Abstracts / Journal of the Neurological Sciences xxx (2017) 757–944
Results: No adverse events or side effects were noted during the
intervention or assessment. After the 3-week intervention, the improve-
ments of outcome measures for the UE-FMA was from 40 to 47 score and
the grip strength of the affected hand was from 21 to 27 lb.
Conclusion: This case report suggests that the feasibility of the tDCS
combined with NMES could be a new rehabilitation approach to
improve the upper-limb function in patients with chronic stroke.
doi:10.1016/j.jns.2017.08.2359
2329
WCN17-2687
SHIFT 6 - NEUROREHABILITATION
Effects of non-invasive brain stimulation for upper limb
rehabilitation in acute stroke patients – A controlled clinical trial
K.H. Wong. Tuen Mun Hospital, Physiotherapy Department, Hong Kong,
Hong Kong S.A.R.
Background: This study was conducted to evaluate and compare
effects of Transcranial Magnetic Stimulation(rTMS) and Transcranial
Direct Current Stimulation(tDCS) on upper limb functional recovery
in acute stroke patients.
Objective: To examine and compare effects of rTMS and tDCS on
enhancing upper limb functional recovery in acute stroke patients.
Patients and Methods/Material and Methods: Patients with acute
stroke were randomly assigned to rTMS, tDCS or control group. For
rTMS group, patient received 1Hz rTMS at 90% of resting motor
threshold to M1 of the unaffected hemisphere for 1200 pulses. For
tDCS group, patient received 1mA anodal stimulation to hand area of
the affected hemisphere for 20 minutes. Five consecutive sessions of
rTMS or tDCS together with intensive physiotherapy upper limb
training were given. For control group, only intensive physiotherapy
upper limb training were given. The upper-extremity section of Fugl-
Meyer Scale(UE-FM) was used as outcome measure.
Results: 24 patients were assigned to rTMS(n=6), tDCS(n =11) and
control(n=7) group. The mean age was 65.3±11.1 years old and
the mean time between stroke onset and the first UE-FM assessment
was 9.25±3.54 days. There was no statistically significant difference
in mean age, baseline UE-FM mean score, mean time between stroke
onset and the first UE-FM assessment among three groups. For
between-group comparison, the changes in mean score of UE-FM in
rTMS(17.0±3.8) and tDCS group(16.1±4.9) were significantly
larger than that in control group(10.7±4.6), there was no significant
difference between rTMS and tDCS group.
Conclusion: Findings showed that both rTMS and tDCS could
augment physiotherapy treatment in enhancing upper limb motor
functional recovery in acute stroke patients.
doi:10.1016/j.jns.2017.08.2360
2330
WCN17-2243
SHIFT 6 - NEUROREHABILITATION
Safety and feasibility of hybrid assistive limb therapy for acute
stroke: Protocol for a pilot study
K. Yamaguchia, Y. Fukamib, Y. Nakaia, O. Hiroakia, M. Kanaia.
a
Ichinomiya Nishi Hospital, Neurology, Ichinomiya, Japan; bNagoya
University Hospital, Neurology, Nagoya, Japan
Background: Hybrid Assistive Limb (HAL) is a wearable-type
exoskeleton robot, which can effectively assist wearer’s voluntary
839
movement by processing information from the sensors. The neuro-
rehabilitation utilizing HAL, called HAL therapy, has recently been
applied to various neurological disorders.
Objective: Acute stroke patients admitted to our hospital are
recruited for the study.
Patients and Methods/Material and Methods: Inclusion criteria are
as follows; age of 20 to 89 years old, 7 to 14 days from the stroke
onset, hemiplegia resulted from acute stroke confirmed on CT or
MRI, FAC score of 0 to 2. Exclusion criteria are as follows; unable to
neither wear HAL nor walk with HAL, disturbance of consciousness,
MMSE of less than 23, NYHA of 3 to 4, receiving intravenous drip or
oxygen therapy. Enrolled patients are alternatively assigned to two
groups. Neurorehabilitation for four weeks is performed utilizing
bilateral leg type HAL (HAL-ML05) for 40 minutes, combined with
conventional physical therapy for 20 minutes per day, 5 days a week
in the intensive HAL group, while 3 days a week in the ordinary HAL
group. Conventional physical therapy is performed for 60 minutes on
the days when HAL is not supposed to be utilized. The primary
outcome is the occurrence of adverse event. Secondary outcomes are
the changes on 6MWT, FMA, and FIM.
