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Study Objectives: The prevalence of obstructive sleep apnea (OSA) after stroke is variable, likely due to the time of examination and patient population. Although risk factors for OSA are well established, those for OSA in patients with ischemic stroke have not yet been fully identified. Therefore, we examined the prevalence of OSA and identified risk factors for OSA in the acute stage of ischemic stroke in the Taiwanese population., Methods: A total of 103 patients with acute ischemic stroke were screened for OSA by performing polysomnography. The demographic and clinical data, Epworth Sleepiness Scale score, and other stroke risk factors were recorded. Sleep parameters, namely sleep efficiency, sleep stages, apnea-hypopnea index, and oxygen desaturation index were recorded. Logistic regression analysis was conducted to determine clinical and demographic risk factors for moderate to severe OSA in patients with stroke., Results: We determined that 91.2% of the patients had OSA in the acute stage of ischemic stroke, and 70% of the patients had moderate to severe OSA. Multivariate logistic regression analysis revealed that patients aged ≥65 years had a significantly higher risk of moderate to severe OSA (adjusted OR: 3.04, 95% CI: 1.20-7.69, p < 0.05) compared with patients with ischemic stroke aged <50 years., Conclusion: OSA is highly prevalent among patients with ischemic stroke in the acute stage, and those aged ≥65 years had a significantly increased risk of moderate to severe OSA. In clinical practice, routine PSG screening of OSA may be necessary among older patients with stroke., Competing Interests: Declaration of competing interest The authors declare no financial and non-financial competing interests., (Copyright © 2023. Published by Elsevier B.V.)

Background: Impaired upper limb function in stroke survivors is characterized by muscle weakness, increased muscle tone, contracture, or impaired motor control., Objective: We aimed to evaluate the effectiveness of Kinesio-taping application for functional recovery on the affected arm and forearm during rehabilitation., Methods: Forty-one patients eligible for this study were randomly assigned to either the Kinesio-taping group (n = 21), receiving Kinesio-taping intervention and conventional therapy, or control group (n = 20), receiving sham Kinesio-taping intervention and conventional therapy. The whole intervention lasted for 3 weeks. Fugl-Meyer assessment of the upper extremity, Barthel Index, the Stroke Impact Scale, and modified Ashworth scale were measured at 3 time points: baseline, post-treatment (3rd week), and follow-up (6th week)., Results: In the Kinesio-taping group, there were significant differences in the upper extremity (p = 0.003), wrist (p = 0.000) and hand (p = 0.000) parts of the Fugl-Meyer assessment of the upper extremity between the three assessment times. On the other hand, the Barthel Index showed significant differences in both groups after therapy., Conclusion: Combining conventional rehabilitation with Kinesio-taping intervention may improve functional motor performance of both the proximal and distal parts of the affected upper extremity in stroke survivors, with potential benefits for activity of daily living.

Objectives: This study is aimed at exploring the feasibility of sonoelastography on muscle stiffness of spastic forearm and evaluating the improvement of functional performance in patients with poststroke spasticity (PSS) after receiving kinesiotaping (KT) and rehabilitation., Methods: According to the spastic levels (using modified Ashworth scale (MAS)) of the affected upper extremity, 59 patients with stroke were allocated into two groups, group A (MAS 0-1): 31 patients (14 men and 17 women; mean age: 60 years) and group B (MAS 1+-2): 28 patients (22 men and 6 women; mean age: 51 years). The Brunnstrom motor recovery stage at the wrist/distal parts in groups A and B was stage 3/3.5 and stage 2.75/3. We evaluated the Brunnstrom stage, spastic levels by MAS and modified Tardieu scale (MTS), and Fugl-Meyer Assessment for upper extremity (FMA-UE). We also evaluated the muscle spasticity of flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and flexor digitorum superficialis (FDS) muscles using sonoelastography with shear wave velocity (SWV). We applied KT for 20 patients in group B, comparing the changes in sonoelastography and functional outcomes between KT and without KT interventions., Results: Both the MAS and MTS scales were moderately correlated with the SWV in forearm muscles on hemiplegic side ( r = 0.336-0.554) After KT intervention, the SWV in FCR decreased ( p = 0.028). Muscle spasticity was reduced ( p < 0.01), and distal part of the Brunnstrom stage and FMA-UE were increased ( p = 0.045 and p = 0.001). In patients without KT intervention, only the MTS degree reduced ( p = 0.026)., Conclusions: The SWV of sonoelastography could objectively assess the reduction of muscle stiffness of the affected forearms in patients with PSS after KT intervention. Advances in Knowledge . Sonoelastography could be a quantitative method to follow up for therapeutic effect of the spastic forearm., Competing Interests: There are no conflicts of interest to declare., (Copyright © 2023 Shih-Jung Lai et al.)

