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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty of approximately 1000 patients attending the arteriosclerosis clinic at MIT during a 13 year period were treated simultaneously with aspirin and warfarin for symptomatic atherosclerotic (19) or rheumatic (1) heart or vascular disease. The average duration of therapy was 5.8 years. Thirteen patients suffered from familial hyperlipoproteinemia; only one patient had none of the major risk factors for arteriosclerosis. Refractory symptoms were related to the central nervous system in 13, peripheral vascular system in 5 and the heart in 2. All twenty patients became asymptomatic or showed marked clinical improvement on aspirin plus warfarin therapy. While on this therapy, complications, both thrombotic and hemorrhagic, occurred in 7 of the 20 patients (graft embolus in 1, and bleeding in 6; with one death as a result of intracranial bleeding) and sudden death, probably from acute myocardial ischemia, in a further 2 patients. We conclude that when alternative therapies are impossible or have proven to be of no avail in patients suffering from the complications of advanced atherosclerosis, the simultaneous administration of aspirin and warfarin may be a therapeutic alternative, although very close and careful followup of the patients' prothrombin times and clinical status is essential.
Stroke
PMID:Simultaneous therapy with antiplatelet and anticoagulant drugs in symptomatic cardiovascular disease. 387 67

The Haemodynamic effects of flunitrazepam (FLU) 1.25 mg X m-2 administered intravenously were studied in 18 anaesthetized cardiac patients suffering from isolated mitral (MIT, n = 6), aortic (AOR, n = 6) or coronary (COR, n = 6) lesions. A placebo group of 18 clinically similar patients was used to assess the stability of the cardiovascular parameters under the conditions of the study. Heart rate, systemic arterial pressure, cardiac output and central venous pressure changes were measured 2, 5, 8 and 12 min after FLU or saline injection and compared with reference values collected before the start of the haemodynamic test. In the FLU group, the cardiovascular state of all the patients developed following the same pattern and the greatest differences were observed at 12 min post-injection. These differences, expressed as a percentage of the initial values were (* P less than 0.05; ** P less than 0.001; ns = non-significant): mean systemic arterial pressure: COR, -18% (**);MIT, -13% (*); AOR, -23% (**); heart rate: COR, 0% (ns); MIT, -10% (*); AOR, -12% (*); cardiac output: COR, -15% (**); MIT, -13% (*); AOR, -16% (**); stroke volume: COR, -12%(*);MIT, 0% (ns);AOR,-3%(ns). This shows some differences concerning the SV and heart rate changes in the valvular and COR patients. As compared to the data from the literature, most of the haemodynamic effects of FLU seem relatively independent of the initial level of consciousness.
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PMID:The haemodynamic effects of flunitrazepam in anaesthetized patients with valvular or coronary artery lesions. 612 62

In an attempt to improve motor recovery of the upper limb after stroke, we added a robot (MIT-Manus) experience that provided additional goal-directed sensorimotor activity to standard rehabilitation treatments. The first trial produced a significant decrease in motor impairment in the upper limb for the treated group. In re-evaluating 12 of those 20 patients, nearly 3 years later, robot-trained patients showed further significant decreases in impairment measures of the affected limb. The groups were comparable at the start of the study.
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PMID:Robot training enhanced motor outcome in patients with stroke maintained over 3 years. 1056 46

The perceived direction of apparent motion can be influenced by both "top-down" factors, such as expectation, and by "bottom-up" or stimulus-driven factors, such as grouping (Tse, P., Cavanagh, P. & Nakayama, K. (1998). The role of parsing in high-level motion processing. In T. Watanabe, High-level motion processing - computational, neurobiological and psychophysical perspectives. Cambridge, MA: MIT Press). Here we report the results of a single experiment that pitted top-down cues against bottom-up cues in an apparent motion sequence over the successive strokes of a Chinese character. Although each stroke was in fact presented all at once, subjects raised in China tended to see apparent motion over a single stroke in the direction it would have taken when drawn by hand, even though bottom-up cues drive a percept of apparent motion in the opposite direction for observers unfamiliar with the Chinese language. There is therefore a learned component to motion perception arising from top-down expectations capable of overriding bottom-up cues to motion.
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PMID:Chinese and Americans see opposite apparent motions in a Chinese character. 1064 May 74

We are applying robotics and information technology to assist, enhance, and quantify neuro-rehabilitation. Our goal is a new class of interactive, user-affectionate clinical devices designed not only for evaluating patients, but also-for delivering meaningful therapy via engaging "video games". Notably, the novel robot MIT-MANUS has been designed and programmed for clinical neurological applications, and has undergone extensive clinical trials for more than four years at Burke Rehabilitation Hospital - White Plains, NY. This paper will review results of the first clinical trial of 20 patients, which showed that: - Stroke patients treated daily with additional robot-aided therapy during acute rehabilitation had improved outcome in motor activity at hospital discharge, when compared to a control group that received only standard acute rehabilitation treatment. - This improved outcome was sustained after three years. - The neuro-recovery process continued far beyond the commonly accepted 3 months post-stroke interval.
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PMID:Overview of clinical trials with MIT-MANUS: a robot-aided neuro-rehabilitation facility. 1066 75

The first groups to use robotic devices to enhance the sensorimotor experience of patients recovering from upper limb paralysis after stroke have generated encouraging information. Patient acceptance and staff enthusiasm for robot training at Burke--MIT is consistently high. Robot training data are consistent with other controlled studies showing that more activity leads to more motor improvement and decreased impairment. Therapists equipped with a robotic device can increase the amount and intensity of movement of the paralyzed limb without sacrificing time spent training complex functionally appropriate kinematics.
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PMID:Robot-aided sensorimotor training in stroke rehabilitation. 1276 Feb 10