Results: This study was started in November 2016, and is now
ongoing.
Conclusion: Present study is expected to verify the safety and
feasibility of the HAL therapy for acute stroke patients.
doi:10.1016/j.jns.2017.08.2361
2331
WCN17-2883
SHIFT 6 - NEUROREHABILITATION
The effects of bobath (BNDT) concept on motor performance,
balance, mobility and disability in early stroke rehabilitation
G. Yazicia, A. Guclu-Gunduzb, C. Ozkulb, H.Z. Batur-Caglayanc, B.
Nazlielc. aGazi University, Faculty of Health Science, Ankara, Turkey;
b
Gazi University, Physiotherapy and Rehabilitation, Ankara, Turkey;
c
Gazi University, Neurology, Ankara, Turkey
Background: Although the effectiveness of Bobath (BNDT) concept
in chronic stroke rehabilitation is acknowledged, there is limited
evidence of the effects on early stage after stroke.
Objective: This study was conducted to investigate the effects of
BNDT concept on motor performance, balance, mobility and
disability in patients with stroke in the Neurointensive Care or
Stroke Unit.
Patients and Methods/Material and Methods: Thirty-nine patients
were included in the study. Patients were randomized into two
groups; BNDT concept (n =21) and Standard Rehabilitation (SR)
(n= 18). Rehabilitation was initiated as early as possible. The
assessments were performed using; Stroke Rehabilitation Assess-
ment of Movement (STREAM), Berg Balance Scale (BBS), Functional
Ambulatory Scale (FAS) and Modified Rankin Scale (MRS) at baseline
and before discharge from the hospital.
Results: There was no statistically significant difference between the
groups in terms of the time Rehabilitation was initiated (BR:80,1
±33,4/SR:92,2± 24,8). The length of hospital stay was similar in
both groups (BR:15,7±3,4/ SR:15,1 ±4,2).In both groups, improve-
ments were evident in all evaluation results when the baseline and
discharge evaluations were analyzed. When the groups were
compared; BBS, FAS, and MRS scores were statistically better in the
BNDT group (pb0,05). Although there was improvement in both of
the groups’ STREAM results, no significant difference was found
between the groups (pN0,05).
840 Abstracts / Journal of the Neurological Sciences xxx (2017) 757–944
Conclusion: The results of this study show that early BNDT concept
used in ischemic stroke patients lead to significant improvements in;
balance, postural control and mobility and also caused a greater
reduction in the disability rate when compared to standard
rehabilitation program.
doi:10.1016/j.jns.2017.08.2362
2332
WCN17-2891
SHIFT 6 - NEUROREHABILITATION
Early rehabilitation for ischemic stroke patients: Should it be
initiated immediately?
G. Yazicia, A. Guclu-Gunduzb, C. Ozkulb, H.Z. Batur-Caglayanc, B.
Nazlielc. aGazi University, Faculty of Health Science, Ankara, Turkey;
b Caspase 3 and the ratio of Bax/Bcl-2, and also attenuate stress fiber
Gazi University, Physiotherapy and Rehabilitation, Ankara, Turkey;
c formation after oxygen-glucose deprivation. Secondly, AST-PCL
Gazi University, Neurology, Ankara, Turkey
Background: Nowadays early rehabilitation studies in stroke
patients have gained momentum. Although early rehabilitation is
reported to be more effective, what is really meant of the term
“early” is not clear.
Objective: This study was conducted to investigate whether the
initiation time of rehabilitation has an effect on impairment, postural
control of trunk and degree of recovery in ischemic stroke patients.
Patients and Methods/Material and Methods: Twenty-one patients
with acute ischemic stroke diagnosis who were admitted to the
hospital were included in the study. The rehabilitation was initiated
as early as possible and the elapsed time; from the stroke occurrence
to initiation of rehabilitation, was noted. Glasgow Outcome Scale
(GOS), National Institutes of Health Stroke Scale (NIHSS) and Trunk
Impairment Scale (TIS) were used as the measurement methods.
Measurements were made at baseline and at discharge.
