bluuebunny/crossref_metadata_2025 huggingface dataset:
Rehabilitation Treatment In Dysarthria Caused By Stroke (Review)
Authors: Rahimifar Parvane , Soltani Majid , Moradi Negin
Published: February 2017

Speech is a unique, complex, dynamic motor activity through which we express thoughts and emotions and respond to and control our environment. Speech damaged due to neurological damage such as stroke. As a consequence of the associated neurological damage, stroke, approximately 20–30% of this population experience weakness, in-coordination or paralysis of the muscles required to produce speech, known as dysarthria. unfortunately dysarthria in stroke tends not to receive specific attention in published texts and reports, despite its frequency. while the speech is among the most powerful tools in communication and speech problems lead to defects in quality of life, So  We  investigated Dysarthria rehabilitation in stroke patients.The Results showed that, the speech-language Pathologists (SLPs) are the professionals normally responsible for dysarthria intervention. Their interventions for individuals with dysarthria depend on the type and nature of the dysarthria, the underlying neuropathology, and the specific communication needs of the individual. SLPs interventions include behavioral or traditional therapy techniques and   instrumental techniques, that can be improve speech, communication and quality of lifes.
Rehabilitation Treatment In Aphasia Caused By Stroke(Review)
Authors: Rahimifar Parvane , Soltani Majid , Moradi Negin
Published: February 2017

Aphasia is a relatively common language disorder, occurring in about 25% of all stroke patients. The ultimate aim of aphasia treatment is to improve patients oral and written language abilities and to facilitate their participation in everyday communication. Over the last decades, a range of approaches in aphasia therapy have been introduced, based on cognitive neuropsychological models, psycholinguistic theories, and socio-pragmatic approaches. In view of the range of different approaches and findings of therapy studies, the challenge for therapists is to decide which approach is the most appropriate one for an aphasic individual at a specific stage of recovery.The Findings showed that, therapy plan for aphasic individuals involves selecting the therapeutic approach most appropriate for dealing with a particular type of disorder, degree of severity, stage of recovery and the extent of the patient's participation in social life. A framework of aphasia treatment is outlined which considers the rehabilitation process at the various stages of recovery, and Different approaches are combined into a comprehensive treatment regimen which differentiates three stages of recovery: the acute, post-acute, and chronic stage. Also ,The intensive therapy in the treatment of language disorders have a great effect, and Brain imaging studies have shown that the linguistic reorganization of a damaged brain is aided by intensive speech therapy even in the chronic phase.
The Comparison Of Relationship Of Depression,Cognitive,Motor And Functional Deficities In Chronic Stroke Patients (A Pilot Study)
Authors: Ghaffari Amin , Akbarfahimi Malahat , Forough Bijan
Published: February 2017

Aim and background: One of the most important psychological disorders that arise after a stroke for people with subsequent depression, which leads to reduced quality of life, optimal rehabilitation failure, loss of cognitive tasks and decrease the recovery process.In this study communication patterns of depression with cognitive, motor and function deficites in people with chronic stroke has been studied.Methods and materials: it is a pilot study of cross-sectional study, 40 patients with chronic stroke (more than 6 months) selected sampling method. depression (Beck Depression Inventory), cognition (attention test TMT-A & B and Wechsler memory), motor (Motorcity index), basic activities of daily living (Barthel scale) and instrumental activities of daily living (Lawton scale) were evaluated.Results: The results of the study revealed a significant positive correlation between post stroke depression with verbal memory(r=./386 ،P<./05), attention(r=./549 ،P<./05), motor status(r=./550 ،P<./05) and independence in activities of daily living(r=./653 ،P<./05)Conclusion: According to the findings, the study of factors affecting  post stroke depression(PSD) clinical and practical aspects are necessary. Cognitive rehabilitation programs with motor rehabilitation can reduce depression in patients with stroke in the direction of independence in activities of daily living and greater participation in society .
Lifestyle And Effective Factors On It Among Patients With Transient Ischemic Attack
Authors: Sarboozi Hosein Tahere , Ghiyasvandian Shahrzad , Zakeri Moghadam Masoome , Kazemnejad Anooshiravan
Published: February 2017

Background Choosing wrong type of lifestyle by a person can predispose him/her to cardiovascular disease such as strokes, which can be a serious hazard for his/her health. Transient ischemic attack is a transient attack of impaired brain function disorder that can predict further strokes. Therefore, this study has done by the purpose of defining lifestyle condition about the patients with transient ischemic attack.Material and methodsThis study is the analytic-descriptive type and has been conducted on 60 patients with transient ischemic attack that admitted to the chosen hospital of Tehran, by random sampling method in 1394.  The research tools were patient condition demographic questionnaire and health promotion lifestyle profile (HPLP ll). The collected data were analyzed by the SPSS 16 software and statistical tests.Findings and resultsLifestyle of 63.25% of patients estimated at medium level. Physical activity, stress management and health responsibility dimensions also had lower score in comparison with other dimensions. Interpersonal relationships dimension had the highest score. Statistically significant relation has seen among the lifestyle and education level and economic situation (P<0.05)ConclusionImprovement and promotion of patient’s lifestyle, especially from the point of physical activity and stress management, requires more attention and by considering the fact that the main cause of stroke is related to person’s lifestyle, the necessity of training programs implementation, in order to change or preserve these patients’ lifestyle, is recommended.
A Clinical Survey Efficacy Of Frankincense In Acute Ischemic Stroke
Authors: Jivad Nahid , Rezaei kheirabadi Fakhri , Rafeian Mahmoud , Yarmohammadi Parisa
Published: February 2017

