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Öğe The effect of robotic rehabilitation for recovery of hand functions in patients with acute stroke: pilot study(Science Direct, 2020) Akçay, S.; Karagözoğlu Coşkunsu, D.; Erkan Oğul, Ö.; Akyol, D.K.; Öztürk, N.; Krespi, YakupStroke is one of the main causes of disability worldwide [1]. Although there are some functional improvements in weeks and months in the acute period after stroke, the improvement of motor functions in the upper limb is rather weak compared to the lower limb.Öğe Effectiveness of Conventional Dysphagia Therapy (CDT), Neuromuscular Electrical Stimulation (NMES), and Transcranial Direct Current Stimulation (tDCS) in Acute Post-Stroke Dysphagia: A Comparative Evaluation(Springer, 2024) Bengisu, Serkan; Demir, Numan; Krespi, YakupThis study aims to compare the effectiveness of conventional dysphagia therapy (CDT), neuromuscular electrical stimulation (NMES), and transcranial direct current stimulation (tDCS) in the treatment of post-stroke dysphagia. A single-blind randomized controlled trial was conducted with 40 acute stroke patients - 18 females and 22 males with a mean age of 65.8 +/- 11.9. The subjects were grouped into 4, with 10 individuals in each. The procedures administered to groups were as follows: the first group, sham tDCS and sham NMES; the second group, tDCS and sham NMES; the third group, NMES and sham tDCS; and the fourth group, all therapy procedures. CDT was applied to all groups either as a standalone procedure or combined with one or two of the instrumental techniques. Gugging Swallowing Screen (GUSS) and Videofluoroscopic Swallowing Study (VFSS) were employed to determine the severity of dysphagia and the effectiveness of treatment modalities. Additionally, the Penetration Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Dysphagia Severity Rating Scale (DSRS) were administered to interpret VFSS data. Pre- and post-treatment comparisons of all groups have revealed a statistically significant difference for all parameters except for the PAS scores at International Dysphagia Diet Standardization Initiative (IDDSI)-Level 4 consistencies. However, the differences between pre- and post-treatment scores of the fourth group across all parameters were significant - GUSS (p = 0.005), FOIS (p = 0.004), DSRS (p = 0.005), PAS IDDSI-4 (p = 0.027), PAS IDDSI-0 (p = 0.004). Inter-group comparisons, on the other hand, pointed out that the difference between pre- and post-treatment GUSS, FOIS, DSRS, and PAS scores at IDDSI Level-0 consistencies was statistically significant for all groups - GUSS (p = 0,009), FOIS (p = 0,004), DSRS (p = 0,002), PAS IDDSI-0 (p = 0,049). Closer examination of treatment groups indicated that the tDCS + CDT group, the NMES + CDT group, and the group that underwent the combination of three modalities made better progress than the one that was treated with only CDT. Though not statistically significant, the NMES + CDT group achieved better improvement than the tDCS + CDT group. This study has yielded that the group in which NMES, tDCS, and CDT were applied in combination has achieved better results than all the other groups. All treatment modalities applied to accelerate the general recovery process in acute stroke patients with dysphagia were found to be effective for the treatment of post-stroke swallowing disorders. The use of instrumental treatments such as NMES and tDCS enhanced the effectiveness of the treatment and provided more significant progress. Furthermore, combining treatment modalities such as NMES and tDCS was more effective when compared to using only conventional therapy. As a result, the most effective treatment outcomes were obtained by the group receiving CDT, NMES, and tDCS in combination. Therefore, the use of combined approaches has been recommended in appropriate patients; yet the provisional results should be tested in randomized trials with more participants.Öğe The effects of diffusion and perfusion MRI mismatch on the admission blood glucose and blood pressure values measured in the first 12 hours of acute stroke(Lippincott Williams & Wilkins, 2019) Gur-Ozmen, Selen; Gungor-Tuncer, Ozlem; Krespi, YakupPatients with severe stroke and salvageable brain tissue at admission, who have higher glycaemic and blood pressure levels, may have a risk of iatrogenic hypoglycemia/iatrogenic hypotension. In this study, we examined the relationship between the presence of diffusion-weighted imaging (DWI)/perfusion-weighted imaging (PWI) mismatch, admission blood glucose level, and admission blood pressure level in patients who were admitted in the first 12 hours after onset. We studied 212 patients who were prospectively and consecutively registered to the