Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study investigated the importance of the side of weakness and sex of the patient in patient outcome after stroke. It was based upon 162 consecutive acute stroke patients attending a rehabilitation unit. Results suggest that functional recovery was not influenced by the factors investigated, provided that measurements were made at set times poststroke. However, patients with right hemiplegia attended rehabilitation longer so they appeared to have made a better functional recovery when activity of daily living (ADL) ability was measured at discharge. Although right hemiplegia was associated with aphasia and left hemiplegia with spatial disorder and loss of sitting balance, these associations were not strong enough to affect functional recovery. Sex of the patient had no significant effect upon either the frequency of initial deficits or upon outcome, and there was no obvious interaction between the two variables (side and sex) and outcome.
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PMID:Stroke: influence of patient's sex and side of weakness on outcome. 647 82

A double-blind study was conducted in order to evaluate the effect of CDP-choline on functional recovery of hemiplegia. A standardized 12-grade scale (Hemiplegia Function Test) was utilized for the evaluation. The results indicate that for the upper limbs, doses of 1,000 and 250 mg of CDP-choline were superior to placebo at 8 weeks. The higher dose showed an effect at 4 weeks equal to that at 8 weeks while the effect of the lower dose was slower but reached the same level of effect as the higher dose at 8 weeks. Similar results were obtained for the lower limbs but the effectiveness was not statistically significant. The lesser effect for the lower limbs could be attributed to the relatively small number of patients in the early stages of recovery in the present series. No significant differences were found for the effects on subjective symptoms, neurological signs and overall judgment of the physicians. The findings suggest that CDP-choline promotes natural recovery in hemiplegia.
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PMID:Evaluation of the effect of CDP-choline on poststroke hemiplegia employing a double-blind controlled trial. Assessed by a new rating scale for recovery in hemiplegia. 700 29

This study was designed to examine the effect of forced use of the affected upper extremity of a hemiplegic patient on the quantity, quality, and efficiency of functional behaviors. The patient was a woman with right hemiplegia of 18 months' duration. The study was divided into three one-week phases: an initial base-line, and experimental, and a second base-line phase. Base-line scores of frequency, quality, and time were recorded for completion of functional tasks. During the experimental phase, the patient's intact upper extremity was restrained. The efficiency and quality of movement scores did not reflect changes related to the period of restraint; however, the frequency of purposeful behaviors and the patient's functional use of her affected extremity increased during the experimental phase. The relationship of forced use to recovery of function in hemiplegia remains uncertain.
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PMID:Effect of forced use of the upper extremity of a hemiplegic patient on changes in function. A single-case design. 724 97

Two experiments examined the effects of single or multiple administrations of methylphenidate (MPH; Ritalin) and differing amounts of beam-walking trials (symptom relevant experience) during the period of drug action on recovery from hemiplegia following unilateral sensorimotor cortex ablation in rat. The first study tested multiple doses of MPH (10 mg/kg) or sterile saline given once daily, followed by four beam-walk (BW) trials at 1, 2, 3, and 6 h on 3 consecutive days. A significant and enduring enhancement of recovery was only observed 24 h after the third administration of MPH, compared to saline controls. In the second study, a single dose of MPH (10 mg/kg) or saline was administered 24 h after ablation, followed by 12 BW trials beginning 1 h and continuing at 15-min intervals until 3 h after MPH or saline administration. A significant and enduring facilitation of BW ability was produced by this single MPH treatment regimen. These data further support the importance of an interaction between symptom-relevant experience and drugs that increase norepinephrine transmission to enhance functional recovery after brain damage.
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PMID:Methylphenidate treatment following ablation-induced hemiplegia in rat: experience during drug action alters effects on recovery of function. 793 34

