A unified engineering model of the first stroke in downward negative lightning

NASA Astrophysics Data System (ADS)

Nag, Amitabh; Rakov, Vladimir A.

2016-03-01

Each stroke in a negative cloud-to-ground lightning flash is composed of downward leader and upward return stroke processes, which are usually modeled individually. The first stroke leader is stepped and starts with preliminary breakdown (PB) which is often viewed as a separate process. We present the first unified engineering model for computing the electric field produced by a sequence of PB, stepped leader, and return stroke processes, serving to transport negative charge to ground. We assume that a negatively charged channel extends downward in a stepped fashion during both the PB and leader stages. Each step involves a current wave that propagates upward along the newly formed channel section. Once the leader attaches to ground, an upward propagating return stroke neutralizes the charge deposited along the channel. Model-predicted electric fields are in reasonably good agreement with simultaneous measurements at both near (hundreds of meters, electrostatic field component is dominant) and far (tens of kilometers, radiation field component is dominant) distances from the lightning channel. Relations between the features of computed electric field waveforms and model input parameters are examined. It appears that peak currents associated with PB pulses are similar to return stroke peak currents, and the observed variation of electric radiation field peaks produced by leader steps at different heights above ground is influenced by the ground corona space charge.

The propagation speed of a positive lightning return stroke

NASA Technical Reports Server (NTRS)

Idone, Vincent P.; Orville, Richard E.; Mach, Douglas M.; Rust, W. David

1987-01-01

The first direct determination of the propagation speed of a lightning return stroke lowering positive charge to ground has been made. This stroke was the third of eight otherwise negative strokes in a triggered lightning flash initiated at the Kennedy Space Center, FL. Two independent optical systems, one photographic and the other photoelectric, yielded common recordings for the third and fourth strokes; the respective two-dimensional return stroke propagation speeds were 1.0 vs 0.93 x 10 to the 8th m/s for the positive (third) stroke and 1.0 vs 1.0 x 10 to the 8th m/s for the fourth stroke. Using fast electric-field data, the positive stroke peak current was estimated to be 21 kA. Photoelectric data only yielded propagation speeds of 1.4, 1.6, 1.2, 1.3, 1.0 and 0.90 x 10 to the 8th m/s for the first, second and fifth through eighth return strokes, respectively.

Characteristics of VLF/LF Sferics from Elve-producing Lightning Discharges

NASA Astrophysics Data System (ADS)

Blaes, P.; Zoghzoghy, F. G.; Marshall, R. A.

2013-12-01

Lightning return strokes radiate an electromagnetic pulse (EMP) which interacts with the D-region ionosphere; the largest EMPs produce new ionization, heating, and optical emissions known as elves. Elves are at least six times more common than sprites and other transient luminous events. Though the probability that a lightning return stroke will produce an elve is correlated with the return stroke peak current, many large peak current strokes do not produce visible elves. Apart from the lightning peak current, elve production may depend on the return stroke speed, lightning altitude, and ionospheric conditions. In this work we investigate the detailed structure of lightning that gives rise to elves by analyzing the characteristics of VLF/LF lightning sferics in conjunction with optical elve observations. Lightning sferics were observed using an array of six VLF/LF receivers (1 MHz sample-rate) in Oklahoma, and elves were observed using two high-speed photometers pointed over the Oklahoma region: one located at Langmuir Laboratory, NM and the other at McDonald Observatory, TX. Hundreds of elves with coincident LF sferics were observed during the summer months of 2013. We present data comparing the characteristics of elve-producing and non-elve producing lightning as measured by LF sferics. In addition, we compare these sferic and elve observations with FDTD simulations to determine key properties of elve-producing lightning.

On the behavior of return stroke current and the remotely detected electric field change waveform

NASA Astrophysics Data System (ADS)

Shao, Xuan-Min; Lay, Erin; Jacobson, Abram R.

2012-04-01

After accumulating a large number of remotely recorded negative return stroke electric field change waveforms, a subtle but persistent kink was found following the main return stroke peak by several microseconds. To understand the corresponding return stroke current properties behind the kink and the general return stroke radiation waveform, we analyze strokes occurring in triggered lightning flashes for which have been measured both the channel base current and simultaneous remote electric radiation field. In this study, the channel base current is assumed to propagate along the return stroke channel in a dispersive and lossy manner. The measured channel base current is band-pass filtered, and the higher-frequency component is assumed to attenuate faster than the lower-frequency component. The radiation electric field is computed for such a current behavior and is then propagated to distant sensors. It is found that such a return stroke model is capable of very closely reproducing the measured electric waveforms at multiple stations for the triggered return strokes, and such a model is considered applicable to the common behavior of the natural return stroke as well. On the basis of the analysis, a number of other observables are derived. The time-evolving current dispersion and attenuation compare well with previously reported optical observations. The observable speed tends to agree with optical and VHF observations. Line charge density that is removed or deposited by the return stroke is derived, and the implication of the charge density distribution on leader channel decay is discussed.

First and subsequent return stroke properties of cloud-to-ground lightning

NASA Technical Reports Server (NTRS)

Namasivayam, S.; Lundquist, Stig

1991-01-01

Lightning properties obtained by a network of magnetic direction finders and by electric field measurements for distances from 50 to 500 km are compared for three summer thunderstorms in Sweden. The data from direct field recordings indicate 31, 17, and 26 pcts. of negative subsequent return strokes with peak current (as inferred from the peak electric field) higher than the first. Electric fields from first strokes are compared with normalized amplitudes registered by the magnetic direction finding system. The efficiency of detection by the magnetic direction finding system is discussed in terms of the percentage of lightning flashes observed by electric field measurements that are not localized. Statistics of the number of strokes per flash and the interstroke time intervals are presented.

The dE/dt and E Waveforms Radiated by Leader Steps Just Before the First Return Stroke in Cloud-to-Ocean Lightning

NASA Astrophysics Data System (ADS)

Krider, E. P.; Baffou, G.; Murray, N. D.; Willett, J. C.

2004-12-01

We have analyzed the shapes and other characteristics of the electric field, E, and dE/dt waveforms that were radiated by leader steps just before the first return stroke in cloud-to-ocean lightning. dE/dt waveforms were recorded using an 8-bit digitizer sampling at 100 MHz, and an integrated waveform, Eint, was computed by numerically integrating dE/dt and comparing the result with an analog E waveform digitized at 10 MHz. All signals were recorded under conditions where the lightning locations were known and there was minimal distortion in the fields due to the effects of ground-wave propagation. The dE/dt waveforms radiated by leader steps tend to fall into three categories: (1) "simple" - an isolated negative peak that is immediately followed by a positive overshoot (where negative polarity follows the normal physics convention), (2) "double" - two simple waveforms that occur at almost the same time, and (3) "burst" - a complex cluster of pulses with a total duration of about one microsecond. In this paper, we will give examples of each of these waveform types, and we will summarize their characteristics on a submicrosecond time-scale. For example, in an interval starting 9 μ s before to 4 μ s before the largest, negative (dominant) peak in dE/dt peak in the return stroke, 131 first strokes produced a total of 296 impulses with a peak amplitude greater than 10% of the dominant peak, and the average amplitude of these pulses was 0.21 of the dominant peak. The last leader step in a 12 μ s interval before the dominant peak was a simple waveform in 51 first strokes, and in these cases, the average time-interval between the peak dE/dt of the step and the dominant peak of the stroke was 5.8 ± 1.7 μ s, a value that is in good agreement with prior measurements. The median full-width-at-half-maximum (FWHM) of 274 simple Eint signatures was 141 ns, and the associated mean and standard deviation were 187 ± 131 ns.

Calculations of lightning return stroke electric and magnetic fields above ground

NASA Technical Reports Server (NTRS)

Master, M. J.; Uman, M. A.; Ling, Y. T.; Standler, R. B.

1981-01-01

Lin et al., (1980) presented a lightning return stroke model with which return stroke electric and magnetic fields measured at ground level could be reproduced. This model and a modified version of it, in which the initial current peak decays with height above ground, are used to compute waveforms for altitudes from 0-10 km and at ranges of 20 m to 10 km. Both the original and modified models gave accurate predictions of measured ground-based fields. The use of the calculated fields in calibrating airborne field measurements from simultaneous ground and airborne data is discussed.

Submicrosecond characteristics of lightning return-stroke currents

NASA Technical Reports Server (NTRS)

Leteinturier, Christiane; Hamelin, Joel H.; Eybert-Berard, Andre

1991-01-01

The authors describe the experimental results obtained during 1987 and 1988 triggered-lightning experiments in Florida. Seventy-four simultaneous submicrosecond time-resolved measurements of triggered return-stroke current (I) and current derivative (dI/dt) were made in Florida in 1987 and 1988. Peak currents ranged from about 5 to 76 kA, peak dI/dt amplitude from 13 to 411 kA/microsec and rise time from 90 to 1000 ns. The mean peak dI/dt values of 110 kA/microsec were 2-3 times higher than data from instrumented towers and peak I and dI/dt appear to be positively correlated. These data confirm previous experiments and conclusions supported by forty measurements. They are important in order to define, for example, standards for lightning protection. Present standards give a dI/dt maximum of 140 kA/microsec.

First images of thunder: Acoustic imaging of triggered lightning

NASA Astrophysics Data System (ADS)

Dayeh, M. A.; Evans, N. D.; Fuselier, S. A.; Trevino, J.; Ramaekers, J.; Dwyer, J. R.; Lucia, R.; Rassoul, H. K.; Kotovsky, D. A.; Jordan, D. M.; Uman, M. A.

2015-07-01

An acoustic camera comprising a linear microphone array is used to image the thunder signature of triggered lightning. Measurements were taken at the International Center for Lightning Research and Testing in Camp Blanding, FL, during the summer of 2014. The array was positioned in an end-fire orientation thus enabling the peak acoustic reception pattern to be steered vertically with a frequency-dependent spatial resolution. On 14 July 2014, a lightning event with nine return strokes was successfully triggered. We present the first acoustic images of individual return strokes at high frequencies (>1 kHz) and compare the acoustically inferred profile with optical images. We find (i) a strong correlation between the return stroke peak current and the radiated acoustic pressure and (ii) an acoustic signature from an M component current pulse with an unusual fast rise time. These results show that acoustic imaging enables clear identification and quantification of thunder sources as a function of lightning channel altitude.

Performance Study of Earth Networks Total Lightning Network using Rocket-Triggered Lightning Data in 2014

NASA Astrophysics Data System (ADS)

Heckman, S.

2015-12-01

Modern lightning locating systems (LLS) provide real-time monitoring and early warning of lightningactivities. In addition, LLS provide valuable data for statistical analysis in lightning research. It isimportant to know the performance of such LLS. In the present study, the performance of the EarthNetworks Total Lightning Network (ENTLN) is studied using rocket-triggered lightning data acquired atthe International Center for Lightning Research and Testing (ICLRT), Camp Blanding, Florida.In the present study, 18 flashes triggered at ICLRT in 2014 were analyzed and they comprise of 78negative cloud-to-ground return strokes. The geometric mean, median, minimum, and maximum for thepeak currents of the 78 return strokes are 13.4 kA, 13.6 kA, 3.7 kA, and 38.4 kA, respectively. The peakcurrents represent typical subsequent return strokes in natural cloud-to-ground lightning.Earth Networks has developed a new data processor to improve the performance of their network. Inthis study, results are presented for the ENTLN data using the old processor (originally reported in 2014)and the ENTLN data simulated using the new processor. The flash detection efficiency, stroke detectionefficiency, percentage of misclassification, median location error, median peak current estimation error,and median absolute peak current estimation error for the originally reported data from old processorare 100%, 94%, 49%, 271 m, 5%, and 13%, respectively, and those for the simulated data using the newprocessor are 100%, 99%, 9%, 280 m, 11%, and 15%, respectively. The use of new processor resulted inhigher stroke detection efficiency and lower percentage of misclassification. It is worth noting that theslight differences in median location error, median peak current estimation error, and median absolutepeak current estimation error for the two processors are due to the fact that the new processordetected more number of return strokes than the old processor.

Horizontal electric fields from lightning return strokes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomson, E.M.; Uman, M.A.; Johnson, J.

1985-01-01

Measurements are presented of simultaneous horizontal and vertical electric fields from both close and distant lightning return strokes. The data were obtained during summer 1984 at the Kennedy Space Center, Florida, using an electrically isolated spherical antenna having a system bandwidth of 3 Hz to 5 MHz. Lightning signals were obtained from flashes at distances from a few to 100 kilometers. Since the horizontal electric field is in part determined by the local ground conductivity, that parameter was measured as a function of depth. The horizontal fields from lightning return strokes had typically 1/50 the peak amplitude of the verticalmore » fields and waveshapes which were consistant with available theory, as expressed by the ''wavetilt'' formula.« less

An experimental test of the 'transmission-line model' of electromagnetic radiation from triggered lightning return strokes

NASA Technical Reports Server (NTRS)

Willett, J. C.; Idone, V. P.; Orville, R. E.; Leteinturier, C.; Eybert-Berard, A.

1988-01-01

Peak currents, two-dimensional average propagation speeds, and electric field waveforms for a number of subsequent return strikes in rocket-triggered lightning flashes were measured in order to test the 'transmission-line model' of return-stroke radiation of Uman and McLain (1970). Reasonable agreement is found between the propagation speeds measured with the streak camera and those deduced from the transmission-line model. A modification of the model is proposed in which two wave fronts travel upward and downward away from a junction point a short distance above the ground.

An experimental test of the 'transmission-line model' of electromagnetic radiation from triggered lightning return strokes

NASA Astrophysics Data System (ADS)

Willett, J. C.; Idone, V. P.; Orville, R. E.; Leteinturier, C.; Eybert-Berard, A.

1988-04-01

Peak currents, two-dimensional average propagation speeds, and electric field waveforms for a number of subsequent return strikes in rocket-triggered lightning flashes were measured in order to test the 'transmission-line model' of return-stroke radiation of Uman and McLain (1970). Reasonable agreement is found between the propagation speeds measured with the streak camera and those deduced from the transmission-line model. A modification of the model is proposed in which two wave fronts travel upward and downward away from a junction point a short distance above the ground.

Comparison of fast electric field changes from subsequent return strokes of natural and triggered lightning

NASA Technical Reports Server (NTRS)

Le Vine, D. M.; Willett, J.

1988-01-01

Fast electric field changes from subsequent return strokes of natural and triggered lightning with propagation paths almost entirely over water are compared. Data were collected at the Kennedy Space Center, Florida. Comparisons have been made of the average shape, the rise time and the spectrum of the electric field changes. The electric field changes from the triggered flashes tend to rise to peak faster and decay faster than do their counterparts in natural cloud-to-ground flashes.

Return Stroke Current Reflections in Rocket-Triggered Lightning

NASA Astrophysics Data System (ADS)

Caicedo, J.; Uman, M. A.; Jordan, D.; Biagi, C. J.; Hare, B.

2015-12-01

In the six years from 2009 to 2014, there have been eight triggered flashes at the ICLRT, from a total of 125, in which a total of ten return stroke channel-base currents exhibited a dip 3.0 to 16.6 μs after the initial current peak. Close range electric field measurements show a related dip following the initial electric field peak, and electric field derivative measurements show an associated bipolar pulse, confirming that this phenomenon is not an instrumentation effect in the current measurement. For six of the eight flashes, high-speed video frames show what appears to be suspended sections of unexploded triggering wire at heights of about 150 to 300 m that are illuminated when the upward current wave reaches them. The suspended wire can act as an impedance discontinuity, perhaps as it explodes, and cause a downward reflection of some portion of the upward-propagating current wave. This reflected wave travels down the channel and causes the dip in the measured channel-base current when it reaches ground and reflects upward. The modified transmission line model with exponential decay (MTLE) is used to model the close electric field and electric field derivatives of the postulated initial and reflected current waves, starting with the measured channel base current, and the results are compared favorably with measurements made at distances ranging from 92 to 444 m. From the measured time between current impulse initiation and the time the current reflection reaches the channel base and the current dip initiates, along with the reflection height from the video records, we find the average return stroke current speed for each of the ten strokes to be from 0.28 to 1.9×108 ms-1, with an error of ±0.01×108 ms-1 due to a ±0.1 μs uncertainty in the measurement. This represents the first direct measurement of return stroke current speed, all previous return stroke speed measurements being derived from the luminosity of the process.

Lightning Return-Stroke Current Waveforms Aloft, from Measured Field Change, Current, and Channel Geometry

NASA Technical Reports Server (NTRS)

Willett, J. C.; LeVine, D. M.; Idone, V. P.

2006-01-01

Three-dimensional reconstructions of six rocket-triggered lightning channels are derived from stereo photographs. These reconstructed channels are used to infer the behavior of the current in return strokes above the ground from current waveforms measured at the channel base and electric-field-change waveforms measured at a range of 5.2 kilometers for 24 return strokes in these channels. Streak photographs of 14 of the same strokes are analyzed to determine the rise times, propagation speeds, and amplitudes of relative light intensity for comparison with the electrical inferences. Results include the following: 1) The fine structure of the field-change waveforms that were radiated by these subsequent return strokes can be explained, in large part, by channel geometry. 2) The average 10 - 90% rise time of the stroke current increased by about a factor of seven in our sample, from an observed 0.31 plus or minus 0.17 microseconds at the surface to an inferred 2.2 plus or minus 0.5 microcseconds at 1 kilometer path length above the surface. 3) The three-dimensional propagation speed of the current front averaged 1.80 plus or minus 0.24 X 10(exp 8) meters per second over channel lengths typically greater than 1 kilometer. 4) Assuming that the measured current was entirely due to the return stroke forced an unreasonably large and abrupt reduction in inferred current amplitude over the first few tens of meters above the surface, especially in cases when the leader was bright relative to its stroke. Therefore, a significant fraction of the current at the surface was probably due to the leader, at least in such cases. 5) Peak return-stroke currents decreased by approximately 37 plus or minus 12% from 100 meters to 1 kilometer of path length above the surface. Because of uncertainty about how to partition the measured current between leader and return stroke, we are unable to infer the variation of current amplitude near the ground.

Characterization of vertical electric fields 500 m and 30 m from triggered lightning

NASA Astrophysics Data System (ADS)

Rubenstein, M.; Rachidi, F.; Uman, M. A.; Thottappillil, R.; Rakov, V. A.; Nucci, C. A.

1995-05-01

Vertical electric field waveforms of leader-return stroke sequences measured 500 m and 30 m from rocket-triggered lightning are presented. The 500-m data were recorded during the summer of 1986, the 30-m data during the summer of 1991, both at the NASA Kennedy Space Center, Florida. The 40 leader-return stroke field waveforms at 500 m and the 8 waveforms at 30 m all appear as asymmetrical V-shaped pulses, the bottom of the V being associated with the transition from the leader to the return stroke. Only two waveforms at 30 m were suitable for quantitative analysis. The widths of the V at half of peak value for these are 1.8 and 5.0 μs, while for the 500-m data they are 1 to 2 orders of magnitude greater, with a median value of 100 μs. Applying a widely used and simple leader model to the measured leader electric fields at 500 m, we infer, for the bottom kilometer or so of the leader channel, leader speeds between 2×106 and 2×107 m/s and leader charges per unit length of 0.02×10-3 to 0.08×10-3 C/m. From the two measured leader electric field changes at 30 m we infer, using the same leader model, for the bottom 100 meters or so of the leader channel, speeds of 3×107 and 1×107 m/s (the corresponding measured waveform half widths are 1.8 μs and 5.0 μs) and charges per unit length of 0.14×10-3 and 0.02×10-3 C/m (the corresponding measured leader field changes are 81 kV/m and 12 kV/m). The corresponding measured return stroke peak currents for the above two cases are 40 kA and 7 kA, respectively. A positive correlation is observed between the magnitude of the leader field change at 500 m and the ensuing return stroke current peak.

Variation in light intensity with height and time from subsequent lightning return strokes

NASA Technical Reports Server (NTRS)

Jordan, D. M.; Uman, M. A.

1983-01-01

Photographic measurements of relative light intensity as a function of height and time have been conducted for seven return strokes in two lightning flashes at 7.8 and 8.7 km ranges, using film which possesses an approximately constant spectral response in the 300-670 nm range. The amplitude of the initial light peak is noted to decrease exponentially with height, with a decay constant of 0.6-0.8 km. The logarithm of the peak light intensity near the ground is found to be approximately proportional to the initial peak electric field intensity, implying that the current decrease with height may be much slower than the light decrease. Absolute light intensity is presently estimated through the integration of the photographic signals from individual channel segments, in order to simulate the calibrated, all-sky photoelectric data of Guo and Krider (1982).

Variation in light intensity with height and time from subsequent lightning return strokes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jordan, D.M.; Uman, M.A.

1983-08-20

Relative light intensity has been measured photographically as a function of height and time for seven subsequent return strokes in two lightning flashes at ranges of 7.8 and 8.7 km. The film used was Kodak 5474 Shellburst, which has a roughly constant spectral response between 300 and 670 nm. The time resolution was about 1.0 ..mu..s, and the spatial resolution was about 4 m. The observed light signals consisted of a fast rise to peak, followed by a slower decrease to a relatively constant value. The amplitude of the initial light peak decreases exponentially with height with a decay constantmore » of about 0.6 to 0.8 km. The 20% to 80% rise time of the initial light signal is between 1 and 4 ..mu..s near ground and increases by an additional 1 to 2 ..mu..s by the time the return stroke reaches the cloud base, a height between 1 and 2 km. The light intensity 30 ..mu..s after the initial peak is relatively constant with height and has an amplitude that is 15% to 30% of the initial peak near the ground and 50% to 100% of the initial peak at cloud base. The logarithm of the peak light intensity near the ground is roughly proportional to the initial peak electric field intensity, and this in turn implies that the current decrease with height may be much slower than the light decrease. The absolute light intensity has been estimated by integrating the photographic signals from individual channel segments to simulate the calibrated all-sky photoelectric data of Guo and Krider (1982). Using this method, the authors find that the mean peak radiance near the ground is 8.3 x 10/sup 5/ W/m, with a total range from 1.4 x 10/sup 5/ to 3.8 x 10/sup 6/ W/m. 16 references, 11 figures.« less

The influence of tortuosity on the spectrum of radiation from lightning return strokes

NASA Technical Reports Server (NTRS)

Levine, D. M.

1978-01-01

An investigation was made of the influence of tortuosity on the spectrum of radiation from lightning return strokes. The shape of the spectrum obtained by including effects of tortuosity was in keeping with data: The spectrum had a peak in the correct frequency regime followed by an initial decrease as the inverse of frequency. This spectrum was in better agreement with data than the spectrum predicted by the same model without tortuosity (i.e. the long straight channel), which decays at a rate proportional to 1/v squared.

Properties of M components from currents measured at triggered lightning channel base

NASA Astrophysics Data System (ADS)

Thottappillil, Rajeev; Goldberg, Jon D.; Rakov, Vladimir A.; Uman, Martin A.; Fisher, Richard J.; Schnetzer, George H.

1995-12-01

Channel base currents from triggered lightning were measured at the NASA Kennedy Space Center, Florida, during summer 1990 and at Fort McClellan, Alabama, during summer 1991. An analysis of the return stroke data and overall continuing current data has been published by Fisher et al. [1993]. Here an analysis is given of the impulsive processes, called M components, that occur during the continuing current following return strokes. The 14 flashes analyzed contain 37 leader-return stroke sequences and 158 M components, both processes lowering negative charge from cloud to ground. Statistics are presented for the following M current pulse parameters: magnitude, rise time, duration, half-peak width, preceding continuing current level, M interval, elapsed time since the return stroke, and charge transferred by the M current pulse. A typical M component in triggered lightning is characterized by a more or less symmetrical current pulse having an amplitude of 100-200 A (2 orders of magnitude lower than that for a typical return stroke [Fisher et al., 1993]), a 10-90% rise time of 300-500 μs (3 orders of magnitude larger than that for a typical return stroke [Fisher et al., 1993]), and a charge transfer to ground of the order of 0.1 to 0.2 C (1 order of magnitude smaller than that for a typical subsequent return stroke pulse [Berger et al., 1975]). About one third of M components transferred charge greater than the minimum charge reported by Berger et al. [1975] for subsequent leader-return stroke sequences. No correlation was found between either the M charge or the magnitude of the M component current (the two are moderately correlated) and any other parameter considered. M current pulses occurring soon after the return stroke tend to have shorter rise times, shorter durations, and shorter M intervals than those which occur later. M current pulses were observed to be superimposed on continuing currents greater than 30 A or so, with one exception out of 140 cases, wherein the continuing current level was measured to be about 20 A. The first M component virtually always (one exception out of 34 cases) occurred within 4 ms of the return stroke. This relatively short separation time between return stroke and the first M component, coupled with the observation of Fisher et al. [1993] that continuing currents lasting longer than 10 ms never occur without M current pulses, implies that the M component is a necessary feature of the continuing current mode of charge transfer to ground.

Lightning Return-Stroke Current Waveforms Aloft, From Measured Field Change, Current, and Channel Geometry

NASA Technical Reports Server (NTRS)

Willett, J. C.; LeVine, D. M.

2002-01-01

Direct current measurements are available near the attachment point from both natural cloud-to-ground lightning and rocket-triggered lightning, but little is known about the rise time and peak amplitude of return-stroke currents aloft. We present, as functions of height, current amplitudes, rise times, and effective propagation velocities that have been estimated with a novel remote-sensing technique from data on 24 subsequent return strokes in six different lightning flashes that were triggering at the NASA Kennedy Space Center, FL, during 1987. The unique feature of this data set is the stereo pairs of still photographs, from which three-dimensional channel geometries were determined previously. This has permitted us to calculate the fine structure of the electric-field-change (E) waveforms produced by these strokes, using the current waveforms measured at the channel base together with physically reasonable assumptions about the current distributions aloft. The computed waveforms have been compared with observed E waveforms from the same strokes, and our assumptions have been adjusted to maximize agreement. In spite of the non-uniqueness of solutions derived by this technique, several conclusions seem inescapable: 1) The effective propagation speed of the current up the channel is usually significantly (but not unreasonably) faster than the two-dimensional velocity measured by a streak camera for 14 of these strokes. 2) Given the deduced propagation speed, the peak amplitude of the current waveform often must decrease dramatically with height to prevent the electric field from being over-predicted. 3) The rise time of the current wave front must always increase rapidly with height in order to keep the fine structure of the calculated field consistent with the observations.

Influence of channel base current and varying return stroke speed on the calculated fields of three important return stroke models

NASA Technical Reports Server (NTRS)

Thottappillil, Rajeev; Uman, Martin A.; Diendorfer, Gerhard

1991-01-01

Compared here are the calculated fields of the Traveling Current Source (TCS), Modified Transmission Line (MTL), and the Diendorfer-Uman (DU) models with a channel base current assumed in Nucci et al. on the one hand and with the channel base current assumed in Diendorfer and Uman on the other hand. The characteristics of the field wave shapes are shown to be very sensitive to the channel base current, especially the field zero crossing at 100 km for the TCS and DU models, and the magnetic hump after the initial peak at close range for the TCS models. Also, the DU model is theoretically extended to include any arbitrarily varying return stroke speed with height. A brief discussion is presented on the effects of an exponentially decreasing speed with height on the calculated fields for the TCS, MTL, and DU models.

