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Lindley, Richard Iain. "Are very large trials of promising treatments for acute stroke feasible?" Thesis, University of Newcastle Upon Tyne, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282953.
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Sonde, Lars. "Rehabilitation after stroke : effects of length of stay and treatments to facilitate motor recovery after stroke /." Stockholm, 2001. http://diss.kib.ki.se/2001/91-628-4730-9/.
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Silasi, Gergely, and University of Lethbridge Faculty of Arts and Science. "Novel treatments for inducing cortical plasticity and functional restitution following motor cortex stroke." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Arts and Science, 2005, 2005. http://hdl.handle.net/10133/278.
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Stroke remains a leading cause of disability in the western world, with symptoms ranging in severity from mild congnitive or motor impairments, to severe impairments in both cognitive and motor domains. Despite ongoing research aimed at helping stroke patients the disease cannot be prevented or cured, therefore a large body of research has been aimed at identifying effective rehabilitative strategies. Based on our understanding of normal brain function, and the meachanisms mediating the limited spontaneous recovery that is observed following injury, factors that promote brain plasticity are likely to be effective treatments for stroke symptoms. The current thesis investigated three novel treatments (COX-2 inhibitor drug, vitamin supplement diet, and social experience) in a rat model of focal ischemia in the motor cortex. All three treatments have been previously shown to alter plasticity in the normal brain, however the current experiments show that the treatments have differential effects following stroke. The COX-2 inhibitors provided limited improvement in functional performance, whereas the vitamin supplement treatment had no effect. Social experience on the other hand was found to block the usually observed spontaneous improvements following the stroke. These results suggest that factors that alter dendritic plasticity may in fact serve as effective stroke treatments depending on the site and the mechanisms whereby the plastic changes are induced.ix, 149 leaves : ill. ; 29 cm.
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Leach, Kelly Rebecca. "The Use of Forelimb Asymmetry Functional Tests to Determine Motor Recovery With Various Drug Treatments Following Endothelin-Induced Stroke." Wright State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=wright1344607995.
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Gibson, Maryika Ivanova. "Effective Strategies for Recognition and Treatment of In-Hospital Strokes." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6756.
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In-hospital onset strokes represent 4% to 20% of all reported strokes in the United States. The variability of treatment protocols and workflows as well as the complex etiology and multiple comorbidities of the in-hospital stroke subpopulation often result in unfavorable outcomes and higher mortality rates compared to those who experience strokes outside of the hospital setting. The purpose of this project was to conduct a systematic review to identify and summarize effective strategies and practices for prompt recognition and treatment of in-hospital strokes. The results of the literature review with leading-edge guidelines for stroke care were corelated to formulate recommendations at an organizational level for improving care delivery and workflow. Peer-reviewed publications and literature not controlled by publishers were analyzed. An appraisal of 24 articles was conducted, using the guide for classification of level of evidence by Fineout-Overholt, Melnyk, Stillwell, and Williamson. The results of this systematic review revealed that the most effective strategies and practices for prompt recognition and treatment of in-hospital strokes included: staff education, creating a dedicated responder team, analysis and improvement of internal processes to shorten the time from discovery to diagnosis, and offering appropriate evidence-based treatments according to acute stroke guidelines. Creating organizational protocols and quality metrics to promote timely and evidence-based care for in-hospital strokes may result in a positive social change by eliminating the existing care disparities between community and in-hospital strokes and improving the health outcomes of this subpopulation of strokes.
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Guillén-Solà, Anna. "Oropharyngeal dysphagia after stroke: assessment and treatment." Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/378351.
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Els transtorns de la deglució afecten un 29-67% dels pacients post-Ictus. L’aspiració silent, aspiració sense expressió clínica, afecta del 15-39% dels ictus aguts. La disfàgia pot comportar malnutrició, deshidratació, pneumònia broncoaspirativa i mort, i té impacte sobre els costos sanitaris. L’evidència científica suggereix que la detecció de la disfàgia en estadis precoços de l’ictus redueix el risc de broncoaspiració i és útil per determinar l’estratègia terapèutica.
Aquesta tesi avalua la capacitat de dos tests clínics de cribatge, el Mètode d’exploració Clínica de Volum Viscositat (MECV-V) i Test de la tos amb àcid cítric (CCT), per la detecció de l’aspiració i l’aspiració silent, respectivament. El MECV-V consisteix en l’administració de líquid a diferents viscositats i volums sota control de pulsioximetria. Canvis en els signes de seguretat com són el to de veu, la tos durant o després del bolus administrat, la desaturació >3% de la saturació basal, és consideren com a test alterat i al pacient com a possible aspirador. EL CCT registra el número de pics de tos durant el minut d’ inhalació oral d’una solució nebulitzada d’àcid cítric a 1M. Es considera > 5 pics de tos normal, mentre que ≤4 es considera disminuït i al pacient com a baix responedor o possible aspirador silent. En compració ala Videofluoroscòpia (VFSS), el gold estàndard, el MECVV detecta aspiració amb una sensibilitat del 88.2% i una especificitat del 71.4% , mentre que el CCT, detecta aspiració silent amb una sensibilitat i especificitat del 19% i 71%, respectivament. En conclusió el MECVV és un test de baix cost i fàcilment aplicable que compleix els criteris de test de cribatge en població afecte d’ictus; mentre que el CCT, a concentració 1M, no sembla un test útil aplicat individualment per la detecció dels potencials aspiradors silents.
S’aporten dades recents sobre un assaig clínic dissenyat per valorar l’efectivitat de dues noves tècniques terapèutiques, l’estimulació elèctrica neuromuscular (NMES) i l’entrenament de la musculatura respiratòria, inspiratòria i espiratòria (IEMT) . Els pacients van ser randomitzats a la logopèdia clàssica (SST) , a NMES i SST o al IEMT i SST. La disfàgia es va avaluar amb el MECV-V i la VFSS, i la força de la musculatura respiratòria també es va recollir. La combinació del NMES o IEMT al SST millora significament els resultats en força respiratòria i els signes de seguretat de la deglució al final de la intervenció. Aquest estudi aporta noves evidències sobre teràpies emergents en el tractament de la disfàgia.Swallowing disorders affect up to 29-67% of patients with stroke. Silent aspiration, aspiration without clinical signs expression, is present in 15-39% of acute stroke samples. Dysphagia can lead to malnutrition, dehydration, bronchoaspirative pneumonia and death, and have impact on health care costs. Available evidence suggests that screening dysphagia in the early stages of stroke onset reduces the risk of bronchoaspiration and is useful to determine the best therapeutic strategy. This thesis project is aimed to evaluate two different screening techniques, the Volume Viscosity Swallow Test (V-VST) and the Citric Cough Test (CCT), for detecting aspiration and silent aspiration, respectively. The V-VST consists of the administration of different liquid viscosities and food consistencies under pulse oximetry control. Changes in security signs as tone of voice, coughing during or after eating, or desaturation of more than 3% compared to baseline oxygen saturation, are considered as a failed test and classifies the patient as potential aspirator or no aspirator. The CCT records the number of cough peaks in the minute to the oral inhalation of a 1M mixture of saline and citric acid through an ultrasonic nebulizer. More than 5 cough peaks are considered as normal responders, whereas those with ≤4 are considered as reduced or absent responders. In comparison with the videofluoroscopic swallow study (VFSS), the gold standard, the V-VST detects aspiration with a sensitivity of 88.2% and specificity of 71.4%, whilst the CCT detects silent aspiration with sensitivity and specificity indexes of 19% and 71%, respectively. In conclusion, the V-VST is low in cost, easy to use and very sensitive, meeting the requirements of oropharyngeal dysphagia and aspiration screening test in subacute stroke; whilst the low sensitivity of the CCT using 1.0% (weight by volume) does not support its use as standalone tool to screen for silent aspiration in stroke patients. In addition, breaking results of a clinical trial aimed to determine effectiveness of two new therapeutic techniques, neuromuscular electrical stimulation (NMES) and inspiratory and expiratory muscle training (IEMT), are discussed. Patients were randomly assigned to standard swallow therapy (SST), IEMT and SST, NMES and SST. Dysphagia was assessed with the V-VST and VFSS, and respiratory muscle strength parameters were also recorded. The combination of IEMT or NMES to the SST was associated with significantly improved respiratory strength and better pharyngeal security. This study provides new evidences on emerging strategies to manage dysphagia
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Ajmo, Craig T. "Alternative targets for the treatment of stroke." [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0002114.