Background &Aims: Ischemic stroke is the most common cause of stroke ,and paralysis and movement disorders are the most symptoms of stroke. Therefore, it is important to find a method for improving the disorders. This study aimed to examine the clinical efficacy of frankincense in patients with the acute ischemic stroke.Methods: In this clinical trial, 60 patients with ischemic stroke were randomly allocated into the treatment and control groups (n=30). In the treatment group, in addition to routine treatment of stroke, four capsules containing 500 mg powdered frankincense was given daily  , but in the control group, was performed only the treatment of stroke (no frankincense). The treatment lasted for 1 month. The NIHSS scale (for assessment of speech and muscle strength) at the beginning,  the seventh day and end of the study for each patient was completed. Statistical analysis was performed using independent t-test, chi-square, mann withney in SPSS software.Results: Results showed that only improvement of muscle strength in patients left limb increased significantly in stage II in the treatment group than the control group.Conclusion: Adding frankincense to treatment of patients with stroke can be effective on improvement muscle strength in patients with muscle weakness and non-dominant side in acute neurological disorders. While that is not effective on improving muscle strength of the right limb or speech.
Movement Disorders Syndromes Associated With Lacunar Infarcts, Clinical Case Series
Authors: Chitsaz A
Published: February 2017

Lacunar infarcts are small (<15 mm diameter) subcortical infarcts that results from occlusion of a single penetrating artery. Lacunar infarcts are associated with clinical lacunar syndromes, one of lacunar syndromes is movement disorders syndrome such as chore, dystonia, hemibolismus and asterixis. Several types of movement disorders have been described with small, deep infarct, majority of these syndrome is caused by penetrating small- artery disease. The movement disorder may appear as the only sign of the infarct or may develop later, after an initial syndrome, different in character, has resolved.Hemichorea – hemiballismus is the most common of movement disorder due to lacunar infarcts.The lacunar size infarcts found in different parts of the striatum including in head of the caudate nucleus and adjacent corona radiate, the subthalamic  and the thalamus. The onset is typically abrupt and is usually- unaccompanied by other complaints. The chorea usually involves the forearm, hand, and fingers. In some cases, chorea has been delayed by some weeks or months after the initial occurrence of hemiparesis. Dystonia: Two types of dystonia have been described in cases of lacunes, action- induced and focal dystonia.Case I-  in a 63 year old woman with lacunar stroke, with abrupt onset of chorea, chorea involves the foream, hand, and fingers, it was  accompanied by hemiparesis that faded within 3 months even though the chorea persisted unchanged.Case II-  In a 75 years old man chorea was delayed by some weeks after initial occurrence of hemiparesis due to lacunar infarct.Case III-  in a 81 years old woman lacunar infarct, whose putaminal lesions was documented by CT scan, suffer choreic movements of the distal parts of the arm and leg that interfered with normal activity and prevented easy walking for more than a weeks, the examination revealed normal strength, sensation and reflexes.Case IV-  A 69 years old man , with lacunar infarct in adjacent corona radiate with action – induced dystonia in the left hand. The finger of the affected hand become flexed in to the palm, leaving only the Thumb free, strength of hand was normal . Activity exacerbated the movements. The left hand and forearm showed involuntary movements that produced an unusual posture.
Stroke And Substance Abuse
Authors: Chitsaz A
Published: February 2017

Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality .

OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking.

Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic) aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes.

Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism.

AMPHETAMINE AND other psychostimulants:

In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two.

Decongestants and diet pills:

Phenylpropanolamine (PPA), an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA) with amphetamine like can induce ischemic or hemorrhagic strokes.