Objective: To investigate the association between poststroke depression (PSD) and psychological crisis in patients who have experienced a stroke within 6 months., Methods: This was a retrospective cross-sectional study that enrolled patients within 6 months after stroke onset. The investigators reviewed medical charts to obtain patients' baseline characteristics, and a psychologist evaluated each patient for depression using the Taiwanese Depression Questionnaire (TDQ) and for psychological crisis using the Triage Assessment System (TAS). A generalized linear model (GLM) was used to analyze the association between the results of the TDQ and TAS., Results: Ninety-seven patients with stroke were included. Age ( p = 0.003), time since onset of stroke ( p = 0.041), diabetes mellitus ( p = 0.004), hypertension ( p = 0.016), heart disease ( p = 0.005), and TDQ score were significantly different between the hemorrhagic stroke group and the ischemic stroke group. The TDQ score was significantly lower in the hemorrhagic stroke group ( p = 0.012). The TDQ score was associated with the TAS total score and each domain score, and the presence of heart disease was associated with poorer TAS score in the behavioral domain ( p = 0.016)., Conclusion: PSD is likely an important component of psychological crisis in stroke patients. For clinicians, a comprehensive psychologic evaluation is necessary to optimize treatment., Competing Interests: There are no conflicts of interest to declare. The authors report no actual or potential conflicts of interest, including any financial, personal, or other relationships with other people or organizations, within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, the work., (Copyright © 2021 Han-Chin Hsieh et al.)

Aim: The aim of this study was to determine the diagnostic accuracy of the water swallow test for screening aspirations in stroke patients., Background: The water swallow test is a simple bedside screening tool for aspiration among stroke patients in nursing practice, but results from different studies have not been combined before., Design: A systematic review and meta-analysis was conducted to provide a synthetic and critical appraisal of the included studies., Data Sources: Electronic literature in MEDLINE, EMBASE, CINAHL and other sources were searched systemically in this study. Databases and registers were searched from inception up to 30 April 2015., Review Methods: This systematic review was conducted using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy. Bivariate random-effects models were used to estimate the diagnostic accuracy across those studies. The tool named Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies., Results: There were 770 stroke patients in the 11 studies for the meta-analysis. The water swallow test had sensitivities between 64-79% and specificities between 61-81%. Meta-regression analysis indicated that increasing water volume resulted in higher sensitivity but lower specificity of the water swallow test., Conclusions: This systematic review showed that the water swallow test was a useful screening tool for aspiration among stroke patients. The test accuracy was related to the water volume and a 3-oz water swallow test was recommended for aspiration screening in stroke patients., (© 2016 John Wiley & Sons Ltd.)