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Winkens, Ieke. "Mental slowness after stroke assessment and treatment /." [Maastricht : Maastricht : Maastricht University] ; University Library, Universiteit Maastricht [host], 2009. http://arno.unimaas.nl/show.cgi?fid=15083.
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Ajmo, Craig T. Jr. "Alternative Targets for the Treatment of Stroke." Scholar Commons, 2007. https://scholarcommons.usf.edu/etd/594.
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Stroke is cerebrovascular injury that has been reported to be the third leading cause of death and the first leading cause of disability in the world (W. H.O. 2007). Currently, there is only one FDA approved treatment for stroke which is recombinant tissue plasminogen activator. This treatment has a narrow therapeutic window of three hours after ischemic stroke and can adversely cause the production of oxygen free radicals and intracranial hemorrhage. These limitations result in only 2-3% of all stroke victims as being candidates for this therapy as many patients do not arrive at the hospital in time to receive treatment, are not properly diagnosed, or do not know that they have had a stroke within this three hour time period. The purpose of these experiments was to elucidate alternative targets of stroke for the benefit of developing new treatments that stimulate neuroprotective and anti-inflammatory effects at the site of injury. It has been shown that transfusion of human umbilical cord blood cells up to 48 hours after stroke significantly reduces infarction and we have examined other targets that mimic these effects. We have shown that sigma receptor activation by DTG, a high affinity universal sigma agonist, reduces infarct volume when administered 24 hours after stroke. This suggests that modulation of neurodegenerative and inflammatory responses can extend the therapeutic window of treatment. For the first time, evidence is provided that shows that the spleen enhances the neurodegeneration caused by stroke as splenectomy prior to stroke profoundly decreased infarction volume. Finally, we studied signaling mechanisms of the splenic reaction to stroke and determined that this response is not directly dependent on neurotransmission via the splenic nerve. Denervation of the spleen prior to stroke showed no changes in neurodegenerative load at the site of injury in rat brains when compared to those subjected to stroke only. Overall, these experiments provide evidence showing that targets mediating neuroprotective and anti-inflammatory effects can lead to novel therapeutic interventions of stroke.
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Kleven, Robert T. "Transcranial Ultrasound for the Treatment of Stroke." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1595848922517413.
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Ali, Khalid Mustafa. "Stroke and oxygen: research relating to acute, stroke, hypoxia, assessment, treatment and study design." Thesis, Keele University, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487905.
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Wallace, A. C. "Recovering hand function after stroke : mechanisms and treatment." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1344098/.
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Maniskas, Michael E. "LOOKING TO THE FUTURE OF STROKE TREATMENT: COMBINING RECANALIZATION AND NEUROPROTECTION IN ACUTE ISCHEMIC STROKE." UKnowledge, 2016. http://uknowledge.uky.edu/neurobio_etds/17.
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Stroke is the 5th leading cause of death in the U.S. with 130,000 deaths and around 800,000 affected annually. Currently, there is a significant disconnect between basic stroke research and clinical stroke therapeutic needs. Few animal models of stroke target the large vessels that produce cortical deficits seen in the clinical setting. Also, current routes of drug administration, intraperitoneal and intravenous, do not mimic the clinical route of intra-arterial drug administration. To bridge this divide, we have retro-engineered a mouse model of stroke from the current standard of care for emergent large vessel occlusion (ELVO) stroke, endovascular thrombectomy, to include selective intra-arterial pharmacotherapy administration. Using the tandem transient common carotid and middle cerebral artery occlusion (MCAo) model to induce stroke, we threaded micro-angio tubing into the external carotid artery (ECA) towards the bifurcation of the common carotid and internal carotid arteries (CCA/ICA) allowing for the delivery of agents to the site of acute ischemia. Our model was optimized through a flow rate and injection volume study using carbon black ink injected through the intra-arterial model at different flow rates and injection volumes. The purpose of this study was to demonstrate that our injections were arriving at the site of ischemia and to improve injection volumes for future dosing while mitigating systemic side effects by preventing or minimizing systemic distribution. We determined that a flow rate of 2.5 µl/minute and injection volume of 10 µl was optimal. Next, we tested potential neuroprotective compounds nitroglycerin, verapamil, and a combination of verapamil and lubeluzole. Compounds were chosen for drug synergy and to target specific pathways in either an acute or delayed manner. Acute treatments included nitroglycerin and/or verapamil while delayed treatment included lubeluzole. The known mechanism of action for FDA approved nitroglycerin is through vessel dilation that results in increased blood flow to the treated region. A secondary mechanism of nitroglycerin is the production of nitric oxide, which has demonstrated antioxidant and anti-apoptotic effects when processed and released from cells surrounding the blood vessels. Verapamil, a calcium channel blocker, also FDA-approved for cerebral artery vasospasm: is thought to act by blocking the L-type calcium channels on the cell membrane from opening following membrane depolarization after insult. Finally, lubeluzole, also FDA-approved, is proposed to work as an NMDA modulator inhibiting the release of glutamate and nitric oxide synthase and blocking sodium and calcium channels. Through our stroke model we were able to demonstrate that each drug(s) showed a significant decrease in infarct volume and improved functional recovery while simultaneously minimizing potential systemic side effects suggesting that our stroke model may improve the preclinical validation of potential stroke therapies and help bridge the bench to bedside divide in developing new stroke therapies.
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Lendrem, Wendy. "Clinical decision analysis and the selection of aphasic patients for active treatment." Thesis, University of Newcastle Upon Tyne, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387357.
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Mahler, Leslie Ann. "Intensive behavioral voice treatment of dysarthria secondary to stroke." Diss., Connect to online resource, 2006. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3239406.
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Yu, Xinge. "Stroke Study: Novel Animal Models and Innovative Treatment Strategy." Ohio University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1450735023.
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Dahllöf, Oliver, Oliver Dahllöf, Felix Hofwimmer, and Felix Hofwimmer. "Optimal placement of a Mobile Stroke Unit (MSU) to achieve improved stroke care." Thesis, Malmö universitet, Fakulteten för teknik och samhälle (TS), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-20525.
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Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra.Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra.
The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would.
The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would.
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Thompson, Douglas David. "Predicted risk of harm versus treatment benefit in large randomised controlled trials." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/15843.
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Most drugs come with unwanted, and perhaps harmful, side-effects. Depending on the size of the treatment benefit such harms may be tolerable. In acute stroke, treatment with aspirin and treatment with alteplase have both proven to be effective in reducing the odds of death or dependency in follow-up. However, in both cases, treated patients are subject to a greater risk of haemorrhage – a serious side-effect which could result in early death or greater dependency. Current treatment licenses are restricted so as to avoid treating those with certain traits or risk factors associated with bleeding. It is plausible however that a weighted combination of all these factors would achieve better discrimination than an informal assessment of each individual risk factor. This has the potential to help target treatment to those most likely to benefit and avoid treating those at greater risk from harm. This thesis will therefore: (i) explore how predictions of harm and benefit are currently made; (ii) seek to make improvements by adopting more rigorous methodological approaches in model development; and (iii) investigate how the predicted risk of harm and treatment benefit could be used to strike an optimal balance. Statistical prediction is not an exact science. Before clinical utility can be established it is essential that the performance of any prediction method be assessed at the point of application. A prediction method must attain certain desirable properties to be of any use, namely: good discrimination – which quantifies how well the prediction method can separate events from non-events; and good calibration – which measures how close the obtained predicted risks match the observed. A comparison of informal predictions made by clinicians and formal predictions made by clinical prediction models is presented using a prospective observational study of stroke patients seen at a single centre hospital in Edinburgh. These results suggest that both prediction methods achieve similar discrimination. A stratified framework based on predicted risks obtained from clinical prediction models is considered using data from large randomised trials. First, with three of the largest aspirin trials it is shown that there is no evidence to suggest that the benefit of aspirin on reducing six month death or dependency varies with the predicted risk of benefit or with the predicted risk of harm. Second, using data from the third International Stroke Trial (IST3) a similar question is posed of the effect of alteplase and the predicted risk of symptomatic intracranial haemorrhage. It was found that this relationship corresponded strongly with the relationship associated with stratifying patients according to their predicted risk of death or dependency in the absence of treatment: those at the highest predicted risk from either event stand to experience the largest absolute benefit from alteplase with no indication of harm amongst those at lower predicted risk. It is concluded that prediction models for harmful side-effects based on simple clinical variables measured at baseline in randomised trials appear to offer little use in targeting treatments. Better separation between harmful events like bleeding and overall poor outcomes is required. This may be possible through the identification of novel (bio)markers unique to haemorrhage post treatment.