Results: All of the patients were discharged, all measurements have
improved and no complication developed in any patient. The elapsed
time; from the stroke occurrence to initiation of rehabilitation was 12
hours in the earliest patient and 234 hours at the latest (median (IQR):
79.5 (58,5/107,5)). When the results were examined, there was no
statistically significant relationship between the initiation time of
rehabilitation and impairment, trunk function and degree of recovery
(pN 0,05).
Conclusion: The results of the study showed that early rehabilitation
program contributed to the recovery in ischemic stroke patients but
the initiation time of rehabilitation had no direct effect on recovery.
Further studies with additional cases should be conducted.
doi:10.1016/j.jns.2017.08.2363
2333
WCN17-1986
SHIFT 6 - NEUROREHABILITATION
Astragoloside IV loaded polycaprolactone membrane for blood
spinal cord barrier repair and spinal cord injury
functional recovery
D. Zhang, X. Zhang. The Second Affiliated Hospital and Yuying
Children's Hospital of Wenzhou Medical, Orthopaedics, Wenzhou, China
Background: Traumatic spinal cord injury (SCI) is a serious central
nervous system disorder which often results in permanent disability.
Blood-spinal cord barrier (BSCB) disruption is a major process for the
secondary injury of SCI, and is considered to be a therapeutic target
for SCI, however few biomaterials have been developed to restore
BSCB.
Objective: The objective of this study was to investigate whether
Astragoloside IV loaded polycaprolactone (AST-PCL) membrane
plays a role in the protection of BSCB disruption and SCI recovery.
Patients and Methods/Material and Methods: AST-PCL membrane
was prepared and related characteristics including micromorpholo-
gy, cytotoxicity and drug release ability were measured. Injured
spinal cord was covered with a piece of AST-PCL membrane. The
anti-apoptosis effect of AST-PCL membrane was evaluated with
human umbilical vein endothelial cells in vitro. BSCB protection and
neuroprotective effects on the SCI rats were studied to evaluate the
enhanced therapy of AST-PCL membrane. Neutrophils and Matrix
metalloproteinase-9 (MMP-9) was analyzed to explore the related
mechanism in BSCB protection.
Results: Firstly, AST-PCL degradation media could decrease cleaved
treatment could inhibit the disruption of BSCB permeability. And
AST-PCL could also up-regulate tight junction proteins including
Occludin, Claudin-5 and ZO-1. Furthermore, we demonstrated that
AST-PCL treatment could inhibit MMP-9 secretion and neutrophil
infiltration. Finally we found that AST-PCL treatment could
inhibit apoptosis, decrease tissue damage and improve functional
recovery.
Conclusion: AST-PCL might be an efficient biomaterial for BSCB
repair and a potential drug for SCI therapy.
doi:10.1016/j.jns.2017.08.2364
2334
WCN17-0683
SHIFT 6 - NEUROREHABILITATION
Some aspects for definition of physical disability at patients with
multiple sclerosis
M. Zhestikovaa, V. Aliferovab, N. Zhukovab, N. Kiselevc, N.
Korotkevichd, I. Zhukovab, L. Sytina, V. Minenkova. aPostgraduate
Medical Institute, Neurology, Novokuznetsk, Russia; bSiberian State
Medical University, Neurology, Tomsk, Russia; cMunicipal Hospital №
29, Neurology, Novokuznetsk, Russia; dRegional Clinical Hospital,
Neurology, Kemerovo, Russia
Background
Introduction: The number of the sick with multiple sclerosis system
is 2,01% in Kemerovo region.
Objective
The aim of research is to analyze the aspects of disability of the sick
with multiple sclerosis.
Patients and Methods/Material and Methods
Material and methods: We used anamnestic, clinical, neurological,
radiation, statistical methods and criteria for physical disability. From
42 examined people with disease duration from 1 to 24 years 20
people (43,5%) have disability. In the group of men there was 1
(2,38%) man with severe disorders, 4 patients (9,52%) with average
degree. Among women there were 7 people (16,70%) with severe
disorders and 8 people (19,04%) with average degree. Working
ability was kept in 22 cases (52,3%), there were 6 men (14,28%) and
16 women (38,09%). 34 patients from 42 lost working ability for the
first 5 years. 60% patients lost working ability for 10 years. The
harder the first exacerbation was, the worse sequent clinical course
was. The longer exacerbation was, the less chances were for
functional recovery.