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Background&Objective: Clinical findings effective on disability of stroke patients have importance due to their effects on prognosis and future recovery following rehabilitation. Materials&Methods: Consecutive stroke patients admitted in Valie-Asr hospital, Khorasan enrolled in a prospective study in 2005. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia were evaluated in the patients. Disability score was determined based on the Rankin scale at 72 hours post stroke. Mean of Rankin Disability Score (MRDS) was analysed by T and Fisher tests and p<0.05 declared as significant. Results: 329 stroke patients were investigated. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia were found in 37.4%, 13.8%, 7.9% and 7.3% respectively. MRDS was significantly higher in patients with hemianesthesia than other stroke patients, p<0.05. MRDS of patients with each of hemihypoestheisa, hemineglect and homonyous hemianopsia was not signigicantly different than patients without these abnormalities respectively. Patients with triad of hemianesthesia, hemineglect and homonymous hemianopsia had significantly higher MRDS than others , p<0.05. Conclusion: Hemianesthesia is the most important clinical effector on MRDS of the stroke patients. Presence of above triad predicts the highest MRDS in these patients.

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Background and Objective: Spasticity is common problem in stroke patients. Spasticity couse dysfunction and restricted activity. The most of patients have hand dysfunction due to stroke. This study was done to determine the effect of adjustable wrist hand splint on upper limb spasticity in post stroke patients.

Materials and Methods: This randomized clinical trial study was carried out on 15 patients with stroke referred to rehabilitation centers in Tehran-Iran during 2009. Patients randomly were divided into interventional (4 female, 3 men) and control (5 female, 3 men) groups. Common occupational therapy practice was carried out for 4 weeks for both groups equally. In treatment group intervention was based on the use of adjustable wrist hand splint moreover common occupational therapy practice. Upper limb spasticity pre and post intervention based on the Modified Ashworth Scale was evaluated. Data were analyzed by SPPS-17 software, pair-t-test and independent  t-test.

Results: Mean age of patients in interventional and control groups were 61.37±4.10 and 58.85±5.01 years respectively. After 4 weeks of treatment, the mean of spasticity was not significant between interventional and control groups, but internal analysis of spasticity were significant in interventional and control groups (P<0.05).

Conclusion: This study showed that the adjustable wrist hand splint is not useful in reduction of upper limb spasticity in post stroke patients.

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Background and Objective: Disability of upper extrimity from stroke are often permanent. Despite numerous functional problems, there is less attention to upper exterimity disabilitis than lower limbs. Some new methods of treatment focuses on using the magnetic stimulation as a means brain currents to produce therapeutic effects. This study was done to evalute the effect of low frequency repeatitive transcranial magnetic stimulation to improve motor function and grip force of upper limb in hemiplegic patients. Materials and Methods: This clinical trial study was done on 12 stroke hemiplegic patients in Firoozgar hospital in Tehran, Iran during 2009-10. Patients in group I, recieved rehabilitation program with placebo magnetic stimulation, and patients in group II, received magnetic stimulation with routine rehabilitation program for 10 session, 3 times in week. Pre and post were evaluated by Barthel and Fugl-Meyer indeces and dynamometer. Data were analyzed using SPSS-15, Kolmogorov-Smirnov, paired t-test, independent t-test and Wilcoxon signed tests. Results: According to Barthel and Fugl-Meyer indeces both groups I, II showed significant improvement (P<0.05). Using dynamometer, it was demenstrated that grip force of upper limb in group I was not significant but this index in group II was significant after intervention (P<0.05). Conclusion: This study showed that low frequency repeatitive truscrianial magnetic stimulation has therapuetic effect on grip force of upper limb.

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Background and Objective: Several studies have shown that during stroke changes occur in some paraclinic parameters which may have either prognostic or diagnostic value, including electrocardiographic changes. This study was done to evaluate the prognostic value of prolonged QT segment in patients with ischemic stroke. Materials and Methods: This descriptive study with an easy convenient sampling was carried out on 175 patients (73 male and 102 female) with acute ischemic stroke whome have been diagnosed by brain imaging (computed tomography scan and magnetic resonance imaging). All patients were suffering from stroke for the first time and if they use any drug or have underlying disease except diabetes mellitus- hypertension- heart disease and hyperlipidemia were excluded. In the first 24 hours of admission, an electrocardiogram (ECG) were taken for measurement of QT segment and according to death or discharge, patients were divided into two groups, and the mean of QT segment (corrected QT) subsequently were assessed. Data were analyzed using SPSS-15, Chi-Square and independent t-tests. Results: Twenty patients died in the course of admission. The mean of QT segment (corrected QT) in dead patients was 471.15±61.70 and in discharged patients was 421.52±62.96 (P<0.05). The abundance of prolonged QT segment accompanied with death was more frequent. Hypertension, diabetes mellitus, hyperlipidemia and heart disease were significantly correlated with morbidity and mortality (P<0.05). There is no relation between mortality with age and sex. Conclusion: This study showed that mean of QT segment (corrected) and also cases of prolonged QT segment were abundant among dead patients, therefore prolongation of QT segment has prognostic value in patients with ischemic stroke.