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Smith, Melissa. "The experiences and perceptions of individuals with stroke about the usefulness of the model of occupational self efficacy in a rural setting." University of the Western Cape, 2019. http://hdl.handle.net/11394/6923.
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Magister Scientiae (Occupational Therapy) - MSc(OT)Individuals diagnosed with stroke particularly in rural communities have a poor return to work rate. Vocational rehabilitation has been used as an intervention strategy with various types of clients with disability or injury in order to improve their work skills. The aim of the proposed study is to describe the experiences and perceptions of individuals diagnosed with stroke about the usefulness of the Model of Occupational Self Efficacy in assisting them in returning to their worker role particularly in a rural setting. Eight participants were purposively selected from the data base of a local hospital and semi structured interviews were conducted with the participants until saturation occurred. Furthermore, two focus groups were conducted with eight participants. A key informant was also interviewed to assist the researcher with a different perspective and to avoid bias. The data was analysed by means of thematic analysis into codes, categories and themes. Trustworthiness was ensured by means of credibility, applicability, transferability and conformability. Informed consent and confidentiality was ensured. Permission was obtained from the UWC research committee and from the Department of Health. Four themes were merged from the findings: Theme one: Obstacles which affects the return to work of CVA Participants in a rural community. Theme two: Establishing a strong belief in functional ability through occupation. Theme three: Adaptation strategies that enhances the work participation of stroke survivors in a rural community. Finally Theme four: The MOOSE enables transition to the worker role in a rural context. The findings revealed that the participants experienced a loss of their former self thus affecting their worker identity as they were no longer able to experience the gratification of fulfilling their worker role. This was due to the participants not being aware of the return to work options that they had. After the stroke the participants battled with not only overcoming their condition but also the stigma which the community and their employers had of stroke. Overcoming the stroke event and returning to work required that potential barriers and facilitators be identified by the participants and the researcher. The study also identified adaptation strategies that the participants utilised in order to overcome the barriers and assist the participants to have a smoother transition into the workplace. In conclusion the findings of the study revealed that the participants suffer a loss of their former abilities and undergo a loss of their self-esteem. As a result of the loss, participants struggled to return to work not only due to their loss of abilities but also their lack of knowledge regarding return to work and stroke. The findings indicated that there should be more education regarding the stroke that needs to be conducted in communities via media such as local newspapers, local radio stations, clinics and hospitals. The findings of the study may assist Occupational Therapy practitioners to improve services in a rural community for stroke survivors and improve the facilitation of the return to work process after stroke. The MOOSE facilitates motivation for participants to regain their self-esteem and thus move forward to resume a worker role.
2020-08-31
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Knapp, Frances Elizabeth. "Social power dynamics and partnership in stroke physiotherapy treatment interactions." Thesis, University of Southampton, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.440414.
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Wardlaw, Joanna Marguerite. "Imaging and treatment of acute ischaemic stroke : the application and verification of non-invasive imaging techniques in the investigation and treatment of acute ischaemic stroke." Thesis, University of Edinburgh, 1994. http://hdl.handle.net/1842/20860.
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The purpose of the project which led to the writing of this thesis was to: 1) Establish the accuracy, limitations and practicality of a simple isotope test, the mean Cerebral Transit Time (MCTT), developed in the Western General Hospital, Edinburgh, and its ability to diagnose the pattern of cerebral arterial occlusion in acute ischaemic stroke; 2) Study the effect of early reperfusion of the cerebral infarct on swelling of the infarct in the acute stage, and clinical outcome in patients with symptoms of extensive acute cerebral ischaemia; 3) Perform an overview analysis of thrombolytic therapy for acute ischaemic stroke; 4) Set up a pilot randomised controlled trial of intra-arterial thrombolysis in acute ischaemic stroke. The Thesis is divided into four parts. Part One describes: a) the background to current understanding of the aetiology and pathogenesis secondary treatment of, and possible primary treatments for acute ischaemic stroke; b) the anatomy and physiology of the cerebral circulation; c) imaging methods for investigating the cerebral circulation and brain parenchyma. Part Two describes a study in 120 acute stroke patients. Part Three is the relationship between reperfusion of the infarct shown by TCD, the amount of swelling in the infarct in the acute stag shown by CT brain scan, and clinical outcome. Part Four contains a review of all publications on thrombolysis in stroke patients.
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Askim, Torunn. "Recovery after stroke - assessment and treatment; with focus on motor function." Doctoral thesis, Norwegian University of Science and Technology, Department of Public Health and General Practice, 2008. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-2089.
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The incidence of stroke has not changed significantly in recent decades. However, the actual number of strokes is likely to increase as a consequence of the increasing number of elderly people, creating a significant burden on the health care system, the patients and their families. Pareses are the most common impairment reported after stroke. Motor impairments are associated with reduced self-perceived health, and consequently rehabilitation after stroke has a strong emphasis on physiotherapy and motor training. However, more knowledge about motor recovery and effects of therapy is needed for further improvement of rehabilitation processes and of outcome for the large number of stroke victims.
The overall aim of this thesis was to increase the knowledge about motor recovery after stroke by evaluating the effect of two different rehabilitation programmes compared to standard rehabilitation regimes and by investigating changes in brain activity in patients treated in terms of the recommended guidelines in the acute phase and during follow-up.
A randomised controlled trial was performed to evaluate the effect of an early supported discharge (ESD) service for patients with acute stroke living in a rural community. Sixty-two eligible patients were included and randomised to either an ESD service or to standard followup. The trial revealed no significant benefit on the Modified Rankin Scale, Barthel Index, Berg Balance Scale or walking speed, but significantly less isolation in the ESD group at the six-week follow-up. However, analysis of all cases with all assessments available showed a non-significant trend toward greater improvement in balance in the ESD group from one week to six weeks follow-up. The trial identified a strong association between initial severe leg paresis, but not with initial moderate leg paresis, and reduced balance one year after the stroke. There was also a strong association between initial inability to walk and reduced balance one year after the stroke.
Another randomised controlled trial was performed to evaluate the efficacy and feasibility of Constraint-Induced Movement Therapy (CIMT) organised as group therapy for patients with subacute and chronic stroke. Thirty eligible patients were included and randomised to a CIMT group receiving ten days of intensive motor training of the affected arm or to a control group receiving standard rehabilitation. The CIMT group showed a statistically significant greater improvement in motor function of the affected arm at the post-treatment assessment.
However, this difference did not persist at six months' follow-up. There were no differences between the groups at any time in relation to the amount of use of the affected arm or to independence in activities of daily living.
Finally, a longitudinal follow-up study was performed to investigate the changes in brain activation patterns from the acute to the chronic phases and their relationship to motor learning after stroke. Twelve eligible patients with acute ischaemic stroke were included and assessed with functional magnetic resonance imaging (fMRI) and clinical tests within one week after stroke and three months later. All patients, except one, had complete recovery of the affected arm according to our criteria. Increased activation in cerebellum, striatum, angular gyrus and insula was revealed in the acute phase compared to the chronic phase. The chronic phase demonstrated a restoration of the lateralised primary motor network, in addition to increased bilateral somatosensory association areas and contralesional secondary somatosensory areas (SII). The activation patterns are not identical but comparable to a motor learning process.
In conclusion, this thesis shows that the ESD service did not significantly influence death or dependency, balance or walking speed for patients living in a rural community. However, it may lead to less isolation and a transient improvement in self-perceived health. The thesis also demonstrates that CIMT organised as group therapy is feasible and efficient in the short term but may not be superior to standard rehabilitation in the long term. Finally, the thesis has revealed that the motor network changes associated with successful motor recovery are comparable to changes observed in motor learning studies in healthy subjects, and also indicating the importance of bi- and contralesional brain activation for successful motor recovery after stroke.
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Martinsson, Louise. "Facilitation of recovery after ischaemic stroke : early dexamphetamine and physiotherapy treatment /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-668-5.
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Gallacher, Katie I. "An exploration of treatment burden and patient capacity in people with stroke." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7736/.