Comparison of fast electric field changes from subsequent return strokes of natural and triggered lightning

NASA Technical Reports Server (NTRS)

Le Vine, D. M.; Willett, J. C.; Bailey, J. C.

1989-01-01

Fast electric field changes from subsequent return strokes of natural and triggered lightning with propagation paths almost entirely over water are compared. Data were collected at the Kennedy Space Center, Florida, during the summer of 1987. Comparisons have been made of the average shape, the risetime, and the spectrum of the electric field changes. To a first approximation, the waveforms are very similar; however, the electric field changes from the triggered flashes tend to rise to peak faster and decay faster than do their counterparts in natural cloud-to-ground flashes.

Anomalous light output from lightning dart leaders

NASA Technical Reports Server (NTRS)

Guo, C.; Krider, E. P.

1985-01-01

About 5 percent of the multiple-stroke cloud-to-ground lightning discharges recorded at the NASA Kennedy Space Center during the summer of 1981 contained dart leaders that produced an unusually large light output. An analysis of these cases indicates that the average peak light output per unit length in the leader may be comparable to or even exceed that of the return stroke that follows.

Striking Distance Determined From High-Speed Videos and Measured Currents in Negative Cloud-to-Ground Lightning

NASA Astrophysics Data System (ADS)

Visacro, Silverio; Guimaraes, Miguel; Murta Vale, Maria Helena

2017-12-01

First and subsequent return strokes' striking distances (SDs) were determined for negative cloud-to-ground flashes from high-speed videos exhibiting the development of positive and negative leaders and the pre-return stroke phase of currents measured along a short tower. In order to improve the results, a new criterion was used for the initiation and propagation of the sustained upward connecting leader, consisting of a 4 A continuous current threshold. An advanced approach developed from the combined use of this criterion and a reverse propagation procedure, which considers the calculated propagation speeds of the leaders, was applied and revealed that SDs determined solely from the first video frame showing the upward leader can be significantly underestimated. An original approach was proposed for a rough estimate of first strokes' SD using solely records of current. This approach combines the 4 A criterion and a representative composite three-dimensional propagation speed of 0.34 × 106 m/s for the leaders in the last 300 m propagated distance. SDs determined under this approach showed to be consistent with those of the advanced procedure. This approach was applied to determine the SD of 17 first return strokes of negative flashes measured at MCS, covering a wide peak-current range, from 18 to 153 kA. The estimated SDs exhibit very high dispersion and reveal great differences in relation to the SDs estimated for subsequent return strokes and strokes in triggered lightning.

On the electromagnetic fields, Poynting vector, and peak power radiated by lightning return strokes

NASA Technical Reports Server (NTRS)

Krider, E. P.

1992-01-01

The initial radiation fields, Poynting vector, and total electromagnetic power that a vertical return stroke radiates into the upper half space have been computed when the speed of the stroke, nu, is a significant fraction of the speed of light, c, assuming that at large distances and early times the source is an infinitesimal dipole. The initial current is also assumed to satisfy the transmission-line model with a constant nu and to be perpendicular to an infinite, perfectly conducting ground. The effect of a large nu is to increase the radiation fields by a factor of (1-beta-sq cos-sq theta) exp -1, where beta = nu/c and theta is measured from the vertical, and the Poynting vector by a factor of (1-beta-sq cos-sq theta) exp -2.

The RF spectra of first and subsequent lightning return strokes in the 1- to 200-km range

NASA Technical Reports Server (NTRS)

Serhan, G. I.; Uman, M. A.; Childers, D. G.; Lin, Y. T.

1980-01-01

An experimental characterization of the frequency spectra of first and subsequent stroke electric fields are presented over a distance range from about 1 km, where the fields are primarily electrostatic, to 200 km, where they are primarily radiation. Spectra are presented to about 700 kHz for lightning within 12 km and to about 300 kHz for lightning at 50 and 200 km. It is shown that the return stroke ground wave spectrum beyond 50 km has a peak near 4 kHz but that within 10 km the spectrum shows a steady increase with decreasing frequency to 1 kHz. Frequency spectra at all ranges fall off roughly as 1/f for frequencies between 5 and 100 kHz, while the falloff above 100 kHz is faster as the distance to the stroke increases. From this high-frequency attenuation an RF conductivity for central Florida of between 0.002 and 0.005/ohm/m was determined.

Detection and analysis of radio frequency lightning emissions

NASA Technical Reports Server (NTRS)

Jalali, F.

1982-01-01

The feasibility study of detection of lightning discharges from a geosynchronous satellite requires adequate ground-based information regarding emission characteristics. In this investigation, a measurement system for collection of S-band emission data is set up and calibrated, and the operations procedures for rapid data collection during a storm activity developed. The system collects emission data in two modes; a digitized, high-resolution, short duration record stored in solid-state memory, and a continuous long-duration record on magnetic tape. Representative lightning flash data are shown. Preliminary results indicate appreciable RF emissions at 2 gHz from both the leader and return strokes portions of the cloud-to-ground discharge with strong peaks associated with the return strokes.

Automated Studies of Continuing Current in Lightning Flashes

NASA Astrophysics Data System (ADS)

Martinez-Claros, Jose

Continuing current (CC) is a continuous luminosity in the lightning channel that lasts longer than 10 ms following a lightning return stroke to ground. Lightning flashes following CC are associated with direct damage to power lines and are thought to be responsible for causing lightning-induced forest fires. The development of an algorithm that automates continuing current detection by combining NLDN (National Lightning Detection Network) and LEFA (Langmuir Electric Field Array) datasets for CG flashes will be discussed. The algorithm was applied to thousands of cloud-to-ground (CG) flashes within 40 km of Langmuir Lab, New Mexico measured during the 2013 monsoon season. It counts the number of flashes in a single minute of data and the number of return strokes of an individual lightning flash; records the time and location of each return stroke; performs peak analysis on E-field data, and uses the slope of interstroke interval (ISI) E-field data fits to recognize whether continuing current (CC) exists within the interval. Following CC detection, duration and magnitude are measured. The longest observed C in 5588 flashes was 631 ms. The performance of the algorithm (vs. human judgement) was checked on 100 flashes. At best, the reported algorithm is "correct" 80% of the time, where correct means that multiple stations agree with each other and with a human on both the presence and duration of CC. Of the 100 flashes that were validated against human judgement, 62% were hybrid. Automated analysis detects the first but misses the second return stroke in many cases where the second return stroke is followed by long CC. This problem is also present in human interpretation of field change records.

Mexican Americans are Less Likely to Return to Work Following Stroke: Clinical and Policy Implications.

PubMed

Skolarus, Lesli E; Wing, Jeffrey J; Morgenstern, Lewis B; Brown, Devin L; Lisabeth, Lynda D

2016-08-01

Greater poststroke disability and U.S. employment policies may disadvantage minority stroke survivors from returning to work. We explored ethnic differences in return to work among Mexican Americans (MAs) and non-Hispanic whites (NHWs) working at the time of their stroke. Stroke patients were identified from the population-based BASIC (Brain Attack Surveillance in Corpus Christi) study from August 2011 to December 2013. Employment status was obtained at baseline and 90-day interviews. Sequential logistic regression models were built to assess ethnic differences in return to work after accounting for the following: (1) age (<65 versus ≥65); (2) sex; (3) 90-day National Institutes of Health Stroke Scale (NIHSS); and (4) education (lower than high school versus high school or higher). Of the 729 MA and NHW stroke survivors who completed the baseline interview, 197 (27%) were working at the time of their stroke, of which 125 (63%) completed the 90-day outcome interview. Forty-nine (40%) stroke survivors returned to work by 90 days. MAs were less likely to return to work (OR = .45, 95% CI .22-.94) than NHWs. The ethnic difference became nonsignificant after adjusting for NIHSS (OR = .59, 95% CI .24-1.44) and further attenuated after adjusting for education (OR = .85, 95% CI .32- 2.22). The majority of stroke survivors did not return to work within 90 days of their stroke. MA stroke survivors were less likely to return to work after stroke than NHW stroke survivors which was due to their greater neurological deficits and lower educational attainment compared with that of NHW stroke survivors. Future work should focus on clinical and policy efforts to reduce ethnic disparities in return to work. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Shipborne LF-VLF oceanic lightning observations and modeling

NASA Astrophysics Data System (ADS)

Zoghzoghy, F. G.; Cohen, M. B.; Said, R. K.; Lehtinen, N. G.; Inan, U. S.

2015-10-01

Approximately 90% of natural lightning occurs over land, but recent observations, using Global Lightning Detection (GLD360) geolocation peak current estimates and satellite optical data, suggested that cloud-to-ground flashes are on average stronger over the ocean. We present initial statistics from a novel experiment using a Low Frequency (LF) magnetic field receiver system installed aboard the National Oceanic Atmospheric Agency (NOAA) Ronald W. Brown research vessel that allowed the detection of impulsive radio emissions from deep-oceanic discharges at short distances. Thousands of LF waveforms were recorded, facilitating the comparison of oceanic waveforms to their land counterparts. A computationally efficient electromagnetic radiation model that accounts for propagation over lossy and curved ground is constructed and compared with previously published models. We include the effects of Earth curvature on LF ground wave propagation and quantify the effects of channel-base current risetime, channel-base current falltime, and return stroke speed on the radiated LF waveforms observed at a given distance. We compare simulation results to data and conclude that previously reported larger GLD360 peak current estimates over the ocean are unlikely to fully result from differences in channel-base current risetime, falltime, or return stroke speed between ocean and land flashes.

Radiation from lightning return strokes over a finitely conducting earth

NASA Technical Reports Server (NTRS)

Le Vine, D. M.; Gesell, L.; Kao, Michael

1986-01-01

The effects of the conductivity of the earth on radiation from lightning return strokes are examined theoretically using a piecewise linear transmission line model for the return stroke. First, calculations are made of the electric field radiated during the return stroke, and then this electric field is used to compute the response of conventional AM radio receivers and electric field change systems during the return stroke. The calculations apply to the entire transient waveform (they are not restricted to the initial portions of the return stroke) and yield fast field changes and RF radiation in agreement with measurements made during real lightning. This research was motivated by measurements indicating that a time delay exists between the time of arrival of the fast electric field change and the RF radiation from first return strokes. The time delay is on the order of 20 microsec for frequencies in the HF-UHF range for lightning in Florida. The time delay is obtained theoretically in this paper. It occurs when both the effects of attenuation due to conductivity of the earth, and the finite velocity of propagation of the current pulse up the return stroke channel, are taken into account in the model.

Classification of Small Negative Lightning Reports at the KSC-ER

NASA Technical Reports Server (NTRS)

Ward, Jennifer G.; Cummins, Kenneth L.; Krider, Philip

2008-01-01

The NASA Kennedy Space Center (KSC) and Air Force Eastern Range (ER) operate an extensive suite of lightning sensors because Florida experiences the highest area density of ground strikes in the United States, with area densities approaching 16 fl/sq km/yr when accumulated in 10x10 km (100 sq km) grids. The KSC-ER use data derived from two cloud-to-ground (CG) lightning detection networks, the "Cloud-to-Ground Lightning Surveillance System" (CGLSS) and the U.S. National Lightning Detection Network (TradeMark) (NLDN) plus a 3-dimensional lightning mapping system, the Lightning Detection and Ranging (LDAR) system, to provide warnings for ground operations and to insure mission safety during space launches. For operational applications at the KSC-ER it is important to understand the performance of each lightning detection system in considerable detail. In this work we examine a specific subset of the CGLSS stroke reports that have low values of the negative inferred peak current, Ip, i.e. values between 0 and -7 kA, and were thought to produce a new ground contact (NGC). When possible, the NLDN and LDAR systems were used to validate the CGLSS classification and to determine how many of these reported strokes were first strokes, subsequent strokes in a pre-existing channel (PEC), or cloud pulses that the CGLSS misclassified as CG strokes. It is scientifically important to determine the smallest current that can reach the ground either in the form of a first stroke or by way of a subsequent stroke that creates a new ground contact. In Biagi et al (2007), 52 low amplitude, negative return strokes ([Ip] < or = 10 kA) were evaluated in southern Arizona, northern Texas, and southern Oklahoma. The authors found that 50-87% of the small NLDN reports could be classified as CG (either first or subsequent strokes) on the basis of video and waveform recordings. Low amplitude return strokes are interesting because they are usually difficult to detect, and they are thought to bypass conventional lightning protection that relies on a sufficient attractive radius to prevent "shielding failure" (Golde, 1977). They also have larger location errors compared to the larger current events. In this study, we use the estimated peak current provided by the CGLSS and the results of our classification to determine the minimum Ip for each category of CG stroke and its probability of occurrence. Where possible, these results are compared to the findings in the literature.

Return to work predictors of stroke survivors and their spousal caregivers.

PubMed

Schulz, Celia H; Godwin, Kyler M; Hersch, Gayle I; Hyde, Leslie K; Irabor, Jocelyn J; Ostwald, Sharon K

2017-01-01

Return to work is an issue of concern for stroke survivors and their spouses. Ramifications may include loss of income and self-efficacy. This study describes the return to work patterns of stroke survivors and their spousal caregivers post stroke. One hundred fifty-nine dyads were examined for their return to work patterns at baseline (post hospital discharge) and then at 3 month intervals for one year. Relationships were determined between work and gender, age, ethnicity, education, type of insurance, type of stroke, location of stroke, motor and cognitive functional status, depression, mutuality, and life satisfaction. Low levels of return to work by stroke survivors (7.5%) and a small decrease in the amount of working caregivers (from 45.3% to 40.35%) were found one year post baseline. Variables that predicted return to work changed over the five data points except for younger age for the caregiver, which was consistently significant across all data points. Three case scenarios representative of working patterns are offered. Further research is needed regarding the return to work needs of stroke survivors and their spousal caregivers, particularly what role the occupational therapist may play in facilitating that process.

Returning to Paid Employment after Stroke: The Psychosocial Outcomes In StrokE (POISE) Cohort Study

PubMed Central

Hackett, Maree L.; Glozier, Nick; Jan, Stephen; Lindley, Richard

2012-01-01

Objectives To determine which early modifiable factors are associated with younger stroke survivors' ability to return to paid work in a cohort study with 12-months of follow-up conducted in 20 stroke units in the Stroke Services NSW clinical network. Participants Were aged >17 and <65 years, recent (within 28 days) stroke, able to speak English sufficiently to respond to study questions, and able to provide written informed consent. Participants with language or cognitive impairment were eligible to participate if their proxy provided consent and completed assessments on the participants' behalf. The main outcome measure was return to paid work during the 12 months following stroke. Results Of 441 consented participants (average age 52 years, 68% male, 83% with ischemic stroke), 218 were in paid full-time and 53 in paid part-time work immediately before their stroke, of whom 202 (75%) returned to paid part- or full-time work within 12 months. Being male, female without a prior activity restricting illness, younger, independent in activities of daily living (ADL) at 28 days after stroke, and having private health insurance was associated with return to paid work, following adjustment for other illnesses and a history of depression before stroke (C statistic 0·81). Work stress and post stroke depression showed no such independent association. Conclusions Given that independence in ADL is the strongest predictor of return to paid work within 12 months of stroke, these data reinforce the importance of reducing stroke-related disability and increasing independence for younger stroke survivors. Trial Registration Australian New Zealand Clinical Trials Registry ANZCTRN 12608000459325 PMID:22848610

Barriers and facilitators associated with return to work after stroke: a qualitative meta-synthesis.

PubMed

Brannigan, Colm; Galvin, Rose; Walsh, Mary E; Loughnane, Cliona; Morrissey, Emma-Jane; Macey, Chris; Delargy, Mark; Horgan, N Frances

2017-02-01

To enhance the employment outcomes of individuals who experience a stroke, it is essential to understand the factors that determine successful return to work. The aim of this systematic review was to examine barriers to and facilitators of return to work after stroke from the perspective of people with stroke through the process of a qualitative meta-synthesis. A systematic literature search was conducted. Studies that employed qualitative methods to explore the experiences of individuals with stroke around return to work after stroke were included. The methodological quality of the studies was assessed by two independent reviewers. Overarching themes, concepts and interpretations were extracted from each individual study, compared and meta-synthesized. Fifteen studies were included and the overall methodological quality of the studies was good. Four broad themes emerged as factors associated with return to work after stroke. These included (i) the nature of the effects of stroke, (ii) the preparatory environment, (iii) personal coping strategies and internal challenges and (iv) the meaning of work. Return to work after stroke is a complex process which can be facilitated or impeded by organizational, social or personal factors, as well as accessibility to appropriate services. Implications for Rehabilitation Following a period of dedicated inpatient rehabilitation, there is a need to integrate community-support services to optimize return to work among stroke survivors. A dedicated community stroke support liaison officer may help to facilitate the transition between the hospital and the community and workplace environment. Education provided by healthcare professionals is necessary in the community and the workplace to ensure that family, friends and employers are aware of the impairments, activity limitations and participation restrictions of the stroke survivor.

Thermal power and heat energy of cloud-to-ground lightning process

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Xuejuan; Yuan, Ping; Xue, Simin

2016-07-15

A cloud-to-ground lightning flash with nine return strokes has been recorded using a high speed slitless spectrograph and a system composed of a fast antenna and a slow antenna. Based on the spectral data and the synchronous electric field changes that were caused by the lightning, the electrical conductivity, the channel radii, the resistance per unit length, the peak current, the thermal power at the instant of peak current, and the heat energy per unit length during the first 5 μs in the discharge channel have all been calculated. The results indicate that the channel radii have linear relationships with themore » peak current. The thermal power at the peak current time increases with increasing resistance, but exponential decays with the square of the peak current.« less

Method and apparatus for determining return stroke polarity of distant lightning

NASA Technical Reports Server (NTRS)

Blakeslee, Richard J. (Inventor); Brook, Marx (Inventor)

1992-01-01

A method is described for determining the return stroke polarity of distant lightning for distances beyond 600 km by detecting the electric field associated with a return stroke of distant lightning, and processing the electric field signal to determine the polarity of the slow tail of the VLF waveform signal associated with the detected electric field. The polarity of the return stroke of distant lightning is determined based upon the polarity of the slow tail portion of the waveform.

Method and apparatus for determining return stroke polarity of distant lightning

NASA Technical Reports Server (NTRS)

Blakeslee, Richard J. (Inventor); Brook, Marx (Inventor)

1990-01-01

A method is described for determining the return stroke polarity of distant lightning for distances beyond 600 km by detecting the electric field associated with a return stroke of distant lightning, and processing the electric field signal to determine the polarity of the slow tail of the VLF waveform signal associated with the detected electric field. The polarity of the return stroke of distant lightning is determined based upon the polarity of the slow tail portion of the waveform.

Why does negative CG lightning have subsequent return strokes?

NASA Astrophysics Data System (ADS)

Wilkes, R. A.; Kotovsky, D. A.; Uman, M. A.; Carvalho, F. L.; Jordan, D.

2017-12-01

It is not understood why cloud-to-ground (CG) lightning flashes lowering negative charge often produce discrete dart-leader/return-stroke sequences rather than having the first stroke drain the available cloud charge, as is almost always the case for CG lightning lowering positive charge. Triggered lightning data obtained at the International Center for Lightning Research and Testing (ICLRT) in north-central Florida have been analyzed to clarify the subsequent return-stroke process. In summers 2013 through 2016 at the ICLRT, 53% of the rocket launches did not initiate any part of a lightning flash, 13% of the rocket launches created an initial stage only (ISO) and failed to produce a following dart-leader/return-stroke sequences, and 34% of rocket launches produced an initial stage (IS) followed by return strokes. The IS of the triggered lightning consists of the upward positive leader and a following initial continuing current, both being responsible for transporting negative charge from the cloud to ground. Our ISO events may well have some commonality with the roughly 20 percent of natural CG flashes that fail to produce a dart-leader/return-stroke. We have analyzed the IS of 41 triggered lightning flashes with (19 cases) and without (22 cases) following return strokes and compared areas and heights of the flash using data collected by a Lightning Mapping Array (LMA). In our preliminary analysis, we can find no geometrical feature of the lightning channel during the IS that will predict the occurrence or lack of occurrence of following return strokes. We also have compared the triggered-lightning electrical current and charge transfer observed at the ground. We found that the average current, duration, and charge transfer during the IS for ISO events is each about half that of ISs analyzed which are followed by dart-leader/return-stroke sequences, contrary to the results presented from the GCOELD in China. Summarizing, there appear to be no differences in the channel geometry between initial stages that do or do not yield dart-leader/return-stroke sequences. In contrast, we find that particular electrical characteristics of the initial stage may indicate whether or not a dart-leader/return-stroke sequence may follow, potentially shedding light on the physical processes necessary for dart-leader initiation.

Recovery from exercise at varying work loads - Time course of responses of heart rate and systolic intervals

NASA Technical Reports Server (NTRS)

Nandi, P. S.; Spodick, D. H.

1977-01-01

The time course of the recovery period was characterized by noninvasive measurements after 4 minute bicycle exercise at 3 separate work loads in volunteers with normal peak responses. Most responses started immediately to return toward resting control values. Left ventricular ejection time and stroke volume change are discussed. Changes in pre-ejection period were determined by changes in isovolume contraction time, and factors affecting the degree and rate of return are considered. The rates of change in the ejection time index and in the ratio pre-ejection period/left ventricular ejection time were virtually independent of load throughout most of recovery.

Positive attitudes and preserved high level of motor performance are important factors for return to work in younger persons after stroke: a national survey.

PubMed

Lindström, Britta; Röding, Jenny; Sundelin, Gunnevi

2009-09-01

Significant numbers of younger persons with stroke should be given the opportunity to return to work. The aim of this study was to investigate factors of importance for return to work among persons after first ever stroke, in the age range 18-55 years. A questionnaire was sent to all persons who had experienced a first ever stroke, 18-55 years of age, registered in the Swedish national quality register for stroke care, Riks-Stroke. Of the 1068 who answered the questionnaire, 855 (539 men and 316 women) were in paid employment before their stroke, and were included in this study. Sixty-five percent returned to work and, of these, an equal proportion were men and women. Significant factors associated with return to work were the perceived importance of work (odds ratio (OR) 5.10), not perceiving themselves as a burden on others (OR 3.33), support from others for return to work (OR 3.66), retaining the ability to run a short distance (OR 2.77), and higher socioeconomic codes (OR 2.12). A negative association was found between those rehabilitated in wards intended for younger persons and return to work (OR 0.37). External support from others, and positive attitudes towards return to work, were factors associated with successful return to work after stroke. Contrary to what was expected, independence in personal activities of daily living and cognitive factors were not associated with return to work to the same extent as persistent higher level of physical functions, such as ability to run a short distance.

Observation of incomplete drainage of a branched negative stepped leader system during the initial return stroke, and its implications

NASA Astrophysics Data System (ADS)

Petersen, D.; Beasley, W. H.

2012-12-01

We present high-speed video, taken at 75,000 frames per second, of an anomalous lightning flash that involved two distinct return strokes from different branches of the same branched negative stepped leader system. During the initial return stroke the leader system was incompletely drained, resulting in the continued development of a large side branch. The upper portions of this side branch exhibited a pulse of luminosity during the initial return stroke, but the luminosity did not extend down the branch. The lower portion of the branch continued to develop downward as a negative stepped leader, but at a much slower velocity. Continued stepping activity was observed in this branch as it continued downward at a significantly reduced velocity, finally attaching to the earth 1.8 milliseconds after the main return stroke. The ensuing return stroke was characterized by a slower vertical velocity and weaker luminous pulse. Based on this observation, we coin the term "orphaned branch" to describe a branch of a leader system that is not drained during a return stroke. While our case involves a branch that eventually connected to the ground and produced a return stroke, we also consider the possibility that such branches may also simply cease to progress and effectively deposit large amounts of space charge near their extremities. Such space charge would have a strong influence on subsequent breakdown activity in their vicinity, such as shielding subsequent descending negative stepped leaders or triggering upward positive leaders from earth's surface.

Characteristics of return stroke electric fields produced by lightning flashes at distances of 1 to 15 kilometers

NASA Technical Reports Server (NTRS)

Hopf, CH.

1991-01-01

Electric field derivative signals from single and multiple lightning strokes are presented. For about 25 pct. of all acquired waveforms, produced by return strokes, stepped leaders or intracloud discharges, type and distance of the signal source are known from the observations by an all sky video camera system. The analysis of the electric field derivative waveforms in the time domain shows a significant difference in the impulse width between return stroke signals and those of stepped leaders and intracloud discharges. In addition, the computed amplitude density spectrum of return stroke waveforms lies by a factor of 10 above that of stepped leaders and intracloud discharges in the frequency range from 50 to 500 kHz.

RF radiation from lightning

NASA Technical Reports Server (NTRS)

Levine, D. M.

1978-01-01

Radiation from lightning in the RF band from 3-300 MHz were monitored. Radiation in this frequency range is of interest as a potential vehicle for monitoring severe storms and for studying the lightning itself. Simultaneous measurements were made of RF radiation and fast and slow field changes. Continuous analogue recordings with a system having 300 kHz of bandwidth were made together with digital records of selected events (principally return strokes) at greater temporal resolution. The data reveal patterns in the RF radiation for the entire flash which are characteristic of flash type and independent of the frequency of observation. Individual events within the flash also have characteristic RF patterns. Strong radiation occurs during the first return strokes, but delayed about 20 micron sec with respect to the begining of the return stroke; whereas, RF radiation from subsequent return strokes tends to be associated with cloud processes preceding the flash with comparatively little radiation occurring during the return stroke itself.

A numerical study on bow shocks around the lightning return stroke channel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Qiang, E-mail: cq0405@126.com; Chen, Bin, E-mail: emcchen@163.com; Yi, Yun

2015-03-15

Bow shock structures are important to various hydrodynamics and magnetohydrodynamics (MHD) phenomena in geophysics and astrophysics. The formation and propagation of bow shocks around the lightning return stroke channel are investigated based on the self-similar motion theory and simulated with a two-dimensional Eulerian finite volume resistive radiation MHD code. In this framework, as verification of theoretical models, the evolving structures of many quantities, such as the plasma density, temperature, pressure, shock velocity, and magnetic field, can be obtained, which present all the characteristics of bow shocks in the lightning return stroke processes. The evolution characteristics and the configuration of themore » curved return stroke channels, e.g., the non-ideal effects and the scaling laws, are discussed in detail. The results may have applications for some observed features of the return stroke channels and other phenomena in the lightning discharge plasmas.« less

Study protocol to a nationwide prospective cohort study on return to gainful occupation after stroke in Denmark 1996 - 2006

PubMed Central

2010-01-01

Background Successful return to work is regarded as one of the most important outcome factors for working-age post stroke patients. The present study will estimate the effect of various predictors on the odds of returning to work after stroke. Nearly twenty thousand 20-57 year-old stroke patients in Denmark who were gainfully occupied prior to the stroke will be included in the study. Methods/design Stroke patients will be followed prospectively through national registers. Multi-level logistic regression will be used to model the odds of being gainfully occupied ca. two years after the stroke as a function of the following predictors: Age (20-49 years, 50-57 years) gender, occupational class, self-employment (yes; no), onset calendar year (1996, 1997, ..., 2006), diagnosis (subarachnoid haemorrhage; intracerebral haemorrhage; cerebral infarction; stroke, not specified as haemorrhage or infarction) and 'type of municipality' (the variable is set to 1 if the person lived in a municipality which had a brain injury rehabilitation centre at the time of the stroke. Otherwise it is set to 0). Municipalities will be treated as the subjects while individual observations within municipalities are treated as correlated repeated measurements. Discussion Since our follow-up is done through registers and all people in the target population are included, the study is free from sampling bias, recall bias and non-response bias. The study is also strengthened by its size. The major weakness of the study is that it does not contain any stroke severity measures. Thus, it cannot accurately predict whether a particular stroke patient will in fact return to work. The study is, however, quite useful from a public health perspective. It can be used to estimate the proportion of patients in a certain group that is expected to return to work, and thereby provide a comparison material, which e.g. municipalities can use to evaluate their success in returning their stroke patients to work. PMID:20958997

Internet-based information-seeking behavior for transient ischemic attack.