Crack cocaine: medical complication of crack cocaine is stroke. Parenteral cocaine users are at risk of stroke related to infectious endocarditis and also experience stroke caused directly by the drug itself.
The Effect Of Biofeedback On The Motor– Muscular Situation In Rehabilitation Of Stroke Patients
Authors: Najafi Zohre , Manzari Zahra sadat , Rezaeitalab Fariborz , Azhari Amin
Published: February 2017

Background:Stroke is the most common debilitating neurological disease in adults. Therefore, rehabilitation is a major consideration to reduce costs and relief disabilities. Biofeedback, a newly recommended method is claimed to be able to improve the consequences following stroke by enhancement the understanding of the psychological functions of the body.  Objectives: The purpose of this study was to investigate the effect of biofeedback on the motor– muscular situation in rehabilitation of stroke patientsMethods:The present study was a randomized clinical trial that was started in May 2016 and completed in September 2016. The sample of this study included all the patients with stroke attending the physiotherapy center of Imam Raza hospital in Mashhad, Iran. The participants were randomly divided into 2 groups (case and control group) after considering the inclusion and exclusion criteria. In the intervention group, biofeedback (2 times a week for 15 sessions, each session lasting 20 minutes) was performed.Before the intervention demographic information questionnaire was complete by all participants. Then a check list of main variables such as hands muscle strength, muscle stiffness (spasticity), balance and ability to walk was complete by a physician. In the 7th session of the exercise and in the end of intervention (14th session), again, the main variables of the check list were reassessed by the researcher. The statistical analysis was done by Statistical Package for the Social Sciences (SPSS) software version 16.Results:the mean score of balance evaluation in pre-intervention had not any significant differences (p=0.503), but in post intervention evaluation, this score in intervention group versus control group showed significant differences (p=0.014).the mean score of muscle strength,Results showed that by eliminating the effects of muscular strength before the intervention, this variable in both intervention and control groups after the intervention, had improvement and significant difference (p=0.005).Comparison the average spasticity, showed that spasticity evaluation score before and after intervention had no significant difference between the two groups (p=1.00)Conclusion: Considering the findings of this study, the biofeedback therapy is a promising treatment modality in improvement the motor– muscular condition following stroke.
The Relationship Between Age And Kind, Location , Presentation And Recent Outcome In Adult Patients With Difference Type Of Stroke
Authors: Shams Vahdati Samad , Ala Alireza , Ahmadi Sepehr Nasim , Fahimi Roshan
Published: February 2017

Stroke is defined as a clinically syndrome consisted of neurological symptoms with early or sudden onset, lasting more than 24 hours, happening because of clot or blockage in brain arteries or vascular dissociation leading to brain hemorrhage. CVA is totally categorized in two types of hemorrhage and ischemic.Ischemic type has two subsets: thrombotic and emboli whereas hemorrhage stroke is studied in two types of SAH and ICH based on part of brain which is bleeding.National institutes of health stroke scale (NIHSS) is designed to fill within 5-8 minutes. One of the most common methods of classifying of acute stroke is NIHSS, that with a structured neurological examination is valuable for diagnosing.About half of all strokes are attributable to established causal and modifiable factors. This finding encourages not only intervention on established etiological factors, but also further study of less well established factors.  public education is needed to increase awareness of the warning signs and risk factors of stroke. Stroke management is extremely demanding for patients, and Prevention of stroke and correct management as soosn as possible is the key to reduction of morbidity and mortality.
Rehabilitation Of Stroke Aphasia: Topics Of Research
Authors: Yadegari Fariba
Published: February 2017

Background: Stroke may result in aphasia, an acquired language disorder which affects receptive and expressive language. The symptoms are observed in the auditory-verbal processing, oral expression, written expression and written language processing. As spoken language is the strongest tool of human communication, loss of it may cause great destructive consequences in the social and personal life of the affected individual. People with aphasia (PWA) and their carers seek rehabilitation in an effort to remove or reduce the effects. Speech-language pathologists (SLPs) are professional in offering such service. This paper aims at addressing new approaches and current research questions about the factors affecting the therapy.Main points: The issues which aphasia therapy research and reviews have addressed are the ones that are asked frequently in clinical settings and research areas. These include the intensity of treatment, the best post-onset time to start, quality of individualized treatment, efficacy of newly-introduced interventions, and the interventions based on the International Classification of Functioning, Disability and Health (ICF) model with emphasis on activity/participation.Findings: The results of studies have revealed that compact therapy in a short period of time might result in better recovery of aphasia. Studies also indicated that starting treatments very early with intensive programs leads to the best therapy results. Chronic stage is good for some intervention strategies as well; however, the effectiveness of these interventions requires further investigations. Moreover, better treatment results could be attained by tailoring the program to match with individual needs. Manipulation of word frequency, personal relevance, and considering reaction time are among important factors in tailor-made therapies. Besides, the conceptual model of ICF which incorporates impairment (body structure and function), activity and participation in the assessment and treatment of aphasia are being researched currently. This model provides a comprehensive functional communicative lookout of the patient.Conclusion: There is no prescribed intervention for different types of aphasia. Customized therapeutic programs which are tailored to the unique needs of the patients and incorporate primary impairment, functional limitations and social restrictions of the patient are needed. This therapy should be intensive enough and be administered as early as possible.
Neuropharmacology In Individual With Aphasia: A Review
Authors: Rezaei Mohammad
Published: February 2017