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Background and aims: Advances in modern medicine have led to improved outcomes after stroke, yet an increased treatment burden has been placed on patients. Treatment burden is the workload of health care for people with chronic illness and the impact that this has on functioning and well-being. Those with comorbidities are likely to be particularly burdened. Excessive treatment burden can negatively affect outcomes. Individuals are likely to differ in their ability to manage health problems and follow treatments, defined as patient capacity. The aim of this thesis was to explore the experience of treatment burden for people who have had a stroke and the factors that influence patient capacity. Methods: There were four phases of research. 1) A systematic review of the qualitative literature that explored the experience of treatment burden for those with stroke. Data were analysed using framework synthesis, underpinned by Normalisation Process Theory (NPT). 2) A cross-sectional study of 1,424,378 participants >18 years, demographically representative of the Scottish population. Binary logistic regression was used to analyse the relationship between stroke and the presence of comorbidities and prescribed medications. 3) Interviews with twenty-nine individuals with stroke, fifteen analysed by framework analysis underpinned by NPT and fourteen by thematic analysis. The experience of treatment burden was explored in depth along with factors that influence patient capacity. 4) Integration of findings in order to create a conceptual model of treatment burden and patient capacity in stroke. Results: Phase 1) A taxonomy of treatment burden in stroke was created. The following broad areas of treatment burden were identified: making sense of stroke management and planning care; interacting with others including health professionals, family and other stroke patients; enacting management strategies; and reflecting on management. Phase 2) 35,690 people (2.5%) had a diagnosis of stroke and of the 39 co-morbidities examined, 35 were significantly more common in those with stroke. The proportion of those with stroke that had >1 additional morbidities present (94.2%) was almost twice that of controls (48%) (odds ratio (OR) adjusted for age, gender and socioeconomic deprivation; 95% confidence interval: 5.18; 4.95-5.43) and 34.5% had 4-6 comorbidities compared to 7.2% of controls (8.59; 8.17-9.04). In the stroke group, 12.6% of people had a record of >11 repeat prescriptions compared to only 1.5% of the control group (OR adjusted for age, gender, deprivation and morbidity count: 15.84; 14.86-16.88). Phase 3) The taxonomy of treatment burden from Phase 1 was verified and expanded. Additionally, treatment burdens were identified as arising from either: the workload of healthcare; or the endurance of care deficiencies. A taxonomy of patient capacity was created. Six factors were identified that influence patient capacity: personal attributes and skills; physical and cognitive abilities; support network; financial status; life workload, and environment. A conceptual model of treatment burden was created. Healthcare workload and the presence of care deficiencies can influence and be influenced by patient capacity. The quality and configuration of health and social care services influences healthcare workload, care deficiencies and patient capacity. Conclusions: This thesis provides important insights into the considerable treatment burden experienced by people who have had a stroke and the factors that affect their capacity to manage health. Multimorbidity and polypharmacy are common in those with stroke and levels of these are high. Findings have important implications for the design of clinical guidelines and healthcare delivery, for example co-ordination of care should be improved, shared decision-making enhanced, and patients better supported following discharge from hospital.
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Rushing, Jessica L. "EVIDENCE-BASED MUSIC THERAPY TREATMENT TO ELEVATE MOOD DURING ACUTE STROKE CARE." UKnowledge, 2019. https://uknowledge.uky.edu/rehabsci_etds/54.
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Stroke is the fifth leading cause of death in the U.S. with approximately 795,000 Americans experiencing a stroke each year. In addition to common difficulties with communication and physical impairments following stroke, psychosocial impacts warrant assessment and treatment. Experiencing a stroke can lead to depression, mood disorders, and difficulties with emotion regulation. It is well documented that post-stroke depression (PSD) affects a third of stroke survivors. Higher levels of depression and depressive symptoms are associated with a less efficient use of rehabilitation services, poor functional outcomes, greater odds of hospital readmission, negative impacts on social participation, and increased mortality. The acute phase of stroke recovery may be a key factor in influencing the depression trajectory with early depression predicting poor longitudinal outcomes. The current approach to treating PSD is medication. However, psychotherapy approaches have demonstrated more promise in preventing PSD. Investigations into music-based treatments have shown encouraging results following acquired brain injuries with active music therapy interventions demonstrating large effect sizes for mood improvement. Therefore, the purpose of this three-part dissertation was to examine the effects of active music therapy on mood and describe the clinical decision making process of using music therapy to target mood elevation for hospitalized adults following a first-time acute ischemic stroke.
The first study examined the effect of one treatment of active music therapy on mood following a first-time ischemic stroke during acute hospitalization. Active music therapy was defined as music making interventions that elicit and encourage active participation from participants. The Faces Scale was used to assess mood immediately prior to and following treatment. Forty-four adults received at least one treatment. A significant change in mood was found following one treatment. Comment analysis indicated that participants viewed music therapy as a positive experience.
The second study investigated the impact of receiving two treatments of active music therapy on mood as compared to one. No significant difference was found between those who received one treatment and those who received two. Both dosing groups demonstrated significant mood improvement; however Group 2 (two treatments) had more severe strokes and did not improve until the second session.
The purpose of the third study was to describe the clinical decision-making (CDM) process of a music therapist targeting mood elevation for hospitalized patients following a first-time acute ischemic stroke. The Three Phase Process Model of Collaborative Self-Study was selected as a guiding qualitative methodological framework. Data was collected from four sources: (a) electronic medical records, (b) audio recordings of eight music therapy treatments, (c) a researcher journal, and (d) patient and caregiver/visitor comments. Results indicate that factors influencing CDM included progression through a four-stage treatment process, use of a variety of music-based and therapy-based techniques, and the monitoring and influencing of participant levels of arousal, affect, salience, and engagement.
In conclusion, active music therapy during acute hospitalization following a first-time ischemic stroke is effective in significantly improving mood. Components of clinical decision making to elevate mood are illustrated in a provided conceptual framework. Continued investigation is warranted with consideration of stroke severity, dosing amounts, and additional outcomes of interest. Longitudinal investigation is needed to evaluate the impact of treatment on the trajectory of post-stroke depression.
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Hagerty, Kailyn M. "Comparing Two Different Statins in a Delayed Pharmacological Treatment for Ischemic Stroke." Wright State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=wright1341957043.
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Chua, Eldrich Norwin Siy, and 蔡季延. "The effects of noninvasive brain stimulation on cognitive function in patients with stroke : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206919.
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Introduction: Cognitive impairments occur frequently in stoke survivors, yet current conventional post-stroke care focuses mainly on motor function. Transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are noninvasive brain stimulation techniques (NIBS) that are used in neurological rehabilitation. Its efficacy is well-established in motor recovery post-stroke, but research on its effects on the associated cognitive decline after stroke is fairly new. The aim of this review is to evaluate recent studies and provide a summary on the effects of NIBS on post-stroke cognitive decline.
Methods: PubMed and CINAHL were searched using the keywords: “cerebrovascular accident”, “stroke”, “NIBS” or “noninvasive brain stimulation”, “tDCS” or “transcranial direct current stimulation”, and “TMS” or “transcranial magnetic stimulation”. PEDro system was used to assess the quality of the studies that passed the inclusion and exclusion criteria.
Results: The initial search returned 1081 citations, among which 12 were included in this review. The mean PEDro score of the studies was 7.5 out of 10. The trials had a total of 176 participants with stroke. Lesion site was heterogeneous. Six trials investigated tDCS, and the other 6 investigated rTMS. The main outcome measures were grouped into 3 domains: memory, visuospatial, and attention. Both tDCS and rTMS resulted in significant changes in the visuospatial domain in terms of improving spatial neglect. The results on memory and attention are mixed, but tDCS shows more consistent results.
Conclusion: NIBS is a safe and low-cost treatment that can improve cognitive decline post-stroke. However, the evidence is still lacking due to the small number of trials and sample sizes. More studies need to be conducted in order to establish a proper guideline for usage. Long term effects also need to be investigated.published_or_final_version
Public Health
Master
Master of Public Health
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Lennermo, Linnéa. "Att drabbas av stroke : En litteraturstudie baserad på självbiografier." Thesis, Högskolan i Skövde, Institutionen för biovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-18372.
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Bakgrund: Stroke innebär blödning eller propp i något eller några av hjärnans blodkärl och är en sjukdom som drabbar många människor världen över varje dag. Insjuknande i stroke kan medföra både fysiska och psykiska funktionsnedsättningar och kan således ha stora konsekvenser för den drabbade individen. Ökad kunskap kring upplevelser av att insjukna i stroke kan hjälpa sjuksköterskan att ge god och specifik omvårdnad, vilket kan vara avgörande för patientens hälsa och välbefinnande. Syfte: Att beskriva människors upplevelser av att drabbas av stroke. Metod: En litteraturstudie där sex självbiografiska böcker analyserades genom en kvalitativ innehållsanalys. Resultat: Ur analysen framkom fyra huvudkategorier: En förändrad livsvärld, Att hamna i andras händer, Att pendla mellan hopp och förtvivlan samt Omgivningens påverkan på välbefinnandet. Konklusion: Insjuknande i stroke kan medföra både psykiska och fysiska förändringar och kan ha stora konsekvenser på hälsa och välbefinnande hos den drabbade. Resultatet av denna studie kanbidra med kunskap och förståelse om hur stroke kan påverka en människa, vilket kan hjälpa sjukvårdspersonal att förbättra omvårdnaden av dessa patienter och således lindra lidande.Background: Stroke includes bleeding or plugs in one or more blood vessels in the brain and is a disease that affects many people around the world every day. Having a stroke can cause both physical and mental disabilities and can thus have major consequences for the affected individual. Increased knowledge about experiences of having a stroke can help nurses to give good and specific care, which can be crucial for the patient’s health and wellbeing. Aim: To describe experiences of having a stroke. Method: A literature study where six autobiographies were analyzed through a qualitative content analysis. Result: Four main categories emerged from the analysis: A changed lifeworld, To end up in the hands of others,To fluctuate between hope and despair and Others’ impact on the patient’s well-being. Conclusion: Having a stroke may result in both physical and mental changes and may have major consequences for the patient’s health and well-being. The result of this study may contribute knowledge and understanding about how stroke may affect a person, which may help healthcare staff to improve the care of these patients and to ease suffering.