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Background and Objective: The silent brain infarctions are common in first-ever stroke. Some recent studies show the possible role of silent brain infarction in ischemic stroke. The aim of this study was to evaluate the frequency of silent brain infarction in acute first-ever ischemic stroke and its association with stroke risk factors. Materials and Methods: This descriptive - analytical study was carried out on 203 (94 males, 109 females) patients with acute first-ever ischemic stroke in Shafa hospital in Kerman, Iran during 2010. The diagnosis of ischemic stroke was made by physical examination and was confirmed by MRI and CT Scan. A questionnaire containing demographic information and risk factors including hypertension, diabetes, hyperlipidemia, cigarette smoking, ischemic and non-ischemic heart disease for stroke as well as presence of silent stroke was completed for each patient. Data were analyzed using SPSS-16 and logistic regression test. Results: The mean age of patients was 62.56±17.35 years. Among our patients history of hypertension, hyperlipidemia, cigarette smoking, diabetes, history of ischemic heart disease, history of other cardiac disease and silent stroke were observed in 66 (32.5%), 26 (12.8%), 16 (7.9%), 40 (19.7%), 27 (13.3%), 16 (7.9%) and 31 (15.3%), respectively. The probability of silent stroke among patient with hyperlipidemia, was 3.7 times more than those without hyperlipidemia (95%CI: 1.556-12.780, P<0.05). There was no significant correlation between silent stroke and the above risk factors. Conclusion: Silent stroke was found in 15% of patients with ischemic stroke. Control of hyperlipidemia can have a vital role in the prevention of silent stroke.

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Background and Objective: Magnesium (Mg) ion has possible role in protecting neurons and glia from ischemic damage through the cerebral blood flow and neuronal action. This study was done to evaluate the correlation of total serum Mg level with clinical outcomes in stroke patients. Materials and Methods: This cross sectional study was done on 316 patients whom diagnosed with stroke in Imam Hossein hospital, Tehran, Iran during 2010-11. Mg levels in all patients were measured. Also, recurrent transient ischemic attack (TIA), recurrent myocardial infarction or stroke, unstable angina and death as clinical outcomes were follow-up for period of 3 and 6 months after admission. Data were analyzed using SPSS-18, Chi-Square, Fisher and Pearson correlation tests. Results: The mean age of patients was 65±15.8 year. Limb weakness (69.9%) and haemoplasia with 63.6% were the most common clinical complaints. Death was the most common finding in 3 month (16.8%) and recurrent stroke was the most common finding in 6 month follow up (2.5%). There was no significant difference between the total serum Mg and the first and second three-months follow up of clinical outcomes. Conclusion: This study can not show a significant correlation between total serum Mg levels and clinical outcomes after 3 and 6 month follow up in stroke patients.

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Background and Objective: Diabetes is a major risk factor for stroke. Some studies have shown that difference between clinical signs and prognosis in diabetic patients with stroke compared to non-diabetic patients with stroke is due to difference in pattern of cerebral vascular involvement. This study was done to compare the findings of extracranial and transcranial doppler sonography in diabetic and nondiabetic patients with thrombotic stroke. Materials and Methods: This case – control study was done on 70 diabetic patients and 70 non-diabetic patients with thrombotic stroke. All patients were new cases. Extracranial and transcranial doppler sonography was performed for all subjects. Results: Basilar artery stenosis was significantly more frequent in diabetic cases in comparison with non-diabetic patients (P<0.05). The prevalenc of posterior circulation stenosis in diabetic patients was significantly higher than non-diabetic patients (P<0.05). Conclusion: In diabetic patients, stenosis in vertebrobasilar circulation was more frequent. Higher morbidity and mortality in diabetic patients may be due to vascular stenosis pattern.

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Background and Objective: Disabilities in upper limb due to stroke are the major problems in hemiplegic patients. Recently, joystick method as new method is applied for the improvment of upper limb disabilities. This study was carried out to compare the effect of joystick in compination verses routine rehabilitation and routine rehabilitation program on hand muscles stiffness in hemiplegic patients. Methods: In this clinical trial study, 12 hemiplegic patients were randomly divided into two control and interventional groups. Subjects in the control group were received rehabilitation program with placebo joystick. Patients in interventional group were received joystick treatment with routine rehabilitation program for 10 sessions, 3 times a week. Pre and post-treatment evaluation was performed based on Wrist Robo Hab method. Results: Flextion and pronation muscle stiffness in control patients showed non significant improvement, but in the interventional group, significant improvement were observed (P<0.05). At the end of study, there was not any significant difference between control and interventional group. Conclusion: According to this finding, there was not any significant difference between the combination of joystick and rehabilitation treatment and routine rehabilitation program on the hand muscle function in hemiplegic patients.