The research described in this review briefly summarizes evidence that short term pharmacological enhancement of noradrenergic (NA) synaptic activity, combined with symptom relevant experience (SRE), promotes functional recovery of some symptoms of cortical damage in rat, cat and human beings even when treatment is initiated from days to weeks after injury. A summary is provided of the numerous drugs tested in rodent cortical injury models which have been proven useful for predicting beneficial or harmful effects on behavioral outcome in human stroke. The pattern of drug effects indicates a central role for NA in functional recovery. Additionally, studies of the effects of direct intraventricular infusion of monoamine neurotransmitters are reviewed and further support the hypothesized role of NA in recovery from some symptoms of cortical injury. The site of NA/SRE interaction to promote recovery from hemiplegia apparently involves the cerebellar hemisphere contralateral to the cortical injury. Microinfusions of NA into the contra- but not ipsilateral cerebellar hemisphere dramatically enhance recovery. Furthermore, like its systemic action, microinfusion of the alpha 1-NA receptor antagonist, phenoxybenzamine, reinstates hemiplegia. A "permanent" symptom of motor cortex injury in the cat is the complete loss of tactile placing contralateral to the injury which does not spontaneously recover for as long as seven years after ablation. This postural reflex is temporarily restored for 8-12 hours following amphetamine administration. However, this permanently lost reflex can be enduringly restored by transplanting catecholamine secreting adrenal tissue into the wound cavity. The experiment is reviewed in detail and involves chromaffin cell autografts into the frontal cortex ablation wound cavity producing a restoration of tactile placing for the 7-10 month duration of the study. This enduring restoration of tactile placing is considered a result of the release of catecholamines into the CNS from the grafted chromaffin cells found, by histochemical methods, surviving 7-10 months after transplant. Lastly, we attribute these delayed treatment effects to an attenuation of a diaschisis, or remote functional depression, in morphologically intact areas anatomically connected to the area of injury. The widespread reduction of glycolytic and oxidative metabolism, produced by focal cortical injury, is normalized by the same treatment which alleviates symptoms and is worsened by drugs which exacerbate deficits. These data support the hypothesis that providing SRE during a period of enhanced NA synaptic activity produces an enduring functional recovery after cortical injury by attenuating remote functional depression. This treatment for enhancing recovery is especially attractive since it is effective even when begun weeks after cortical damage.
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PMID:Noradrenergic pharmacotherapy, intracerebral infusion and adrenal transplantation promote functional recovery after cortical damage. 801 52

Surface electromyographic "EMG" activity in biceps brachii (agonist muscle) and triceps brachii (antagonist muscle) as well as the discharge behaviour of motor units "MUs" (needle recording) in biceps brachii muscle were recorded during slow (0.33 Hz) and fast (0.66 Hz) voluntary elbow flexion movements (auditory matching task) in fifty patients with spastic hemiplegia. In the spastic limbs, a long lasting, small amplitude tonic co-contraction of antagonist muscles was seen during slow flexions (SF) in 29 cases. This effect was strongest during the fast elbow flexion movements (FF). In 33 patients a triphasic pattern of muscle activation was observed on the unaffected side but not on the spastic side. The amplitude of the agonist surface EMG was significantly reduced and the amplitudes of the MU potentials recruited during maximal effort were generally smaller on the spastic side compared to the unaffected side. The agonist-antagonist activation pattern was analysed with respect to three clinically identifiable functional recovery stages of voluntary movements in the spastic limbs, namely synergistic, isolated and useful movements. The MU amplitudes and the amplitude of the surface EMG activity in the agonist muscle recorded during FF movements became significantly larger whereas the amplitude of the antagonist tonic activity became smaller with increasing functional recovery of the limb. It is concluded that impaired recruitment of type II motor units in the agonist muscles and the inability to selectively activate the agonist muscle contribute to the deficit in motor performance in spastic paresis.
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PMID:Impaired activation pattern in antagonistic elbow muscles of patients with spastic hemiparesis: contribution to movement disorder. 835 30

Dysphagia is common after a stroke and is associated with a poor outcome in terms of survival or functional recovery. Percutaneous gastrostomy (PG) provides reliable and safe nutrition for patients with neurological dysphagia in the short term but little is known about the the subsequent outcome in stroke patients. We reviewed the medical records of all stroke patients who had required a PG in four West Yorkshire hospitals over a 30-month period. All patients alive at the time of the study were contacted and functional status was recorded. Forty-one stroke patients had undergone PG and 37 records were obtained. There were 24 men and 13 women with a mean age of 74 years. Thirty-three patients had had a hemiplegia while four patients presented acutely with dysphagia but no hemiplegia (all had cerebral infarcts on CT scan). The timing of PG varied with a median time from stroke of 26 days (range 12-131). Complications include five chest infections ( < 1 week after PG), three local infections, two tubes pulled out and one perforation. Three patients died in the first 5 days after the PG. Thirty-one of the 37 patients had died at the time of the assessment, 21 during the original hospital admission. The median survival from the time of PG was 53 days (range 2-528) with only 12 patients surviving for more than 3 months. Six patients were alive at the time of the study and all but one were severely disabled (mean modified Barthel Index seven). There is no consensus about patients selection or timing of PG and our data should lead to more careful consideration of the risks and benefits of the procedure in stroke patients.
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PMID:Outcome in patients who require a gastrostomy after stroke. 900 88