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Michou, Emilia. "Mechanisms and therapeutic application of neurostimulation in the treatment of dysphagia after stroke." Thesis, University of Manchester, 2010. http://www.manchester.ac.uk/escholar/uk-ac-man-scw:136896.
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Edmans, Judith Alison. "A comparison of two approaches in the treatment of perceptual problems after stroke." Thesis, University of Nottingham, 1999. http://eprints.nottingham.ac.uk/14194/.
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Perceptual problems are common following stroke and affect the patients' functional ability, suggesting that these problems should be treated. Eighty patients admitted to the Nottingham Stroke Unit, were assessed for perceptual and functional abilities, using standardised assessments (Rivermead Perceptual Assessment Battery, Barthel ADL Index and Edmans ADL index). Each patient identified as having perceptual problems, was randomly allocated to one of two groups for perceptual treatment. One group followed the transfer of training approach and one group followed the functional approach. The study compared the effectiveness of the two approaches in improving perceptual and functional abilities. Treatment was given for 2.5 hours per week for six weeks. On completion of the six weeks treatment, each patient was reassessed for perceptual and functional abilities. There was no significant difference between the treatment groups on patient characteristics or impairments. The results also showed no significant difference between the treatment groups before and after treatment on perceptual ability total scores, individual perceptual subtest scores, or functional ability total scores (Mann Whitney U 642.5-798.0, p > 0.05). Wilcoxon Matched Pairs Signed Ranks Tests showed a significant improvement after treatment, on perceptual and functional abilities, (perceptual z = 6.02, p<0.001, functional z = 6.72, p<0.001). These results indicated the improvement in perceptual abilities was equivalent using either of the two approaches. Therefore, a no treatment group of 20 patients was studied. The results showed similar results between the treatment and no treatment groups, suggesting that neither treatment approach improved outcome. However, these results may have been influenced by spontaneous recovery or the effects of the Stroke Unit.
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McCulloch, Hollis. "Fabrication and Characterization of Composite Membranes as Drug-Delivering Duraplasty for Stroke Treatment." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39156.
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Malhotra, Konark, Jason J. Chang, Arjun Khunger, David Blacker, Jeffrey A. Switzer, Nitin Goyal, Adrian V. Hernandez, Vinay Pasupuleti, Andrei V. Alexandrov, and Georgios Tsivgoulis. "Minocycline for acute stroke treatment: a systematic review and meta-analysis of randomized clinical trials." Dr. Dietrich Steinkopff Verlag GmbH and Co. KG, 2018. http://hdl.handle.net/10757/624615.
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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.Background: Various randomized-controlled clinical trials (RCTs) have investigated the neuroprotective role of minocycline in acute ischemic stroke (AIS) or acute intracerebral hemorrhage (ICH) patients. We sought to consolidate and investigate the efficacy and safety of minocycline in patients with acute stroke. Methods: Literature search spanned through November 30, 2017 across major databases to identify all RCTs that reported following efficacy outcomes among acute stroke patients treated with minocycline vs. placebo: National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin Scale (mRS) scores. Additional safety, neuroimaging and biochemical endpoints were extracted. We pooled mean differences (MD) and risk ratios (RR) from RCTs using random-effects models. Results: We identified 7 RCTs comprising a total of 426 patients. Of these, additional unpublished data was obtained on contacting corresponding authors of 5 RCTs. In pooled analysis, minocycline demonstrated a favorable trend towards 3-month functional independence (mRS-scores of 0–2) (RR = 1.31; 95% CI 0.98–1.74, p = 0.06) and 3-month BI (MD = 6.92; 95% CI − 0.92, 14.75; p = 0.08). In AIS subgroup, minocycline was associated with higher rates of 3-month mRS-scores of 0–2 (RR = 1.59; 95% CI 1.19–2.12, p = 0.002; I2 = 58%) and 3-month BI (MD = 12.37; 95% CI 5.60, 19.14, p = 0.0003; I2 = 47%), whereas reduced the 3-month NIHSS (MD − 2.84; 95% CI − 5.55, − 0.13; p = 0.04; I2 = 86%). Minocycline administration was not associated with an increased risk of mortality, recurrent stroke, myocardial infarction and hemorrhagic conversion. Conclusions: Although data is limited, minocycline demonstrated efficacy and seems a promising neuroprotective agent in acute stroke patients, especially in AIS subgroup. Further RCTs are needed to evaluate the efficacy and safety of minocycline among ICH patients.
Revisión por pares
Revisión por pares
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Sudlow, Christopher Mark. "The prevalence of atrial fibrillation in the UK and of suitability for warfarin treatment amongst those with atrial fibrillation." Thesis, University of Oxford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301176.
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Campbell, Carla Hoffman. "Development and implementation of a protocol for treatment of in-patient ischemic stroke patients." Montana State University, 2011. http://etd.lib.montana.edu/etd/2011/campbell/CampbellC1211.pdf.
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"Stroke continues to be a significant cause of mortality and morbidity in the United States. Approximately 700,000 Americans have a new or recurrent stroke each year, and stroke remains the third leading cause of death in the United States when considered independently from other cardiovascular diseases. Stroke also remains a leading cause of serious, long-term disability in the United States." (Schwamm, 2005, p.690) The purpose of this project was to develop an evidence based care management protocol for persons admitted to a small rural hospital with the symptoms or diagnosis of Ischemic Stroke. A committee was formed, evidence based best practices were identified, tools were developed and the protocol was implemented. The protocol was based on the Core Measures established by the Joint Commission and adopted by the centers for Medicare and Medicaid as a basis for validating quality and setting reimbursement. The protocol was successfully implemented; a process for the Quality Department of the facility was put in place to insure continued success.
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Willmot, Mark. "An investigation of GTN and NO related therapeutics in the treatment of acute stroke." Thesis, University of Nottingham, 2007. http://eprints.nottingham.ac.uk/10305/.
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Background: High blood pressure is common in acute stroke and has been linked with poor outcome. Hence, outcome might be improved by lowering blood pressure. This thesis investigates the potential for glyceryl trinitrate, a nitric oxide donor, for lowering blood pressure in acute stroke. Methods: A systematic review was employed to clarify the relationship between outcome and BP in observational studies. Next two systematic reviews of animal studies using nitric oxide therapeutics in experimental stroke were performed to assess the effects on infarct volume and cerebral perfusion. Finally, two randomised controlled clinical trials of glyceryl trinitrate were performed in acute stroke patients to measure the systemic and cerebral haemodynamic effects. Results: In observational studies high blood pressure in acute stroke was associated with subsequent death, death or dependency, and death or deterioration. In experimental stroke nitric oxide sources and selective nitric oxide synthase inhibitors significantly reduced stroke volume. Glyceryl trinitrate lowered peripheral and central blood pressure and increased aortic compliance when given <48 hours from stroke. Glyceryl trinitrate did not alter quantitative measures of cerebral perfusion despite significantly lowering blood pressure <5 days from stroke. Conclusion: High blood pressure is a therapeutic target in acute stroke and animal data support the use of nitric oxide sources for lowering blood pressure. It is feasible to use glyceryl trinitrate for this purpose since it does not compromise cerebral perfusion. Trials now need to urgently assess the effect of lowering BP on outcome.
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England, Timothy John. "Mobilisation of endogenous haematopoietic stem cells and their use as treatment for subacute stroke." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/13302/.