Introduction: The neuropharmacology of aphasia is an area of cognitive neuroscience. In this article we review what is known about these domain, especially with regard to treating aphasia with drugs. Neurotransmitters can improve language function in certain patients with aphasia. We discuss which neurotransmitters work for which language functions in which patients.Method: PubMed and Science databases were searched to identify studies investigated effects of drugs on language function in aphasia in peer-reviewed journals between 2000 and 2015. Results: Studies show that Catecholamines seem especially promising for nonfluent aphasias. Dopamine agonists, in particular bromocriptine, improve verbal fluency in transcortical motor aphasia. Norepinephrine affects prefrontal functions and seems to relieve symptoms of depression and improve overall recovery of function, including language, following stroke. Amphetamines potentiate norepinephrine to promote general recovery, and have been shown to improve language performance in some patients with nonfluent aphasia.Conclusion: studies have been looking at the possibility of manipulating brain chemistry for functional gain in patients with aphasia, but, to date, no overwhelming evidence has emerged to support routine use of drugs as either a complementary or alternative treatment for aphasia. Studies have been largely anecdotal with small numbers of patients and varying types of aphasia. Improvements due to spontaneous recovery have been difficult to separate from treatment benefits.
Designing And Implementation Of An Intelligent Monitoring System For Hand Rehabilitation Exercises
Authors: Rashidzadeh Parysa , Foomani Dr , Behzadipoor Dr , Mobini Dr
Published: February 2017

Background: intelligent hand rehabilitee exerciser provides direct supervising on therapeutic movements which patient with hemiplegia disorder have done during treatment sessions. This instrument improves hand functions without continuous present of therapist.Objectives: purpose of this study is indirect palpation control in hand rehabilitive exercises among hemiplegia patients. In that, encourage hemiplegia patients to repeat hand therapeutic movements without continuous present of therapist.Finally, intelligent hand  rehabilitee exerciser flourishes the quality and quantity hand functions.Methods: participants include 13 hemiplegia patients and 3 healthy persons who followed seventy therapeutic sessions. Functional movements and quality of life were assessed . moreover recorded captures were examined by specialists.Result: kinematic parameters (average and maximum velocity , maximum angular velocity ) , acceleration , accurate movements or ability to induce profit  motor pattern 3-5 and trunk movements pattern with final scoring the movements showed increasing the upper limb function with intelligent hand rehabilitee exerciser.Conclusion: Results depict intelligent  hand rehabilitee exerciser increased in accurate thera peutic exercises and quality of life in hemiplegia patients also , confidence  coefficient of specialists had improvement.
Anterior Circulation Steal Syndrome
Authors: Afrakhteh Motahareh
Published: February 2017

Introduction: Arteriovenous fistula (AVF) can be congenital or acquired. Congenital AVF are less common while acquired fistula are most frequently the result of penetrating trauma or iatrogenic action.Acquired common carotid jugular fistulas are uncommon in the head and neck region, accounting only 4 to 7% of all the traumatic AVFs encountered throughout the body that is not usually detected during the acute injury phase.Objective:For the first time in our center we diagnose and treat a carotid jugular vein fistula due to neck stab wound.Case Description:A 48 years old man with neck stab wound and strangulation was treated as an outpatient in a clinic with suturing the wound. he was stable and discharged without apparent neurologic deficit, after two days he was referred to our center due to left hemiparesis .in our assessment, Brain imaging showed right side hemodynamic infarct, in carotid duplex the flow was bidirectional and low RI, in angiography there was fistula from Right ICA to jugular vein, in left ICA angiography there was reversible flow from Right distal ICA to the fistula. After two times of brachychardia and asystolic cycle the patient was intubated and CPR was done. Cardiac arrest maybe because of cardiac problems dueto carotid jugular fistula.Approach:Due to carotid injury and high flow fistula, the Right ICA jugular fistula was obliterated by Balloon and ICA was also sacrificed. in left ICA Angiography the flow to Right ICA was stopped and MCA  and ACA got flow from left side .the patient was stable and after few days he could be extubated and he was discharged with stable condition.Discussion:Carotid jugular fistula is a rare complication of neck trauma, because its symptoms appear late, with neurologic deficit many times neurologist was suspect to dissection and maybe MRA and CTA report Carotid occlusion but Duplex is an efficient device to differentiated between these two disease. in dissection  there is prestenotic pattern and we can see the Flap flow in pseudolumen but in Carotid jugular fistula there is bidirectional and low resistance flow in proximal ICA. Meanwhile jugular vein have pulsatile flow due to direct carotid arterial flow.we presented a case of carotid-jugular fistula following cervical trauma.we are implicating on the role of carotid duplex for evaluation of cervical trauma. Duplex could efficiently differentiate between the two major  complication of trauma that is cervical arteries dissection and carotid-jugular fistula.
The Role Of Neuroplasticity Types In Aphasia Recovery And Its Influencing Factors: A Systematic Review Of Literature
Authors: Aghaz Alireza
Published: February 2017