PubMed

Abedi, Vida; Mbaye, Marieme; Tsivgoulis, Georgios; Male, Shailesh; Goyal, Nitin; Alexandrov, Andrei V; Zand, Ramin

2015-12-01

In recent years, Internet became an increasingly important tool for accessing health information and is being used more frequently to promote public health. To use Google search data to explore information seeking behavior for transient ischemic attack. We selected two groups of keywords related to transient ischemic attack: 'Transient Ischemic Attack' and 'Mini Stroke'. We obtained all available online search data performed in the United States from the Google search engine for a 10-year span--January 2004 to December 2013. The monthly and daily search data for the selected keywords were analyzed--using moving average--to explore the trends, peaks, and declining effects. There were three significant concurrent peaks in the Google search data for the selected keywords. Each peak was directly associated with media coverage and news headlines related to the incident of transient ischemic attack in a public figure. Following each event, it took three- to seven-days for the search trend to return to its respective average value. Furthermore, the trend was steady for 'Transient Ischemic Attack'; however, the search interest for the keyword 'Mini Stroke' shows a steady increase. The overall search interest for the selected keywords was significantly higher in the southeastern United States. Our study shows that changes in online search behavior can be associated with media coverage of key events (in our case transient ischemic attack) in public figures. These findings suggest that multimedia health promotion campaigns might be more effective, if increased promptly after similar media coverage. © 2015 World Stroke Organization.

Characteristics of the most intense lightning storm ever recorded at the CN Tower

NASA Astrophysics Data System (ADS)

Hussein, A. M.; Kazazi, S.; Anwar, M.; Yusouf, M.; Liatos, P.

2017-02-01

Lightning strikes to the CN Tower have been optically observed since 1978. In 1990, five independent systems started to operate to simultaneously record parameters of lightning strikes to the tower, including the time derivative of the current, the associated electric and magnetic fields, and the channel optical characteristics. On August 24, 2011, during an unusually severe lightning storm, video records showed that the CN Tower was struck with 52 lightning flashes within 84 min and 6.9 s. Thus, this storm produced, on average, a flash to the tower every 99 s. However, the CN Tower lightning current derivative measurement system only recorded 32 flashes, which were perfectly time-matched with 32 of the 52 video-recorded flashes. It is found that the current derivative measurement system recorded every video-recorded flash that contained at least one return stroke. Based on the analysis of video records, it is noted that each of the storm's 52 flashes contains an initial-stage current, proving that all flashes were upward initiated. This unique CN Tower storm - the most intense ever recorded at the tower - is here thoroughly analyzed, based on video and current records. The inter-flash time within the storm is found to vary between 10.6 s and 274 s, with an overall average of 98 s. It is also found that the inter-flash time between successive non-return-stroke flashes is on average 64% longer than that for successive flashes containing return strokes. Statistical analysis of video and current data clearly reveals that the time duration of flashes containing initial-stage currents and return strokes is on average 27% longer than that of flashes that only have initial-stage currents. Furthermore, it is important to note that the time duration of the initial-stage current in flashes containing no return strokes is on average 76% longer than that in flashes containing return strokes. Therefore, it is possible to conclude that if the time duration of the initial-stage current in a flash is long enough, resulting in large charge transfer, then there is less probability of having return strokes following it. The 32 current-recorded flashes contain a total of 156 return strokes, with an average multiplicity of 4.875. It is worth mentioning that during one decade, 1992-2001, the CN Tower current derivative measurement system only recorded 478 return strokes, demonstrating that the number of return strokes recorded at the tower within about 84 min is close to one third of those recorded at the tower during one decade. This finding clearly shows the great value and rarity of the presented extensive lightning current derivative data. Only one of the 32 current-recorded flashes is proved to be positive with a single return stroke. Based on current records, out of a total of 124 inter-stroke time intervals, 94% are found to be within 200 ms, with an overall inter-stroke time average of 68.1 ms. The maximum inter-stroke time recorded during this storm is 726.3 ms, the longest ever recorded at the CN Tower.

Geometrical Effects on the Electromagnetic Radiation from Lightning Return Strokes

NASA Technical Reports Server (NTRS)

Willett, J. C.; Smith, D. A.; LeVine, D. M.; Zukor, Dorothy J. (Technical Monitor)

2001-01-01

The morphological difference between the electromagnetic radiation-field waveforms of "first" and "subsequent" return strokes in cloud-to-ground lightning flashes is well known and can be used to identify the formation of new channels to ground. This difference is generally believed due to the existence of branches on first-stroke channels, whereas subsequent strokes re-illuminate only the main channel of a previous stroke; but experimental evidence for this hypothesis is relatively weak. It has been argued for the influence of channel geometry on the fine structure of radiation from subsequent return strokes by comparing the field-change waveforms recorded at the same station from strokes within the same flash and between different flashes of both natural and triggered lightning. The present paper introduces new evidence for both of these hypotheses from a comparison of waveforms between sensors in different directions from the same stroke.

Multi-instrument Observations of Transient Luminous Events Associated with a Small-scale Winter Thunderstorm

NASA Astrophysics Data System (ADS)

Kolmasova, I.; Santolik, O.; Spurny, P.; Borovicka, J.; Mlynarczyk, J.; Popek, M.; Lan, R.; Uhlir, L.; Diendorfer, G.; Slosiar, R.

2017-12-01

We present observations of transient luminous events (TLEs) produced by a small-scale winter thunderstorm which occurred on 2 April 2017 in the southwest of Czechia. Elves, sprites and associated positive lightning strokes have been simultaneously recorded by different observational techniques. Optical data include video recordings of TLEs from Nydek (Czechia) and data recorded by high time-resolution photometers at several stations of the Czech fireball network which measured the all-sky brightness originating from lightning return strokes. Electromagnetic data sets include 3-component VLF measurements conducted in Rustrel (France), 2-component ELF measurements recorded at the Hylaty station (Poland) and signal intensity variations of a VLF transmitter (DHO38, Rhauderfehn, Germany) recorded in Bojnice (Slovakia). Optical and electromagnetic data are completed by positions and peak currents of all strokes recorded during the observed thunderstorm by the EUCLID lightning detection network. We focus our analysis on positive lightning discharges with high peak currents and we compare properties of those which produced TLE with properties of discharges for which TLE was not detected. The current moment waveforms and charge moment changes associated with the TLE events are reconstructed from the ELF electromagnetic signals. Obtained current moment waveforms show excellent agreement with high time-resolution optical data.

Ship-borne Radio and GLD360 Measurements of Intense Oceanic Lightning

NASA Astrophysics Data System (ADS)

Zoghzoghy, F. G.; Cohen, M.; Said, R.; Lehtinen, N. G.; Inan, U.

2013-12-01

Recent studies with the GLD360 lightning geo-location network have shown that the peak current intensity of cloud-to-ground (CG) lightning is more powerful over the ocean than over land. This remains a poorly understood phenomenon. The Stanford VLF group has recently deployed a Very Low Frequency (1 MHz sampling rate) radio receiver system aboard the NOAA Ronald W. Brown research vessel. The goal of this transatlantic experiment is to improve our understanding of oceanic lightning and to investigate the physical difference between oceanic and land lightning. When positioned reasonably close to deep oceanic thunderstorms, the LF-VLF receiver aboard the Ronald W. Brown detects the impulsive radio emissions from the return stroke, up to 1 MHz, which enables us to estimate the return-stroke waveform shapes generated by the lightning channel. In this presentation, we present our experimental setup and a summary of the data collected during the transatlantic voyages of the NOAA ship. We process lightning-generated waveforms, compare them to LF-VLF data from land lightning over Oklahoma, extract statistical patterns, and compare the data to numerical and analytical models.

Review of measurements of the RF spectrum of radiation from lightning

NASA Technical Reports Server (NTRS)

Levine, D. M.

1986-01-01

Measurements reported in the literature of the spectrum of electromagnetic radiation from lightning in the frequency range from 1 kHz to 1 GHz are reviewed. Measurements have been made either by monitoring the power received at individual frequencies using a narrow bandwidth recording device tuned to the frequencies under investigation or by recording the transient (time dependent) radiation with a wide bandwidth device and then Fourier transforming the waveform to obtain a spectrum. Measurements of the first type were made extensively in the 1950's and 1960's and several composite spectra have been deduced by normalizing the data of different investigators to common units of bandwidth and distance. The composite spectra tend to peak near 5 kHz and then decrease roughly as (frequency) to the -1, up to nearly 100 MHz where scatter in the data make the behavior uncertain. Measurements of the second type have been reported for return strokes, the stepped leader and for some intracloud processes. The spectrum of first return strokes obtained in this manner is very similar to the composite spectra obtained from the narrow-band measurements.

A 21st century investigation of the lightning spectrum

NASA Astrophysics Data System (ADS)

Walker, Thomas Daniel

In the mid 1960s, Martin Uman, Leon Salanave and Richard Orville laid the foundation for lightning spectroscopy. They were among the first to acquire time resolved return stroke spectra and the first to use spectroscopy as a diagnostic technique to characterize physical properties of the lightning channel. Now, almost 50 years later, technology, including CMOS and CCD high speed cameras, volume-phase holographic (VPH) gratings, and triggered lightning, has progressed to the point at which new studies in lightning spectroscopy are needed to verify and extend past measurements. New spectral lines have been discovered in the lightning spectrum as a result of the modern studies, mainly doubly ionized nitrogen lines which had not been observed in the past. The modern technique uses CMOS and CCD cameras with frame rates of up to 1Mfps with exposure down to 0.5mus. The high frame rate paired with camera memory enables a view into the quick high temperature heating period within the first few microseconds of the return stroke, as well as a detailed look at the cooling period which can last for milliseconds. The spectra are recorded digitally and discretely, hence the data can be summed to to view different exposure times revealing long lasting low emission lines during the cooling period as well. Spectral line identification for the natural and triggered lightning are for a range of wavelengths from soft ultraviolet around 3800A to the near infrared at 9500A. The first few microseconds of the lightning return stroke spectrum consists of hydrogen from disassociated water and singly and doubly ionized lines of atomic atmospheric constituents, i.e. argon, nitrogen, and oxygen. Temperatures calculated during this period have been measured above 40000 K. The peak temperature is measured from the first spectrum of the return stroke. After this the channel continuously cools over the lifetime of the return stroke unless there is an increase in the continuing current. Tens of microseconds after the onset, a cool period in the spectra exists which consists solely of neutral atomic emission lines. The cooling period temperature measurements begin in the low 20000 K range and decrease slowly over the course of milliseconds until strength of the emission lines drop below measurement threshold. Besides the return stroke, other specific lightning processes analyzed include stepped leaders, dart-stepped leaders, and m-components within the continuing current. Stepped and dart-stepped leader spectra consist both of pulsing singly ionized lines and steadily growing neutral lines. Each step within these processes cause increased ionization to occur in the channel upward from the step, demonstrating a pulsing temperature throughout the lifetime of these stepped features. Spectra of the stroke processes, m-components and continuing currents, consist of neutral atmospheric emission lines and copper emission lines which demonstrate the long duration of the channel milliseconds after the initial stages. These spectra indicate long lasting low temperatures which should give insight into temperature profiles where NOx reactions occur. From the spectra, emission identification and lifetime as well as calculations of physical parameters such as temperature, number density, and conductivity about each of these processes give insight into what is physically happening within the channel throughout the lifetime of a stroke.

Measured close lightning leader-step electric-field-derivative waveforms.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jordan, Doug M.; Hill, Dustin; Biagi, Christopher J.

2010-12-01

We characterize the measured electric field-derivative (dE/dt) waveforms of lightning stepped-leader steps from three negative lightning flashes at distances of tens to hundreds of meters. Electromagnetic signatures of leader steps at such close distances have rarely been documented in previous literature. Individual leader-step three-dimensional locations are determined by a dE/dt TOA system. The leader-step field derivative is typically a bipolar pulse with a sharp initial half-cycle of the same polarity as that of the return stroke, followed by an opposite polarity overshoot that decays relatively slowly to background level. This overshoot increases in amplitude relative to the initial peak andmore » becomes dominant as range decreases. The initial peak is often preceded by a 'slow front,' similar to the slow front that precedes the fast transition to peak in first return stroke dE/dt and E waveforms. The overall step-field waveform duration is typically less than 1 {micro}s. The mean initial peak of dE/dt, range-normalized to 100 km, is 7.4 V m{sup -1} {micro}s{sup -1} (standard deviation (S.D.), 3.7 V m{sup -1} {micro}s{sup -1}, N = 103), the mean half-peak width is 33.5 ns (S.D., 11.9 ns, N = 69), and the mean 10-to-90% risetime is 43.6 ns (S.D., 24.2 ns, N = 69). From modeling, we determine the properties of the leader step currents which produced two typical measured field derivatives, and we use one of these currents to calculate predicted leader step E and dE/dt as a function of source range and height, the results being in good agreement with our observations. The two modeled current waveforms had maximum rates of current rise-to-peak near 100 kA {micro}s{sup -1}, peak currents in the 5-7 kA range, current half-peak widths of about 300 ns, and charge transfers of {approx}3 mC. As part of the modeling, those currents were propagated upward at 1.5 x 10{sup 8} m s{sup -1}, with their amplitudes decaying exponentially with a decay height constant of 25 m.« less

Working after a stroke: survivors' experiences and perceptions of barriers to and facilitators of the return to paid employment.

PubMed

Alaszewski, Andy; Alaszewski, Helen; Potter, Jonathan; Penhale, Bridget

2007-12-30

This paper examines respondents' relationship with work following a stroke and explores their experiences including the perceived barriers to and facilitators of a return to employment. Our qualitative study explored the experiences and recovery of 43 individuals under 60 years who had survived a stroke. Participants, who had experienced a first stroke less than three months before and who could engage in in-depth interviews, were recruited through three stroke services in South East England. Each participant was invited to take part in four interviews over an 18-month period and to complete a diary for one week each month during this period. At the time of their stroke a minority of our sample (12, 28% of the original sample) were not actively involved in the labour market and did not return to the work during the period that they were involved in the study. Of the 31 participants working at the time of the stroke, 13 had not returned to work during the period that they were involved in the study, six returned to work after three months and nine returned in under three months and in some cases virtually immediately after their stroke. The participants in our study all valued work and felt that working, especially in paid employment, was more desirable than not working. The participants who were not working at the time of their stroke or who had not returned to work during the period of the study also endorsed these views. However they felt that there were a variety of barriers and practical problems that prevented them working and in some cases had adjusted to a life without paid employment. Participants' relationship with work was influenced by barriers and facilitators. The positive valuations of work were modified by the specific context of stroke, for some participants work was a cause of stress and therefore potentially risky, for others it was a way of demonstrating recovery from stroke. The value and meaning varied between participants and this variation was related to past experience and biography. Participants who wanted to work indicated that their ability to work was influenced by the nature and extent of their residual disabilities. A small group of participants had such severe residual disabilities that managing everyday life was a challenge and that working was not a realistic prospect unless their situation changed radically. The remaining participants all reported residual disabilities. The extent to which these disabilities formed a barrier to work depended on an additional range of factors that acted as either barriers or facilitator to return to work. A flexible working environment and supportive social networks were cited as facilitators of return to paid employment. Participants in our study viewed return to work as an important indicator of recovery following a stroke. Individuals who had not returned to work felt that paid employment was desirable but they could not overcome the barriers. Individuals who returned to work recognized the barriers but had found ways of managing them.

Statistical Evolution of the Lightning Flash

NASA Astrophysics Data System (ADS)

Zoghzoghy, F. G.; Cohen, M.; Said, R.; Inan, U. S.

2012-12-01

Natural lightning is one of the most fascinating and powerful electrical processes on Earth. To date, the physics behind this natural phenomenon are not fully understood, due primarily to the difficulty of obtaining measurements inside thunderstorms and to the wide range of timescales involved (from nanoseconds to seconds). Our aim is to use accurate lightning geo-location data from the National Lightning Detection Network (NLDN) to study statistical patterns in lightning, taking advantage of the fact that millions of lightning flashes occur around the globe every day. We present two sets of results, one involving the patterns of flashes in a storm, and a second involving the patterns of strokes in a flash. These patterns can provide a surrogate measure of the timescales and the spatial extents of the underlying physical processes. First, we study the timescales of charge buildup inside thunderstorms. We find that, following a lightning flash, the probability of another neighboring flash decreases and takes tens of seconds to recover. We find that this suppression effect is a function of flash type, stroke peak current, cloud-to-ground (CG) stroke multiplicity, and other lightning and geographical parameters. We find that the probabilities of subsequent flashes are more suppressed following oceanic lightning, or following flashes with higher peak currents and/or higher multiplicities (for CG flashes). Second, we use NLDN data to study the evolution of the strokes within a CG flash. A CG flash typically includes multiple return strokes, which can occur in the same channel or in multiple channels within a few kilometers. We cluster NLDN stroke data into flashes and produce the probability density function of subsequent strokes as a function of distance and time-delays relative to the previous stroke. Using this technique, we investigate processes which occur during the CG lightning flash with nanosecond to millisecond timescales. For instance, our results suggest that subsequent strokes that occur in a newly formed channel follow a pattern that propagates at a speed of ~200 km/s. We present our statistical techniques and discuss more thoroughly our work and results.

Post-stroke fatigue and return to work: a 2-year follow-up.

PubMed

Andersen, G; Christensen, D; Kirkevold, M; Johnsen, S P

2012-04-01

Post-stroke fatigue may affect the ability to return to work but quantitative studies are lacking. We included 83 first-ever stroke patients <60 years and employed either full-time (n = 77) or part-time (n = 6) at baseline. The patients were recruited from stroke units at Aarhus University Hospital between 2003 and 2005 and were followed for 2 years. Fatigue was assessed by the Multidimensional Fatigue Inventory. Pathological fatigue was defined as a score ≥12 on the General Fatigue dimension. Return to paid work was defined as working at least 10 h per week. Data were analyzed using multivariable logistic regression. A total of 58% of patients had returned to paid work after 2 years. The adjusted Odds Ratio (OR) for returning to paid work was 0.39 (95% confidence interval (CI) 0.16-1.08) for patients with a General Fatigue score ≥12 at baseline. Persisting pathological fatigue after 2 years of follow-up was associated with a lower chance of returning to paid work [adjusted OR 0.29 (95% CI 0.11-0.74)]. Higher scores of General Fatigue at follow-up also correlated negatively with the chance of returning to paid work when analyzing fatigue on a continuous scale (adjusted OR 0.87, 95% CI 0.80-0.94 for each point increase in General Fatigue). Post-stroke fatigue appears to be an independent determinant of not being able to resume paid work following stroke. © 2011 John Wiley & Sons A/S.

Mathematical Formulation of the Remote Electric and Magnetic Emissions of the Lightning Dart Leader and Return Stroke

NASA Astrophysics Data System (ADS)

Thiemann, Edward M. B.

Lightning detection and geolocation networks have found widespread use by the utility, air traffic control and forestry industries as a means of locating strikes and predicting imminent recurrence. Accurate lightning geolocation requires detecting VLF radio emissions at multiple sites using a distributed sensor network with typical baselines exceeding 150 km, along with precision time of arrival estimation to triangulate the origin of a strike. The trend has been towards increasing network accuracy without increasing sensor density by incorporating precision GPS synchronized clocks and faster front-end signal processing. Because lightning radio waveforms evolve as they propagate over a finitely conducting earth, and that measurements for a given strike may have disparate propagation path lengths, accurate models are required to determine waveform fiducials for precise strike location. The transition between the leader phase and return stroke phase may offer such a fiducial and warrants quantitative modeling to improve strike location accuracy. The VLF spectrum of the ubiquitous downward negative lightning strike is able to be modeled by the transfer of several Coulombs of negative charge from cloud to ground in a two-step process. The lightning stepped leader ionizes a plasma channel downward from the cloud at a velocity of approximately 0.05c, leaving a column of charge in its path. Upon connection with a streamer, the subsequent return stroke initiates at or near ground level and travels upward at an average but variable velocity of 0.3c. The return stroke neutralizes any negative charge along its path. Subsequent dart leader and return strokes often travel smoothly down the heated channel left by a preceding stroke, lacking the halting motion of the preceding initial stepped leader and initial return stroke. Existing lightning models often neglect the leader current and rely on approximations when solving for the return stroke. In this thesis, I present an analytic solution to Maxwell's Equations for the lightning leader followed by a novel return stroke model. I model the leader as a downward propagating boxcar function of uniform charge density and constant velocity, and the subsequent return stroke is modeled as an upward propagating boxcar with a time dependent velocity. Charge conservation is applied to ensure self-consistency of the driving current and charge sources, and physical observations are used to support model development. The resulting transient electric and magnetic fields are presented at various distances and delay times and compared with measured waveforms and previously published models.

Enterprise size and return to work after stroke.

PubMed

Hannerz, Harald; Ferm, Linnea; Poulsen, Otto M; Pedersen, Betina Holbæk; Andersen, Lars L

2012-12-01

It has been hypothesised that return to work rates among sick-listed workers increases with enterprise size. The aim of the present study was to estimate the effect of enterprise size on the odds of returning to work among previously employed stroke patients in Denmark, 2000-2006. We used a prospective design with a 2 year follow-up period. The study population consisted of 13,178 stroke patients divided into four enterprise sizes categories, according to the place of their employment prior to the stroke: micro (1-9 employees), small (10-49 employees), medium (50-249 employees) and large (>250 employees). The analysis was based on nationwide data on enterprise size from Statistics Denmark merged with data from the Danish occupational hospitalisation register. We found a statistically significant association (p = 0.034); each increase in enterprise size category was followed by an increase in the estimated odds of returning to work. The chances of returning to work after stroke increases as the size of enterprise increases. Preventive efforts and research aimed at finding ways of mitigating the effect are warranted.

Barriers and facilitators to staying in work after stroke: insight from an online forum.

PubMed

Balasooriya-Smeekens, Chantal; Bateman, Andrew; Mant, Jonathan; De Simoni, Anna

2016-04-06

To explore barriers and facilitators to staying in work following stroke. Qualitative analysis of posts regarding staying in work following stroke using the archives of an online forum for stroke survivors. 60 stroke survivors (29 male, 23 female, 8 not stated; mean age at stroke 44 years) who have returned to work, identified using terms 'return to work' and 'back at work'. Posts from UK stroke survivors and family members on Talkstroke, the forum of the Stroke Association, between 2004 and 2011. Stroke and transient ischaemic attack (TIA) survivors reported residual impairments that for many had impact on work. Most impairments were 'invisible', including fatigue, problems with concentration, memory and personality changes. Participants described positive (eg, back at work being better than expected) and negative work experiences, including being at risk of losing the job because of stroke-related impairments. Barriers to successfully staying in work included lack of understanding of stroke--in particular invisible impairments--of survivors, employers and general practitioners (GPs), and lack of support in terms of formal adjustments, and 'feeling supported'. Stroke survivors described how they developed their own coping strategies, and how workplace and employer helped them to stay in work. Despite having been able to return to work after a stroke, people may still experience difficulties in staying in work and risking losing their job. There is a need to improve awareness, in particular of invisible stroke-related impairments, among stroke survivors, work personnel and clinicians. This might be achieved through improved assessments of residual impairments in the workplace and in general practice. Future studies should investigate the effect of unrecognised fatigue and invisible impairments on staying in work following stroke, and explore the potential role for primary care in supporting stroke survivors who have returned to employment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Returning to Work after the Onset of Illness: Experiences of Right Hemisphere Stroke Survivors

ERIC Educational Resources Information Center

Koch, Lynn; Egbert, Nichole; Coeling, Harriet; Ayers, Denise

2005-01-01

Experiences of right hemisphere stroke survivors in their attempts to return to work after the onset of stroke were explored through an interdisciplinary qualitative investigation. Key findings indicate that (a) participants experienced an array of functional limitations that precipitated employment changes; (b) employment changes had a…

The (im)possibilities of returning to work after a stroke.

PubMed

Norstedt, Maria

2017-01-01

What a stroke means for working-age persons has not been sufficiently studied from a sociological perspective. This article uses the empirical material of a larger study to describe and analyze how institutional practices and discourses influence attempts to return to work after a stroke. Semi-structured interviews were conducted with ten persons who have had a stroke and ten civil servants and professionals from the Swedish Public Employment Service, the Social Insurance Agency, and different health care institutions. The qualitative analysis was inspired by institutional ethnography. The analysis shows how persons who have had a stroke and civil servants and professionals in welfare organizations share the same goal: a return to working life for the former. The persons in this study related to, translated, and put into practice discourses of normality and employability in this process. However, there were, at times, conflicting institutional practices between the different organizations. Conflicting institutional practices connected to the discourses of normality and employability contribute to the difficulties that persons who have had a stroke face when trying to return to work after recovery.

The influence of the breakdown electric field in the configuration of lightning corona sheath on charge distribution in the channel

NASA Astrophysics Data System (ADS)

Ignjatovic, Milan; Cvetic, Jovan; Heidler, Fridolin; Markovic, Slavoljub; Djuric, Radivoje

2014-11-01

A model of corona sheath that surrounds the thin core of the lightning channel has been investigated by using a generalized traveling current source return stroke model. The lightning channel is modeled by a charged corona sheath that stretches around a highly conductive central core through which the main current flows. The channel core with the negatively charged outer channel sheath forms a strong electric field, with an overall radial orientation. The return stroke process is modeled as the negative leader charge in the corona sheath being discharged by the positive charge coming from the channel core. Expressions that describe how the corona sheath radius evolves during the return stroke are obtained from the corona sheath model, which predicts charge motion within the sheath. The corona sheath model, set forth by Maslowski and Rakov (2006), Tausanovic et al. (2010), Marjanovic and Cvetic (2009), Cvetic et al. (2011) and Cvetic et al. (2012), divides the sheath onto three zones: zone 1 (surrounding the channel core with net positive charge), zone 2 (surrounding zone 1 with negative charge) and zone 3 (the outer zone, representing uncharged virgin air). In the present study, we have assumed a constant electric field inside zone 1, as suggested by experimental research of corona discharges in coaxial geometry conducted by Cooray (2000). The present investigation builds upon previous studies by Tausanovic et al. (2010) and Cvetic et al. (2012) in several ways. The value of the breakdown electric field has been varied for probing its effect on channel charge distribution prior and during the return stroke. With the aim of investigating initial space charge distribution along the channel, total electric field at the outer surface of the channel corona sheath, just before the return stroke, is calculated and compared for various return stroke models. A self-consistent algorithm is applied to the generalized traveling current source return stroke model, so that the boundary condition for total electric field is fulfilled. The new density of space charge and the new radius of channel corona envelope, immediately before the return stroke stage, are calculated. The obtained results indicate a strong dependence of channel charge distribution on the breakdown electric field value. Among the compared return stroke models, transmission-line-type models have exhibited a good agreement with the predictions of the Gauss' law regarding total breakdown electric field on the corona sheath's outer surface. The generalized lightning traveling current source return stroke model gives similar results if the adjustment of the space charge density inside the corona sheath is performed.