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The potential application for stem cell therapy is vast. Despite a limited understanding of their mechanisms of action, clinical trials assessing stem cells in human stroke are underway. Colony stimulating factors (CSF) such as granulocyte colony stimulating factor (G-CSF), which have been used to mobilise haematopoietic stem cells (HSC), also show promise in treating stroke. Preclinical experiments evaluating the effect of G-CSF in stroke were meta-analysed; G-CSF significantly reduced lesion size in transient but not permanent models of ischaemic stroke. Further studies assessing dose-response, administration time, length of ischaemia and long-term functional recovery are needed. Tracking iron-labelled cells with MRI may help to establish migratory patterns following transplantation. Our systematic review of iron-labelled stem cells in experimental stroke suggests that compounds already licensed for humans (ferumoxide and protamine) may potentially be used in clinical trials. In a phase IIb single-centre randomised controlled trial (n=60), the safety of G-CSF in recent stroke was assessed (STEMS-2). G-CSF appears safe when administered subacutely and may reduce stroke lesion volume. Phase III trials are required to test efficacy. An updated Cochrane review on CSFs in stroke shows that G-CSF was associated with a non-significant reduction in early impairment but had no effect on functional outcome in 6 small studies. In two trials, erythropoietin therapy was significantly associated with death by the end of the trial. It is too early to know whether G-CSF could improve functional outcome in stroke. In 8 recruits randomised into STEMS-2, mobilised CD34+ HSCs were paramagnetically labelled, re-infused and tracked with serial T2* MRI. Post-stroke HSC labelling appears safe and feasible. There is suggestive evidence in one patient that labelled HSCs migrate to the ischaemic lesion. Our in vitro evaluation of CD34+ HSCs has revealed that uptake of superparamagnetic iron oxide (SPIO) is enhanced but not dependent upon a transfection agent. Iron labelling of CD34+ cells in this manner did not affect cell viability or inhibit growth. This methodology could be applied to clinical trials. We have established the expression of G-CSF protein, its receptor (G-CSFR) and CD34 antigen in post-mortem brain tissue from participants recruited to STEMS-2. Areas of angiogenesis and expression of G-CSFR in acute and chronic infarction suggest potential targets for therapy. There are many preclinical studies reporting the effects of stem cells in treating stroke (with a noticeable lack of neutral or negative articles). Despite the wealth of literature there remain many unanswered questions and patients should not undergo stem cell therapy unless it is as part of a well designed clinical trial.
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Kirkland, Scott, and University of Lethbridge Faculty of Arts and Science. "Modulation of recovery and compensation after stroke." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Arts and Science, 2007, 2007. http://hdl.handle.net/10133/387.
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Stress has been shown to exacerbate cell death and cognitive deficits after ischemic
injury in rodents, however, little is known of the effects of stress on motor recovery. The
objective of this present thesis is to examine the effects of chronic stress on skilled motor
recovery after devascularization lesion in rats. It was found that pre-lesion stress induced
the most behavioural impairments, while post-lesion stress exacerbated infarct volume.
The effects of chronic multiple stress on skilled motor recovery after lesion was also
examined. Chronic multiple stress did not modulate skilled motor recovery nor did it
have any influence on infarct volume. Additionally, stress had effect on edema after
devascularization lesion. The present thesis suggests that the time of exposure to chronic
stress in respect to the ischemic lesion, in addition to the type of stress, will differentially
affect recovery and compensation in rats.xii, 122 leaves : ill. ; 29 cm.
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Chan, Chu-fung, and 陳柱峰. "Neuroprotective effects of granulocyte-colony stimulating factor in a mice stroke model." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B40687284.
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Man, Lai-mei, and 文麗媚. "An exploratory study for the health seeking pattern of stroke survivors on alternative medicine." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B31978617.
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Foroud, Afra, and University of Lethbridge Faculty of Arts and Science. "Moving from stroke to development : a deconstruction of skilled reaching in humans." Thesis, Lethbridge, Alta. : University of Lethbridge, Dept. of Neuroscience, c2008, 2008. http://hdl.handle.net/10133/1307.
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The purpose of this thesis is to describe the organization of the movements of skilled
reaching. Our knowledge of reaching behaviour has been limited to an understanding of
specific actions. Results from this thesis describe how reaching is the product of
interactions of various parameters that assemble in an integrative way in ontogeny, yet
can become dismantled on one level, or generally, throughout multiple levels of what
constitutes the behaviour after stroke in adults. These findings demonstrate that skilled
reaching constitutes motor parameters that may not be visible in a healthy adult, but that
function through development, and by inhibitory systems in adults, to create a smooth
and finely articulated action. An examination of the movement patterns of reaching
within the full context of the behaviour can be applied to therapeutic strategies for motor
disorders and, most importantly, deepen our understanding of the relations between
reaching and cognition.xiii, 254 leaves : ill. (some col.) ; 29 cm
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Hägg, Mary. "Sensorimotor Brain Plasticity in Stroke Patients with Dysphagia : A Methodological Study on Investigation and Treatment." Doctoral thesis, Uppsala University, Otolaryngology and Head and Neck Surgery, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8337.
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Aims
The aims of the thesis were to validate investigation instruments for stroke patients with dysphagia, and to improve oropharyngeal dysphagia therapies.
Methods/Results
A Lip Force Meter, LF 100, affirmed excellent intra- and inter-reliability, sensitivity and specificity. Controls had significantly stronger lip force (LF) and swallowing capacity (SC) than stroke patients. A normal lower limit of LF was set to 15 Newton. Dysphagia symptoms improved in 7 stroke patients after a 5-week sensorimotor stimulation therapy comprising manual body and facial regulation in combination with palatal plate application. Impaired LF and impaired SC were parallel phenomena in 22 acute stroke patients and did not differ regardless of presence or absence of facial palsy. LF and SC improved and were parallel phenomena in 30 stroke patients and did not differ regardless of presence or absence of facial palsy, time lag between stroke attack and start of treatment, or age. SC was normalized in 19 of 30 dysphagia patients after a 5-8-week daily lip muscle self-training with an oral screen.
Conclusions
LF100 is an appropriate and reliable instrument for measuring lip force. Dysphagia improvement, by body and facial sensorimotor stimulation in combination with palatal plate application, or by training with an oral screen is excellent examples of brain plasticity and cortical reorganisation. . Swallowing capacity and lip force in stroke patients are parallel phenomena. A sub clinical facial paresis seems to be present in most stroke patients. Training with an oral screen can improve LF and SC in stroke patients with oropharyngeal dysphagia.
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Zou, Danni. "Fabrication and Characterization of Double-Walled Microsphere as a Drug Delivery System for Stroke Treatment." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42006.
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Stroke is a medical condition in which poor blood flow to the brain results in cell death. The current treatment options are limited and only very few patients can benefit from these treatments. Stroke causes brain swelling and often a decompressive craniectomy is performed for some of the patients to release intracranial pressure to prevent further damage. As a result, a duraplasty is implanted to replace the surgically-damaged dura mater to protect the brain. In view of that, the purpose of this project was to develop double-walled microspheres (DWMS) which can be used as a drug delivery system when incorporated into duraplasty to promote endogenous stem cell therapy to treat stroke. The DWMS were composed of poly (l-lactic acid) (PLLA) and poly (lactic-co-glycolic acid) (PLGA) using a solvent evaporation method. Bovine serum albumin (BSA), as a model protein, was entrapped within these DWMS with different core-shell thicknesses and compositions to investigate the distribution of protein, encapsulation efficiency, and in vitro release. The fabrication process parameters of DWMS were also optimized to attain higher yields, and the phase separation and surface morphology were examined by differential scanning calorimetry and scanning electron microscopy.
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Kane, Ingrid. "Thrombolysis for acute ischaemic stroke : can brain imaging and consent processes before treatment be improved?" Thesis, University of Edinburgh, 2008. http://hdl.handle.net/1842/24750.
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The general aim of my research was to work on streamlining and improving a few key areas in the care for patients with stroke, particularly those likely to be candidates for thrombolysis. I focussed on: optimising the imaging method for patient selection; assessing the availability of different imaging methods; and evaluating a range of options for obtaining consent for treatment or research in this setting. In the imaging work I discuss some aspects of the two major imaging modalities available to stroke patients – computerised tomography (CT) and magnetic resonance imaging (MRI) and the evidence available for the treatment of acute stroke with thrombolysis. I then explore the evidence lying behind the use of some of the advanced MR imaging modalities and how they may assist in the selection of patients for thrombolysis. Using a systematic review, I play particular attention to the evidence behind the MR perfusion diffusion mismatch theory and the interaction with thrombolysis. Having analysed the evidence available on ‘mismatch’ and thrombolysis I go on to compare the many techniques available for measuring the perfusion lesion and the problems that arise as a result of this. I move from the more complex details of specific MR techniques to the practicalities of imaging acute stroke patients with MR, dealing with a UK survey on the actual availability of MR scanners. Finally, I deal with patients who meet clinical and imaging criteria for thrombolysis who require consent. This is a stage that can cause huge delays, particularly with an acutely ill patient. The process of consent needs to begin imaging. It is a vital first step in thrombolysis because, without it, patients can not undergo the complex MR imaging techniques that are discussed in earlier chapters of the thesis.