Background: Cardiopulmonary function can be adversely affected after a cerebrovascular accident in patients with congestive heart failure (CHF). The aim of this study was to investigate the efficacy and feasibility of inspiratory muscle training (IMT) for stroke patients with CHF., Methods: A prospective randomized single-blind controlled trial was conducted in a single tertiary medical center in southern Taiwan between May 2011 and July 2015. Forty-one patients were enrolled, of whom 21 completed the study (IMT group n = 11 and control group n = 10). Both groups participated in a conventional stroke rehabilitation program. Patients in the IMT group received an additional IMT program beginning with an intensity of 30% maximal inspiratory pressure (MIP), then increased by 2cmH2O each week for 30 minutes daily for at least 5 days a week for 10 weeks. MIP, maximal expiratory pressure, spirometry, resting oxyhemoglobin saturation, modified Borg Scale, Fatigue Assessment Scale, and Barthel Index were assessed in each patient., Results: There were significant differences from baseline in MIP (P = 0.008), percent predicted forced vital capacity (P = 0.033), forced expiratory volume in 1 second (FEV1) (P = 0.008), percent predicted FEV1 (P = 0.008), and Barthel Index (P = 0.012) in the IMT group, and Barthel Index (P = 0.027) in the control group. There were significant differences between groups in MIP (20.91 ± 19.73 vs -9.00 ± 26.01, adjusted P value = 0.023) and Barthel Index (24.55 ± 22.30 vs 7.50 ± 8.25, adjusted P value = 0.044)., Conclusion: The 10-week IMT was feasible and effective in improving inspiratory force and activities of daily living for the stroke patients with CHF.

Music therapy (MT) has been adapted to post-stroke rehabilitation for years and there were several theories of treatment methods. Our music therapist utilized neurological MT to design a treatment program for stroke survivors. We aimed to compare the effects of a low-dose neurological MT with no MT on outcomes measuring depression, activity of daily living and cognitive function amongst stroke survivors. A single masked, randomized controlled study was designed and patients with subacute stroke were recruited. The patients were assigned to a MT group or a conventional therapy (CT) group. Both groups received CT including physical therapy and occupational therapy. Patients with aphasia also received speech therapy. The MT group underwent an additional hour of neurological MT per week for a total duration of 4 weeks. Our MT method comprised therapeutic singing, therapeutic instrument music playing, melodic intonation therapy, and rhythmic speech cueing. The primary outcome measure was the Beck Depression Inventory-II (BDI-II). Secondary outcomes were the Mini-Mental State Examination (MMSE), modified Rankin Scale (MRS) and Barthel Index (BI). Eighty-two patients were recruited. No significant differences were found at baseline. There was significant post-treatment effect among both groups for the BI (p < 0.001, Mdiff = 13.96, 95%CI = (11.64,16.29)), MMSE (p < 0.001, Mdiff = 1.04, 95%CI = (0.51,1.57)) and MRS (p < 0.001, Mdiff = −0.45, 95%CI = (−0.57,−0.34)). Additionally, a significant difference was observed between the groups for the MRS (p = 0.033, Mdiff = −0.24, 95%CI = (−0.03,0.52)). No significant between-group effect was found regarding the BI and MMSE. This study highlights the added value of MT in improving MRS, while requiring relatively less therapeutic time. [ABSTRACT FROM AUTHOR]

Background: Stimulant poisoning frequently causes altered mental status (AMS) and can result in severe cerebral vascular complications. The role of noncontrast brain computed tomography (CT) in acute stimulant-poisoned patients presenting with AMS remains unclear.Objectives: We examined the results and impacts of brain CT in acute stimulant-poisoned patients with AMS.Methods: We performed a retrospective single-center study that included all adult patients who presented to the emergency department with stimulant poisoning and AMS (Glasgow coma scale [GCS] score <15) between January 1, 2010 and December 31, 2017. Patients who had concomitant head trauma or who presented with focal neurologic symptoms were excluded. The primary outcome was the rate of acute abnormalities on brain CT. The secondary outcomes were to identify factors that affected the decision to perform brain CT in stimulant-poisoned patients with AMS and whether obtaining the brain CT scan itself affected the patients' prognoses.Results: The analysis included 66 patients, of whom 6 died from the poisoning. Noncontrast brain CT was performed in 31 patients and none had acute abnormalities. Patients who underwent brain CT were found to have worse GCS scores, higher body temperatures, higher intubation rates, higher admission rates, longer admission periods and intensive care unit stays, and a higher mortality rate. After adjusting for the propensity score, performing brain CT itself did not independently affect the patients' clinical outcomes.Conclusions: Nontrauma stimulant-poisoned patients presenting with AMS and without focal neurologic symptoms were unlikely to have acute abnormalities on brain CT. Patients who underwent brain CT scans had worse consciousness and greater disease severity. [ABSTRACT FROM AUTHOR]