Barriers and facilitators to staying in work after stroke: insight from an online forum

PubMed Central

Balasooriya-Smeekens, Chantal; Bateman, Andrew; Mant, Jonathan; De Simoni, Anna

2016-01-01

Objective To explore barriers and facilitators to staying in work following stroke. Design Qualitative analysis of posts regarding staying in work following stroke using the archives of an online forum for stroke survivors. Participants 60 stroke survivors (29 male, 23 female, 8 not stated; mean age at stroke 44 years) who have returned to work, identified using terms ‘return to work’ and ‘back at work’. Setting Posts from UK stroke survivors and family members on Talkstroke, the forum of the Stroke Association, between 2004 and 2011. Results Stroke and transient ischaemic attack (TIA) survivors reported residual impairments that for many had impact on work. Most impairments were ‘invisible’, including fatigue, problems with concentration, memory and personality changes. Participants described positive (eg, back at work being better than expected) and negative work experiences, including being at risk of losing the job because of stroke-related impairments. Barriers to successfully staying in work included lack of understanding of stroke—in particular invisible impairments—of survivors, employers and general practitioners (GPs), and lack of support in terms of formal adjustments, and ‘feeling supported’. Stroke survivors described how they developed their own coping strategies, and how workplace and employer helped them to stay in work. Conclusions Despite having been able to return to work after a stroke, people may still experience difficulties in staying in work and risking losing their job. There is a need to improve awareness, in particular of invisible stroke-related impairments, among stroke survivors, work personnel and clinicians. This might be achieved through improved assessments of residual impairments in the workplace and in general practice. Future studies should investigate the effect of unrecognised fatigue and invisible impairments on staying in work following stroke, and explore the potential role for primary care in supporting stroke survivors who have returned to employment. PMID:27053267

Lightning channel current persists between strokes

NASA Astrophysics Data System (ADS)

Wendel, JoAnna

2014-09-01

The usual cloud-to-ground lightning occurs when a large negative charge contained in a "stepped leader" travels down toward the Earth's surface. It then meets a positive charge that comes up tens of meters from the ground, resulting in a powerful neutralizing explosion that begins the first return stroke of the lightning flash. The entire flash lasts only a few hundred milliseconds, but during that time, multiple subsequent stroke-return stroke sequences usually occur.

Positive cloud-to-ground lightning flashes in severe storms

NASA Technical Reports Server (NTRS)

Rust, W. D.; Macgorman, D. R.; Arnold, R. T.

1981-01-01

The occurrence of cloud-to-ground flashes that effectively lower positive charge to earth (+CG flash) over flat terrain has been documented in the mature stage of severe thunderstorms. Of the 31 documented +CG flashes, most had only one return stroke. Zero-to-peak rise times for the strokes averaged 7 microsec. The +CG flashes averaged 520 ms in duration, with 25 percent lasting more than 800 ms. Many of these had field changes suggestive of continuing current. Positive flashes have been observed to emanate from several regions of severe storms: high on the back of the main storm tower, through the wall cloud, and from the downshear anvil. Visually most of these positive flashes have emanated from high in the storm, and acoustic mapping of two shows thunder sources to a height of about 15 km.

Changes in cardiac output and tibial artery flow during and after progressive LBNP

NASA Technical Reports Server (NTRS)

1980-01-01

A 3.0 MHz Pulsed Doppler velocity meter (PD) was used to determine blood velocities in the ascending aorta from the suprasternal notch before, during and after progressive 5 min stages of lower body negative pressure (LBNP) in 7 subjects. Changes in stroke volume were calculated from the systolic velocity integrals. A unique 20 MHz PD was used to estimate bloodflow in the posterior tibial artery. With -20 torr mean stroke volume fell 11% and then continued to decline by 48% before LBNP was terminated. Mean tibial flow fell progressively with LBNP stress, due to an increase in reverse flow component and a reduction in peak forward flow and diameter. Stroke volume increased and heart rate fell dramatically during the first 15 sec of recovery. The LBNP was terminated early in 2 subjects because of vasovagal symptons (V). During V the stroke volume rose 86% which more than compensated for the drop in heart rate. This implies that V is accompanied by a paradoxical increase in venous return and that the reduction in HR is the primary cardiovascular event. During the first 15 sec of recovery these 2 subjects had a distinctive marked rise to heart rate reminiscent of the Bainbridge reflex.

Evaluation of Lightning Incidence to Elements of a Complex Structure: A Monte Carlo Approach

NASA Technical Reports Server (NTRS)

Mata, Carlos T.; Rakov, V. A.

2008-01-01

There are complex structures for which the installation and positioning of the lightning protection system (LPS) cannot be done using the lightning protection standard guidelines. As a result, there are some "unprotected" or "exposed" areas. In an effort to quantify the lightning threat to these areas, a Monte Carlo statistical tool has been developed. This statistical tool uses two random number generators: a uniform distribution to generate origins of downward propagating leaders and a lognormal distribution to generate returns stroke peak currents. Downward leaders propagate vertically downward and their striking distances are defined by the polarity and peak current. Following the electrogeometrical concept, we assume that the leader attaches to the closest object within its striking distance. The statistical analysis is run for 10,000 years with an assumed ground flash density and peak current distributions, and the output of the program is the probability of direct attachment to objects of interest with its corresponding peak current distribution.

A review of advances in lightning observations during the past decade in Guangdong, China

NASA Astrophysics Data System (ADS)

Zhang, Yijun; Lü, Weitao; Chen, Shaodong; Zheng, Dong; Zhang, Yang; Yan, Xu; Chen, Lüwen; Dong, Wansheng; Dan, Jianru; Pan, Hanbo

2016-08-01

This paper reviews recent advances in understanding the physical processes of artificially triggered lightning and natural lightning as well as the progress in testing lightning protection technologies, based on a series of lightning field campaigns jointly conducted by the Chinese Academy of Meteorological Sciences and Guangdong Meteorological Bureau since 2006. During the decade-long series of lightning field experiments, the technology of rocket-wire artificially triggered lightning has been improved, and has successfully triggered 94 lightning flashes. Through direct lightning current waveform measurements, an average return stroke peak current of 16 kA was obtained. The phenomenon that the downward leader connects to the lateral surface of the upward leader in the attachment process was discovered, and the speed of the upward leader during the connection process being significantly greater than that of the downward leader was revealed. The characteristics of several return strokes in cloud-to-ground lighting have also been unveiled, and the mechanism causing damage to lightning protection devices (i.e., ground potential rise within the rated current) was established. The performance of three lightning monitoring systems in Guangdong Province has also been quantitatively assessed.

Horizontal fields generated by return strokes

NASA Technical Reports Server (NTRS)

Cooray, Vernon

1991-01-01

Horizontal fields generated by return strokes play an important role in the interaction of lightning generated electric fields with power lines. In many of the recent investigations on the interaction of lightning electromagnetic fields with power lines, the horizontal field was calculated by employing the expression for the tilt of the electric field of a plane wave propagating over finitely conducting earth. The method is suitable for calculating horizontal fields generated by return strokes at distances as close as 200m. At these close ranges, the use of the wavetilt expression can cause large errors.

Submicrosecond risetimes in lightning return-stroke fields

NASA Technical Reports Server (NTRS)

Weidman, C. D.; Krider, E. P.

1980-01-01

Measurements of lightning electric field, E, and dE/dt signatures have been made near Tampa Bay, Florida, under conditions where the lightning locations were known and where the results were not significantly affected by the response time of the measuring system or groundwave propagation. The fast transitions found on the initial portion of return-stroke fields have 10-90% risetimes ranging from 40 to 200 nsec, with a mean of 90 nsec. The maximum field derivatives during return strokes range from 5 to 75 V/m per microsec with a mean of 29 V/m per microsec when normalized to a distance of 100 km. These field risetime and derivative values suggest that return-stroke currents contain large, submicrosecond components, and this in turn suggests that it may be necessary to reevaluate the possible effects of lightning and the performance of lightning-protection devices in many situations.

Update Direct-Strike Lightning Environment for Stockpile-to-Target Sequence (Second Revision)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Uman, Martin A.; Rakov, V. A.; Elisme, J. O.

2010-10-05

The University of Florida has surveyed all relevant publications reporting lightning characteristics and presents here an up-to-date version of the direct-strike lightning environment specifications for nuclear weapons published in 1989 by R. J. Fisher and M. A. Uman. Further, we present functional expressions for current vs. time, current derivative vs. time, second current derivative vs. time, charge transfer vs. time, and action integral (specific energy) vs. time for positive and negative first return strokes, for negative subsequent return strokes, and for positive and negative continuing currents; and we give sets of constants for these functional expressions so that the resultantmore » waveforms exhibit approximately the median and extreme lightning parameters presented in the updated direct strike environment. Fourier transforms of the return stroke current waveforms are presented. The results of our literature survey are included in three Appendices entitled Return Stroke Current, Continuing Current, and Positive Lightning.« less

Geometrical Effects on the Electromagnetic Radiation from Lightning Return Strokes

NASA Technical Reports Server (NTRS)

Willett, John C.; Smith, David A.; LeVine, David M.; Zukor, Dorothy J. (Technical Monitor)

2000-01-01

The Los Alamos National Laboratory (LANL) Sferic Array has recorded electric-field-change waveforms simultaneously at several stations surrounding the ground-strike points of numerous return strokes in cloud-to-ground lightning flashes. Such data are available from the five-station sub-networks in both Florida and New Mexico. With these data it has been possible for the first time to compare the waveforms radiated in different directions by a given stroke. Such comparisons are of interest to assess both the effects of channel geometry on the fine structure of subsequent-stroke radiation fields and the role of branches in the more jagged appearance of first-stroke waveforms. This paper presents multiple-station, time-domain waveforms with a 200 Hz to 500 kHz pass-band from both first and subsequent return strokes at ranges generally between 100 and 200 km. The differences among waveforms of the same stroke received at stations in different directions from the lightning channel are often obvious. These differences are illustrated and interpreted in the context of channel tortuosity and branches.

On the flow generated by rotating flat plates of low aspect ratio

NASA Astrophysics Data System (ADS)

DeVoria, Adam C.

Low-aspect-ratio propulsors typically allow for high maneuverability at low-to-moderate speeds. This has made them the subject of much recent research aimed at employing such appendages on autonomous vehicles which are required to navigate tumultuous environments. This experimental investigation focuses on the fluid dynamic aspects associated with overly-simplified versions of such biologically-inspired propulsors. In doing so, fundamental contributions are made to the research area. The unsteady, three-dimensional flow of a low-aspect-ratio, trapezoidal flat plate undergoing rotation from rest at a 90° angle of attack and Reynolds numbers of O(103) is investigated experimentally. The objectives are to develop a straightforward protocol for vortex saturation, and to understand the effects of the root-to-tip flow for different velocity programs. The experiments are conducted in a glass-walled tank, and digital particle image velocimetry is used to obtain planar velocity measurements. A formation-parameter definition is investigated and is found to reasonably predict the state corresponding to the pinch-off of the initial tip vortex across the velocity programs tested. The flow in the region near the tip is relatively insensitive to Reynolds number over the range studied. The component normal to the plate is unaffected by total rotational amplitude while the tangential component has dependence on this angle. Also, an estimate of the first tip-vortex pinch-off time is obtained from the near-tip velocity data and agrees very well with values estimated using circulation. The angle of incidence of the bulk root-to-tip flow relative to the plate normal becomes more oblique with increasing rotational amplitude. Accordingly, the peak magnitude of the tangential velocity is also increased and as a result advects fluid momentum away from the plate at a higher rate. The more oblique impingement of the root-to-tip flow for increasing rotational amplitude is shown to have a distinct effect on the associated fluid dynamic force normal to the plate. For impulsive plate deceleration the time that a non-negligible force exists decreases, while for non-impulsive plate deceleration both this time and the relative force magnitude decrease for larger rotational amplitudes. In a separate set of experiments, force measurements are conducted on a similar plate that performs an advancing stroke from rest followed by a returning stroke. The parameters varied are the rotational amplitude of the motion and the rest time between the advancing and returning strokes. The unsteady normal forces track with the angular acceleration of the plate, with the added mass force peak in the returning stroke being larger than that in the advancing stroke. However, as the rest time is increased, the normal forces generated in each stroke become dynamically similar. The maximum total impulse is calculated from the force measurements and rapidly decays from its largest value at zero rest time and asymptotes to a constant with increased rest time. The direction of this impulse is also calculated and quickly approaches the direction about which the plate motion is symmetric. The largest additional impulse contribution obtained from executing a returning stroke within a finite time is approximately 18%. Increases in rotational amplitude initially increase the maximum total impulse, but it then plateaus at an amplitude of around 90 degrees. For non-zero rest times, any maxima of the impulse in a fixed direction are weak and necessarily reduced from the maximum possible impulse. For a nearly 100 degrees range of directions, the impulse is largest for rotational amplitudes between 75--90 degrees. The results are also applied to three types of propulsive configurations.

The changes on physical characteristics of lightning discharge plasma during individual return stroke process

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xu, He; Yuan, Ping; Cen, Jian-Yong

2014-03-15

A cloud-to-ground lightning with six return strokes has been recorded with a slit-less spectrograph in Qinghai province. According to the spectra of return strokes without continuous current, the electron density, the channel temperature, and the gas pressure have been calculated. Then, the correlativity of these parameters has been analyzed. The results indicate that the total intensity of spectra is positive correlated to the intensity of spectral line, they both decrease with time rapidly; furthermore, the channel temperature and the gas pressure decrease with time slowly in the similar trends.

Evaluation of bioimpedance for the measurement of physiologic variables as related to hemodynamic studies in space flight

NASA Technical Reports Server (NTRS)

Taylor, Bruce C.

1993-01-01

Orthostatic intolerance, following space flight, has received substantial attention because of the possibility that it compromises astronaut safety and reduces the ability of astronauts to function at peak performance levels upon return to a one-g environment. Many pre- and post-flight studies are performed to evaluate changes in hemodynamic responses to orthostatic challenges after shuttle missions. The purpose of this present project is to validate bioimpedance as a means to acquire stroke volume and other hemodynamic information in these studies. In this study, ten male and ten female subjects were subjected to simultaneous measurements of thoracic bioimpedance and Doppler ultrasonic velocimetry under supine, 10 degree head down and 30 degree head up conditions. Paired measurements were made during six periods of five seconds breath holding, over a two minute period, for each of the three positions. Stroke volume was calculated by three bioimpedance techniques and ultrasonic Doppler.

Calculation of induced voltages on overhead lines caused by inclined lightning strokes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sakakibara, A.

1989-01-01

Equations to calculate the inducing scalar and vector potentials produced by inclined return strokes are shown. Equations are also shown for calculating the induced voltages on overhead lines where horizontal components of inducing vector potential exist. The adequacy of the calculation method is demonstrated by field experiments. Using these equations, induced voltages on overhead lines are calculated for a variety of directions of return strokes.

Stroke Stories | NIH MedlinePlus the Magazine

MedlinePlus

... of this page please turn Javascript on. Feature: Stroke Rehabilitation Stroke Stories Past Issues / Spring 2013 Table of Contents ... these well-known personalities suffered one or more strokes. In each case, he or she has returned ...

Oceanic Lightning versus Continental Lightning: VLF Peak Current Discrepancies

NASA Astrophysics Data System (ADS)

Dupree, N. A., Jr.; Moore, R. C.

2015-12-01

Recent analysis of the Vaisala global lightning data set GLD360 suggests that oceanic lightning tends to exhibit larger peak currents than continental lightning (lightning occurring over land). The GLD360 peak current measurement is derived from distant measurements of the electromagnetic fields emanated during the lightning flash. Because the GLD360 peak current measurement is a derived quantity, it is not clear whether the actual peak currents of oceanic lightning tend to be larger, or whether the resulting electromagnetic field strengths tend to be larger. In this paper, we present simulations of VLF signal propagation in the Earth-ionosphere waveguide to demonstrate that the peak field values for oceanic lightning can be significantly stronger than for continental lightning. Modeling simulations are performed using the Long Wave Propagation Capability (LWPC) code to directly evaluate the effect of ground conductivity on VLF signal propagation in the 5-15 kHz band. LWPC is an inherently narrowband propagation code that has been modified to predict the broadband response of the Earth-Ionosphere waveguide to an impulsive lightning flash while preserving the ability of LWPC to account for an inhomogeneous waveguide. Furthermore, we evaluate the effect of return stroke speed on these results.

The influence of ground conductivity on the structure of RF radiation from return strokes

NASA Technical Reports Server (NTRS)

Levine, D. M.; Gesell, L.

1984-01-01

The combination of the finite conductivity of the Earth plus the propagation of the return stroke current up the channel which results in an apparent time delay between the fast field changes and RF radiation for distant observers is shown. The time delay predicted from model return strokes is on the order of 20 micro and the received signal has the characteristics of the data observed in Virginia and Florida. A piecewise linear model for the return stroke channel and a transmission line model for current propagation on each segment was used. Radiation from each segment is calculated over a flat Earth with finite conductivity using asymptotics approximations for the Sommerfeld integrals. The radiation at the observer is processed by a model AM radio receiver. The output voltage was calculated for several frequencies between HF-UHF assuming a system bandwidth (300 kHz) characteristic of the system used to collect data in Florida and Virginia. Comparison with the theoretical fast field changes indicates a time delay of 20 microns.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Qiang, E-mail: cq0405@126.com; Luoyang Electronic Equipment Testing Center, Luoyang 471000; Chen, Bin, E-mail: emcchen@163.com

The Rayleigh-Taylor (R-T) instabilities are important hydrodynamics and magnetohydrodynamics (MHD) phenomena that are found in systems in high energy density physics and normal fluids. The formation and evolution of the R-T instability at channel boundary during back-flow of the lightning return stroke are analyzed using the linear perturbation theory and normal mode analysis methods, and the linear growth rate of the R-T instability in typical condition for lightning return stroke channel is obtained. Then, the R-T instability phenomena of lightning return stroke are simulated using a two-dimensional Eulerian finite volumes resistive radiation MHD code. The numerical results show that themore » evolution characteristics of the R-T instability in the early stage of back-flow are consistent with theoretical predictions obtained by linear analysis. The simulation also yields more evolution characteristics for the R-T instability beyond the linear theory. The results of this work apply to some observed features of the return stroke channel and further advance previous theoretical and experimental work.« less

An electrodynamic description of lightning return strokes and dart leaders: Guided wave propagation along conducting cylindrical channels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Borovsky, J.E.

1995-02-20

The return-stroke breakdown pulse and the dart leader are treated as electric waves guided by conducting lightning channels; such waves are launched when current is injected into a conducting channel (producing the dart leader) or when charge on a channel begins to drain to Earth (producing the return stroke). The guided waves are self-consistent solutions to the full set of Maxwell`s equations, obeying the physical boundary conditions for cylindrical channels. These waves are shown (1) to move with velocities substantially slower than c along the channel, (2) to push current inside the lightning channel, (3) to move charge and voltagemore » along the channel, and (4) to transport energy along and into the channel via Poynting flux. The velocity of a guided wave is a function of only three parameters: the channel radius r{sub ch}, the channel temperature T, and the risetime {triangle}t of the wave front. These velocities are found to fall in the range of velocities of return strokes and of dart leaders. The dart leader and the return stroke are caused by the same type of guided electromagnetic waves: the difference in velocity is owed mostly to the difference in channel temperature. In the case of the dart leader the waves deliver Poynting flux along the outside of the channel down from a thundercloud generator to the downward-propagating wave front. At the wave front of the dart leader the delivered energy goes into heating the channel and into storage in the form of E{sup 2}/8{pi} around the newly charged channel. In the case of the return stroke the Poynting flux is localized to the vicinity of the wave front where stored energy E{sup 2}/8{pi} is delivered radially inward onto the channel to heat the channel in the propagating front. The net result of a dart leader and return stroke is that charge is moved from the cloud to the ground and that energy is moved from the cloud onto the channel. 123 refs., 11 figs., 5 tabs.« less

Characteristics of downward leaders in a cloud-to-ground lightning strike on a lightning rod

NASA Astrophysics Data System (ADS)

Wang, Caixia; Sun, Zhuling; Jiang, Rubin; Tian, Yangmeng; Qie, Xiushu

2018-05-01

A natural downward negative cloud-to-ground (CG) lightning was observed at a close distance of 370 m by using electric field change measurements and a high-speed camera at 5400 frames per second (fps). Two subsequent leader-return strokes of the lightning hit a lightning rod installed on the top of a seven-story building in Beijing city, while the grounding point for the stepped leader-first return stroke was 12 m away, on the roof of the building. The 2-D average speed of the downward stepped leader (L1) before the first return stroke (R1) was approximately 5.1 × 104 m/s during its propagation over the 306 m above the building, and those before the subsequent strokes (R2 and R3) ranged from 1.1 × 106 m/s to 2.2 × 106 m/s. An attempted leader (AL) occurred 201 ms after R1 and 10 ms before R2 reached approximately 99 m above the roof and failed to connect to the ground. The 2-D average speed of the AL was approximately 7.4 × 104 m/s. The luminosity at tip of the leader was brighter than the channel behind it. The leader inducing the R2 with an alteration of terminating point was a dart-stepped leader (DSL), which propagated through the channel of AL and continued to develop downward with new branches at about 17 m above the roof. The 2-D speed of the DSL at the bottom 99 m was 6.6 × 105 m/s. The average time interval between the stepped pulses of the DSL was approximately 10 μs, smaller than that of L1 with value of about 17 μs. The average step lengths of the DSL were approximately 6.6 m. The study shows that the stepped leader-first return stroke of lightning will not always hit the tip of a tall metal rod due to the significant branching property of the leader. However, under certain conditions, the subsequent return strokes may alter the grounding point to the tip of a tall metal rod. For the lightning rod, the protection against subsequent return strokes may be better than that against the first return stroke.

Lightning energetics: Estimates of energy dissipation in channels, channel radii, and channel-heating risetimes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Borovsky, J.E.

1998-05-01

In this report, several lightning-channel parameters are calculated with the aid of an electrodynamic model of lightning. The electrodynamic model describes dart leaders and return strokes as electromagnetic waves that are guided along conducting lightning channels. According to the model, electrostatic energy is delivered to the channel by a leader, where it is stored around the outside of the channel; subsequently, the return stroke dissipates this locally stored energy. In this report this lightning-energy-flow scenario is developed further. Then the energy dissipated per unit length in lightning channels is calculated, where this quantity is now related to the linear chargemore » density on the channel, not to the cloud-to-ground electrostatic potential difference. Energy conservation is then used to calculate the radii of lightning channels: their initial radii at the onset of return strokes and their final radii after the channels have pressure expanded. Finally, the risetimes for channel heating during return strokes are calculated by defining an energy-storage radius around the channel and by estimating the radial velocity of energy flow toward the channel during a return stroke. In three appendices, values for the linear charge densities on lightning channels are calculated, estimates of the total length of branch channels are obtained, and values for the cloud-to-ground electrostatic potential difference are estimated. {copyright} 1998 American Geophysical Union« less

Lightning electromagnetic radiation field spectra in the interval from 0. 2 to 20 MHz

DOE Office of Scientific and Technical Information (OSTI.GOV)

Willett, J.C.; Bailey, J.C.; Leteinturier, C.

1990-11-20

Average energy spectral densities are presented for the fast transitions in most of the components that produce large radiation field impulses from cloud-to-ground lightning; first and subsequent return strokes; stepped, dart-stepped, and 'chaotic' leaders; and 'characteristic' cloud pulses. A disagreement in the previous literature about the spectral energy radiated by return strokes at high frequencies is noted and explained. The authors show that the spectral amplitudes are not seriously distorted by propagation over less than 35 km of seawater, although as much as 45 km of such propagation does appear to produce significant attenuation above about 10 MHz. First andmore » subsequent return strokes produce identical spectra between 0.2 and 20 MHz. The spectra of stepped and dart-stepped leader steps are nearly identical and are very similar to that of characteristic pulses. The spectra of leader steps also match return stroke spectra above 2-3 MHz after the former are increased by about 7 dB. The shapes of individual spectra do not depend on their amplitude, so the shapes of the average spectra are probably not distorted by the trigger thresholds used in the data acquisition. Return strokes are the strongest sources of radiation from cloud-to-ground lightning in the 0.2- to 20-MHz frequency range, although certain intracloud processes are stronger radiators above 8 MHz.« less

Estimated Prestroke Peak VO2 Is Related to Circulating IGF-1 Levels During Acute Stroke.

PubMed

Mattlage, Anna E; Rippee, Michael A; Abraham, Michael G; Sandt, Janice; Billinger, Sandra A

2017-01-01

Background Insulin-like growth factor-1 (IGF-1) is neuroprotective after stroke and is regulated by insulin-like binding protein-3 (IGFBP-3). In healthy individuals, exercise and improved aerobic fitness (peak oxygen uptake; peak VO 2 ) increases IGF-1 in circulation. Understanding the relationship between estimated prestroke aerobic fitness and IGF-1 and IGFBP-3 after stroke may provide insight into the benefits of exercise and aerobic fitness on stroke recovery. Objective The purpose of this study was to determine the relationship of IGF-1 and IGFBP-3 to estimated prestroke peak VO 2 in individuals with acute stroke. We hypothesized that (1) estimated prestroke peak VO 2 would be related to IGF-1 and IGFBP-3 and (2) individuals with higher than median IGF-1 levels will have higher estimated prestroke peak VO 2 compared to those with lower than median levels. Methods Fifteen individuals with acute stroke had blood sampled within 72 hours of hospital admission. Prestroke peak VO 2 was estimated using a nonexercise prediction equation. IGF-1 and IGFBP-3 levels were quantified using enzyme-linked immunoassay. Results Estimated prestroke peak VO 2 was significantly related to circulating IGF-1 levels (r = .60; P = .02) but not IGFBP-3. Individuals with higher than median IGF-1 (117.9 ng/mL) had significantly better estimated aerobic fitness (32.4 ± 6.9 mL kg -1 min -1 ) than those with lower than median IGF-1 (20.7 ± 7.8 mL kg -1 min -1 ; P = .03). Conclusions Improving aerobic fitness prior to stroke may be beneficial by increasing baseline IGF-1 levels. These results set the groundwork for future clinical trials to determine whether high IGF-1 and aerobic fitness are beneficial to stroke recovery by providing neuroprotection and improving function. © The Author(s) 2016.