Research on treatments for cerebral stroke or traumatic brain injury (TBI) has focused on limiting the cascade of toxic pathologic events leading to primary and secondary neuronal death occurring early after injury. This approach of rescuing compromised neurons or "sparing" has had limited clinical success, and the very short therapeutic window limits therapeutic potential. This hopeless attitude for improving the status of patients weeks or a month after stroke may change with the accumulating data on the noradrenergic strategy. This approach uses any of a family of drugs to increase central levels of noradrenaline (NA), which, combined with physical therapy (NA/PT), produces an enduring alleviation of some symptoms of cortical injury. Importantly, beneficial effects of short-term treatment endure even when treatment is initiated a month after stroke. Long-term follow-up showed that the beneficial effect is robust, producing recovery to an ultimately higher level of hemiplegia recovery. Data from TBI patients indicate enhanced functional recovery of cognitive deficits using a similar intervention. The NA hypothesis for the beneficial effect is complemented with data from laboratory as well as from stroke patients that show slowing of recovery is produced by commonly prescribed drugs blocking alpha 1 NA receptors and other drugs shown harmful to recovery in animal models. Preliminary data suggest these beneficial and harmful effects on recovery may be extended to more complex functions such as aphasia. These findings are interpreted as NA modulation of a diaschisis, or remote functional depression in the cerebellum resulting from cortical injury.
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PMID:From laboratory to clinic: noradrenergic enhancement of physical therapy for stroke or trauma patients. 895 28

As rehabilitation for post-stroke hemiplegic patients has become widely accepted practice, there has been an increase in patients who are more difficult to treat. In the prescription rationale of orthoses for hemiplegics, the knee-ankle-foot orthosis (KAFO) for the lower limb has generally been underestimated because of its inhibitory effect on the normal walking pattern and also its interference with gait training. The authors had an experience of 28 hemiplegics with severe physical impairments who were fitted with a convertible plastic KAFO. Among these patients, there were 11 cases in which the KAFO was replaced by an ankle-foot orthosis (AFO) within 1.5 to 8 months (average 4 months) following initial prescription when they were able to control their knee actively. Ambulatory capability in these patients was superior to that of the remaining KAFO group. The Barthel index of the AFO group patients was higher than the KAFO group (p < 0.01). However neither age, sex, severity of hemiplegia, starting time of rehabilitation following onset of stroke, time of fitting with the orthosis, nor the functional recovery stage were critical factors between the two groups, only the incidence of major complications affected ambulatory capability.
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PMID:Clinical experiences with a convertible thermoplastic knee-ankle-foot orthosis for post-stroke hemiplegic patients. 898 99

We have previously shown beneficial effects of a Ginkgo biloba extract (EGb761-IPSEN) in accelerating functional recovery from hemiplegia induced by unilateral motor cortex ablation. Here, we report the behavioral and histological effects of various dose regimes of EGb761. In young rats (3 months), 10 mg/kg/day for 7 days produced an improvement in motor performance, relative to untreated controls, on the last day of treatment. Applying a priming (P)-maintenance (M) dose regime (P-7 = 7 days, M-21 = 21 days), a P-7 of 50 (all doses expressed in mg/kg/day) and a M-21 of 10 promoted recovery from the second day after surgery. However, in aged rats (26-28 months old) this treatment ameliorated motor performance only after the 10th day of treatment. A P-7 of 100 or 200 and a M-21 of 50 or 100 produced an acceleration of behavioral recovery in aged animals. Improvement was evident by the fifth day of treatment and was maintained after the treatment regimen. These two groups also demonstrated reduced glial fibrillary acid protein (GFAP) immunostaining and ex vacuo hydrocephalus. Thus, the confirmed efficacy of EGb in hemiplegic rats can be enhanced by an appropriate posology.
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PMID:Motor function in young and aged hemiplegic rats: effects of a Ginkgo biloba extract. 925


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