Background and Objectives: aphasia is common consequence of stroke. Most people with aphasia in the acute phase show some degree of spontaneous recovery, most of which occurs during the first two to three months. Neuro-linguistic mechanisms of recovery in aphasia remain a lot unknown still, but considerably depends to the amount of change plasticity in brain of patients after stroke. The aim of this article is review of the role of Neuroplasticity types in aphasia recovery and its influencing factors: a systematic review of literatureMethods: this study is a review of all articles listed in PubMed database from January 1990 to September, 2016 that were identified using the keywords Neuroplasticity and aphasia (in titles) and language.Results: Three types of changes in the activity of the nervous system after a stroke, is closely linked with aphasia recovery: 1. Reactivation of damaged areas of the left hemisphere or activities it`s surrounding in language tasks 2. Acquisition or manifest of the ability to process language in the nondominant right Hemisphere 3. The wrong activity of nondominant right hemisphere that can prevent language improvement.Discussion and Conclusion: Most of studies have shown involvement of surrounding areas in the left hemisphere lesion in language improvement, others reported employment of the right hemisphere regions and some others have known useful the involvement of both hemispheres in language improvement. It is difficult, aphasia improvement prediction due to the interaction of various factors. The most promising results aphasia treatment for the reorganization of the brain, caused by speech therapy that lead to quick improvements considerably.
Medical Or Surgical Treatment In Cryptographic Stroke With Pattent Foramen Oval (PFO)
Authors: Sharifi Razavi Athena
Published: February 2017

PFO is one of common congenital cardiac anomalies. It's incidence is 15-30% and decreases with age.PFO is associated with several disease processes such as transient ischemic attacks and stroke. Various studies have reported that 45-54% of patients with cryptogenic stroke have PFO.The underlying pathological mechanism of PFO-associated stroke is the passage of abnormal material from the venous circulation through the PFO into the systemic circulation.As individuals age and develop comorbid cardiovascular disease such as heart failure or diastolic dysfunction the propensity to shunt right to left may increase and the risk of hypercoaguability may increase as well. Thus PFO only become pathogenic in the setting of certain comorbid conditions that cause the formation of phatogenic material with embolic potential.Controversy exists regarding closure of PFO as a therapeutic treatment modality for cryptogenic stroke. In properly selected patient closure of PFO is a safe and effective treatment modality. Contemporary indication for PFO closure in stroke or TIA is: 1.Documented paradoxical embolus. 2. Recurrent cryptogenic events. 3. Single cryptogenic event and inability to tolerate medical therapy. 4. Single cryptogenic event with high risk anatomical PFO features.
Current Canadian And American Experiences In The Treatment Of Acute Ischemic Stroke
Authors: Dolati Parviz
Published: February 2017

Stroke remains one of the main public health issues worldwide. It is the third leading cause of death in the United States, with more than 200,000 people dying from strokes each year. Approximately 80% of all acute ischemic strokes are due to intracranial artery occlusion, most commonly thromboembolic clot occlusion. Revascularization of occluded territories is the cornerstone of acute ischemic stroke and Thrombolysis for ischemic stroke has been systematically studied in large randomized trials only since the 1990s. To date, thrombolytic therapy for ischemic stroke has been investigated in 21 randomized controlled clinical trials enrolling more than 7,000 patients. The advent of modern imaging and endovascular tools and technologyhas revolutionized treatment of stroke. In this talk, I will review current clinical trials published in The NEJM (ESCAPE, MR Clean, EXTENDED IA, ….) regarding superiority of the endovascular treatments, especially, the stent retrievers, over Iv tPA. I will also go over all endovascular techniques used in the endovascular treatment of acute stroke using my Canadian and American experiences.
Rehabilitation Robots: Concepts and Applications in Stroke Rehabilitation
Authors: Ahmadi-Pajouh Mohammad Ali
Published: February 2017

Robotics is a tool to assist human in different applications from industry to medicine. There are many reasons that human tends to use these machines. They are very reliable in repetitive, high precision, preprogrammed and high risk jobs in which human is not too good enough. In medicine, robotic applications are evolving so fast that in near future nobody can imagine a surgery without a robot involved. In Rehabilitation we have the same scenario; there are commercialized robots to assist disable people to eat and perform daily activities. There are also clinical rehabilitation robots which can train handicaps. They can help subjects as a passive tool that improves low level impairments such as rigidity. On the other hand robots can train brain as an active tool to have a better movement again. We will see how robots can help therapist to apply repetitive passive movements in quadriplegic subject (i.e. in Brunnstrom stages 1 to 3). On the other hand they can teach subjects how to complete a task in an active manner (i.e. in stages 5 and 6) which can facilitate neuroplasticity. There are different robots designed for different organs; for example rehabilitation of upper extremities (e.g. Gloreha) or lower extremities (e.g. Lokomat). There are also exoskeleton robots to help subjects to grip objects and perform ADLs easily (e.g. Bioservo) or help paraplegic patient to walk again (e.g. Rewalk). In this talk, we will also discuss about how robots are helping rehab specialist to improve standard protocols. For example we will show how action observation therapy, bimanual therapy, assistive active therapy, proprioceptive facilitation and passive mobilization therapy are realized using an upper extremity rehabilitation robot. Robotics is the future of technology and rehabilitation needs this technology. Be part of this technology!
Stroke Management: Nursing Roles
Authors: Esmaeili Maryam
Published: February 2017