Analysis on the correlation between temperature and discharge characteristic of cloud-to-ground lightning discharge plasma with multiple return strokes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qu Haiyan; Chang Zhengshi; Yuan Ping

2011-01-15

The spectra of cloud-to-ground lightning with multiple return strokes have been obtained by using a slitless spectrograph on the Chinese Tibet plateau. Combining the spectra with synchronous electrical information, the correlation among spectral properties, channel temperatures and discharge characteristics, and thermal effects of current is discussed for the first time. The results show that the channel plasma temperature varies significantly from stroke to stroke within a given flash, and the total intensity of spectra is directly proportional to the amplitude of electric field change. Moreover, the positive correlation has been confirmed between the channel plasma temperature and the thermal effectmore » which shows the effect of the electric current accumulation. It is inferred that the total intensity of the spectra should be directly proportional to the intensity of discharge current, and channel temperature is correlated positively with the energy transmission in one return stroke.« less

Psychosocial Outcomes in StrokE: the POISE observational stroke study protocol

PubMed Central

Hackett, Maree L; Glozier, Nick; Jan, Stephen; Lindley, Richard

2009-01-01

Background Each year, approximately 12,000 Australians of working age survive a stroke. As a group, younger stroke survivors have less physical impairment and lower mortality after stroke compared with older survivors; however, the psychosocial and economic consequences are potentially substantial. Most of these younger stroke survivors have responsibility for generating an income or providing family care and indicate that their primary objective is to return to work. However, effective vocational rehabilitation strategies to increase the proportion of younger stroke survivors able to return to work, and information on the key target areas for those strategies, are currently lacking. Methods/Design This multi-centre, three year cohort study will recruit a representative sample of younger (< 65 years) stroke survivors to determine the modifiable predictors of subsequent return to work. Participants will be recruited from the New South Wales Stroke Services (SSNSW) network, the only well established and cohesively operating and managed, network of acute stroke units in Australia. It is based within the Greater Metropolitan area of Sydney including Wollongong and Newcastle, and extends to rural areas including Wagga Wagga. The study registration number is ACTRN12608000459325. Discussion The study is designed to identify targets for rehabilitation-, social- and medical-intervention strategies that promote and maintain healthy ageing in people with cardiovascular and mental health conditions, two of the seven Australian national health priority areas. This will rectify the paucity of information internationally around optimal clinical practice and social policy in this area. PMID:19519918

Exploring the experiences of rehabilitated stroke survivors and stakeholders with regard to returning to work in South- West Nigeria.

PubMed

Soeker, Mogammad Shaheed; Olaoye, Olumide Ayoola

2017-01-01

Stroke has been identified as a global cause of neurological disability with a resultant burden shared not only by the survivor but also by society. The resumption of an individual's role as a worker after having a stroke, is an important rehabilitation goal. South-West Nigeria has experienced a high incidence and prevalence of stroke, leaving a quarter of survivors with severe disabilities and difficulties in community integration after rehabilitation. The study was aimed at exploring and describing the experiences of rehabilitated stroke survivors and perceptions of stakeholders about stroke survivors returning to work in South-West Nigeria. A qualitative research design was used to explore these experiences and perceptions from 19 participants, comprising nine stroke survivors, two key informants, who were rehabilitation specialists, and eight caregivers of the respective stroke survivors. The researcher made use of focus groups with the caregivers and semi-structured interviews with the stroke survivors and rehabilitation specialists. The data from the study were analysed using thematic analysis. Three themes emerged: Themes one and two described the barriers experienced by the stroke survivors on returning to work. Theme three described the factors that facilitated the resumption of the worker role. The study findings clearly depicted the many barriers experienced by stroke survivors and how these negatively impact their worker roles. Limited facilitatory factors exist to assist stroke survivors in regard to adapting to their worker roles. Promoting participation of stroke survivors in work emanating from government policies was deemed to be a necessary recommendation for the study. These policies were seen to be achievable if rehabilitation resources were improved.

Evaluation of Lightning Incidence to Elements of a Complex Structure: A Monte Carlo Approach

NASA Technical Reports Server (NTRS)

Mata, Carlos T.; Rakov, V. A.

2008-01-01

There are complex structures for which the installation and positioning of the lightning protection system (LPS) cannot be done using the lightning protection standard guidelines. As a result, there are some "unprotected" or "exposed" areas. In an effort to quantify the lightning threat to these areas, a Monte Carlo statistical tool has been developed. This statistical tool uses two random number generators: a uniform distribution to generate the origin of downward propagating leaders and a lognormal distribution to generate the corresponding returns stroke peak currents. Downward leaders propagate vertically downward and their striking distances are defined by the polarity and peak current. Following the electrogeometrical concept, we assume that the leader attaches to the closest object within its striking distance. The statistical analysis is run for N number of years with an assumed ground flash density and the output of the program is the probability of direct attachment to objects of interest with its corresponding peak current distribution.

Daylight time-resolved photographs of lightning.

PubMed

Qrville, R E; Lala, G G; Idone, V P

1978-07-07

Lightning dart leaders and return strokes have been recorded in daylight with both good spatial resolution and good time resolution as part of the Thunder-storm Research International Program. The resulting time-resolved photographs are apparently equivalent to the best data obtained earlier only at night. Average two-dimensional return stroke velocities in four subsequent strokes between the ground and a height of 1400 meters were approximately 1.3 x 10(8) meters per second. The estimated systematic error is 10 to 15 percent.

Cloud-to-ground lightning in tropical cyclones: A study of Hurricanes Hugo (1989) and Jerry (1989)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Samsury, C.E.; Orville, R.E.

1994-08-01

Cloud-to-ground lightning characteristics of two Atlantic tropical cyclones of 1989, Hurricanes Hugo and Jerry, are presented. Statistics on the number of flashes, location, polarity, peak currents, and multiplicity (number of strokes per flash) are examined in an 18-h period divided into prelandfall and postlandfall categories. Land-based and aircraft lower fuselage radar data are also analyzed to determine the nature of the precipitation in which lightning is detected. Jerry is found to be more electrically active than Hugo, with 691 flashes detected compared with 33 flashes for Hugo. The majority of these flashes, regardless of the polarity, are located in themore » right front and right rear quadrants of the hurricanes, almost exclusively in outer convective rainbands. One reason for the large difference in the number of flashes between the two storms is the presence of many convective rainbands in Jerry, compared to only a few in Hugo. More than 20% of the flashes in each storm have a positive polarity. Median negative peak currents of the first return strokes are 49 kA in Hugo and 40 kA in Jerry. Median positive peak currents are 65 kA in Hugo and 52 kA in Jerry. The mean multiplicity of the negative flashes is 1.7 in Hugo and 2.6 in Jerry. Twenty percent of the negative flashes detected in Jerry have a multiplicity of 4 or higher.« less

A study on the influence of corona on currents and electromagnetic fields predicted by a nonlinear lightning return-stroke model

NASA Astrophysics Data System (ADS)

De Conti, Alberto; Silveira, Fernando H.; Visacro, Silvério

2014-05-01

This paper investigates the influence of corona on currents and electromagnetic fields predicted by a return-stroke model that represents the lightning channel as a nonuniform transmission line with time-varying (nonlinear) resistance. The corona model used in this paper allows the calculation of corona currents as a function of the radial electric field in the vicinity of the channel. A parametric study is presented to investigate the influence of corona parameters, such as the breakdown electric field and the critical electric field for the stable propagation of streamers, on predicted currents and electromagnetic fields. The results show that, regardless of the assumed corona parameters, the incorporation of corona into the nonuniform and nonlinear transmission line model under investigation modifies the model predictions so that they consistently reproduce most of the typical features of experimentally observed lightning electromagnetic fields and return-stroke speed profiles. In particular, it is shown that the proposed model leads to close vertical electric fields presenting waveforms, amplitudes, and decay with distance in good agreement with dart leader electric field changes measured in triggered lightning experiments. A comparison with popular engineering return-stroke models further confirms the model's ability to predict consistent electric field waveforms in the close vicinity of the channel. Some differences observed in the field amplitudes calculated with the different models can be related to the fact that current distortion, while present in the proposed model, is ultimately neglected in the considered engineering return-stroke models.

Tortuosity of lightning return stroke channels

NASA Technical Reports Server (NTRS)

Levine, D. M.; Gilson, B.

1984-01-01

Data obtained from photographs of lightning are presented on the tortuosity of return stroke channels. The data were obtained by making piecewise linear fits to the channels, and recording the cartesian coordinates of the ends of each linear segment. The mean change between ends of the segments was nearly zero in the horizontal direction and was about eight meters in the vertical direction. Histograms of these changes are presented. These data were used to create model lightning channels and to predict the electric fields radiated during return strokes. This was done using a computer generated random walk in which linear segments were placed end-to-end to form a piecewise linear representation of the channel. The computer selected random numbers for the ends of the segments assuming a normal distribution with the measured statistics. Once the channels were simulated, the electric fields radiated during a return stroke were predicted using a transmission line model on each segment. It was found that realistic channels are obtained with this procedure, but only if the model includes two scales of tortuosity: fine scale irregularities corresponding to the local channel tortuosity which are superimposed on large scale horizontal drifts. The two scales of tortuosity are also necessary to obtain agreement between the electric fields computed mathematically from the simulated channels and the electric fields radiated from real return strokes. Without large scale drifts, the computed electric fields do not have the undulations characteristics of the data.

Triggered lightning spectroscopy: Part 1. A qualitative analysis

NASA Astrophysics Data System (ADS)

Walker, T. Daniel; Christian, Hugh J.

2017-08-01

The first high-speed spectra of triggered lightning have been obtained. During the summers of 2012 and 2013, spectra were recorded at the International Center for Lightning Research and Testing, Camp Blanding, FL. The spectra were recorded with a high-speed camera with a grism mounted in front of it. The triggered lightning channels observed were generally at low altitude in a region that included the copper wire. Spectral emissions were recorded at each phase: the initial stage, dart leader, return stroke, and continuing current. These spectra are separated into two major regions: soft ultraviolet to visible (3800-6200 Å) and visible to near infrared (6200-8700 Å). The emissions during the initial stage reflect those of a copper wire burn in air. The majority of the emissions are neutral copper. After the initial stage comes the first return stroke which contains no detected molecular emissions; however, it does contain neutral, singly, and doubly ionized nitrogen and oxygen, neutral argon, and neutral hydrogen. Occasionally, before a return stroke, the dart leader coming down the channel will be stepped. During these occasions the leader spectra resemble that of the return stroke but are dimmer and shorter lived. After the initial portion of the return stroke, there are often changes in the luminosity of the spectrum which corresponds with fluctuations in the continuing current. During these "reillumination phases" no singly or doubly ionized lines have been observed to reemerge over the detection threshold, only neutral emission features.

A Summary of the NASA Lightning Nitrogen Oxides Model (LNOM) and Recent Results

NASA Technical Reports Server (NTRS)

Koshak, William; Peterson, Harld

2011-01-01

The NASA Marshall Space Flight Center introduced the Lightning Nitrogen Oxides Model (LNOM) a couple of years ago to combine routine state-of-the-art measurements of lightning with empirical laboratory results of lightning NOx production. The routine measurements included VHF lightning source data [such as from the North Alabama Lightning Mapping Array (LMA)], and ground flash location, peak current, and stroke multiplicity data from the National Lightning Detection Network(TradeMark) (NLDN). Following these initial runs of LNOM, the model was updated to include several non-return stroke lightning NOx production mechanisms, and provided the impact of lightning NOx on an August 2006 run of CMAQ. In this study, we review the evolution of the LNOM in greater detail and discuss the model?s latest upgrades and applications. Whereas previous applications were limited to five summer months of data for North Alabama thunderstorms, the most recent LNOM analyses cover several years. The latest statistics of ground and cloud flash NOx production are provided.

Stroke patients' experiences of return to work.

PubMed

Medin, Jennie; Barajas, Josefin; Ekberg, Kerstin

2006-09-15

Purpose. The aim of this study was to describe the experience of return to work (RTW) after stroke from the patient's perspective.Method. Six patients who had their first ever stroke in 2001, were <65 years of age and were working at the time of their stroke were included. Information was obtained via an open-ended interview. The material was transcribed verbatim and analysed using Giorgi's empirical phenomenology.Results. Rehabilitation was perceived as primarily aimed at restoring bodily functions and a return to everyday activities, rather than at promoting a return to work. It was not experienced as adapted to the participants' needs or their age. The workplace was experienced as very important in the rehabilitation process. When the informants experienced that the rehabilitation professionals were not taking action, they took control of the situation themselves. The informants expressed pride in their own capacity to take the initiative and in their ability to take action. Both self-employed and employed informants said they had possibilities and opportunities to take action since their work situation was flexible. The informants' adaptation to a new role at work was perceived as facilitated by the understanding and positive attitude of co-workers.Conclusion. Among this group of stroke patients, the individual patient's capacity and ability to return to work was enhanced by motivation or "will" and self-efficacy in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. There are similarities between the RTW process and processes of health promotion.

Influence of the rehabilitation outcome on returning to drive after neurological impairment.

PubMed

Čižman, Urša Š; Vidmar, Gaj; Drnovšek, Petra

2017-06-01

In traumatic brain injury (TBI) and stroke rehabilitation, the question of reintegration of the driver into traffic is faced very often. Driving is an important domain and for some patients, return to driving represents a crucial event for community inclusion. The aim of our study was to examine the utility of Glasgow Coma Scale within the first 24 h of injury and the Functional Independence Measure (FIM) at rehabilitation admission for predicting the return to driving. We included 72 patients after TBI or stroke. Driving outcome was assessed in terms of being allowed to drive without restrictions as opposed to failing the test or being allowed to drive with restrictions. We examined two samples: the TBI patients only and the entire sample including patients after stroke. The results indicate that for TBI patients, Glasgow Coma Scale and motor FIM could be predictors of driving outcome; in the entire sample, the unrestricted driving outcome was also associated with a high score on the FIM motor scale. Early prediction of return to driving after TBI and stroke is important for the patients, their families and the rehabilitation teams to set realistic goals that enable the best possible reintegration after rehabilitation.

Three years of lightning impulse charge moment change measurements in the United States

NASA Astrophysics Data System (ADS)

Cummer, Steven A.; Lyons, Walter A.; Stanley, Mark A.

2013-06-01

We report and analyze 3 years of lightning impulse charge moment change (iCMC) measurements obtained from an automated, real time lightning charge moment change network (CMCN). The CMCN combines U.S. National Lightning Detection Network (NLDN) lightning event geolocations with extremely low frequency (≲1 kHz) data from two stations to provide iCMC measurements across the entire United States. Almost 14 million lightning events were measured in the 3 year period. We present the statistical distributions of iCMC versus polarity and NLDN-measured peak current, including corrections for the detection efficiency of the CMCN versus peak current. We find a broad distribution of iCMC for a given peak current, implying that these parameters are at best only weakly correlated. Curiously, the mean iCMC does not monotonically increase with peak current, and in fact, drops for positive CG strokes above +150 kA. For all positive strokes, there is a boundary near 20 C km that separates seemingly distinct populations of high and low iCMC strokes. We also explore the geographic distribution of high iCMC lightning strokes. High iCMC positive strokes occur predominantly in the northern midwest portion of the U.S., with a secondary peak over the gulf stream region just off the U.S. east coast. High iCMC negative strokes are also clustered in the midwest, although somewhat south of most of the high iCMC positive strokes. This is a region far from the locations of maximum occurrence of high peak current negative strokes. Based on assumed iCMC thresholds for sprite production, we estimate that approximately 35,000 positive polarity and 350 negative polarity sprites occur per year over the U.S. land and near-coastal areas. Among other applications, this network is useful for the nowcasting of sprite-producing storms and storm regions.

Survey of survivors' perspective on return to work after stroke.

PubMed

Hartke, Robert J; Trierweiler, Robert

2015-10-01

To describe the development and results of a detailed survey on return to work (RTW) after stroke completed by survivors at various stages of recovery. This study used a multi-method qualitative and quantitative research strategy to design and implement a 39-item survey for stroke survivors. Individual interviews, focus groups, and working committees were used to conceptualize the issues and translate them into a survey format. Surveys were distributed in regular and electronic mail. Groups of rehabilitation professionals, employers, and stroke survivors were assembled to review findings and obtain feedback to aide in interpretation. Overall 715 surveys were completed. The respondents were on average 54 years of age, mostly white, well-educated, urban dwelling, and in skilled occupations. Results are described in seven areas: financial, stroke impairments, organizational, work and psychological issues, interpersonal support, and therapy. Several salient findings are described including the role of fatigue, under utilization of vocational rehabilitation (VR) services, and motivational factors related to finances, self-esteem, work, and workplace relationships. Although earning an income is a strong motivation to RTW, salary decreases in importance when compared with other psychological benefits. Fatigue was rated as the second highest impairment barrier to RTW and persisted as a relevant impediment over time. Attitudes of co-workers and flexibility in work schedule were viewed as most helpful to the RTW process, whereas work stress was viewed as the greatest impediment to return. Only 24% of the sample received VR counseling with more respondents receiving counseling if they returned 6 months or longer after their stroke. Other trends and clinical and research implications are discussed.

Characteristics of lightning leader propagation and ground attachment

NASA Astrophysics Data System (ADS)

Jiang, Rubin; Qie, Xiushu; Wang, Zhichao; Zhang, Hongbo; Lu, Gaopeng; Sun, Zhuling; Liu, Mingyuan; Li, Xun

2015-12-01

The grounding process and the associated leader behavior were analyzed by using high-speed video record and time-correlated electric field change for 37 natural negative cloud-to-ground flashes. Weak luminous grounded channel was recognized below the downward leader tip in the frame preceding the return stroke, which is inferred as upward connecting leader considering the physical process of lightning attachment, though not directly confirmed by sequential frames. For stepped leader-first return strokes, the upward connecting leaders tend to be induced by those downward leader branches with brighter luminosity and lower channel tip above ground, and they may accomplish the attachment with great possibility. The upward connecting leaders for 2 out of 61 leader-subsequent stroke sequences were captured in the frame prior to the return stroke, exhibiting relatively long channel lengths of 340 m and 105 m, respectively. The inducing downward subsequent leaders were of the chaotic type characterized by irregular electric field pulse train with duration of 0.2-0.3 ms. The transient drop of the high potential difference between stepped leader system and ground when the attachment occurred would macroscopically terminate the propagation of those ungrounded branches while would not effectively prevent the development of the existing space stem systems in the low-conductivity streamer zone apart from the leader tip. When the ungrounded branches are of poor connection with the main stroke channel, their further propagation toward ground would be feasible. These two factors may contribute to the occurrence of multiple grounding within the same leader-return stroke sequence.

Cardiopulmonary Response to Exercise Testing in People with Chronic Stroke: A Retrospective Study

PubMed Central

Billinger, Sandra A.; Taylor, Jordan M.; Quaney, Barbara M.

2012-01-01

Background and Purpose. This study investigated the cardiopulmonary response and safety of exercise testing at peak effort in people during the chronic stage of stroke recovery. Methods. This retrospective study examined data from 62 individuals with chronic stroke (males: 32; mean (SD); age: (12.0) yr) participating in an exercise test. Results. Both males and females had low cardiorespiratory fitness levels. No significant differences were found between gender for peak HR (P = 0.27), or VO2 peak (P = 0.29). Males demonstrated higher values for minute ventilation, tidal volume, and respiratory exchange ratio. No major adverse events were observed in the exercise tests conducted. Discussion and Conclusion. There are differences between gender that may play a role in exercise testing performance and should be considered when developing exercise programs. The low VO2 peak of this cohort of chronic stroke survivors suggests the need for participation in exercise interventions. PMID:21961083

Examining impairment of adaptive compensation for stabilizing motor repetitions in stroke survivors.

PubMed

Kim, Yushin; Koh, Kyung; Yoon, BumChul; Kim, Woo-Sub; Shin, Joon-Ho; Park, Hyung-Soon; Shim, Jae Kun

2017-12-01

The hand, one of the most versatile but mechanically redundant parts of the human body, suffers more and longer than other body parts after stroke. One of the rehabilitation paradigms, task-oriented rehabilitation, encourages motor repeatability, the ability to produce similar motor performance over repetitions through compensatory strategies while taking advantage of the motor system's redundancy. The previous studies showed that stroke survivors inconsistently performed a given motor task with limited motor solutions. We hypothesized that stroke survivors would exhibit deficits in motor repeatability and adaptive compensation compared to healthy controls in during repetitive force-pulse (RFP) production tasks using multiple fingers. Seventeen hemiparetic stroke survivors and seven healthy controls were asked to repeatedly press force sensors as fast as possible using the four fingers of each hand. The hierarchical variability decomposition model was employed to compute motor repeatability and adaptive compensation across finger-force impulses, respectively. Stroke survivors showed decreased repeatability and adaptive compensation of force impulses between individual fingers as compared to the control (p < 0.05). The stroke survivors also showed decreased pulse frequency and greater peak-to-peak time variance than the control (p < 0.05). Force-related variables, such as mean peak force and peak force interval variability, demonstrated no significant difference between groups. Our findings indicate that stroke-induced brain injury negatively affects their ability to exploit their redundant or abundant motor system in an RFP task.

Non-collinear valve actuator

NASA Technical Reports Server (NTRS)

Richard, James A. (Inventor)

2012-01-01

A non-collinear valve actuator includes a primary actuating system and a return spring system with each applying forces to a linkage system in order to regulate the flow of a quarter-turn valve. The primary actuating system and return spring system are positioned non-collinearly, which simply means the primary actuating system and return spring system are not in line with each other. By positioning the primary actuating system and return spring system in this manner, the primary actuating system can undergo a larger stroke while the return spring system experiences significantly less displacement. This allows the length of the return spring to be reduced due to the minimization of displacement thereby reducing the weight of the return spring system. By allowing the primary actuating system to undergo longer strokes, the weight of the primary actuating system may also be reduced. Accordingly, the weight of the non-collinear valve actuator is reduced.

Developing stroke-specific vocational rehabilitation: a soft systems analysis of current service provision

PubMed Central

Radford, Kathryn; Grant, Mary; Terry, Jane

2014-01-01

Purpose: This study aimed to clarify the existing service provision of stroke-specific vocational rehabilitation (VR) in one English county, in order to facilitate future service development. Method: Using soft systems methodology, services in Health, Social Care, Department of Work and Pensions, the voluntary and private sectors, which were identified as supporting return to work after stroke, were mapped using a mixed-methodology approach. Results: A lack of a sanctioned VR pathway meant access to support relied on brokered provision and tacit knowledge. The timing of an intervention was complex and there was a substantial degree of unmet need for mild stroke patients. VR was seen as “non-essential” due to competing commissioning priorities. Service providers from all sectors lacked training and cross-sector partnerships were tenuous and provider roles unclear. Conclusions: Stroke-specific VR should be delivered by an integrated, cross-sector multi-disciplinary team and integrated commissioning between health and other sectors is necessary. Although early intervention is important, support later on in the recovery process is also necessary. Service providers need adequate training to meet the needs of stroke survivors wishing to return to work and better awareness of best practice guidelines. Business cases which demonstrate the efficacy and cost-effectiveness of VR are vital. Implications for Rehabilitation The timeliness of a vocational rehabilitation (VR) intervention is complex; services need to be responsive to the changing needs of the stroke survivor throughout their recovery process and have better mechanisms to ensure re-entry into the stroke pathway is possible. Return to work is a recognised health outcome; health services need to develop better mechanisms for interagency/cross sector working and liaison with employers and not assume that VR is beyond their remit. Therapists and non-health service providers should receive sufficient training to meet the needs of stroke survivors wishing to return to work. Rehabilitation teams must decide how to implement national guidance within existing resources and what training is needed to deploy SSVR. The lack of a sanctioned pathway results in disorganised and patchy provision of VR for stroke survivors; mild stroke patients can fall through the net and receive little or no support. The journey back to work commences at the point of stroke. Mechanisms for identifying acute stroke survivors who were working at onset and for assessing the impact of the stroke on their work need to be put in place. The entire MDT has a role to play. In the absence of a VR specialist, even patients without obvious disability should be referred for ongoing rehabilitation with detailed work assessment and signposted to employment specialists e.g. disability employment advisors EARLY after stroke. Health-based VR interventions can influence work return and job retention. However, therapists must routinely measure work outcomes to inform their business case and be encouraged to demonstrate these outcomes to local commissioners. Commissioners should consider emerging evidence of early VR interventions on reduced length of stay, health and social care resource use and the wider health benefits of maintaining employment. PMID:23692389

Developing stroke-specific vocational rehabilitation: a soft systems analysis of current service provision.

PubMed

Sinclair, Emma; Radford, Kathryn; Grant, Mary; Terry, Jane

2014-01-01

This study aimed to clarify the existing service provision of stroke-specific vocational rehabilitation (VR) in one English county, in order to facilitate future service development. Using soft systems methodology, services in Health, Social Care, Department of Work and Pensions, the voluntary and private sectors, which were identified as supporting return to work after stroke, were mapped using a mixed-methodology approach. A lack of a sanctioned VR pathway meant access to support relied on brokered provision and tacit knowledge. The timing of an intervention was complex and there was a substantial degree of unmet need for mild stroke patients. VR was seen as "non-essential" due to competing commissioning priorities. Service providers from all sectors lacked training and cross-sector partnerships were tenuous and provider roles unclear. Stroke-specific VR should be delivered by an integrated, cross-sector multi-disciplinary team and integrated commissioning between health and other sectors is necessary. Although early intervention is important, support later on in the recovery process is also necessary. Service providers need adequate training to meet the needs of stroke survivors wishing to return to work and better awareness of best practice guidelines. Business cases which demonstrate the efficacy and cost-effectiveness of VR are vital. Implications for Rehabilitation The timeliness of a vocational rehabilitation (VR) intervention is complex; services need to be responsive to the changing needs of the stroke survivor throughout their recovery process and have better mechanisms to ensure re-entry into the stroke pathway is possible. Return to work is a recognised health outcome; health services need to develop better mechanisms for interagency/cross sector working and liaison with employers and not assume that VR is beyond their remit. Therapists and non-health service providers should receive sufficient training to meet the needs of stroke survivors wishing to return to work. Rehabilitation teams must decide how to implement national guidance within existing resources and what training is needed to deploy SSVR. The lack of a sanctioned pathway results in disorganised and patchy provision of VR for stroke survivors; mild stroke patients can fall through the net and receive little or no support. The journey back to work commences at the point of stroke. Mechanisms for identifying acute stroke survivors who were working at onset and for assessing the impact of the stroke on their work need to be put in place. The entire MDT has a role to play. In the absence of a VR specialist, even patients without obvious disability should be referred for ongoing rehabilitation with detailed work assessment and signposted to employment specialists e.g. disability employment advisors EARLY after stroke. Health-based VR interventions can influence work return and job retention. However, therapists must routinely measure work outcomes to inform their business case and be encouraged to demonstrate these outcomes to local commissioners. Commissioners should consider emerging evidence of early VR interventions on reduced length of stay, health and social care resource use and the wider health benefits of maintaining employment.

