Neurological outcome, mental fatigue and occurrence of aneurysms more than 15 years after aneurysmal subarachnoid haemorrhage

Your definition of good is NOT what your survivors would say. I would suggest listening to survivors you might then do the right thing.

Neurological outcome, mental fatigue and occurrence of aneurysms more than 15 years after aneurysmal subarachnoid haemorrhage

Author links open overlay panelJenniferSamuelsson¹²

HugoJakobsson¹AlexandrosRentzos³⁴Asgeir S.Jakola¹²DanielNilsson¹²

¹

Institute of neurosciences and Physiology, Sahlgrenska Academy, Gothenburg University, Sweden

²

Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden

³

Department of Diagnostic and interventional neuroradiology, Sahlgrenska University Hospital, Gothenburg, Sweden

⁴

Department of Radiology, Institute of clinical sciences, University of Gothenburg, Sweden

Received 1 December 2020, Revised 28 March 2021, Accepted 29 March 2021, Available online 5 April 2021.

https://doi.org/10.1016/j.wneu.2021.03.148Get rights and content

Objectives

Long-term data on neurological and radiological outcome after aneurysmal subarachnoid haemorrhage (aSAH) is scarce. The aims of this study were to report neurological and radiological outcome more than 15 years after aSAH.

Patients and methods

Patients from Western Sweden with aSAH randomized to endovascular (EVT) or microsurgical treatment (MST) from 1997 to 2001 were included. Main end-points were neurological outcome assessed by modified Rankin scale (mRS), fatigue assessed by mental fatigue scale (MFS) and radiological outcome assessed by magnetic resonance angiography (MRA). Results were compared to a control group for MFS.

Results

Forty-six patients (62.2%) of the 74 survivors replied after 15-21 years. Eighteen had MST and 28 had EVT. mRS 0-2 was found in 100% of EVT patients and in 88.8 % of MST patients. Moderate or severe mental fatigue was found in 7/28 patients (25 %) in the EVT group and 7/18 patients (38.8 % (p<0.05)) in the MST group, whereas moderate or severe mental fatigue was observed in 3/34 (8.9 %) in the control group. Twenty-nine patients agreed to do an MRA. In the EVT group, new neck remnants were found in 2/16 (12.5%) and de novo aneurysm was found in 2/16 (12.5%). In the MST group de novo aneurysm was found in 1/13 (7.7%).

Conclusions

Neurological outcome at long-term follow-up after aSAH was good, however mental fatigue was overrepresented compared to healthy controls, regardless of treatment modality. Residual or de novo aneurysm was found in 17% of patients warranting radiological long-term follow-up.

 

Exercise-mediated locomotor recovery and lower-limb neuroplasticity after stroke

Maybe you can get a protocol out of this.  I don't do treadmills anymore, they don't readily transfer to the vagaries of walking over rocks, tree roots and through water.  Real life walking will train your balance much faster and you can get forest bathing out of it.

Exercise-mediated locomotor recovery and lower-limb neuroplasticity after stroke

 Larry W. Forrester, PhD;
1–2
*
 Lewis A. Wheaton, PhD;
3
 Andreas R. Luft, MD
4
1
 Department of Veterans Affairs (VA) Maryland Health Care System, Research Service, Baltimore, MD;
2
 Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD;
3
VA  Maryland Health Care System, Baltimore, MD;
4
 Hertie Brain Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany

Abstract—

Assumptions that motor recovery plateaus within months after stroke are being challenged by advances in novel motor-learning-based rehabilitation therapies. The use of lower-limb treadmill (TM) exercise has been effective in improving hemiparetic gait function. (Improving is NOT GOOD ENOUGH! We want full recovery. Damn it all, do the right thing. 100% recovery for all.)In this review, we provide a rationale for treadmill exercise as stimulus for locomotor relearning after stroke. Recent studies using neuroimaging and neurophysiological measures demonstrate central nervous system (CNS) influences on lower-limb motor control and gait. As with studies of upper limbs, evidence shows that rapid transient CNS plasticity can be elicited in the lower limb. Such effects observed after short-term paretic leg exercises suggest potential mechanisms for motor learning with TM exercise. Initial intervention studies provide evidence that long-term TM exercise can mediate CNS plasticity, which is associated with improved gait function. Critical needs are to determine the optimal timing and intensities of TM therapy to maximize plasticity and learning effects.