Introduction: The subacute and long-term assessment and management of patients who have suffered a stroke includes physical therapy and testing to determine the precise etiology of the event so as to prevent recurrence. The acute management differs. Immediate goals include minimizing brain injury, treating medical complications, and moving toward uncovering the pathophysiologic basis of the patient's symptoms.Methods: This is a review paper that report up to date finding with review some research papers and databases.Results: Sudden loss of focal brain function is the core feature of the onset of ischemic stroke. However, patients with conditions other than brain ischemia may present in a similar fashion. The goals in the initial phase include: ensuring medical stability, with particular attention to airway, breathing, and circulation, quickly reversing any conditions that are contributing to the patient's problem, determining if patients with acute ischemic stroke are candidates for thrombolytic therapy, moving toward uncovering the pathophysiologic basis of the patient's neurologic symptoms. Time is of the essence in the hyperacute evaluation of stroke patients. In addition to stabilization of airway, breathing, and circulation, and rapid neurologic evaluation, early key management issues that often arise in acute stroke include blood pressure control, fluid management, treatment of abnormal blood glucose levels, swallowing assessment and treatment of fever and infection. Care in a dedicated stroke unit is associated with better outcomes.Conclusion: The main goals in the initial phase of acute stroke management are to ensure medical stability, to quickly reverse conditions that are contributing to the patient's problem, to determine if patients with acute ischemic stroke are candidates for thrombolytic therapy, and to begin to uncover the pathophysiologic basis of the neurologic symptoms.
Patient Selection For Acute Stroke Intravenous Thrombolysis
Authors: Farhoudi Mehdi
Published: February 2017

Stroke is a leading cause of mortality worldwide. Unfortunately its incidence is more and the age of occurrence is one decade earlier in our country, Iran. About 75-90 percent of stroke etiology is ischemic. The only approved drug treatment for eligible acute ischemic stroke (AIS) patients is thrombolytic therapy by recombinant tissue plasminogen activator (tPA). Related level of evidence is the highest (1a) and it has been approved by FDA following NINDS study since 1996. First golden time for use of tPA was less than 3 hours but later it has extended to 4.5 hours following re-analysis of the data since 2009. In the beginning, related exclusion criteria was strict considering many absolute items, however, some of them changed or removed as relative exclusion criteria by practicing and performing researches and analysis of results and it is going to be more simplified. For example, in 2013 there were 15 absolute and 10 relative exclusion criteria for intravenous thrombolysis in AIS in less than 4.5 hours period from onset of symptoms but in 2016 following publishing American heart and Stroke Association (AHA/ASA) scientific statement this criteria was more clarified and some of relative exclusion criteria removed. And finally new published researches extended this therapeutic time window to 6 hours by using mechanical thrombectomy in defined patients not responding to IV thrombolysis. In the ninth national Iranian Stroke Congress this updated criteria will be discussed.
Cerebrovascular Accidents In Myopathies
Authors: Fatehi Farzad
Published: February 2017

Several types of stroke in myopathies are described: ischemic, metabolic, or cryptogenic. Ischemic stroke may be categorized as cardioembolic, angiopathic, hemodynamic, or thrombophilic. Cardiac involvement in the form of atrial fibrillation/flutter, dilated cardiomyopathy, or non-compaction Cardioembolic could ensue in stroke. Angiopathic stroke occurs provided that there is atherosclerosis or mitochondrial disorders. Thrombophilic stroke may happen in polymyositis or dermatomyositis along with anti-phospholipid syndrome. Metabolic stroke usually manifests as stroke-like episode and is a distinct feature of various mitochondrial disorders, principally MELAS syndrome. The clinical manifestations are as a result of a vasogenic edema, demonstrating as hyperintensity on T2, DWI, and apparent diffusion coefficient mapping. Differentiation between ischemic and metabolic stroke is essential in terms of diagnosis, therapy, and prognosis. In conclusion, ischemic stroke attributable to cardioembolism, arteriopathy, or thrombophilia are occasional events in myopathies, but metabolic stroke is a frequent feature of mitochondrial disorders.
Spinal Cord Vascular Disease
Authors: Ghoreishi Abdoreza
Published: February 2017