Horizontal electric fields from lightning return strokes

NASA Technical Reports Server (NTRS)

Thomson, E. M.; Medelius, P. J.; Rubinstein, M.; Uman, M. A.; Johnson, J.

1988-01-01

An experiment to measure simultaneously the wideband horizontal and vertical electric fields from lightning return strokes is described. Typical wave shapes of the measured horizontal and vertical fields are presented, and the horizontal fields are characterized. The measured horizontal fields are compared with calculated horizontal fields obtained by applying the wavetilt formula to the vertical fields. The limitations and sources of error in the measurement technique are discussed.

Dynamics of a lightning corona sheath—A constant field approach using the generalized traveling current source return stroke model

NASA Astrophysics Data System (ADS)

Cvetic, Jovan; Heidler, Fridolin; Markovic, Slavoljub; Radosavljevic, Radovan; Osmokrovic, Predrag

2012-11-01

A generalized lightning traveling current source return stroke model has been used to examine the characteristics of the lightning channel corona sheath surrounding a thin channel core. A model of the lightning channel consisting of a charged corona sheath and a narrow, highly conducting central core that conducts the main current flow is assumed. Strong electric field, with a predominant radial direction, has been created during the return stroke between the channel core and the outer channel sheath containing the negative charge. The return stroke process is modeled with the positive charge coming from the channel core discharging the negative leader charge in the corona sheath. The corona sheath model that predicts the charge motion in the sheath is used to derive the expressions of the sheath radius vs. time during the return stroke. According to the corona sheath model proposed earlier by Maslowski and Rakov (2006) and Maslowski et al. (2009), it consists of three zones, zone 1 (surrounding channel core with net positive charge), zone 2 (surrounding zone 1 with negative charge) and zone 3 (outer zone representing the virgin air without charges). We adopted the assumption of a constant electric field inside zone 1 of the corona sheath observed in the experimental research of corona discharges in a coaxial geometry by Cooray (2000). This assumption seems to be more realistic than the assumption of a uniform corona space charge density used previously in the study of Maslowski and Rakov (2006), Marjanovic and Cvetic (2009), and Tausanovic et al. (2010). Applying the Gauss' law on the infinitesimally small cylindrical section of the channel the expressions for time-dependence of the radii of zones 1 and 2 during the return stroke are derived. The calculations have shown that the overall channel dynamics concerning electrical discharge is roughly 50% slower and the maximum radius of zone 1 is about 33% smaller compared to the corresponding values calculated in the study of Tausanovic et al. (2010).

Evaluation of the Performance Characteristics of the CGLSS and NLDN Systems Based on Two Years of Ground-Truth Data from Launch Complex 39B, Kennedy Space Center, Florida

NASA Technical Reports Server (NTRS)

Mata, Carlos T.; Hill, Jonathan D.; Mata, Angel G.; Cummins, Kenneth L.

2014-01-01

From May 2011 through July 2013, the lightning instrumentation at Launch Complex 39B (LC39B) at the Kennedy Space Center, Florida, has obtained high-speed video records and field change waveforms (dE/dt and three-axis dH/dt) for 54 negative polarity return strokes whose strike termination locations and times are known with accuracy of the order of 10 m or less and 1 µs, respectively. A total of 18 strokes terminated directly to the LC39B lighting protection system (LPS), which contains three 181 m towers in a triangular configuration, an overhead catenary wire system on insulating masts, and nine down conductors. An additional 9 strokes terminated on the 106 m lightning protection mast of Launch Complex 39A (LC39A), which is located about 2.7 km southeast of LC39B. The remaining 27 return strokes struck either on the ground or attached to low-elevation grounded objects within about 500 m of the LC39B LPS. Leader/return stroke sequences were imaged at 3200 frames/sec by a network of six Phantom V310 high-speed video cameras. Each of the three towers on LC39B had two high-speed cameras installed at the 147 m level with overlapping fields of view of the center of the pad. The locations of the strike points of 54 return strokes have been compared to time-correlated reports of the Cloud-to-Ground Lightning Surveillance System (CGLSS) and the National Lightning Detection Network (NLDN), and the results of this comparison will be presented and discussed.

Remote sensing and modeling of lightning caused long recovery events within the lower ionosphere using VLF/LF radio wave propagation

NASA Astrophysics Data System (ADS)

Schmitter, E. D.

2014-11-01

On the 4 November 2012 at 3:04:27 UT a strong lightning in the midst of the North Sea affected the propagation conditions of VLF/LF transmitter radio signals from NRK (Iceland, 37.5 kHz) and GBZ (UK, 19.58 kHz) received at 5246° N 8° E (NW Germany). The amplitude and phase dips show a recovery time of 6-12 min pointing to a LOng Recovery Early VLF (LORE) event. Clear assignment of the causative return stroke in space and time was possible with data from the WWLLN (Worldwide Lightning Location Network). Based on a return stroke current model the electric field is calculated and an excess electron density distribution which decays over time in the lower ionosphere is derived. Ionization, attachment and recombination processes are modeled in detail. Entering the electron density distribution in VLF/LF radio wave propagation calculations using the LWPC (Long Wavelength Propagation Capability) code allows to model the VLF/LF amplitude and phase behavior by adjusting the return stroke current moment. The results endorse and quantify the conception of lower ionosphere EMP heating by strong - but not necessarily extremely strong - return strokes of both polarities.

Temporal profile of body temperature in acute ischemic stroke: relation to stroke severity and outcome.

PubMed

Karaszewski, Bartosz; Thomas, Ralph G R; Dennis, Martin S; Wardlaw, Joanna M

2012-10-18

Pyrexia after stroke (temperature ≥37.5°C) is associated with poor prognosis, but information on timing of body temperature changes and relationship to stroke severity and subtypes varies. We recruited patients with acute ischemic stroke, measured stroke severity, stroke subtype and recorded four-hourly tympanic (body) temperature readings from admission to 120 hours after stroke. We sought causes of pyrexia and measured functional outcome at 90 days. We systematically summarised all relevant previous studies. Amongst 44 patients (21 males, mean age 72 years SD 11) with median National Institute of Health Stroke Score (NIHSS) 7 (range 0-28), 14 had total anterior circulation strokes (TACS). On admission all patients, both TACS and non-TACS, were normothermic (median 36.3°C vs 36.5°C, p=0.382 respectively) at median 4 hours (interquartile range, IQR, 2-8) after stroke; admission temperature and NIHSS were not associated (r(2)=0.0, p=0.353). Peak temperature, occurring at 35.5 (IQR 19.0 to 53.8) hours after stroke, was higher in TACS (37.7°C) than non-TACS (37.1°C, p<0.001) and was associated with admission NIHSS (r(2)=0.20, p=0.002). Poor outcome (modified Rankin Scale ≥3) at 90 days was associated with higher admission (36.6°C vs. 36.2°C p=0.031) and peak (37.4°C vs. 37.0°C, p=0.016) temperatures. Sixteen (36%) patients became pyrexial, in seven (44%) of whom we found no cause other than the stroke. Normothermia is usual within the first 4 hours of stroke. Peak temperature occurs at 1.5 to 2 days after stroke, and is related to stroke severity/subtype and more closely associated with poor outcome than admission temperature. Temperature-outcome associations after stroke are complex, but normothermia on admission should not preclude randomisation of patients into trials of therapeutic hypothermia.

Ventilatory threshold may be a more specific measure of aerobic capacity than peak oxygen consumption rate in persons with stroke.

PubMed

Boyne, Pierce; Reisman, Darcy; Brian, Michael; Barney, Brian; Franke, Ava; Carl, Daniel; Khoury, Jane; Dunning, Kari

2017-03-01

After stroke, aerobic deconditioning can have a profound impact on daily activities. This is usually measured by the peak oxygen consumption rate achieved during exercise testing (VO2-peak). However, VO2-peak may be distorted by motor function. The oxygen uptake efficiency slope (OUES) and VO2 at the ventilatory threshold (VO2-VT) could more specifically assess aerobic capacity after stroke, but this has not been tested. To assess the differential influence of motor function on three measures of aerobic capacity (VO2-peak, OUES, and VO2-VT) and to evaluate the inter-rater reliability of VO2-VT determination post-stroke. Among 59 persons with chronic stroke, cross-sectional correlations with motor function (comfortable gait speed [CGS] and lower extremity Fugl-Meyer [LEFM]) were compared between the different aerobic capacity measures, after adjustment for covariates, in order to isolate any distorting effect of motor function. Reliability of VO2-VT determination between three raters was assessed with intra-class correlation (ICC). CGS was moderately correlated with VO2-peak (r = 0.52, p < 0.0001) and weakly correlated with OUES (r = 0.41, p = 0.002) and VO2-VT (r = 0.37, p = 0.01). LEFM was weakly correlated with VO2-peak (r = 0.26, p = 0.055) and very weakly correlated with OUES (r = 0.19, p = 0.17) and VO2-VT (r = 0.14, p = 0.31). Compared to VO2-peak, VO2-VT was significantly less correlated with CGS (r difference = -0.16, p = 0.02). Inter-rater reliability of VO2-VT determination was high (ICC: 0.93, 95% CI: 0.89-0.96). Motor dysfunction appears to artificially lower measured aerobic capacity. VO2-VT seemed to be less distorted than VO2-peak and had good inter-rater reliability, so it may provide more specific assessment of aerobic capacity post-stroke.

Factors Contributing to Patient Satisfaction with Rehabilitation Following Stroke.

ERIC Educational Resources Information Center

Clark, M. S.; Smith, D. S.

1998-01-01

A study that investigated the satisfaction of 60 Australian stroke survivors with their rehabilitative progress over 12 months found satisfaction with progress improved with time and was influenced by the return to previous lifestyle activities, depression, family functioning, understanding of stroke, and clarity of expectations on admission to…

Physical fitness interventions for nonambulatory stroke survivors: A mixed-methods systematic review and meta-analysis.

PubMed

Lloyd, Megan; Skelton, Dawn A; Mead, Gillian E; Williams, Brian; van Wijck, Frederike

2018-06-19

Physical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke survivors (FAC score ≤2) are at increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesize evidence regarding case fatality, effects, experiences, and feasibility of fitness training for nonambulatory stroke survivors. Eight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data, and assessed study quality, using published tools. Random-effects meta-analysis was used. Following their separate analysis, qualitative and quantitative data were synthesized using a published framework. Of 13,614 records, 33 studies involving 910 nonambulatory participants met inclusion criteria. Most studies were of moderate quality. Interventions comprised assisted walking (25 studies), cycle ergometer training (5 studies), and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13-3.78, p = 0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed, and mobility at intervention end, and walking endurance, balance, mobility, and independent walking at follow-up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose, and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants' experiences, but those reported were positive. There were few intervention-related adverse events, and dropout rate ranged from 12 to 20%. Findings suggest safety, effectiveness, and feasibility of adapted fitness training for screened nonambulatory stroke survivors. Further research needs to investigate the clinical and cost-effectiveness as well as experiences of fitness training-especially for chronic stroke survivors in community settings. © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

Reliability in the parameterization of the functional reach test in elderly stroke patients: a pilot study.

PubMed

Merchán-Baeza, Jose Antonio; González-Sánchez, Manuel; Cuesta-Vargas, Antonio Ignacio

2014-01-01

Postural instability is one of the major complications found in stroke survivors. Parameterising the functional reach test (FRT) could be useful in clinical practice and basic research. To analyse the reliability, sensitivity, and specificity in the FRT parameterisation using inertial sensors for recording kinematic variables in patients who have suffered a stroke. Cross-sectional study. While performing FRT, two inertial sensors were placed on the patient's back (lumbar and trunk). Five subjects over 65 who suffer from a stroke. FRT measures, lumbosacral/thoracic maximum angular displacement, maximum time of lumbosacral/thoracic angular displacement, time return initial position, and total time. Speed and acceleration of the movements were calculated indirectly. FRT measure is  12.75±2.06 cm. Intrasubject reliability values range from 0.829 (time to return initial position (lumbar sensor)) to 0.891 (lumbosacral maximum angular displacement). Intersubject reliability values range from 0.821 (time to return initial position (lumbar sensor)) to 0.883 (lumbosacral maximum angular displacement). FRT's reliability was 0.987 (0.983-0.992) and 0.983 (0.979-0.989) intersubject and intrasubject, respectively. The main conclusion could be that the inertial sensors are a tool with excellent reliability and validity in the parameterization of the FRT in people who have had a stroke.

Length estimations of presumed upward connecting leaders in lightning flashes to flat water and flat ground

NASA Astrophysics Data System (ADS)

Stolzenburg, Maribeth; Marshall, Thomas C.; Karunarathne, Sumedhe; Orville, Richard E.

2018-10-01

Using video data recorded at 50,000 frames per second for nearby negative lightning flashes, estimates are derived for the length of positive upward connecting leaders (UCLs) that presumably formed prior to new ground attachments. Return strokes were 1.7 to 7.8 km distant, yielding image resolutions of 4.25 to 19.5 m. No UCLs are imaged in these data, indicating those features were too transient or too dim compared to other lightning processes that are imaged at these resolutions. Upper bound lengths for 17 presumed UCLs are determined from the height above flat ground or water of the successful stepped leader tip in the image immediately prior to (within 20 μs before) the return stroke. Better estimates of maximum UCL lengths are determined using the downward stepped leader tip's speed of advance and the estimated return stroke time within its first frame. For 17 strokes, the upper bound length of the possible UCL averages 31.6 m and ranges from 11.3 to 50.3 m. Among the close strokes (those with spatial resolution <8 m per pixel), the five which connected to water (salt water lagoon) have UCL upper bound estimates averaging significantly shorter (24.1 m) than the average for the three close strokes which connected to land (36.9 m). The better estimates of maximum UCL lengths for the eight close strokes average 20.2 m, with slightly shorter average of 18.3 m for the five that connected to water. All the better estimates of UCL maximum lengths are <38 m in this dataset

Nonparetic Knee Extensor Strength Is the Determinant of Exercise Capacity of Community-Dwelling Stroke Survivors

PubMed Central

Wang, Wei-Te; Huang, Ling-Tzu; Chou, Ya-Hui; Wei, Ta-Sen; Lin, Chung-Che

2014-01-01

Objective. To investigate the relationship among walking speed, exercise capacity, and leg strength in community dwelling stroke subjects and to evaluate which one was the leading determinant factor of them. Design. This is a descriptive, cross-sectional study. Thirty-five chronic stroke patients who were able to walk independently in their community were enrolled. Walking speed was evaluated by using the 12-meter walking test. A maximal exercise test was used to determine the stroke subjects' exercise capacity. Knee extensor strength, measured as isokinetic torque, was assessed by isokinetic dynamometer. Results. The main walking speed of our subjects was 0.52 m/s. Peak oxygen uptake (VO2 peak) was 1.21 ± 0.43 L/min. Knee extensor strength, no matter whether paretic or nonparetic side, was significantly correlated to 12-meter walking speed and exercise capacity. Linear regression also showed the strength of the affected knee extensor was the determinant of walking speed and that of the nonparetic knee extensor was the determinant of exercise capacity in community dwelling stroke subjects. Conclusions. Walking speed and peak oxygen uptake were markedly decreased after stroke. Knee extensor strength of nonparetic leg was the most important determinant of exercise capacity of the community-dwelling stroke subjects. Knee extensor strengthening should be emphasized to help stroke patient to achieve optimal community living. PMID:25197712

Nonparetic knee extensor strength is the determinant of exercise capacity of community-dwelling stroke survivors.

PubMed

Wang, Wei-Te; Huang, Ling-Tzu; Chou, Ya-Hui; Wei, Ta-Sen; Lin, Chung-Che

2014-01-01

To investigate the relationship among walking speed, exercise capacity, and leg strength in community dwelling stroke subjects and to evaluate which one was the leading determinant factor of them. This is a descriptive, cross-sectional study. Thirty-five chronic stroke patients who were able to walk independently in their community were enrolled. Walking speed was evaluated by using the 12-meter walking test. A maximal exercise test was used to determine the stroke subjects' exercise capacity. Knee extensor strength, measured as isokinetic torque, was assessed by isokinetic dynamometer. The main walking speed of our subjects was 0.52 m/s. Peak oxygen uptake (VO₂ peak) was 1.21 ± 0.43 L/min. Knee extensor strength, no matter whether paretic or nonparetic side, was significantly correlated to 12-meter walking speed and exercise capacity. Linear regression also showed the strength of the affected knee extensor was the determinant of walking speed and that of the nonparetic knee extensor was the determinant of exercise capacity in community dwelling stroke subjects. Walking speed and peak oxygen uptake were markedly decreased after stroke. Knee extensor strength of nonparetic leg was the most important determinant of exercise capacity of the community-dwelling stroke subjects. Knee extensor strengthening should be emphasized to help stroke patient to achieve optimal community living.

Socioeconomic disparities in work performance following mild stroke.

PubMed

Brey, Joseph K; Wolf, Timothy J

2015-01-01

The purpose of this study was to investigate the relationships among the factors that influence return to work for young individuals with mild stroke from different socioeconomic backgrounds. Prospective cohort study of working adults with mild stroke (N = 21). Participants completed an assessment battery of cognitive, work environment and work performance measures at approximately 3 weeks and 7 months post mild stroke. Individuals were placed in "skilled" and "unskilled" worker categories based on the Hollingshead Index. Unskilled workers had significantly poorer scores on the majority of the cognitive assessments. Unskilled workers also perceived less social support (p = 0.017) and autonomy (p = 0.049) in work responsibilities than individuals in the skilled worker group and also reported significantly poorer work productivity due to stroke than those in the skilled group (p = 0.015). Individuals from low socioeconomic backgrounds have more difficulty returning to work following mild stroke than individuals from higher socioeconomic backgrounds. Future work is needed to identify factors that can increase long-term work success and quality of work performance following a mild stroke that specifically targets the needs of individuals who have a lower socioeconomic status.

Benefits of aerobic exercise after stroke.

PubMed

Potempa, K; Braun, L T; Tinknell, T; Popovich, J

1996-05-01

The debilitating loss of function after a stroke has both primary and secondary effects on sensorimotor function. Primary effects include paresis, paralysis, spasticity, and sensory-perceptual dysfunction due to upper motor neuron damage. Secondary effects, contractures and disuse muscle atrophy, are also debilitating. This paper presents theoretical and empirical benefits of aerobic exercise after stroke, issues relevant to measuring peak capacity, exercise training protocols, and the clinical use of aerobic exercise in this patient population. A stroke, and resulting hemiparesis, produces physiological changes in muscle fibres and muscle metabolism during exercise. These changes, along with comorbid cardiovascular disease, must be considered when exercising stroke patients. While few studies have measured peak exercise capacity in hemiparetic populations, it has been consistently observed in these studies that stroke patients have a lower functional capacity than healthy populations. Hemiparetic patients have low peak exercise responses probably due to a reduced number of motor units available for recruitment during dynamic exercise, the reduced oxidative capacity of paretic muscle, and decreased overall endurance. Consequently, traditional methods to predict aerobic capacity are not appropriate for use with stroke patients. Endurance exercise training is increasingly recognised as an important component in rehabilitation. An average improvement in maximal oxygen consumption (VO2max) of 13.3% in stroke patients who participated in a 10-week aerobic exercise training programme has been reported compared with controls. This study underscored the potential benefits of aerobic exercise training in stroke patients. In this paper, advantages and disadvantages of exercise modalities are discussed in relation to stroke patients. Recommendations are presented to maximise physical performance and minimise potential cardiac risks during exercise.

Lightning Step Leader and Return Stroke Spectra at 100,000 fps

NASA Astrophysics Data System (ADS)

Harley, J.; McHarg, M.; Stenbaek-Nielsen, H. C.; Haaland, R. K.; Sonnenfeld, R.; Edens, H. E.; Cummer, S.; Lapierre, J. L.; Maddocks, S.

2017-12-01

A fundamental understanding of lightning can be inferred from the spectral emissions resulting from the leader and return stroke channels. We examine events recorded at 00:58:07 on 19 July 2015 and 06:44:24 on 23 July 2017, both at Langmuir Laboratory. Analysis of both events is supplemented by data from the Lightning Mapping Array at Langmuir. The 00:58:07 event spectra was recorded using a 100 line per mm grating in front of a Phantom V2010 camera with an 85mm (9o FOV) Nikon lens recording at 100,000 frames per second. Coarse resolution spectra (approximately 5 nm resolution) are produced from approximately 400 nm to 800 nm for each frame. We analyze several nitrogen and oxygen lines to understand step leader temperature behavior between cloud and ground. The 06:44:24 event spectra was recorded using a 300 line per mm grating (approximately 1.5 nm resolution) in front of a Phantom V2010 camera with an 50mm (32o FOV) Nikon lens also recording at 100,000 frames per second. Two ionized atomic nitrogen lines at 502 nm and 569 nm appear upon attachment and disappear as the return stroke travels from ground to cloud in approximately 5 frames. We analyze these lines to understand initial return stroke temperature and species behavior.

Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

PubMed Central

Li, Chao-jin-zi; Du, Xiao-xia; Yang, Kun; Song, Lu-ping; Li, Peng-kun; Wang, Qiang; Sun, Rong; Lin, Xiao-ling; Lu, Hong-yu; Zhang, Tong

2016-01-01

Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6%) was the primary stroke type found in the young group, while ischemic stroke (60.0%) was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship) improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small. PMID:28123417

Temporal profile of body temperature in acute ischemic stroke: relation to stroke severity and outcome

PubMed Central

2012-01-01

Background Pyrexia after stroke (temperature ≥37.5°C) is associated with poor prognosis, but information on timing of body temperature changes and relationship to stroke severity and subtypes varies. Methods We recruited patients with acute ischemic stroke, measured stroke severity, stroke subtype and recorded four-hourly tympanic (body) temperature readings from admission to 120 hours after stroke. We sought causes of pyrexia and measured functional outcome at 90 days. We systematically summarised all relevant previous studies. Results Amongst 44 patients (21 males, mean age 72 years SD 11) with median National Institute of Health Stroke Score (NIHSS) 7 (range 0–28), 14 had total anterior circulation strokes (TACS). On admission all patients, both TACS and non-TACS, were normothermic (median 36.3°C vs 36.5°C, p=0.382 respectively) at median 4 hours (interquartile range, IQR, 2–8) after stroke; admission temperature and NIHSS were not associated (r2=0.0, p=0.353). Peak temperature, occurring at 35.5 (IQR 19.0 to 53.8) hours after stroke, was higher in TACS (37.7°C) than non-TACS (37.1°C, p<0.001) and was associated with admission NIHSS (r2=0.20, p=0.002). Poor outcome (modified Rankin Scale ≥3) at 90 days was associated with higher admission (36.6°C vs. 36.2°C p=0.031) and peak (37.4°C vs. 37.0°C, p=0.016) temperatures. Sixteen (36%) patients became pyrexial, in seven (44%) of whom we found no cause other than the stroke. Conclusions Normothermia is usual within the first 4 hours of stroke. Peak temperature occurs at 1.5 to 2 days after stroke, and is related to stroke severity/subtype and more closely associated with poor outcome than admission temperature. Temperature-outcome associations after stroke are complex, but normothermia on admission should not preclude randomisation of patients into trials of therapeutic hypothermia. PMID:23075282

Observations of lightning processes using VHF radio interferometry

NASA Technical Reports Server (NTRS)

Rhodes, C. T.; Shao, X. M.; Krehbiel, P. R.; Thomas, R.

1991-01-01

A single station, multiple baseline radio interferometer was used to locate the direction of VHF radiation from lightning discharges with microsec time resolution. Radiation source directions and electric field waveforms were analyzed for various types of breakdown events. These include initial breakdown and K type events of in-cloud activity, and the leaders of initial and subsequent strokes to ground and activity during and following return strokes. Radiation during the initial breakdown of a flash and in the early stages of initial leaders to ground is found to be similar. In both instances, the activity consists of localized bursts of radiation that are intense and slow moving. Motion within a given burst is unresolved by the interferometer. Radiation from in-cloud K type events is essentially the same as that from dart leaders; in both cases it is produced at the leading edge of a fast moving streamer that propagates along a well defined, often extensive path. K type events are sometimes terminated by fast field changes that are similar to the return stroke initiated by dart leaders; such K type events are the in-cloud analog of the dart leader return stroke process.

Feedback-controlled robotics-assisted treadmill exercise to assess and influence aerobic capacity early after stroke: a proof-of-concept study.

PubMed

Stoller, Oliver; Schindelholz, Matthias; Bichsel, Lukas; Schuster, Corina; de Bie, Rob A; de Bruin, Eling D; Hunt, Kenneth J

2014-07-01

The majority of post-stroke individuals suffer from low exercise capacity as a secondary reaction to immobility. The aim of this study was to prove the concept of feedback-controlled robotics-assisted treadmill exercise (RATE) to assess aerobic capacity and guide cardiovascular exercise in severely impaired individuals early after stroke. Subjects underwent constant load and incremental exercise testing using a human-in-the-loop feedback system within a robotics-assisted exoskeleton (Lokomat, Hocoma AG, CH). Inclusion criteria were: stroke onset ≤8 weeks, stable medical condition, non-ambulatory status, moderate motor control of the lower limbs and appropriate cognitive function. Outcome measures included oxygen uptake kinetics, peak oxygen uptake (VO2peak), gas exchange threshold (GET), peak heart rate (HRpeak), peak work rate (Ppeak) and accuracy of reaching target work rate (P-RMSE). Three subjects (18-42 d post-stroke) were included. Oxygen uptake kinetics during constant load ranged from 42.0 to 60.2 s. Incremental exercise testing showed: VO2peak range 19.7-28.8 ml/min/kg, GET range 11.6-12.7 ml/min/kg, and HRpeak range 115-161 bpm. Ppeak range was 55.2-110.9 W and P-RMSE range was 3.8-7.5 W. The concept of feedback-controlled RATE for assessment of aerobic capacity and guidance of cardiovascular exercise is feasible. Further research is warranted to validate the method on a larger scale. Aerobic capacity is seriously reduced in post-stroke individuals as a secondary reaction to immobility. Robotics-assisted walking devices may have substantial clinical relevance regarding assessment and improvement of aerobic capacity early after stroke. Feedback-controlled robotics-assisted treadmill exercise represents a new concept for cardiovascular assessment and intervention protocols for severely impaired individuals.

[Predictors of epilepsy in children after ischemic stroke].

PubMed

Lvova, O A; Shalkevich, L V; Dron, A N; Lukaschuk, M Y; Orlova, E A; Gusev, V V; Suleymanova, E V; Sulimov, A V; Kudlatch, A I

To determine clinical/instrumental predictors of symptomatic epilepsy after ischemic stroke in children. One hundred and thirty-six patients, aged 0-15 years, with the diagnosis of ischemic stroke (ICD-10 I63.0-I63.9) were examined. The duration of the study was 18 months - 12 years. Patients were stratified into post-stroke (n=22) and control (n=114) groups, the latter included patients without epilepsy regardless of the presence of convulsive seizures in the acute stage of stroke. Predictors were determined based on EEG and characteristics of convulsive syndrome in the acute stage of stroke. The following prognostic criteria were found: generalized type of seizures, focal type of seizures with secondary generalization, epileptiform (peak and/or peak-wave) activity, focal character of epileptiform activity, generalized type of seizures in the combination with slow wave background activity on EEG, generalized type of seizures in the combination with slow wave activity and disorganized activity on EEG.