BACKGROUND: Previous results with the planar robot MIT-MANUS demonstrated positive benefits in trials with over 250 stroke patients. Consistent with motor learning, the positive effects did not generalize to other muscle groups or limb segments. Therefore we are designing a new class of robots to exercise other muscle groups or limb segments. This paper presents basic engineering aspects of a novel robotic module that extends our approach to anti-gravity movements out of the horizontal plane and a pilot study with 10 outpatients. Patients were trained during the initial six-weeks with the planar module (i.e., performance-based training limited to horizontal movements with gravity compensation). This training was followed by six-weeks of robotic therapy that focused on performing vertical arm movements against gravity. The 12-week protocol includes three one-hour robot therapy sessions per week (total 36 robot treatment sessions). RESULTS: Pilot study demonstrated that the protocol was safe and well tolerated with no patient presenting any adverse effect. Consistent with our past experience with persons with chronic strokes, there was a statistically significant reduction in tone measurement from admission to discharge of performance-based planar robot therapy and we have not observed increases in muscle tone or spasticity during the anti-gravity training protocol. Pilot results showed also a reduction in shoulder-elbow impairment following planar horizontal training. Furthermore, it suggested an additional reduction in shoulder-elbow impairment following the anti-gravity training. CONCLUSION: Our clinical experiments have focused on a fundamental question of whether task specific robotic training influences brain recovery. To date several studies demonstrate that in mature and damaged nervous systems, nurture indeed has an effect on nature. The improved recovery is most pronounced in the trained limb segments. We have now embarked on experiments that test whether we can continue to influence recovery, long after the acute insult, with a novel class of spatial robotic devices. This pilot results support the pursuit of further clinical trials to test efficacy and the pursuit of optimal therapy following brain injury.
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PMID:Rehabilitation robotics: pilot trial of a spatial extension for MIT-Manus. 1567 16

In 1991, a novel robot, MIT-MANUS, was introduced to study the potential that robots might assist in and quantify the neuro-rehabilitation of motor function. MIT-MANUS proved an excellent tool for shoulder and elbow rehabilitation in stroke patients, showing in clinical trials a reduction of impairment in movements confined to the exercised joints. This successful proof of principle as to additional targeted and intensive movement treatment prompted a test of robot training examining other limb segments. This paper focuses on a robot for wrist rehabilitation designed to provide three rotational degrees-of-freedom. The first clinical trial of the device will enroll 200 stroke survivors. Ultimately 160 stroke survivors will train with both the proximal shoulder and elbow MIT-MANUS robot, as well as with the novel distal wrist robot, in addition to 40 stroke survivor controls. So far 52 stroke patients have completed the robot training (ongoing protocol). Here, we report on the initial results on 36 of these volunteers. These results demonstrate that further improvement should be expected by adding additional training to other limb segments.
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PMID:Robot-aided neurorehabilitation: a robot for wrist rehabilitation. 1789 65

ECG heartbeat type detection and classification are regarded as important procedures since they can significantly help to provide an accurate automated diagnosis. This paper addresses the specific problem of detecting atrial premature beats, that had been demonstrated to be a marker for stroke risk or cardiac arrhythmias. The proposed methodology consists of a stage to estimate characteristics such as morphology of P wave and QRS complex as well as indices of prematurity and a non-supervised stage used by the algorithm J-means to separate heartbeat feature vectors into classes. Partition initialization is carried out by a Max-Min approach. Experimental data set is taken from MIT-BIH arrhythmia database. Results evidence the reliability of the method since achieved sensitivity and specificity are high, 92.9 and 99.6%, respectively, for an average output number of 12 discovered clusters that can be considered as appropriate value to separate heartbeat classes from recordings.
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PMID:Unsupervised classification of atrial heartbeats using a prematurity index and wave morphology features. 1918 58

In 1991, a novel robot named MIT-MANUS was introduced as a test bed to study the potential of using robots to assist in and quantify the neurorehabilitation of motor function. It introduced a new modality of therapy, offering a highly backdrivable experience with a soft and stable feel for the user. MIT-MANUS proved an excellent fit for shoulder and elbow rehabilitation in stroke patients, showing a reduction of impairment in clinical trials with well over 300 stroke patients. The greatest impairment reduction was observed in the group of muscles exercised. This suggests a need for additional robots to rehabilitate other target areas of the body. Previous work has expanded the planar MIT-MANUS to include an antigravity robot for shoulder and elbow, and a wrist robot. In this paper we present the "missing link": a hand robot. It consists of a single-degree-of-freedom (DOF) mechanism in a novel statorless configuration, which enables rehabilitation of grasping. The system uses the kinematic configuration of a double crank and slider where the members are linked to stator and rotor; a free base motor, i.e., a motor having two rotors that are free to rotate instead of a fixed stator and a single rotatable rotor (dual-rotor statorless motor). A cylindrical structure, made of six panels and driven by the relative rotation of the rotors, is able to increase its radius linearly, moving or guiding the hand of the patients during grasping. This module completes our development of robots for the upper extremity, yielding for the first time a whole-arm rehabilitation experience. In this paper, we will discuss in detail the design and characterization of the device.
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PMID:Design and Characterization of Hand Module for Whole-Arm Rehabilitation Following Stroke. 2022 69


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