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Qi, Chuanjie, and 亓传洁. "Effects of notoginsenoside R1 against glutamate neurotoxicity in vitro and on mice brain following ischemic stroke in vivo." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206464.
Full textAbstract:
Ischemic stroke is a leading cause of disability and death around the world. Higher concentration of glutamate following ischemic stroke is a factor leading to cell death, including neural stem cell death. Up to now no effective treatments of ischemic stroke are available. Notoginsenoside R1 (Noto R1) is the main component of Panax notoginseng, which is a traditional Chinese medicine for the treatment of cardiovascular disease. Its protective effects on the neural cell were noted recently. The main purpose of this experimental study was to investigate the mechanism of Noto R1 against glutamate neurotoxicity on primary cultured mouse cortical neural stem cells in vitro, and its effects on ischemic stroke on mice brain in vivo.
In the in vitro part, primary culture of neural stem cells was prepared from 12.5-day-old C57BL/6N mice embryos cortex. Neural stem cells were confirmed by nestin-staining and differentiation study afterwards. Then neural stem cells were incubated with Noto R1 and glutamate for 24 hours. Cells were fixed for TUNEL staining and caspase-3 staining. Protein was collected for western blot for Bax, Bcl-2, phos-AKT, JNK/SAPK, and phospho-p38 MAPK. Results showed that glutamate has cytotoxicity in a dose-dependent manner on neural stem cells. Noto R1 showed remarkable neuro-protective effects on neural stem cells exposed to excessive glutamate by higher viability. Noto R1 significantly reduced caspase-3 expression and TUNEL-positive cells. Furthermore, Noto R1 increased the protein expression of Bcl-2 and phospho-AKT, and reduced Bax expression. Moreover apoptosis pathway study showed phospho-p38 expression was suppressed in the Noto R1 group.
In the in vivo part, Noto R1 was administrated systemically to mice of MCAo followed by reperfusion. Behavior score and viability rate were assessed before sacrifice. TTC staining was performed for evaluating infarct area, volume and edema. H&E staining was applied for histological examination. TUNEL staining, IHC staining of Nestin, AQP4 and GFAP were performed. In the first part of Noto R1 of 40 mg/kg or PBS was injected into venous at the onset of blood vessel occlusion for 2 hours, and then followed by 22 hours of reperfusion. Results were all negative. In the second part, Noto R1 was injected intra-peritoneum for 10 days prior to MCAo which lasted for 1 hour 50 minutes, then reperfusion was allowed for 22 hours. Results showed Noto R1 improved behavior score and viability rate. Meanwhile Noto R1 significantly reduced ischemic area, volume and edema percentage. Moreover TUNEL-positive cells in the affected cortex were significantly decreased. Nestin-positive cell in the striatum were significantly increased in the Noto R1 group, and immunoactivity of AQP4 and GFAP was apparently decrease with Noto R1 treatment.
In conclusion, this study showed that Noto R1 protected cultured neural stem cells against glutamate neurotoxicity in vitro via p38 MAPK pathway by inhibiting Bax protein expression and enhancing protein expression of Bcl-2 and phospho-AKT. Moreover, it also demonstrated significant preventive effects against ischemic stroke with mice model in vivo. In a word Noto R1 presents a highly potential candidate preventing ischemic stroke clinically in the future.published_or_final_version
Anatomy
Doctoral
Doctor of Philosophy
45
Hadjisavvas, Venediktos. "Treatment of brain cancer and ischaemic stroke utilising High Intensity Focus Ultrasound (HIFU) guide with MRI." Thesis, City University London, 2012. http://openaccess.city.ac.uk/1399/.
Full textAbstract:
In this thesis high intensity focused ultrasound (HIFU) is utilized for cancer treatment (thermal mode) and treatment of ischaemic stroke (mechanical mode). These two applications were investigated in vitro and in vivo models. MRI was utilized to monitor the lesions created by HIFU either in thermal or cavitation mode in freshly excised lamb brain tissue in vitro, and in rabbit brain in vivo. Additionally, MRI was used to monitor lesions deep in tissue for both in vitro and in vivo exposures. All three MRI sequences used (T1-W FSE, T2-W FSE and FLAIR) were able to detect lesions. Both thermal and bubbly lesions were best monitored using T1-W FSE with excellent contrast, proving the potential of HIFU to treat reliably tumours in the brain. A HIFU system was also used to assist thrombolysis in cooperation with a thrombolytic drug such as recombinant tissue plasminogen activator (rt-PA) in vitro and in vivo. It was shown that higher intensity results to higher volume of dissolved clot, but there is a limit of the intensity to be used in order to avoid heating of the clot and the surrounding tissue. The goal in this study was to achieve temperature elevation not exceeding 1ºC (called safe temperature). It was found that the larger the beam area the larger the dissolved clot volume. Also, the lower the frequency, the larger the volume of the dissolved clot. The results reported herein point to the use of frequency around 0.5 MHz and pulsing to optimize thrombolysis and skull penetration and at the same time avoiding unwanted heating. Finally, an Acrylonitrile Butadiene Styrene (ABS) phantom skull model was developed in order to evaluate the propagation of ultrasound using a single element transducer. The skull model was appropriately designed so that it has the same attenuation as a human skull. It was demonstrated that using a frequency of 0.5 MHz versus 1 MHz, ultrasound propagation through the phantom skull was higher. Therefore, higher frequency has poor skull penetration and a small beam size at the focus, while low frequencies have better skull penetration but with the risk of reaching the unpredictable effect of cavitation. The developed system has proven to successfully create large lesions in the brain and at the same time, these lesions are successfully monitored with excellent contrast using MRI (T1-W FSE) enabling the accurate determination of the margins of these lesions. The results reported in this study point to the use of frequency around 0.5 MHz and pulsing to optimize thrombolysis and skull penetration and at the same time avoiding unwanted heating. For treating tumours located deep in the brain and for dissolving thrombus causing an acute ischaemic stroke, further extensive clinical studies will be needed before this technology is applied to humans.
46
Gibson, Josephine Mary Evelyn. "Reducing uncertainty : an exploratory study of people's treatment decisions after transient ischaemic attack or minor stroke." Thesis, University of Central Lancashire, 2007. http://clok.uclan.ac.uk/6560/.
Full textAbstract:
Little is known about people's responses to the impact of a transient ischaemic attack or minor stroke on their health status and future risk of stroke. In this thesis my aims are: to explore how the experience of TIA or minor stroke affects people's perception of their health and their uptake of health maintenance measures; to examine people's assessment, interpretation and perceptions of evidence in relation to their stroke risk; to explore the ways in which people reach decisions about treatment options in the light of their personal experience and in the context of evidence-based healthcare; and to explore the effect of anticipated regret in these processes. I conducted 28 audiotaped one-to one interviews with a purposive sample of 20 participants, each of whom had previously experienced a TIA or minor stroke. Ten of them had carotid endarterectomy in addition to best medical treatment (BMT). The data collection and analysis used a reflexive approach, based on my clinical nursing practice in this field, and was informed by the constant comparative method of grounded theory. My findings show that the experience of TIA diminishes people's quality of life and leads to a process of acknowledgement versus denial of its potential threat to health. People access evidence from formal and informal sources in the process of reaching decisions about their treatment. Their decisions tend to be deterministic in nature, even when they are aware of the scientific evidence. I present a theoretical framework, in which the central theme is the person's use of strategies to reduce uncertainty relating to their risk of stroke. I propose that people's primary aim in seeking health care, accessing information, and making treatment choices after TIA or minor stroke, is to reduce their perception of uncertainty about the threat of a future stroke, rather than to reduce stroke risk itself. I discuss the implications of these findings in relation to directions for future research, health care policy and nursing practice.
47
Balch, Maria Helen Harley. "Effects of Delayed Pharmacological Treatment and Limb Rehabilitation on Infarct Size and Functional Recovery After Stroke." Wright State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=wright1408630500.
Full text
48
Khanasari, Parto S. "An investigation of the neuroprotective properties of fenamate NSAIDs, against experimental model of ischemic stroke." Scholarly Commons, 2007. https://scholarlycommons.pacific.edu/uop_etds/671.