Split-Step Timing of Professional and Junior Tennis Players

PubMed Central

Leskosek, Bojan; Filipcic, Tjasa

2017-01-01

Abstract The purpose of the study was to determine the timing of a split-step in three categories of tennis players in four groups of strokes. Subjects were divided into three groups: male and female junior, and male professional tennis players. During two tournaments, all matches were recorded with two fixed video cameras. For every stroke, the timing of the split-step between the opponent’s impact point when hitting the ball and the player’s split-step was measured. A two-way analysis of variance (ANOVA) was used to determine the differences between groups of strokes, players and the interaction Player x Stroke Group. A Tukey post-hoc test was employed to determine specific differences. The results revealed differences between players in detecting the opponent’s movement, stroke and ball flight, which were reflected in different split-step timings. Each tennis player has his/her own timing mechanism which they adapt to various game situations. Response times differ significantly depending on the game situation. On average, they are the lowest in the serve, and then gradually rise from the return of the serve to baseline game, reaching the highest values in specific game situations. Players react faster in the first serve than in the second one and in the return of the serve, the response times are lower after the return of the second serve PMID:28210342

Upper Limb Kinematics in Stroke and Healthy Controls Using Target-to-Target Task in Virtual Reality.

PubMed

Hussain, Netha; Alt Murphy, Margit; Sunnerhagen, Katharina S

2018-01-01

Kinematic analysis using virtual reality (VR) environment provides quantitative assessment of upper limb movements. This technique has rarely been used in evaluating motor function in stroke despite its availability in stroke rehabilitation. To determine the discriminative validity of VR-based kinematics during target-to-target pointing task in individuals with mild or moderate arm impairment following stroke and in healthy controls. Sixty-seven participants with moderate (32-57 points) or mild (58-65 points) stroke impairment as assessed with Fugl-Meyer Assessment for Upper Extremity were included from the Stroke Arm Longitudinal study at the University of Gothenburg-SALGOT cohort of non-selected individuals within the first year of stroke. The stroke groups and 43 healthy controls performed the target-to-target pointing task, where 32 circular targets appear one after the other and disappear when pointed at by the haptic handheld stylus in a three-dimensional VR environment. The kinematic parameters captured by the stylus included movement time, velocities, and smoothness of movement. The movement time, mean velocity, and peak velocity were discriminative between groups with moderate and mild stroke impairment and healthy controls. The movement time was longer and mean and peak velocity were lower for individuals with stroke. The number of velocity peaks, representing smoothness, was also discriminative and significantly higher in both stroke groups (mild, moderate) compared to controls. Movement trajectories in stroke more frequently showed clustering (spider's web) close to the target indicating deficits in movement precision. The target-to-target pointing task can provide valuable and specific information about sensorimotor impairment of the upper limb following stroke that might not be captured using traditional clinical scale. The trial was registered with register number NCT01115348 at clinicaltrials.gov, on May 4, 2010. URL: https://clinicaltrials.gov/ct2/show/NCT01115348.

Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability.

PubMed

Stoller, Oliver; de Bruin, Eling D; Schindelholz, Matthias; Schuster-Amft, Corina; de Bie, Rob A; Hunt, Kenneth J

2014-10-11

Exercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke. 20 subjects (age 44-84 years, <6 month post-stroke) with severe motor limitations (Functional Ambulatory Classification 0-2) were selected for consecutive constant load testing (CLT) and incremental exercise testing (IET) within a powered exoskeleton, synchronised with a treadmill and a body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability. Peak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC =0.82), relative peak oxygen uptake (ICC =0.72), peak work rate (ICC =0.91), peak heart rate (ICC =0.80), absolute gas exchange threshold (ICC =0.91), relative gas exchange threshold (ICC =0.88), oxygen cost of work (ICC =0.87), oxygen pulse at peak oxygen uptake (ICC =0.92), ventilation rate versus carbon dioxide output slope (ICC =0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied. This study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate repeatability for the most important peak cardiopulmonary performance parameters. These findings have important implications for the design and implementation of cardiovascular exercise interventions in severely impaired populations. Future research needs to develop advanced control strategies to enable the true limit of functional exercise capacity to be reached and to further assess test-retest reliability and repeatability in larger samples.

The role of postural control in the association between aerobic capacity and walking capacity in chronic stroke: a cross-sectional analysis.

PubMed

Outermans, Jacqueline C; van de Port, Ingrid; Kwakkel, Gert; Visser-Meily, Johanna M; Wittink, Harriet

2018-03-12

Reports on the association between aerobic capacity and walking capacity in people after stroke show disparate results. To determine (1) if the predictive validity of peak oxygen uptake (VO2peak) for walking capacity post stroke is different from that of maximal oxygen uptake (VO2max) and (2) if postural control, hemiplegic lower extremity muscle strength, age and gender distort the association between aerobic capacity and walking capacity. Cross-sectional study. General community in Utrecht, the Netherlands. Community-dwelling people more than three months after stroke. Measurement of aerobic capacity were performed with cardiopulmonary exercise testing (CPET) and differentiated between the achievement of VO2peak or VO2max. Measurement of walking capacity with the Six Minute Walk Test (6MWT), postural control with the Performance Oriented Mobility Assessment (POMA) and hemiplegic lower extremity muscle strength with the Motricity Index (MI-LE). Fifty-one out of 62 eligible participants, aged 64.7 (±12.5) years were included. Analysis of covariance (ANCOVA) showed a nonsignificant difference between the predictive validities of VO2max (N = 22, β = 0.56; 95%CI 0.12 - 0.97) and VO2peak (N = 29, β = 0.72; 95%CI 0.38 - 0.92). Multiple regression analysis of the pooled sample showed a significant decrease in the β value of VO2peak (21.6%) for the 6MWT when adding the POMA as a covariate in the association model. VO2peak remained significantly related to 6MWT after correcting for the POMA (β = 0.56 (95%CI 0.39 - 0.75)) CONCLUSIONS: The results suggest similar predictive validity of aerobic capacity for walking capacity in participants achieving VO2max compared to those only achieving VO2peak. Postural control confounds the association between aerobic capacity and walking capacity. Aerobic capacity remains a valid predictor of walking capacity. Aerobic capacity is an important factor associated with walking capacity after stroke. However, to understand this relationship, postural control needs to be measured. Both aerobic capacity and postural control may need to be addressed during interventions aiming to improve walking capacity after stroke.

Effects of a 6-Week Aquatic Treadmill Exercise Program on Cardiorespiratory Fitness and Walking Endurance in Subacute Stroke Patients: A PILOT TRIAL.

PubMed

Han, Eun Young; Im, Sang Hee

2017-03-15

To assess the feasibility and safety of a 6-week course of water walking performed using a motorized aquatic treadmill in individuals with subacute stroke for cardiorespiratory fitness, walking endurance, and activities of daily living. Twenty subacute stroke patents were randomly assigned to aquatic treadmill exercise (ATE) or land-based exercise (LBE). The ATE group (n = 10) performed water-based aerobic exercise on a motorized aquatic treadmill, and the LBE group (n = 10) performed land-based aerobic exercise on a cycle ergometer. Both groups performed aerobic exercise for 30 minutes, 5 times per week for 6 weeks. Primary outcome measures were 6-minute walk test for walking endurance and cardiopulmonary fitness parameters of a symptom-limited exercise tolerance test, and secondary measures were Korean version of the Modified Barthel Index (K-MBI) for activities of daily living. All variables were assessed at baseline and at the end of the intervention. The ATE group showed significant improvements in 6-minute walk test (P = .005), peak oxygen uptake (V·o2peak; P = .005), peak heart rate (P = .007), exercise tolerance test duration (P = .005), and K-MBI (P = .008). The LBE group showed a significant improvement only in K-MBI (P = .012). In addition, improvement in V·o2peak was greater in the ATE than in the LBE group. This preliminary study showed that a 6-week ATE program improved peak aerobic capacity and walking endurance in patients with subacute stroke. The improvement in V·o2peak after an ATE exercise program was greater than that observed after an LBE program. Therefore, ATE effectively improves cardiopulmonary fitness in patients with subacute stroke.

[Good practice in occupational health services--Certification of stroke as an accident at work. Need for secondary prevention in people returning to work after acute cerebrovascular events].

PubMed

Marcinkiewicz, Andrzej; Walusiak-Skorupa, Jolanta

2015-01-01

The classification of an acute vascular episode, both heart infarct and stroke, as an accident at work poses difficulties not only for post accidental teams, but also to occupational health professionals, experts and judges at labor and social insurance courts. This article presents the case of a 41-year-old office worker, whose job involved client services. While attending a very aggressive customer she developed solid stress that resulted in symptoms of the central nervous system (headache, speech disturbances). During her hospitalisation at the neurological unit ischemic stroke with transient mixed type aphasia was diagnosed. Magnetic resonance imaging (MRI) scan of the head revealed subacute ischemia. After an analysis of the accident circumstances, the employer's post accidental team decided that ischemic stroke had been an accident at work, because it was a sudden incident due to an external cause inducing work-related traumatic stroke. As a primary cause tough stress and emotional strain due to the situation developed while attending the customer were acknowledged. During control medical check up after 5 months the patient was found to be fit for work, so she could return to work. However, it should be noted that such a check up examination of subjects returning to work after stroke must be holistic, including the evaluation of job predispositions and health education aimed at secondary prevention of heart and vascular diseases with special reference to their risk factors. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Determining distance to lightning strokes from a single station

NASA Technical Reports Server (NTRS)

Ruhnke, L. H. (Inventor)

1973-01-01

Apparatus is described for determining the distance to lightning strokes from a single station. The apparatus includes a first loop antenna system for sensing the magnetic field produced by the lightning which is filtered, square rooted, and fed into a peak voltage holding circuit. A second antenna is provided for sensing the electric field produced by the lightning which is fed into a filter, an absolute value meter, and to a peak voltage holding circuit. A multivibrator gates the magnetic and electric signals through the peak holding circuits to a ratio meter which produces a signal corresponding to the ratio between the magnetic component and the electric component. The amplitude of this signal is proportional to the distance from the apparatus to the lightning stroke.

Bipolar cloud-to-ground lightning flash observations

NASA Astrophysics Data System (ADS)

Saba, Marcelo M. F.; Schumann, Carina; Warner, Tom A.; Helsdon, John H.; Schulz, Wolfgang; Orville, Richard E.

2013-10-01

lightning is usually defined as a lightning flash where the current waveform exhibits a polarity reversal. There are very few reported cases of cloud-to-ground (CG) bipolar flashes using only one channel in the literature. Reports on this type of bipolar flashes are not common due to the fact that in order to confirm that currents of both polarities follow the same channel to the ground, one necessarily needs video records. This study presents five clear observations of single-channel bipolar CG flashes. High-speed video and electric field measurement observations are used and analyzed. Based on the video images obtained and based on previous observations of positive CG flashes with high-speed cameras, we suggest that positive leader branches which do not participate in the initial return stroke of a positive cloud-to-ground flash later generate recoil leaders whose negative ends, upon reaching the branch point, traverse the return stroke channel path to the ground resulting in a subsequent return stroke of opposite polarity.

Protection characteristics of a Faraday cage compromised by lightning burnthrough.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Warne, Larry Kevin; Bystrom, Edward; Jorgenson, Roy Eberhardt

2012-01-01

A lightning flash consists of multiple, high-amplitude but short duration return strokes. Between the return strokes is a lower amplitude, continuing current which flows for longer duration. If the walls of a Faraday cage are made of thin enough metal, the continuing current can melt a hole through the metal in a process called burnthrough. A subsequent return stroke can couple energy through this newly-formed hole. This LDRD is a study of the protection provided by a Faraday cage when it has been compromised by burnthrough. We initially repeated some previous experiments and expanded on them in terms of scopemore » and diagnostics to form a knowledge baseline of the coupling phenomena. We then used a combination of experiment, analysis and numerical modeling to study four coupling mechanisms: indirect electric field coupling, indirect magnetic field coupling, conduction through plasma and breakdown through the hole. We discovered voltages higher than those encountered in the previous set of experiments (on the order of several hundreds of volts).« less

Evaluation of exercise capacity after severe stroke using robotics-assisted treadmill exercise: a proof-of-concept study.

PubMed

Stoller, O; de Bruin, E D; Schindelholz, M; Schuster, C; de Bie, R A; Hunt, K J

2013-01-01

Robotics-assisted treadmill exercise (RATE) with focus on motor recovery has become popular in early post-stroke rehabilitation but low endurance for exercise is highly prevalent in these individuals. This study aimed to develop an exercise testing method using robotics-assisted treadmill exercise to evaluate aerobic capacity after severe stroke. Constant load testing (CLT) based on body weight support (BWS) control, and incremental exercise testing (IET) based on guidance force (GF) control were implemented during RATE. Analyses focussed on step change, step response kinetics, and peak performance parameters of oxygen uptake. Three subjects with severe motor impairment 16-23 days post-stroke were included. CLT yielded reasonable step change values in oxygen uptake, whereas response kinetics of oxygen uptake showed low goodness of fit. Peak performance parameters were not obtained during IET. Exercise testing in post-stroke individuals with severe motor impairments using a BWS control strategy for CLT is deemed feasible and safe. Our approach yielded reasonable results regarding cardiovascular performance parameters. IET based on GF control does not provoke peak cardiovascular performance due to uncoordinated walking patterns. GF control needs further development to optimally demand active participation during RATE. The findings warrant further research regarding the evaluation of exercise capacity after severe stroke.

Oxygen uptake response to cycle ergometry in post-acute stroke patients with different severity of hemiparesis.

PubMed

Chen, Chun-Kai; Weng, Ming-Cheng; Chen, Tien-Wen; Huang, Mao-Hsiung

2013-11-01

This study evaluated the impact of severity of hemiparesis on oxygen uptake (VO2) response in post-acute stroke patients. Sixty-four patients with a mean poststroke interval of 8.6 ± 3.8 days underwent a ramp cardiopulmonary exercise test on a cycling ergometer to volitional termination. Mean peak VO2 (VO2peak) and work efficiency (ΔVO2/ΔWR) were measured by open-circuit spirometry during standard upright ergometer cycling. Severity of the hemiparetic lower limb was assessed by Brunnstrom's motor recovery stages lower extremity (BMRSL). VO2peak was 10% lower in hemiparetic leg with BMRSL V than in that with BMRSL VI, 20% lower in BMRSL IV, and 50% lower in BMRSL III. ΔVO2/ΔWR was higher for the group with increased BMRSL. The relations were consistent after adjustment for age, sex, body mass index, stroke type, hemiparetic side, modified Ashworth Scale, time poststroke, comorbidities, and medications. Our findings revealed that O2peak is dependent on the severity of hemiparesis in leg, and along with ΔO2/ΔWR closely related to the severity of hemiparesis in post-acute stroke patients, regardless of the types and locations of lesion after stroke, as well as the differences in comorbidities and medications. Copyright © 2013. Published by Elsevier B.V.

Self-Paced Reaching after Stroke: A Quantitative Assessment of Longitudinal and Directional Sensitivity Using the H-Man Planar Robot for Upper Limb Neurorehabilitation.

PubMed

Hussain, Asif; Budhota, Aamani; Hughes, Charmayne Mary Lee; Dailey, Wayne D; Vishwanath, Deshmukh A; Kuah, Christopher W K; Yam, Lester H L; Loh, Yong J; Xiang, Liming; Chua, Karen S G; Burdet, Etienne; Campolo, Domenico

2016-01-01

Technology aided measures offer a sensitive, accurate and time-efficient approach for the assessment of sensorimotor function after neurological insult compared to standard clinical assessments. This study investigated the sensitivity of robotic measures to capture differences in planar reaching movements as a function of neurological status (stroke, healthy), direction (front, ipsilateral, contralateral), movement segment (outbound, inbound), and time (baseline, post-training, 2-week follow-up) using a planar, two-degrees of freedom, robotic-manipulator (H-Man). Twelve chronic stroke (age: 55 ± 10.0 years, 5 female, 7 male, time since stroke: 11.2 ± 6.0 months) and nine aged-matched healthy participants (age: 53 ± 4.3 years, 5 female, 4 male) participated in this study. Both healthy and stroke participants performed planar reaching movements in contralateral, ipsilateral and front directions with the H-Man, and the robotic measures, spectral arc length (SAL), normalized time to peak velocities ( T peakN ), and root-mean square error (RMSE) were evaluated. Healthy participants went through a one-off session of assessment to investigate the baseline. Stroke participants completed a 2-week intensive robotic training plus standard arm therapy (8 × 90 min sessions). Motor function for stroke participants was evaluated prior to training (baseline, week-0), immediately following training (post-training, week-2), and 2-weeks after training (follow-up, week-4) using robotic assessment and the clinical measures Fugl-Meyer Assessment (FMA), Activity-Research-Arm Test (ARAT), and grip-strength. Robotic assessments were able to capture differences due to neurological status, movement direction, and movement segment. Movements performed by stroke participants were less-smooth, featured longer T peakN , and larger RMSE values, compared to healthy controls. Significant movement direction differences were observed, with improved reaching performance for the front, compared to ipsilateral and contralateral movement directions. There were group differences depending on movement segment. Outbound reaching movements were smoother and featured longer T peakN values than inbound movements for control participants, whereas SAL, T peakN , and RMSE values were similar regardless of movement segment for stroke patients. Significant change in performance was observed between initial and post-assessments using H-Man in stroke participants, compared to conventional scales which showed no significant difference. Results of the study indicate the potential of H-Man as a sensitive tool for tracking changes in performance compared to ordinal scales (i.e., FM, ARAT).

Three unusual strokes in a triggered lightning flash

NASA Technical Reports Server (NTRS)

Idone, V. P.; Orville, R. E.

1984-01-01

Time-resolved photographic records of three strokes of a triggered lightning flash are examined. These strokes exhibit several examples of novel behavior that include (1) the abrupt transformation of dart leaders to stepped leaders and (2) the partial 'reflection' of dart leader luminosity back up the channel. Both phenomena are associated with an apparent discontinuity in channel characteristics between the natural and artificial (wire) sections of the channel. We estimate the ratio of characteristic impedances for these sections to have an upper bound of about a factor of 3. Analysis of one of the dart leader 'reflections' yields a propagation speed of 9.6 x 10 to the 7th m/s whereas the dart leader and return stroke speeds (two-dimensional) over the same channel section are 1.7 x 10 to the 7th and 13 x 10 to the seventh m/s, respectively. Also, one of the return strokes reveals the occurrence of two distinct waves of luminosity that are separated by only 5 microns and that travel up nearly identical channels that differ only in the channel terminus.

[Impairment and disability in patients with a severe ischemic cerebral infarction at admission to the rehabilitation center and six months after stroke].

PubMed

Prevo, A J; Dijkman, M M; Le Fèvre, F A

1998-03-21

Evaluation of impairment and disability in stroke patients with a severe cortical infarction at admission as well as six months after the stroke. Prospective and descriptive study. Rehabilitation Centre Heliomare, Wijk aan Zee, the Netherlands. Between 1 January 1987 en 31 May 1992 stroke patients were admitted to the rehabilitation centre with a severe, first ever, cortical infarction without any comorbidity. The patients were dependent in activities of daily living and wheel-chair-bound. Motor and neuropsychological impairment and disability were evaluated at admission to the rehabilitation centre as well as six months after the stroke. Return to home and length of stay were evaluated. 43 patients were included. Recovery of arm and hand function was very poor (there was complete paresis at admission in 33 patients (77%) and six months after the CVA in 25 patients (58%)); recovery of the affected leg was reasonable (complete paresis in 10 (23%) and 0 patients, respectively). Cognitive deficits diminished in severity, but remained noticeable in three-quarters of the patients. Independent walking was achieved by 30 patients (70%), independence in personal activities of daily living by 32 patients (74%) and returning home by 36 patients (84%). The mean hospital stay was 26 weeks (SD: 9.26; range: 11-30). Prognosis of personal independence and returning home after a severe cortical infarction was rather good despite poor recovery of motor and cognitive impairment.

Accuracy of clinical observations of push-off during gait after stroke.

PubMed

McGinley, Jennifer L; Morris, Meg E; Greenwood, Ken M; Goldie, Patricia A; Olney, Sandra J

2006-06-01

To determine the accuracy (criterion-related validity) of real-time clinical observations of push-off in gait after stroke. Criterion-related validity study of gait observations. Rehabilitation hospital in Australia. Eleven participants with stroke and 8 treating physical therapists. Not applicable. Pearson product-moment correlation between physical therapists' observations of push-off during gait and criterion measures of peak ankle power generation from a 3-dimensional motion analysis system. A high correlation was obtained between the observational ratings and the measurements of peak ankle power generation (Pearson r =.98). The standard error of estimation of ankle power generation was .32W/kg. Physical therapists can make accurate real-time clinical observations of push-off during gait following stroke.

Lightning Reporting at 45th Weather Squadron: Recent Improvements

NASA Technical Reports Server (NTRS)

Finn, Frank C.; Roeder, William P.; Buchanan, Michael D.; McNamara, Todd M.; McAllenan, Michael; Winters, Katherine A.; Fitzpatrick, Michael E.; Huddleston, Lisa L.

2010-01-01

The 45th Weather Squadron (45 WS) provides daily lightning reports to space launch customers at CCAFS/KSC. These reports are provided to assess the need to inspect the electronics of satellite payloads, space launch vehicles, and ground support equipment for induced current damage from nearby lightning strokes. The 45 WS has made several improvements to the lightning reports during 2008-2009. The 4DLSS, implemented in April 2008, provides all lightning strokes as opposed to just one stroke per flash as done by the previous system. The 45 WS discovered that the peak current was being truncated to the nearest kilo amp in the database used to generate the daily lightning reports, which led to an up to 4% underestimate in the peak current for average lightning. This error was corrected and led to elimination of this underestimate. The 45 WS and their mission partners developed lightning location error ellipses for 99% and 95% location accuracies tailored to each individual stroke and began providing them in the spring of 2009. The new procedure provides the distance from the point of interest to the best location of the stroke (the center of the error ellipse) and the distance to the closest edge of the ellipse. This information is now included in the lightning reports, along with the peak current of the stroke. The initial method of calculating the error ellipses could only be used during normal duty hours, i.e. not during nights, weekends, or holidays. This method was improved later to provide lightning reports in near real-time, 24/7. The calculation of the distance to the closest point on the ellipse was also significantly improved later. Other improvements were also implemented. A new method to calculate the probability of any nearby lightning stroke. being within any radius of any point of interest was developed and is being implemented. This may supersede the use of location error ellipses. The 45 WS is pursuing adding data from nine NLDN sensors into 4DLSS in real-time. This will overcome the problem of 4DLSS missing some of the strong local strokes. This will also improve the location accuracy, reduce the size and eccentricity of the location error ellipses, and reduce the probability of nearby strokes being inside the areas of interest when few of the 4DLSS sensors are used in the stroke solution. This will not reduce 4DLSS performance when most of the 4DLSS sensors are used in the stroke solution. Finally, several possible future improvements were discussed, especially for improving the peak current estimate and the error estimate for peak current, and upgrading the 4DLSS. Some possible approaches for both of these goals were discussed.

Grip type and task goal modify reach-to-grasp performance in post-stroke hemiparesis

PubMed Central

Schaefer, Sydney Y.; DeJong, Stacey L.; Cherry, Kendra M.; Lang, Catherine E.

2011-01-01

This study investigated whether grip type and/or task goal influenced reaching and grasping performance in post-stroke hemiparesis. Sixteen adults with post-stroke hemiparesis and twelve healthy adults reached to and grasped a cylindrical object using one of two grip types (3-finger or palmar) to achieve one of two task goals (hold or lift). Performance of the stroke group was characteristic of hemiparetic limb movement during reach-to-grasp, with more curved handpaths and slower velocities compared to the control group. These effects were present regardless of grip type or task goal. Other measures of reaching (reach time and reach velocity at object contact) and grasping (peak thumb-index finger aperture during the reach and peak grip force during the grasp) were differentially affected by grip type, task goal, or both, despite the presence of hemiparesis, providing new evidence that changes in motor patterns after stroke may occur to compensate for stroke-related motor impairment. PMID:22357103

A Unified Model of Cloud-to-Ground Lightning Stroke

NASA Astrophysics Data System (ADS)

Nag, A.; Rakov, V. A.

2014-12-01

The first stroke in a cloud-to-ground lightning discharge is thought to follow (or be initiated by) the preliminary breakdown process which often produces a train of relatively large microsecond-scale electric field pulses. This process is poorly understood and rarely modeled. Each lightning stroke is composed of a downward leader process and an upward return-stroke process, which are usually modeled separately. We present a unified engineering model for computing the electric field produced by a sequence of preliminary breakdown, stepped leader, and return stroke processes, serving to transport negative charge to ground. We assume that a negatively-charged channel extends downward in a stepped fashion through the relatively-high-field region between the main negative and lower positive charge centers and then through the relatively-low-field region below the lower positive charge center. A relatively-high-field region is also assumed to exist near ground. The preliminary breakdown pulse train is assumed to be generated when the negatively-charged channel interacts with the lower positive charge region. At each step, an equivalent current source is activated at the lower extremity of the channel, resulting in a step current wave that propagates upward along the channel. The leader deposits net negative charge onto the channel. Once the stepped leader attaches to ground (upward connecting leader is presently neglected), an upward-propagating return stroke is initiated, which neutralizes the charge deposited by the leader along the channel. We examine the effect of various model parameters, such as step length and current propagation speed, on model-predicted electric fields. We also compare the computed fields with pertinent measurements available in the literature.

Peak Cardiorespiratory Responses of Patients with Subacute Stroke During Land and Aquatic Treadmill Exercise.

PubMed

Lee, Yong Ki; Kim, Bo Ryun; Han, Eun Young

2017-05-01

The aim of this work was to investigate the cardiorespiratory responses of patients with subacute stroke to exercise stress tests with aquatic and land treadmills. Twenty-one consecutive patients who presented with first-ever subacute stroke in 2013-2015. All subjects underwent symptom-limited incremental exercise testing with aquatic and land treadmills. Land treadmill speed started at 1.5 km/h and increased 0.5 km/h every 1 to 2 minutes until maximal tolerable speed was achieved. Thereafter, the grade was elevated by 2% every 2 minutes. In the aquatic treadmill test, subjects were submerged to the xiphoid in 28°C water. Treadmill speed started at 1.5 km/h and was increased 0.5 km/h every 2 minutes thereafter. Cardiorespiratory responses were recorded with aquatic and land treadmills. Compared to land treadmill exercise, aquatic treadmill exercise achieved significantly better peak VO2 (22.0 vs 20.0; P = 0.02), peak metabolic equivalents (6.3 vs 5.8; P = 0.02), and peak rating of perceived exertion (17.6 vs 18.4, P = 0.01). Heart rate and VO2 correlated significantly during both tests (land treadmill: r = 0.96, P < 0.001; aquatic treadmill: r = 0.99, P < 0.001). Aquatic treadmill exercise elicited significantly better peak cardiorespiratory responses than land treadmill exercise and may be as effective for early intensive aerobic training in subacute stroke patients.

