of this study was to describe the kinematic and kinetic changes that occur during walking following BTX-A treatment of the hypertonic ankle plantarflexors. As well, the study explored whether there were clinical characteristics uniquely associated with subjects that exhibited biomechanical improvement. The study was a single group, open label trial with repeated measures, including multiple baseline and three post-intervention time points. Seven chronic hemiparetic stroke subjects with ankle hypertonicity were included in the study. Full lower limb bilateral gait analysis provided joint kinematic and kinetic information throughout stance. As well, clinical measures of ankle range of motion and spasticity were assessed pre and post treatment. Data were analyzed using paired samples t-tests and repeated measures ANOVA with Least Significant Difference adjustment for post-hoc analysis as necessary (significance level p≤0.05). Of the kinematic variables, significant improvements in peak dorsiflexion and plantarflexion and the ankle angle at initial contact were found 10 weeks post-injection relative to baseline. No significant kinetic changes were detected, however 2 subjects showed improved positive work at the ankle post-injection and 5 subjects demonstrated increased positive work at the hip post-treatment. Although subjects were classified as “responders” or “non-responders” based on clinical improvement observed 2 weeks post-injection, there was no observable association between those who responded clinically and those who demonstrated improved gait. The major findings suggest that BTX-A injection results in tone reduction and in some cases improves the biomechanical efficiency of gait. In cases where kinetic variables remained unchanged following treatment, perhaps the increased tone was not the limiting factor of reduced function. / Thesis (Master, Neuroscience Studies) -- Queen's University, 2007-08-30 09:41:03.24