The results demonstrate a strong association between the APOE-epsilon4 allele and a poor clinical outcome, implying genetic susceptibility to the effect of brain injury. Additional studies of TBI patients are warranted to confirm their findings.
Objective
To evaluate the effectiveness of early and prolonged locomotor treatment with the use of a robotic‐assisted gait training (RAGT) device (Lokomat; Hocoma Inc., Zurich, Switzerland) on the functional outcomes of patients after subacute stroke.
Design
A nonblinded prospective, randomized, controlled study.
Setting
Rehabilitation department in tertiary university medical center.
Patients
Sixty‐seven patients in the first 3 months after subacute stroke were randomized into 2 groups as follows. Thirty‐seven patients were treated with RAGT, and 30 were treated with regular physiotherapy. Inclusion criteria were first stroke, independent ambulation before the stroke, and neurological severity between 6 and 20 according to the National Institutes of Health Stroke Scale (NIHSS).
Intervention
RAGT treatment was administered 3 times a week for 30 minutes, combined with regular physiotherapy for 6 weeks. Control patients received the equivalent additional time of regular physiotherapy.
Main outcome measurements
The primary outcome was the ability to walk independently, as assessed by use of the functional ambulatory capacity scale. The secondary outcomes included the neurological status according to the NIHSS; functional motor assessment (determined by use of the stroke activity scale); and gait parameters, including gait velocity, endurance, and number of climbed stairs.
Results
In the intention‐to‐treat analysis, subjects in the RAGT group exhibited greater gains than the control group in their ability to walk independently, as expressed by a greater functional ambulatory capacity score (P < .01), and in their neurological status according to NIHSS (P < .01). Among those who achieved independent walking, nonsignificant differences between groups were noted according to secondary outcome measures of gait parameters except from step climbing.
Conclusion
This controlled study showed, at the end of a 6‐week trial, that locomotor therapy with the use of RAGT combined with regular physiotherapy produced promising effects on functional and motor outcomes in patients after subacute stroke as compared with regular physiotherapy alone.
Early, moderately intense aerobic training has no direct impact on independence in daily and social activities as measured by FAI total score six months after a stroke.
Electromyography (EMG) of the inferior pharyngeal constrictor (IC) and the cricopharyngeal (CP) muscle was recorded in 18 patients with swallowing and/or aspiration problems who were candidates for cricopharyngeal myotomy. The EMG recordings were compared to those of 13 "normal" subjects who did not suffer from such problems. Differences in EMG activity between the control group and the patient group were considered with respect to the clinical symptoms in the patient group. Recording of EMG in the CP and IC muscles is relatively safe, useful, and easily mastered. The technique may provide important information regarding the function of some of the muscles involved in deglutition.
Aims-To study the localisation of the endothelial nitric oxide synthase (eNOS) in the normal placenta, with special emphasis on the implantation site in the first trimester of pregnancy, and in the diVerent subtypes of trophoblastic cells in gestational trophoblastic disease. Methods-The immunoperoxidase technique with an antibody directed against eNOS was applied to paraYn sections from first and second trimester placentas, placenta accreta, partial and complete hydatidiform moles, and choriocarcinoma. Immunoperoxidase staining for human placental lactogen (hPL) was performed on parallel sections. Results-Prominent immunoreactivity for eNOS was found to be present in the intermediate trophoblastic cells of the cell columns of the anchoring villi and in trophoblastic cells at the implantation site. Staining was also present in the syncytiotrophoblast, most conspicuous at the apical cell border. In trophoblastic disease, proliferating large mononuclear cells, which were strongly positive for hPL, were found to be immunoreactive for eNOS. Conclusions-eNOS immunoreactivity is strongly positive in the extravillous trophoblastic cells and to a lesser extent in the syncytiotrophoblast. In the former it may play a role in implantation and vascular invasion. Cells with diVerentiation to intermediate trophoblast in complete hydatidiform mole and choriocarcinoma also show high levels of eNOS, which may be associated with the haematogenous mode of spread of trophoblastic disease. (J Clin Pathol 1998;51:427-431)
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