View clinical trials related to Cerebrovascular Accidents.
Filter by:Cerebral Vascular Accidents (stroke) and Myocardial Infarction (MI), which share the same risk factors, treatments and pathophysiological mechanisms, have become two major public health problems due to the increase in their prevalence rate and the longer survival after such an event in developed countries. International data, including French data and data from our own registries, illustrate that: - risk factors that are common, mainly hypertension, smoking, high cholesterol or diabetes, remain insufficiently controlled, although they are easily detectable and treatable; - the incidence rate of stroke has doubled in 20 years in people under 55 years of age, increasing the number of people with chronic disabilities; - 1-month and 1-year mortality rates for stroke and MIs have decreased by 17% in 5 years, increasing the number of survivors but with chronic disabilities; - the aging of the population and the arrival of the baby boomers of the 1950s in the at-risk age groups has increased the at-risk population; - Stroke and MI recurrence rates reached a threshold of 6% / year, in contrast to the very high rates of re-hospitalization at 1 year: 30% post-stroke and 20% post-MI, due to poorly anticipated and controlled complications. These reasons explain the lack of significant progress in preventing recurrences, preventable complications (heart failure and arrhythmias after MI; falls, sphincter and swallowing disorders, dementia and arrhythmias after stroke) and re-admission. This observation is aggravated by problems of medical demography and therefore the availability of neurologists, cardiologists and general practitioners. Local and foreign experiments have demonstrated the value of intensive, coordinated and multi-professional stroke and MI monitoring, including nurses, in terms of: better control of risk factors and reduction of the rate of re-hospitalization by recurrence in stroke follow-up; improvement of the patient's general condition, control of risk factors, reduction in the number of events, decrease in the number of re-hospitalizations and their duration in MI follow-up. The value of pharmacists' additional intervention in intensive post-MI follow-up compared to routine follow-up has also been demonstrated, particularly in terms of significant improvement in patient compliance. The hypothesis is that 2 years of intensive follow-up for both post-stroke or post-MI patients, by trained hospital and liberal nurses, in conjunction with doctors and pharmacists, is of medico-economic interest compared to usual follow-up. Therefore a medico-economic evaluation was designed to evaluate the efficiency of this model, which combines community-based and recourse care, prevention and coordination of care compared to usual follow-up.
The objective of this study is to evaluate the functional benefits of a myoelectric Elbow-Wrist-Hand orthosis for persons with upper limb paralysis caused by a cerebrovascular accident (CVA).
This project consists of two parts: Robotic Rehabilitation Trials, and Study of Outcome Predictors and Clinimetric Attributes. In the first part of study, the investigators aim to (1) investigate the treatment effects of robot-assisted therapy (RAT) in patients with stroke on various outcomes, (2) test the dose-response relations by using two different intensities (higher versus lower intensity RAT), and (3) investigate the effects of the training intensity on a biomarker of oxidative stress. Treatment outcomes will encompass the spectrum of functioning including motor ability, motor control strategies, basic/extended daily functions, mobility, community reintegration, quality of life, and biomarker (8-OHdG). In the second part of study, the purposes are to define the appropriate populations for RAT and to examine the clinimetric properties of clinical measures relevant for use in robotic rehabilitation research. the investigators will identify the clinical predictors that will potentially influence the functional outcomes after interventions. Finally, the investigators will examine and compare the clinimetric properties (e.g., validity and responsiveness) of the clinical measures of rehabilitation outcome to inform selection of test instruments that may detect clinically meaningful change after rehabilitation therapy.
We will employ modern test theory (i.e., Rasch model) to refine the Stroke Rehabilitation Assessment of Movement instrument (STREAM), which will be called the refined version of the STREAM, R-STREAM).
This study is going to comprehensively examine the psychometric properties of the three depression scales (Hamilton depression scale (HAMD), Hospital anxiety and depression scale (HADS), and Beck Depression Inventory (BDI)) in stroke patients over a period of three years.
our research team will develop a new CADL scale for stroke patients over the next three years. In the first year, we had established a CADL item bank of 50 items. The investigators will administer the 50 items on 300 patients with stroke living in the community. Then we will select 10 to 15 items from the item bank for the CADL scale based on the International Classification of Functioning, Disability and Health (ICF), the opinions of an expert panel, and Rasch analysis. It is anticipated that the CADL scale will have unidimensionality, an interval level of measurement, soundly psychometric characteristics, a reduced number of items, and ease of administration. In the second and third years, we will compare the psychometric properties of the CADL scale and the combined BI and FAI scale. The psychometric properties investigated will include reliability (e.g. inter-rater reliability, intra-rater reliability, and internal consistency), validity (e.g. concurrent validity, convergent validity, predictive validity and discriminant validity), and responsiveness. A total of 150 patients will be recruited. Both the CADL scale and the combined BI and FAI scale will be used on patients from the initial stage (within one month) to six months after hospital discharge. The results will be useful for researchers and clinicians to determine whether the CADL scale is better than the combined BI and FAI scale in stroke patients.