The spinal cord is subject to many of the same vascular diseases that involve the brain, but its anatomy and embryology render it susceptible to some syndromes that do not have intracranial counterparts.The embryonic arterial supply to the spinal cord derives from intradural vessels that enter at each spinal level and divide to follow the dorsal and ventral roots.SPINAL CORD ISCHEMIA: The midthoracic levels of the spinal cord are traditionally considered to be the most vulnerable to compromise from hypoperfusion, but more recent evidence suggests that the lower thoracic cord is at greater risk . The actual prevalence of spinal cord infarction is unknown, but is generally cited as representing 1% to 2% of all central neurovascular events and 5% to 8% of all acute myelopathies.Weakness (100%), sensory loss (89%), back pain at onset (82%), and urinary complaints requiring catheterization (75%) were the most common symptoms of cord ischemia at the time of presentation . Weakness most commonly affects both legs. Examination typically reveals flaccid paresis accompanied by diminished superficial and tendon reflexes below the level of the lesion. Preservation of strength and reflexes suggests the rare syndrome of posterior spinal artery territory infarction. Weakness most commonly affects both legs. Examination typically reveals flaccid paresis accompanied by diminished superficial and tendon reflexes below the level of the lesion. Preservation of strength and reflexes suggests the rare syndrome of posterior spinal artery territory infarction.  Aortic pathologies with regional hemodynamic compromise are the most common cause of spinal cord infarction, accounting for 30% to 40% of cases.                                                                                 The medical management of spinal cord ischemia is generally supportive and focused on reducing risk for recurrence.SPINAL VASCULAR MALFORMATIONS :Spinal vascular malformations consist of normal-sized to enlarged arteries and enlarged, tortuous veins without an intervening capillary network. A commonly accepted classification system categorizes spinal vascular malformations into four types:Type I—dural arteriovenous fistula (AVF); subtypes IA (single feeding artery) and IB (multiple feeding arteries).Type II—intramedullary glomus-type arteriovenous malformation (AVM).Type III—intramedullary juvenile-type AVM, which is more extensive than a glomus-type AVM, frequently having an extramedullary component and sometimes an extradural component.Type IV—intradural, extramedullary (perimedullary) AVF: subtypes IVA, IVB, and IVC correspond to lesions with progressively increased arteriovenous shunting manifested as increased number, size, and tortuosity of feeding arteries.Spinal vascular malformations, especially dural AVFs, are frequently misdiagnosed. The onset of manifestations can be acute or insidious, and the course may include remissions and relapses. The most common complaints at onset are pain, weakness, and sensory symptoms.
Strokes In Young Adults And Children
Authors: Iranmanesh Farhad
Published: February 2017

Stroke is in second place on a mortality list in the world. Also, stroke is a leading cause of disability. Approximately 20% of all strokes occur in Children and young adults. The etiology of stroke in Children and young adults is different from that in older patients, and has an influence on diagnostic evaluation and treatment, so knowledge about older patients cannot always be applied to these patients. The list of stroke etiologies among young adults and children is extensive. Ischemic stroke are more frequent than hemorrhagic strokes in both groups. Stroke in young adults had been thought to be associated with   risk factors, including arterial (such as dissection, reversible cerebral vasoconstriction syndrome, inflammatory arteritis ,moyamoya ,migraine - induced stroke, genetic or inherted arteriopathy, premature atherosclerosis ) cardiac (such as patent foramen ovale, cardiomyopathy , congenital heart disease) and   hematologic (such as  deficiencies of protein S,protein C,or antithrombin;factor V lieden mutation) . Common risk factors for stroke in children include: Sickle-cell disease, diseases of the arteries, abnormal blood clotting, head or neck trauma. There are no specific recommendations or guidelines for primary or secondary stroke prevention in young adults. Primary prevention focused on identifying and managing known vascular risk factors, such as hypertension, disorders of lipid metabolism, and diabetes, and non-drug strategies and lifestyle changes, including smoking, reducing body weight, increasing regular aerobic physical activity, and adopting a healthy diet with more fruit and vegetables and less salt. For secondary stroke prevention, identification of the etiologic mechanism of the initial stroke and the presence of any additional risk factors is most important. It consists of optimal treatment of vascular risk factors administering antiplatelet or anticoagulant therapy, and if indicated, invasive surgical or endovascular therapeutic procedures. An integral part of this is lifestyle changes, emphasizing regular physical activity, a diet low in salt and saturated fat and high in fruit and vegetables, reducing overweight and quitting smoking.
How To Manage Intracranial Arterial Stenosis? I'm Medical Or Interventional Treatment?
Authors: Rahim Kohansal
Published: February 2017

Background and review: The risk of stroke per year  is about 3.9-28.7% in patients with stenosis of the intracranial internal carotid artery and about 2.8-12% in patients with stenosis of middle cerebral artery. Intracranial stenoses are dynamic lesions. They can show progression, can remain stable or even undergo regression. The treatment of these patients is still controversial and several questions have to be answered.for example,whether only anti platelet/anticoagulantion therapy  or angioplasty/stenting is the best first-line therapy?what is the best or maximal medical therapy?furthermore,what is the risk of stroke with medical or with interventional therapy or, what is the risk of complication from interventional therapy?is stenting necessary but or is angioplasty alone sufficient? Annual risk of stroke in patients with symptomatic intracranial stenosis where anti platelet/anticoagulantion therapy failed is about 4-12%(-45%). The intracranial complication rates of intracranial angioplasty or stenting are as high as 20%.during treatment,ischemic stroke has been reported in 0-20%,intracranial hemorrhage in 0-4%,vessel dissection in 0-10%,vessel rupture in 0-4%, vessel occlusion/thrombosis in 0-4% and death in 0-8%.Conclusion: In patients with intracranial  areterial stenosis  angioplasty or stenting placement should not be the first-line therapy. Instead,initial treatment should include the standard control of vascular risk factors and application of antiplatelet/anticoagulantion drugs,statins and angiotensin convert ing enzym ihibitor.
Management Of Patients With Stroke In Critical Care Units, Considering Osmotic Therapy And Hypothermia
Authors: Mahmoodpoor Ata
Published: February 2017