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Background and Objective: Cardioembolic stroke account for one-fifth of ischemic stroke and atrial fibrillation is the most common underlying cause. Taking an oral anticoagulation (Warfarin) is an effective way of preventing ischemic stroke but bleeding complication is common. This study was carried out to evaluate the validation of HASBLED score in prediction of hemorrhagic complications in patients with brain ischemia and atrial fibrillation under warfarin therapy. Methods: In this cohort study 112 patients with non-valvular atrial fibrillation in term of major and minor bleeding complications were followed to the predictive value of HASBLED criteria for one year. Major bleeding complications defined as intracranial bleeding, bleeding leading to hospitalization, drop of hemoglubin of more than 2gr/dl or requiring transfusion. HASBLED criteria were defined as hypertension, abnormality in liver and renal function tests, history of stroke, history of bleeding, large fluctuations in coagulation tests results, age more than 65 years and an Anti-platelet and non steroidal anti-inflammatory drugs and alcohol use one point is awarded to each of the aboves. Results: During one year follow up, 10 (9.1%) of patients had major bleeding and 28 (25%) patients had minor bleeding. The risk of major bleeding was significantly related with a history of minor bleeding and HASBLED scores (P<0.05). The risk of minor bleeding was significantly related with warfarin toxicity and high INR (P<0.05). HASBLED score>3 was associated with the likelihood of major bleeding in future. Conclusion: Patients with HASBLED score>3 should be causious in initial stage of taking oral anticoagulant.

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Background and Objective: Stroke has a high prevalence and is associated with a high premature mortality rate. Thus, it is important to identify the effective factors in increasing the incidence of stroke. The aim of this study was to investigate the role of seasonal changes and environmental factors in the occurrence of stroke.
Methods: This descriptive-analytical study was done on 3,639 patients including 3,102 (85.3%) with ischemic stroke, 472 (12.9%) with intracerebral hemorrhage and 65 (1.9%) with subarachnoid hemorrhage patients. After measuring environmental factors such as air temperature, air pressure, humidity and geomagnetic field, admission data of stroke patients between 2015-2019 were extracted from the Sayyad Shirazi Hospital information system.
Results: The mean occurrence of intracerebral hemorrhage was highest in winter, especially in January and March, and lowest in summer, especially in July and August. Intracerebral hemorrhage had a positive significant correlation with air pressure (P=0.001, r=0.452) and a negative correlation with ambient temperature (P<0.001, r= - 0.457). Subarachnoid hemorrhage and ischemia were not related to the season or the month. It was also found that ischemic stroke had a significant positive correlation with geomagnetic field fluctuations. Subarachnoid hemorrhage was not associated with any of the variables, but intracerebral hemorrhage was significantly positively associated with air pressure and inversely associated with temperature.
Conclusion: This study illustrated that winter, low temperature, high air pressure and high geomagnetic fluctuations are associated with a higher risk of stroke. Therefore, the underlying physiopathological causes of this relationship should be carefully investigated in future studies.
 

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Stroke survivors often experience various motor complications, and sustained treatment is crucial for their recovery. Game-based telerehabilitation interventions appear to facilitate motor improvement in these patients by ensuring sustained treatment. Therefore, the present study aimed to evaluate game-based telerehabilitation on motor function in stroke patients. This narrative review involved a comprehensive search of the PubMed database up to August 2024, using the keywords "Game," "Games," "Serious games," "Telerehabilitation," and "Stroke," both individually and in combination. Out of 118 articles initially identified, duplicates and articles published before 2018 were excluded. Ultimately, 9 articles meeting the inclusion and exclusion criteria were selected for review. The full text of these English articles was then analyzed and compared in terms of study design and intervention outcomes on improving motor function. Of the 9 studies reviewed, 6 focused on improving upper extremity motor function, 2 on improving lower extremity motor function, and 1 on improving motor function in both upper and lower extremities. All 9 studies reported positive results regarding improving upper and lower extremity motor function through game-based telerehabilitation. However, most studies had small and varied sample sizes, and there was no consensus on the optimal frequency or duration of game use. Furthermore, the technology employed in these games was found to be expensive for less developed countries. Given the positive outcomes of this approach for stroke patients, developing affordable, localized games and integrating them into national rehabilitation programs could significantly benefit both patients and healthcare systems.