Full textAbstract:
Stroke is a devastating neurological disease with limited treatment opportunities. Recent advances in understanding the underlying pathogenesis of cerebral ischemia support the involvement of multiple biochemical pathways in the development of the ischemic injury.
The work reported in this thesis was undertaken to investigate the hypothesis that fenamate NSAIDs have neuroprotective properties against ischemic stroke and to explore the underlying mechanisms for any efficacy.
Fenamates are non-selective inhibitors of cyclooxygenases. In addition, fenamates are antagonists of non-selective cation channels, subtype-selective modutators of GABAA receptors, weak inhibitors of glutaniate receptors and activators of some potassium channels, all potentially important in the pathogenesis of ischemic stroke, Mefenamic acid, a prototype fenamate, administered by intracerebroventricular (ICV) infusion, reduced the ischemic brain damage and edema volume in the middle cerebral artery occlusion model in male rats. Consistent with these results; systemic administration of mefenamic acid, by multiple intravenous injections, also reduced the ischemic damage and edema volume measured by morphometric analysis and as a function of brain water content. These are the first set of experiments to demonstrate a significant neuroprotective effect of a fenamate against an in vivo model of ischemic stroke.
In vitro, mefenamic acid was also shown to reduce glutamate-evoked cell death (excitotoxicity) in a concentration-dependent manner in cultured embryonic rat hippocampal neurons. Similarly, selected other fenamates also reduced excitotoxicity in the rank order (from highest): mefenamic acid > flufenamic acid ≥ meclofenamic acid > niflumic acid supporting the idea that this is a drug class action.
Three pharmacological properties of fenamates, cyclooxygenase inhibition, GABAA receptor modulation and potassium channel activation were investigated as the potential mechanism(s} for the neuroprotective effects of mefenamic acid against excitotoxicity. The experimental results suggest that these are not the primary mechanisms for neuroprotective effects of mefenamic acid against glutamate-evoked cell death.
Collectively, these data support the hypothesis that fenamate NSAIDs are neuroprotective against experimental models of cerebral ischemia and suggest they should be further investigated as potential pharmacological treatments for stroke.
49
Luo, Dan, and 骆丹. "Anti-inflammatory mechanisms of compound C from gastrodia and uncaria decoction, a commonly used post-stroke decoction." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hdl.handle.net/10722/211556.
Full textAbstract:
Ischemic stroke is a leading cause of death and long-term disability in the world. Although many pathological aspects of mechanisms are considered to be involved in the stroke, accumulating evidences implicated that inflammation accounts for its progression and complications. Tumor necrosis factor-alpha (TNF-α) and nitric oxide are considered as key mediators produced by cells like microglia in the pathogenesis of the disease. Therefore, the development of therapies targeting at the suppression of nitric oxide and TNF-α productions may ameliorate the severity of ischemic stroke.
Gastrodia and Uncaria Decoction (GUD) is a traditional herbal decoction that is commonly used in the therapy of post-ischemic stroke in China. Although it shows great efficacy in clinical treatment, few studies have been conducted to investigate the mechanisms of action of GUD. Furthermore, GUD contains a complex mixture of constituents and the effects of these compounds are unknown. In this study, individual herbs from GUD were extracted and the bioactive fractions were further separated using liquid-liquid partition, silica gel chromatography and high performance liquid chromatography (HPLC). The inhibitory effect of the extracts on lipopolysaccharide (LPS)-stimulated nitric oxide production in BV-2 microglial cells was utilized as the biological marker for the screening. After several rounds of purification, a purified bioactive compound was isolated. After spectroscopic analysis by nuclear magnetic resonance and gas chromatography-mass spectrometry, the compound was identified as genipin (1R,4aS,5,7aS-tetrahydro-1-hydroxy-7-(hydroxymethyl)-cyclopenta[c]pyran-4-carboxylic acid, methyl ester). Mechanisms of the suppressive action on signaling pathways were investigated in the LPS-activated BV-2 cells.
Our results demonstrated that genipin can dose-dependently inhibit LPS-stimulated nitric oxide overproduction. It can also suppress mRNA levels and protein expressions of inducible nitric oxide synthase (iNOS) and TNF-αupon LPS-induction. In addition, the phosphorylations of phosphoinositide-3 kinase (PI3K) and protein kinase B (Akt) were suppressed. In contrast, the phosphorylations of mitogen-activated protein kinases (MAPKs), nuclear translocation of nuclear factor-κB (NF-κB) p65 and degradation of inhibitory κB-α (IκB-α) were not affected by genipin. Finally, genipin protected murine Neuro-2a neuroblast against neurotoxicity stimulated by the conditioned media transferred from LPS-challenged BV-2 cells.
In conclusion, the anti-inflammatory effects of genipin are via the modulation of PI3K/Akt signaling pathway. Genipin and its synthetic analogues may have great potential for developing into new drugs in treating ischemic stroke. In addition, genipin can be used as the chemical marker to standardize the extract of Eucommia ulmoides Oliver as anti-inflammatory agents for treating inflammatory conditions associated with ischemic stroke.published_or_final_version
Paediatrics and Adolescent Medicine
Master
Master of Philosophy
50
Gu, Yong, and 顧勇. "Targeting caveolin-1 as a therapeutic approach to prevent blood-brain barrier breakdown in ischemic stroke : from mechanism to isoflavones treatment." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/197561.
Full textAbstract:
Our group previously reported that caveolin-1 (cav-1) was down-regulated by nitric oxide (NO) during cerebral ischemia and reperfusion (I/R). However, the role of cav-1 in regulating blood-brain barrier (BBB) permeability is unclear yet. This study aims to address whether the loss of cav-1 induced by NO production affects BBB permeability. Data showed that the expression of cav-1 in isolated cortical microvessels was down-regulated in ischemia-reperfused rat brains subjected to middle cerebral artery occlusion (MCAO). Treatment of NG-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor, reserved cav-1 expression, inhibited matrix metalloproteinases (MMPs) activity and reduced the BBB permeability. Moreover, cav-1 knockdown remarkably increased MMPs activity in the culture medium of brain microvascular endothelial cells. Cav-1 deficiency mice displayed higher MMPs activity and BBB permeability than that of the wild-type mice. Interestingly, the effects of L-NAME on MMPs activity and BBB permeability were partly reversed in cav-1 deficiency mice. These results suggest that cav-1 plays important roles in regulating MMPs activity and BBB permeability in cerebral I/R injury.
After completing the mechanism study, I investigated the potential drug candidate that targets cav-1 for protecting BBB and neuronal damage during cerebral I/R. Results showed that calycosin, an isoflavones from Astragali Radix, up-regulated the expression of cav-1 and inhibited MMPs activity, and decreased the BBB permeability in the MCAO ischemia-reperfused rat brains. I further investigated the neuroprotective effects of isoflavones of Astragali Radix, with in vitro oxygen glucose deprivation (OGD) model and in vivo cerebral ischemia-reperfusion models. In addition to calycosin and formononetin, two major isoflavones in Astragali Radix, daidzein was also included because it is a metabolite of formononetin after absorption. Results showed that all three isoflavones decreased infarction volume and neurological scores in MCAO rats and dose-dependently attenuated neuronal death induced by L-glutamate treatment and oxygen-glucose deprivation plus reoxygenation (OGD/RO). The neuroprotective effects were inhibited by estrogen receptors (ER) antagonist ICI 182,780. Interestingly, combine treatment of isoflavones displayed synergistic effects in both OGD/RO and L-glutamate induced neuronal injury models, as well as in MCAO cerebral ischemia-reperfusion rat brains. Mechanistically, estrogen receptor antagonist partly reduced the synergism in these models. PI3K/Akt activation was synergistically induced by treatment of those isoflavones simultaneously.
In summary, cav-1 could be a potential therapeutic target for protecting the BBB in the treatment of cerebral I/R injury. Major findings in this thesis include: 1) Cav-1 plays an important role in maintaining BBB integrity through inhibition of MMPs activity. NO induced MMPs activities and BBB leakage are partially mediated by the down-regulation of cav-1 during cerebral I/R injury. 2) Calycosin treatment reserved cav-1 expression and reduced BBB permeability. 3) Isoflavones synergistically protected neurons against I/R-induced neuronal insults both in vitro and in vivo. The works provide a valuable step towards the clarification of the physiological and pathophysiological functions of cav-1, and a new clue for developing isoflavones as agents targeting cav-1 for the prevention or treatment of ischemic stroke.published_or_final_version
Chinese Medicine
Doctoral
Doctor of Philosophy