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October 2017 Monthly Abstract


Nutrition and Stroke. Know your resources.

Stroke and nutrition: a review of studies

BACKGROUND: Stroke is one of the leading causes of death and certainly the major cause of disability in the world. Diet and nutrient has an effective role in prevention and control of the risk of stroke. The aim of this study was to review the studies on the relationship between dietary intake and stroke incidence. METHODS: In this study, the terms of "Fat", "cholesterol", "antioxidant", "vitamins", "salt", "potassium", "calcium", "carbohydrate", "vegetables", "fruits", "meat", "tea", "whole grains", "sugar-sweetened beverages", "Mediterranean diet", "dietary approaches to stop hypertension diet (DASH diet)", "Western diet", and "stroke" were searched in Pubmed search engine. The observational studies, cohort studies, clinical trial studies, systemic review, and meta-analysis reviews are also included in this study. RESULTS: The study revealed that adherence to theimprovements in nutrition and diet canreducethe incidence ofstroke. Higher antioxidant, vitamins, potassium, calcium, vegetables, fruits, whole grain intake, and adherence to the Mediterranean dietor DASH diet can lower stroke incidence. CONCLUSIONS: Adherence to Mediterranean diet or DASH diet and increasing the consumption of antioxidant, vitamins, potassium, calcium food sources, vegetables, fruits, and whole grains intake can lower the risk of stroke. Healthy diet is effective in reducing risk of stroke, however, more studies need to be carried out in this area.

Foroughi M, Akhavanzanjani M, Maghsoudi Z, Ghiasvand R, Khorvash F, Askari G. Stroke and nutrition: a review of studies. Int J Prev Med. 2013;4(Suppl 2):S165-179.


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August 2017 Monthly Abstract

Practical information, sleep hygiene tips!!

Siengsukon, C. F., et al. (2017). "Sleep Health Promotion: Practical Information for Physical Therapists." PHYS THER 97(8): 826-836.

Sleep disturbances occur in one third of the US population, and the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control has deemed insufficient sleep to be a public health problem. Knowledge about sleep and skills to screen sleep disorders and to promote sleep health have been recommended for physical therapists. Furthermore, in survey studies, physical therapists overwhelmingly agree that sleep is important for health and poor sleep impairs function. Sleep is critical for the proper functioning of the body, including immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, and learning and memory. Sleep disruptions occur across the life span and in individuals with various conditions that are typically treated by physical therapists. Therefore, the purpose of this perspective paper is to (1) discuss the relevance of sleep to physical therapist practice, (2) recommend tools to screen for the 3 most common sleep disorders, and (3) provide suggestions for how therapists can integrate sleep health in prevention, health promotion, and wellness interventions.

March 2017 Monthly Abstract

Can Neurological Biomarkers of Brain Impairment Be Used to Predict Poststroke Motor Recovery? A Systematic Review.

Background. There is growing interest to establish recovery biomarkers, especially neurological biomarkers, in order to develop new therapies and prediction models for the promotion of stroke rehabilitation and recovery. However, there is no consensus among the neurorehabilitation community about which biomarker(s) have the highest predictive value for motor recovery. Objective. To review the evidence and determine which neurological biomarker(s) meet the high evidence quality criteria for use in predicting motor recovery. Methods. We searched databases for prognostic neuroimaging/neurophysiological studies. Methodological quality of each study was assessed using a previously employed comprehensive 15-item rating system. Furthermore, we used the GRADE approach and ranked the overall evidence quality for each category of neurologic biomarker. Results. Seventy-one articles met our inclusion criteria; 5 categories of neurologic biomarkers were identified: diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), functional magnetic resonance imaging (fMRI), conventional structural MRI (sMRI), and a combination of these biomarkers. Most studies were conducted with individuals after ischemic stroke in the acute and/or subacute stage (~70%). Less than one-third of the studies (21/71) were assessed with satisfactory methodological quality (80% or more of total quality score). Conventional structural MRI and the combination biomarker categories ranked “high” in overall evidence quality. Conclusions. There were 3 prevalent methodological limitations: (a) lack of cross-validation, (b) lack of minimal clinically important difference (MCID) for motor outcomes, and (c) small sample size. More high-quality studies are needed to establish which neurological biomarkers are the best predictors of motor recovery after stroke. Finally, the quarter-century old methodological quality tool used here should be updated by inclusion of more contemporary methods and statistical approaches.

Kim B, Winstein C. Can Neurological Biomarkers of Brain Impairment Be Used to Predict Poststroke Motor Recovery? A Systematic Review. Neurorehabilitation and neural repair. 2017;31(1):3-24.

Andrews AW, Li D, Freburger JK. Association of Rehabilitation Intensity for Stroke and Risk of Hospital Readmission. PHYS THER. 2015.


BACKGROUND: Little is known about the use of rehabilitation in the acute care setting and its impact on hospital readmissions. OBJECTIVE: The objective of this study was to examine the association between the intensity of rehabilitation services received during the acute care stay for stroke and the risk of 30-day and 90-day hospital readmission. DESIGN: A retrospective cohort analysis of all acute care hospitals in Arkansas and Florida was conducted. METHODS: Patients (N=64,065) who were admitted for an incident stroke in 2009 or 2010 were included. Rehabilitation intensity was categorized as none, low, medium-low, medium-high, or high based on the sum and distribution of physical therapy, occupational therapy, and speech therapy charges within each hospital. Cox proportional hazards regression was used to estimate hazard ratios, controlling for demographic characteristics, illness severity, comorbidities, hospital variables, and state. RESULTS: Relative to participants who received the lowest intensity therapy, those who received higher-intensity therapy had a decreased risk of 30-day readmission. The risk was lowest for the highest-intensity group (hazard ratio=0.86; 95% confidence interval=0.79, 0.93). Individuals who received no therapy were at an increased risk of hospital readmission relative to those who received low-intensity therapy (hazard ratio=1.30; 95% confidence interval=1.22, 1.40). The findings were similar, but with smaller effects, for 90-day readmission. Furthermore, patients who received higher-intensity therapy had more comorbidities and greater illness severity relative to those who received lower-intensity therapy. LIMITATIONS: The results of the study are limited in scope and generalizability. Also, the study may not have adequately accounted for all potentially important covariates. CONCLUSIONS: Receipt of and intensity of rehabilitation therapy in the acute care of stroke is associated with a decreased risk of hospital readmission.

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