stroke unit from 2006 to 2009. Correlations between mismatch and admission blood pressure level (ABPL) and admission blood glucose level (ABGL) were analyzed using multivariate logistic regression. Mismatch (P=.064, adjusted OR=2.297, 95% CI, 0.953-5.536) was not associated with a high ABGL in the whole group. However, after excluding patients with diabetes mellitus (DM) (n=67, 35%), mismatch (P=.033, adjusted OR=3.801, 95% CI, 1.110-13.015), an impaired level of consciousness, use of anti-DM medication, glycated hemoglobin levels, and cardioembolic aetiology were independent predictors of a high ABGL. The presence of mismatch or proximal vessel occlusion was not associated with ABPL. Female sex (P=.048) and total anterior circulation stroke (P=.008) were independent predictors associated with a higher ABPL. We conclude that patients with hyperacute ischemic stroke with PWI/DWI mismatch are more likely to have hyperglycemia.Öğe Effects of robotic rehabilitation on recovery of hand functions in acute stroke: A preliminary randomized controlled study(Wiley, 2022) Karagozoglu Coskunsu, Dilber; Akcay, Sumeyye; Ogul, Ozden Erkan; Akyol, D. Kubra; Ozturk, Necla; Zileli, Fusun; Baştan Tuzun, Birgul; Krespi, YakupObjective: The aim of this study was to investigate the effects of EMG-driven robotic rehabilitation on hand motor functions and daily living activities of patients with acute ischemic stroke. Materials & method: A preliminary randomized-controlled, single-blind trial rectuited twenty-four patients with acute ischemic stroke (<1 month after cerebrovascular accident) and randomly allocated to experimental group (EG) and control group (CG). Neurophysiological rehabilitation program was performed to both EG and CG for 5 days a week and totally 15 sessions. The EG also received robotic rehabilitation with the EMG-driven exoskeleton hand robot (Hand of Hope®, Rehab-Robotics Company) 15 sessions over 3 weeks. Hand motor functions (Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT)), activities of daily living (Motor Activity Log (MAL)), force and EMG activities of extensor and flexor muscles for the cup test were evaluated before treatment (pretreatment) and after the 15th session (posttreatment). Results: Eleven patients (59.91 ± 14.20 yr) in the EG and 9 patients (70 ± 14.06 yr) in the CG completed the study. EG did not provide a significant advantage compared with the CG in FMA-UE, ARAT and MAL scores and cup-force and EMG activities (p > .05 for all). Conclusion: In this preliminary study, improvement in motor functions, daily living activities and force were found in both groups. However, addition of the EMG-driven robotic treatment to the neurophysiological rehabilitation program did not provide an additional benefit to the clinical outcomes in 3 weeks in acute stroke patients.Öğe Gastrostomy in hospitalized patients with acute stroke: norotek Turkey point prevalence study subgroup analysis(Galenos Publ House, 2022) Topçuoğlu,Mehmet Akif; Özdemir, Atilla Özcan; Aykaç, Özlem; Milanoğlu, Aysel; Gökçe, Mustafa; Krespi, YakupObjective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NoroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69 +/- 14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (ss): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (ss): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (ss): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (ss): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (ss): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NoroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.Öğe Outcome after intravenous thrombolysis in patients with acute lacunar stroke: an observational study based on SITS international registry and a meta-analysis(Sage Publications Ltd, 2019) Matusevicius, Marius; Paciaroni, Maurizio; Caso, Valeria; Bottai, Matteo; Khurana, Dheeraj; de Bastos, Mario; Martins, Sheila C. O.; Krespi, Yakup; Cooray, Charith; Toni, Danilo; Ahmed, NiazBackground Intravenous thrombolysis (IVT) for lacunar stroke (LS) is debated, as the underlying pathophysiological mechanism may not be thrombogenic. Aims To investigate outcomes after IVT in LS in the SITS International Stroke Thrombolysis Register and perform a meta-analysis. Methods LS was identified by both baseline NIHSS-subscores and discharge ICD-10 codes, and contrasted by IVT to non-IVT treated. IVT patients were predominantly from Europe, non-IVT patients predominantly from South America and Asia. Outcome measurements were functional independence (modified Rankin Scale [mRS] score <= 2), excellent outcome (mRS <= 1), and mortality at three months. Matched-control comparisons of symptomatic intracerebral hemorrhage (SICH) between IVT-treated LS and