Cytotoxic brain edema is an early complication of stroke which increases the possibility of secondary ischemia. Hypertonic solutions, mannitol and recently hypertonic saline (HS) has been considered for treatment of increased ICP. HS could decrease ICP especially in hypotensive patients with different mechanisms, direct effect on edema, decreasing inflammation which is mediated by attenuation of TNFa and IL-1b stimulation on Na-K-Cl cotransporter 1 and improvement of microcirculation. Improvement of microcirculation is so important for hypertonic solutions to be effective in ischemia especially focal ischemia. Based on the literature, hypertonic saline is more effective in decreasing cerebral edema than the equal volume of mannitol. The optimal dose and duration of therapy needs more trials. Caution should be performed with patients with moderate size hemispheric infarcts on presentation, race and genetic factors regarding osmotic therapy.Hypothermia has been rated as one of the most active modes of neuroprotection based on the results of different trials. Hypothermia in both ways, surface and intravascular, decreases cerebral metabolic rate of O2 and glucose and reduces brain oxygen consumption, inflammation and oxidative stress. Recent data continue to support consideration of therapeutic hypothermia for cerebral ischemia in larger clinical trials of acute ischemic stroke. By increasing the time window to therapy initiation and decreasing the treatment duration, selective intracarotid cold saline administration brings increased feasibility, potentially better outcomes and perhaps fewer complications compared with the whole body cooling. Hypothermia is now recommended as a targeted temperature management with defined protocol which should be started early; it may be performed pharmacologically in combination with other therapies. Applying hypothermia should be considered regarding its cost, using in awaked patients, re-warming protocol, incorporation of thrombolysis and its complications.
Development Of An Atherothrombotic Occlusion In The Rabbit Carotid Artery: Accessed By New Computerized B- Mode Ultrasound Image Processing Technology And Histopathology
Authors: Mehrad Hossein , Farhoudi Mehdi , Sharifipour Ehsan , Mahvi Behyad
Published: February 2017

Introduction: Thrombus formation on a disrupted atherosclerotic soft plaque is a key event that leads to atherothrombosis. Atherothrombosis is one of the leading causes of acute coronary syndrome and ischemic stroke. Our ability to test new protocols for the treatment of atherothrombotic stenosis in humans is limited for obvious ethical reasons; therefore, a precise understanding of the mechanism of atherothrombotic occlusion in human carotid artery, which give rise to thrombosis, emboli and stroke, requires a suitable animal model that would mimic the same characteristics well.Aims: The aim of this study was to generate an easily reproducible and inexpensive experimental rabbit carotid model of atherothrombotic occlusion with morphological similarities to the human disease and the subsequent assessment of the reliability of new computerized B- mode ultrasound image processing technology in the study of lumen area stenosis in this model.Methods: Briefly, male New Zealand white rabbits were submitted to common carotid artery atherothrombotic occlusion by primary balloon injury followed 1.5% cholesterol- rich diet injury for eight weeks and finally perivascularly severe cold injury. All of the rabbits' arteries were imaged by B-mode ultrasound weekly, after which the rabbits were sacrificed, and their vessels were processed for histopathology. Ultrasound longitudinal view images from three cardiac cycles were processed by a new computerized analyzing method based on dynamic programming and maximum gradient algorithm for measurement of instantaneous changes in arterial wall thickness and lumen diameter in sequential ultrasound images.Results: Histopathology results showed progressive changes, from the lipid-laden cells and fibrous connective tissue proliferation, fibrolipid plaque formation, resulting in vessel wall thickening, remodeling, neovascularization and lumen narrowing (before perivascularly severe cold injury using liquid nitrogen) up to atherothrombotic occlusion (after perivascularly severe cold injury using liquid nitrogen) in the treatment group respect to other groups (P < 0.05).Conclusion: In conclusion we successfully developed a new rabbit carotid artery model of atherothrombotic occlusion, which is not only quickly and easily reproducible and inexpensive, but also without mortality and similar to the condition seen in patients. The merits of our model render the evaluation of carotid artery atherothrombotic stenosis and its treatment strategies more feasible in humans. This condition in rabbits can be properly assessed by our new computerized B-mode ultrasound image processing technology.