IVT-treated non-LS patients were performed. Additionally, we performed a meta-analysis. Results Median age for IVT-treated LS patients (n = 4610) was 66 years vs. 64 years and NIHSS score was 6 vs. 3, compared to non-IVT-treated LS (n = 1221). Univariate outcomes did not differ; however, IVT-treated LS patients had higher adjusted odds ratios (aOR) for functional independence (aOR = 1.65, 95% CI = 1.28-2.13) but similar mortality at three months (aOR = 0.57, 0.29-1.13) than non-IVT-LS. Propensity-score matched analysis showed that IVT-treated LS patients had a 7.1% higher chance of functional independency than non-IVT LS patients (p < 0.001). IVT-treated LS patients had lower odds for SICH (aOR = 0.33, 0.19-0.58 per SITS, aOR = 0.40, 0.27-0.57 per ECASS-2) than matched non-LS controls, which was mirrored in the meta-analysis. Conclusions Our adjusted results show that IVT treatment in LS patients was associated with better functional outcome than non-IVT-treated LS and less SICH than IVT-treated non-LS patients.Öğe Validation of the Turkish version of the Neurological Fatigue Index for Stroke(Routledge Journals, Taylor & Francis Ltd, 2024) Kucukakgun, Hilalnur; Tulek, Zeliha; Kilicaslan, Kimya; Uncu, Jbid Dursun; Bayrak, Ceren; Soltanalizadeh, Roya; Krespi, YakupIntroductionPost-stroke fatigue is an often overlooked problem that hinders recovery. Therefore, stroke patients should be evaluated for fatigue during the recovery period. This study aimed to adapt the Neurological Fatigue Index for Stroke (NFI-Stroke) into the Turkish language.MethodsThis methodological study was carried out on 110 stroke patients admitted to a university hospital in Istanbul. In addition to the NFI-Stroke, Functional Independence Measure, National Institutes of Health Stroke Scale, modified-Rankin Scale, Fatigue Severity-Scale, and Stroke Self Efficacy Questionnaire were used to collect data.ResultsSince the linguistic validity study of the scale has already been carried out, only psychometric properties were evaluated. The items in the scale were grouped under two factors. The Cronbach`s alpha coefficient was found to be 0.96 for the physical sub-dimension and 0.84 for the cognitive sub-dimension. Item-total correlation coefficients were found between 0.74-0.91 for the physical sub-dimension, and 0.82-0.91 for the cognitive sub-dimension. The test-retest evaluation confirmed the consistency of the responses to the scale against time. The scale was correlated with other scales used in the study as expected.ConclusionsThe NFI-Stroke will be useful in clinical practice in assessment of fatigue, which may affect the adaptation of patients to rehabilitation.Öğe Vasküler risk faktörlerinin kognitif durumla ilişkisi(2020) Tufekcioglu, Zeynep; Tuncer, Ozlem Gungor; Krespi, Margorit Rita; Krespi, YakupGiriş: Vasküler risk faktörlerinin kognitif bozukluğun değiştirilebilir risk faktörlerinden olduğu öne sürülmektedir. Çalışmamızda, kardiyovasküler hastalık ve demans öyküsü olmayan, 60 yaş ve üzerindeki bireylerde on yıllık koroner kalp hastalığı ve inme risk skorları ile kognitif durum arasındaki ilişki araştırıldı. Gereç ve Yöntem:İnme Merkezi “İnme ve Demans Primer Koruma Polikliniği” ne ardışık olarak başvurmuş olan bireylerin verileri retrospektif olarak incelendi. On yıllık koroner kalp hastalığı ve inme risklerini değerlendirmek amacıyla sırasıyla Framingham Risk Skoru (FRS) ve ModifiyeFramingham İnme Risk Profili (FSRP) kullanıldı. Kognitif fonksiyonlar Montreal Bilişsel Değerlendirme Ölçeği (MoCA) ile değerlendirilmişti. Bu testin Türkiye standardizasyon çalışmasına göre MoCA? 21 olanlar kognisyonu bozuk olarak kabul edildi. Kognitif durum ile vasküler risk arasındaki ilişki multivariat lojistik regresyon analizi ile araştırıldı. Yaş, cinsiyet, eğitim düzeyi, diğer kognisyonla ilişkili olabilecek etkenler, antihiperlipidemik, antidiyabetik ve antihipertansif tedavi kullanımı analize alındı. Bulgular: Örneklem 167 bireyden (40 erkek ve 127 kadın) oluşmaktaydı. Ortalama yaş 68 (SD: 6 Aralık: 28) idi. Ortalama FRS ve FSRP sırasıyla 8(20-3) ve 7(11-4) idi. Elli beş kişinin (%33) kognitif durumu bozuktu. Framingham Risk Skorundaki her %10’ luk artış kognisyonun bozuk olmasıyla ilişkiliydi (OR:1,669, 95%CI 1,038-2,682). İleri yaş, düşük eğitim düzeyi, alkol ve antihiperlipimik tedavi kullanmıyor olmak da ilişkili diğer bağımsız faktörlerdi. Ancak FSRP ile kognitif durum arasında ilişki saptanmadı. Sonuç: Kardiyovasküler hastalık öyküsü olmayan yaşlı bireylerde, FRS ile ölçülen global vasküler risk kognitif bozuklukla ilişkiliyken FSRP ile benzer ilişki saptanmamıştır. Bu ilişki, rutin klinik değerlendirmede kullanılan ve hafif kognitif bozukluğa duyarlı nöropsikolojik bir test olan MoCA ile gösterilmiştir.