Analysis of swimming performance from physical, physiological, and biomechanical parameters in young swimmers.

PubMed

Jürimäe, Jaak; Haljaste, Kaja; Cicchella, Antonio; Lätt, Evelin; Purge, Priit; Leppik, Aire; Jürimäe, Toivo

2007-02-01

The purpose of this study was to examine the influence of the energy cost of swimming, body composition, and technical parameters on swimming performance in young swimmers. Twenty-nine swimmers, 15 prepubertal (11.9 +/- 0.3 years; Tanner Stages 1-2) and 14 pubertal (14.3 +/- 1.4 years; Tanner Stages 3-4) boys participated in the study. The energy cost of swimming (Cs) and stroking parameters were assessed over maximal 400-m front-crawl swimming in a 25-m swimming pool. The backward extrapolation technique was used to evaluate peak oxygen consumption (VO2peak). A stroke index (SI; m2 . s(-1) . cycles(-1)) was calculated by multiplying the swimming speed by the stroke length. VO2peak results were compared with VO2peak test in the laboratory (bicycle, 2.86 +/- 0.74 L/min, vs. in water, 2.53 +/- 0.50 L/min; R2 = .713; p = .0001). Stepwise-regression analyses revealed that SI (R2 = .898), in-water VO2peak (R2 = .358), and arm span (R2 = .454) were the best predictors of swimming performance. The backward-extrapolation method could be used to assess VO2peak in young swimmers. SI, arm span, and VO2peak appear to be the major determinants of front-crawl swimming performance in young swimmers.

Barriers and facilitators of return to work for individuals with strokes: perspectives of the stroke survivor, vocational specialist, and employer.

PubMed

Culler, Kathleen H; Wang, Ying-Chih; Byers, Katherine; Trierweiler, Robert

2011-01-01

The purpose of this study was to identify factors that facilitated or acted as a barrier to return to work (RTW) for stroke survivors. We applied 3 approaches to identify the factors. First, we conducted qualitative interviews with 10 stroke survivors about their RTW experience post stroke. Second, we surveyed 21 vocational specialists about barriers and facilitators of RTW based on their clinical practice. Last, we interviewed 7 employers who had experience in interviewing individuals with disabilities or had the authority to make hiring decisions. Descriptions of barriers and facilitators to RTW from these 3 perspectives were illustrated. Identified components were mapped based on the ICF framework. From stroke survivors' perspectives, factors affecting employment after stroke include neurological (motor, cognition, communication), social, personal, and environmental factors. Vocational specialists described similar barriers and facilitators of RTW as the stroke survivors but emphasized personal factors such as flexibility and being realistic in vocational goals. The employers explained that the candidate's disability plays no role in the hiring process and indicated that all applicants must meet the essential job requirements. Some employers described the benefits of having the support of vocational rehabilitation staff and being able to interact with the vocational rehabilitation specialists during the hiring process. The interaction allows the employer to gather initial information (consented to by the job applicant) about the applicants from the vocational rehabilitation service and to be educated about any specific needs related to the applicant's medical issues.

What are the social consequences of stroke for working-aged adults? A systematic review.

PubMed

Daniel, Katie; Wolfe, Charles D A; Busch, Markus A; McKevitt, Christopher

2009-06-01

Approximately one fourth of strokes occur in people aged <65 years. UK current policy calls for services that meet the specific needs of working-aged adults with stroke. We aimed to identify the social consequences of stroke in working-aged adults, which might subsequently inform the development and evaluation of services for this group. We reviewed quantitative and qualitative studies identifying social consequences for working-aged adults with stroke using multiple search strategies (electronic databases, bibliographic references, hand searches). Social consequences were defined as those pertaining to the World Health Organization International Classification of Functioning, Disability and Health domain "participation." Two authors reviewed articles using a standardized matrix for data extraction. Seventy-eight studies were included: 66 were quantitative observational studies, 2 were quantitative interventional studies, 9 were qualitative studies, and one used mixed methods. Seventy studies reported data on return to work after stroke with proportions ranging from 0% to 100%. Other categories of social consequences included negative impact on family relationships (5% to 54%), deterioration in sexual life (5% to 76%), economic difficulties (24% to 33%), and deterioration in leisure activities (15% to 79%). Methodological variations account for the wide range of rates of return to work after stroke. There is limited evidence of the negative impact of stroke on other aspects of social participation. Robust estimates of the prevalence of such outcomes are required to inform the development of appropriate interventions. We propose strategies by which methodology and reporting in this field might be improved.

Robot-assisted gait training improves brachial–ankle pulse wave velocity and peak aerobic capacity in subacute stroke patients with totally dependent ambulation

PubMed Central

Han, Eun Young; Im, Sang Hee; Kim, Bo Ryun; Seo, Min Ji; Kim, Myeong Ok

2016-01-01

Abstract Objective: Brachial–ankle pulse wave velocity (baPWV) evaluates arterial stiffness and also predicts early outcome in stroke patients. The objectives of this study were to investigate arterial stiffness of subacute nonfunctional ambulatory stroke patients and to compare the effects of robot-assisted gait therapy (RAGT) combined with rehabilitation therapy (RT) on arterial stiffness and functional recovery with those of RT alone. Method: The RAGT group (N = 30) received 30 minutes of robot-assisted gait therapy and 30 minutes of conventional RT, and the control group (N = 26) received 60 minutes of RT, 5 times a week for 4 weeks. baPWV was measured and calculated using an automated device. The patients also performed a symptom-limited graded exercise stress test using a bicycle ergometer, and parameters of cardiopulmonary fitness were recorded. Clinical outcome measures were categorized into 4 categories: activities of daily living, balance, ambulatory function, and paretic leg motor function and were evaluated before and after the 4-week intervention. Results: Both groups exhibited significant functional recovery in all clinical outcome measures after the 4-week intervention. However, peak aerobic capacity, peak heart rate, exercise tolerance test duration, and baPWV improved only in the RAGT group, and the improvements in baPWV and peak aerobic capacity were more noticeable in the RAGT group than in the control group. Conclusion: Robot-assisted gait therapy combined with conventional rehabilitation therapy represents an effective method for reversing arterial stiffness and improving peak aerobic capacity in subacute stroke patients with totally dependent ambulation. However, further large-scale studies with longer term follow-up periods are warranted to measure the effects of RAGT on secondary prevention after stroke. PMID:27741123

The short physical performance battery as a predictor of functional capacity after stroke.

PubMed

Stookey, Alyssa D; Katzel, Leslie I; Steinbrenner, Gregory; Shaughnessy, Marianne; Ivey, Frederick M

2014-01-01

The short physical performance battery is a widely used instrument for quantifying lower extremity function in older adults. However, its utility for predicting endurance-based measures of functional performance that are more difficult to conduct in clinical settings is unknown. An understanding of this could be particularly relevant in mobility impaired stroke survivors, for whom establishing the predictive strength of simpler to perform measures would aid in tracking broader categories of functional disability. This cross-sectional study was conducted to determine whether the short physical performance battery is related to functional measures with a strong endurance component. Functional measures (short physical performance battery, peak aerobic capacity, and 6-minute walk) were obtained and compared for the first time in stroke survivors with hemiparetic gait. Pearson correlation coefficients were used to assess strength of the relationships (α P < .05). Forty-three stroke participants performed a standardized short physical performance battery. Forty-one of the subjects completed a 6-minute walk, and 40 completed a peak treadmill test. Mean short physical performance battery (6.3 ± 2.5 [mean ± SD]), 6-minute walk (242 ± 115 meters), and peak aerobic capacity (17.4 ± 5.4 mL/kg/min) indicated subjects had moderate to severely impaired lower extremity functional performance. The short physical performance battery was related to both 6-minute walk (r = 0.76; P < .0001) and peak fitness (r = 0.52; P < .001). Our results show that the short physical performance battery may be reflective of endurance-based, longer-distance performance measures that would be difficult to perform in standard clinical stroke settings. Additional studies are needed to explore the value of using the short physical performance battery to assess rehabilitation-related functional progression after stroke. Published by Elsevier Inc.

The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis

PubMed Central

Pang, Marco YC; Eng, Janice J; Dawson, Andrew S; Gylfadóttir, Sif

2011-01-01

Objective To determine whether aerobic exercise improves aerobic capacity in individuals with stroke. Design A systematic review of randomized controlled trials. Databases searched MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews, Physiotherapy Evidence Database were searched. Inclusion criteria Design: randomized controlled trials; Participants: individuals with stroke; Interventions: aerobic exercise training aimed at improving aerobic capacity; Outcomes Primary outcomes: aerobic capacity [peak oxygen consumption (VO2), peak workload); Secondary outcomes: walking velocity, walking endurance. Data Analysis The methodological quality was assessed by the PEDro scale. Meta-analyses were performed for all primary and secondary outcomes. Results Nine articles (seven RCTs) were identified. The exercise intensity ranged from 50% to 80% heart rate reserve. Exercise duration was 20–40 minutes for 3–5 days a week. The total number of subjects included in the studies was 480. All studies reported positive effects on aerobic capacity, regardless of the stage of stroke recovery. Meta-analysis revealed a significant homogeneous standardized effect size (SES) in favour of aerobic exercise to improve peak VO2 (SES, 0.42; 95%CI, 0.15 to 0.69; p=0.001) and peak workload (SES, 0.50; 95%CI, 0.26 to 0.73; p<0.001). There was also a significant homogeneous SES in favour of aerobic training to improve walking velocity (SES, 0.26; 95%CI, 0.05 to 0.48; p=0.008) and walking endurance (SES, 0.30; 95%CI, 0.06to 0.55; p=0.008). Conclusions There is good evidence that aerobic exercise is beneficial for improving aerobic capacity in people with mild and moderate stroke. Aerobic exercise should be an important component of stroke rehabilitation. PMID:16541930

Electrification in winter storms and the analysis of thunderstorm overflight data

NASA Technical Reports Server (NTRS)

Brook, Marx

1993-01-01

We have been focusing our study of electrification in winter storms on the lightning initiation process, making inferences about the magnitude of the electric fields from the initial pulses associated with breakdown, i.e., with the formation of the initial streamers. The essence of the most significant finding is as follows: (1) initial breakdown radiation pulses from stepped leaders prior to the first return stroke are very large, reaching values of 20-30 Volts/meter, comparable to return stroke radiation; and (2) the duration of the stepped leader, from the initial detectable radiation pulse to the return stroke onset, is very-short-ranging from a minimum 1.5 ms to a maximum of 4.5 ms. This past summer (June-August of 1991) we participated in the CAPE program at the Kennedy Space Center in order to acquire data on stepped leaders in summer storms with the same equipment used to get the winter storm data. We discovered that the vigorous leaders seen in winter so frequently were present in summer storms, although not as large in amplitude and certainly not as frequent.

Enhanced electrohydrodynamic force generation in a two-stroke cycle dielectric-barrier-discharge plasma actuator

NASA Astrophysics Data System (ADS)

Sato, Shintaro; Takahashi, Masayuki; Ohnishi, Naofumi

2017-05-01

An approach for electrohydrodynamic (EHD) force production is proposed with a focus on a charge cycle on a dielectric surface. The cycle, consisting of positive-charging and neutralizing strokes, is completely different from the conventional methodology, which involves a negative-charging stroke, in that the dielectric surface charge is constantly positive. The two-stroke charge cycle is realized by applying a DC voltage combined with repetitive pulses. Simulation results indicate that the negative pulse eliminates the surface charge accumulated during constant voltage phase, resulting in repetitive EHD force generation. The time-averaged EHD force increases almost linearly with increasing repetitive pulse frequency and becomes one order of magnitude larger than that driven by the sinusoidal voltage, which has the same peak-to-peak voltage.

Returners Exhibit Greater Jumping Performance Improvements During a Peaking Phase Compared With New Players on a Volleyball Team.

PubMed

Bazyler, Caleb D; Mizuguchi, Satoshi; Kavanaugh, Ashley A; McMahon, John J; Comfort, Paul; Stone, Michael H

2018-06-21

To determine if jumping-performance changes during a peaking phase differed among returners and new players on a female collegiate volleyball team and to determine which variables best explained the variation in performance changes. Fourteen volleyball players were divided into 2 groups-returners (n = 7) and new players (n = 7)-who completed a 5-wk peaking phase prior to conference championships. Players were tested at baseline before the preseason on measures of the vastus lateralis cross-sectional area using ultrasonography, estimated back-squat 1-repetition maximum, countermovement jump height (JH), and relative peak power on a force platform. Jumping performance, rating of perceived exertion training load, and sets played were recorded weekly during the peaking phase. There were moderate to very large (P < .01, Glass Δ = 1.74) and trivial to very large (P = .07, Δ = 1.09) differences in JH and relative peak power changes in favor of returners over new players, respectively, during the peaking phase. Irrespective of group, 7 of 14 players achieved peak JH 2 wk after the initial overreach. The number of sets played (r = .78, P < .01) and the athlete's preseason relative 1-repetition maximum (r = .54, P = .05) were the strongest correlates of JH changes during the peaking phase. Returners achieved greater improvements in jumping performance during the peaking phase compared with new players, which may be explained by the returners' greater relative maximal strength, time spent competing, and training experience. Thus, volleyball and strength coaches should consider these factors when prescribing training during a peaking phase to ensure their players are prepared for important competitions.

Biomechanical contributions of the trunk and upper extremity in discrete versus cyclic reaching in survivors of stroke.

PubMed

Massie, Crystal L; Malcolm, Matthew P; Greene, David P; Browning, Raymond C

2014-01-01

Stroke rehabilitation interventions and assessments incorporate discrete and/or cyclic reaching tasks, yet no biomechanical comparison exists between these 2 movements in survivors of stroke. To characterize the differences between discrete (movements bounded by stationary periods) and cyclic (continuous repetitive movements) reaching in survivors of stroke. Seventeen survivors of stroke underwent kinematic motion analysis of discrete and cyclic reaching movements. Outcomes collected for each side included shoulder, elbow, and trunk range of motion (ROM); peak velocity; movement time; and spatial variability at target contact. Participants used significantly less shoulder and elbow ROM and significantly more trunk flexion ROM when reaching with the stroke-affected side compared with the less-affected side (P < .001). Participants used significantly more trunk rotation during cyclic reaching than discrete reaching with the stroke-affected side (P = .01). No post hoc differences were observed between tasks within the stroke-affected side for elbow, shoulder, and trunk flexion ROM. Peak velocity, movement time, and spatial variability were not different between discrete and cyclic reaching in the stroke-affected side. Survivors of stroke reached with altered kinematics when the stroke-affected side was compared with the less-affected side, yet there were few differences between discrete and cyclic reaching within the stroke-affected side. The greater trunk rotation during cyclic reaching represents a unique segmental strategy when using the stroke-affected side without consequences to end-point kinematics. These findings suggest that clinicians should consider the type of reaching required in therapeutic activities because of the continuous movement demands required with cyclic reaching.

Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme.

PubMed

Öst Nilsson, Annika; Eriksson, Gunilla; Johansson, Ulla; Hellman, Therese

2017-09-01

In Sweden, less than 50% of those getting stroke in working age return to work (RTW). Effective rehabilitation programmes need to be developed and therapeutic aspects understood. To explore and describe how persons with stroke experience their RTW process while participating in a person-centred rehabilitation programme focusing on RTW. Seven persons with mild or moderate stroke were interviewed twice during the intervention in the vocational training phase using semi-structured interviews. Data were analysed using grounded theory. Having a coordinator by their side gave support and guidance during the RTW process. Knowledge of stroke, strategies and a straightforward communication created a structure for the RTW process. Expressing one's own wishes increased opportunities to influence and decide which path to follow in order to reach the goal. Straightforward, open and recurring communication facilitated the possibility to adapt to the situation. These aspects increased insight and awareness which facilitated the RTW process. The findings indicate that a precondition for a fruitful RTW process was that suitable platforms at work were created in which the actors involved could cooperate. This knowledge might also be valuable in the RTW process for people with other diagnosis.

Application of the Lienard-Wiechert solution to a lightning return stroke model

NASA Technical Reports Server (NTRS)

Meneghini, R.

1983-01-01

The electric and magnetic fields associated with the lightning return stroke are expressed as a convolution of the current waveform shape and the fields generated by a moving charge of amplitude one (i.e., the Lienard-Wiechert solution for a unit charge). The representation can be used to compute the fields produced by a current waveform of non-uniform velocity that propagates along a filament of arbitrary, but finite, curvature. To study numerically the effects of linear charge acceleration and channel curvature two simple channel models are used: the linear and the hyperbolic.

Application of the Lienard-Wiechert solution to a lightning return stroke model

NASA Technical Reports Server (NTRS)

Meneghini, R.

1984-01-01

The electric and magnetic fields associated with the lightning return stroke are expressed as a convolution of the current waveform shape and the fields generated by a moving charge of amplitude one (i.e., the Lienard-Wiechert solution for a unit charge). The representation can be used to compute the fields produced by a current waveform of non-uniform velocity that propagates along a filament of arbitrary, but finite, curvature. To study numerically the effects of linear charge acceleration and channel curvature two simple channel models are used: the linear and the hyperbolic.

Athletics, minor trauma, and pediatric arterial ischemic stroke.

PubMed

Sepelyak, Kathryn; Gailloud, Philippe; Jordan, Lori C

2010-05-01

Pediatric arterial ischemic stroke may occur as the result of trivial head or neck trauma sustained during a sports activity. We describe three cases of sports-related stroke in previously healthy school-age children and discuss acute and long-term stroke care. Possible mechanisms of sports-related stroke are addressed, as is evaluation for cause of stroke in children. In one of the reported cases, the child was found to have a vertebral artery dissection as the cause of his stroke, but no definitive cause of stroke was identified in the other two cases despite extensive evaluation. The advisability and timing of returning to athletic activities after stroke is also discussed. Many children with sports-related stroke are initially seen by a sports trainer, a pediatrician, or an ER physician. Thus, it is particularly important that these professionals are aware of the possibility of ischemic stroke occurring after even mild athletic injury. Childhood stroke may result from injuries sustained during athletic activities and should be considered when a child has acute focal neurologic signs.

KAPS (kinematic assessment of passive stretch): a tool to assess elbow flexor and extensor spasticity after stroke using a robotic exoskeleton.

PubMed

Centen, Andrew; Lowrey, Catherine R; Scott, Stephen H; Yeh, Ting-Ting; Mochizuki, George

2017-06-19

Spasticity is a common sequela of stroke. Traditional assessment methods include relatively coarse scales that may not capture all characteristics of elevated muscle tone. Thus, the aim of this study was to develop a tool to quantitatively assess post-stroke spasticity in the upper extremity. Ninety-six healthy individuals and 46 individuals with stroke participated in this study. The kinematic assessment of passive stretch (KAPS) protocol consisted of passive elbow stretch in flexion and extension across an 80° range in 5 movement durations. Seven parameters were identified and assessed to characterize spasticity (peak velocity, final angle, creep (or release), between-arm peak velocity difference, between-arm final angle, between-arm creep, and between-arm catch angle). The fastest movement duration (600 ms) was most effective at identifying impairment in each parameter associated with spasticity. A decrease in peak velocity during passive stretch between the affected and unaffected limb was most effective at identifying individuals as impaired. Spasticity was also associated with a decreased passive range (final angle) and a classic 'catch and release' as seen through between-arm catch and creep metrics. The KAPS protocol and robotic technology can provide a sensitive and quantitative assessment of post-stroke elbow spasticity not currently attainable through traditional measures.

Nighttime observations of thunderstorm electrical activity from a high altitude airplane

NASA Technical Reports Server (NTRS)

Brook, M.; Rhodes, C.; Vaughan, O. H., Jr.; Orville, R. E.; Vonnegut, B.

1984-01-01

Photographs from a NASA U-2 airplane flying over nocturnal thunderstorms show frequent lightning activity in the upper part of the cloud. In some cases, unobscured segments of lightning channels 1 km or longer are visible in clear air around and above the cloud. Multiple images of lightning channels indicate multiple discharges in the same channel. Photographs taken through a diffraction grating show that the lightning has a spectrum similar to that observed in the lower troposphere. Lightning spectra obtained with a slitless line-scan spectrometer show strong singly ionized nitrogen emissions at 463.0 and 500.5 nm. Field changes measured with an electric field-change meter correlate with pulses measured with a photocell optical system. Optical signals corresponding to dart leader, return stroke, and continuing current events are readily distinguished in the scattered light emerging from the cloud surface. The variation of light intensity with time in lightning events is consistent with predicted modification of optical lightning signals by clouds. It appears that satellite based optical sensor measurements cannot provide reliable information on current rise times in return strokes. On the other hand, discrimination between cloud-to-ground and intracloud flashes and the counting of ground strokes is possible using the optical pulse pairs which have been identified with leader, return-stroke events in the cloud-to-ground flashes studied.

An experimental system for controlled exposure of biological samples to electrostatic discharges.

PubMed

Marjanovič, Igor; Kotnik, Tadej

2013-12-01

Electrostatic discharges occur naturally as lightning strokes, and artificially in light sources and in materials processing. When an electrostatic discharge interacts with living matter, the basic physical effects can be accompanied by biophysical and biochemical phenomena, including cell excitation, electroporation, and electrofusion. To study these phenomena, we developed an experimental system that provides easy sample insertion and removal, protection from airborne particles, observability during the experiment, accurate discharge origin positioning, discharge delivery into the sample either through an electric arc with adjustable air gap width or through direct contact, and reliable electrical insulation where required. We tested the system by assessing irreversible electroporation of Escherichia coli bacteria (15 mm discharge arc, 100 A peak current, 0.1 μs zero-to-peak time, 0.2 μs peak-to-halving time), and gene electrotransfer into CHO cells (7 mm discharge arc, 14 A peak current, 0.5 μs zero-to-peak time, 1.0 μs peak-to-halving time). Exposures to natural lightning stroke can also be studied with this system, as due to radial current dissipation, the conditions achieved by a stroke at a particular distance from its entry are also achieved by an artificial discharge with electric current downscaled in magnitude, but similar in time course, correspondingly closer to its entry. © 2013.

Status Epilepticus: Epidemiology and Public Health Needs

PubMed Central

Sánchez, Sebastián; Rincon, Fred

2016-01-01

Status epilepticus (SE) is defined as a continuous clinical and/or electrographic seizure activity lasting five minutes or more or recurrent seizure activity without return to baseline. There is a paucity of epidemiological studies of SE, as most research is derived from small population studies. The overall incidence of SE is 9.9 to 41 per 100,000/year, with peaks in children and the elderly and with febrile seizures and strokes as its main etiologies. The etiology is the major determinant of mortality. Governments and the academic community should predominantly focus on the primary prevention of etiologies linked to SE, as these are the most important risk factors for its development. This review describes the incidence, prevalence, etiology, risk factors, outcomes and costs of SE and aims to identify future research and public health needs. PMID:27537921

Peak Oxygen Uptake during and after Long-duration Space Flight

NASA Technical Reports Server (NTRS)

Moore, Alan D., Jr.; Downs, Meghan E.; Lee, Stuart M. C.; Feiveson, Alan H.; Knudsen, Poul; Evetts, Simon N.; Ploutz-Snyder, Lori

2014-01-01

Aerobic capacity (VO2peak) previously has not been measured during or after long-duration spaceflight. PURPOSE: To measure VO2peak and submaximal exercise responses during and after International Space Station (ISS) missions. METHODS: Astronauts (9 M, 5 F: 49 +/- 5 yr, 175 +/- 7 cm, 77.2 +/- 15.1 kg, 40.6 +/- 6.4 mL/kg/min [mean +/-SD]) performed graded peak cycle tests 90 days before spaceflight, 15 d (FD15) after launch and every 30 d thereafter during flight, and 1 (R+1), 10 (R+10), and 30 d (R+30) after landing. Oxygen consumption (VO2) and heart rate (HR) were measured from rest to peak exercise, while cardiac output (Q), stroke volume (SV), and arterial-venous oxygen difference (a-vO2diff) were measured only during rest and submaximal exercise. Data were analyzed using mixed-model linear regression. Body mass contributed significantly to statistical models, and thus results are reported as modeled estimates for an average subject. RESULTS: Early inflight (FD15) VO2peak was 17% lower (95% CI = - 22%, -13%) than preflight. VO2peak increased during spaceflight (0.001 L/min/d, P = 0.02) but did not return to preflight levels. On R+1 VO2peak was 15% (95% CI = -19%, -10%) lower than preflight but recovered to within 2% of preflight by R+30 (95% CI = -6%, +3%). Peak HR was not significantly different from preflight at any time. Inflight submaximal VO2 and a-vO2diff were generally lower than preflight, but the Q vs. VO2 slope was unchanged. In contrast, the SV vs. VO2 slope was lower (P < 0.001), primarily due to elevated SV at rest, and the HR vs. VO2 slope was greater (P < 0.001), largely due to elevated HR during more intense exercise. On R+1 although the relationships between VO2 and Q, SV, and HR were not statistically different than preflight, resting and submaximal exercise SV was lower (P < 0.001), resting and submaximal exercise HR was higher (P < 0.002), and a-vO2diff was unchanged. HR and SV returned to preflight levels by R+30. CONCLUSION: In the average astronaut VO2peak was reduced during spaceflight and immediately after landing but factors contributing to lower VO2peak may be different during spaceflight and recovery. Maintaining Q while VO2 is reduced inflight may be suggestive of an elevated blood flow to vascular beds other than exercising muscles, but decreased SV after flight likely reduces Q at peak exertion.

The experiences and needs of Chinese-Canadian stroke survivors and family caregivers as they re-integrate into the community.

PubMed

Yeung, Emily H L; Szeto, Amy; Richardson, Denyse; Lai, Suk-han; Lim, Eva; Cameron, Jill I

2015-09-01

Stroke is a leading cause of adult disability and community re-integration is a priority for stroke rehabilitation. In North America, we have a growing population of individuals whose first language is not English. Little is known about the experiences of visible minorities living in North America as they re-integrate into the community post stroke or how these experiences change over time. Specifically, this research aimed to explore the experiences and needs of Chinese stroke survivors and family caregivers as they return to community living using the Timing it Right Framework as a conceptual guide. We recruited Cantonese-speaking stroke survivors and family caregivers from outpatient rehabilitation programmes. Using qualitative interviews conducted in Cantonese or English, we examined their experiences and needs as they return to community living and explored the influence of culture and time on their experiences. The interviews were transcribed and translated, and then analysed using framework analysis. Using framework analysis, we coded the data corresponding to the phases of the Timing it Right framework to determine the influence of time on the themes. We interviewed five Cantonese-speaking stroke survivors and 13 caregivers in 2009. We identified two main themes: (i) Participants' education and support needs change over time and (ii) Chinese resources are needed across care environments. These resources include access to care in their preferred language, traditional Chinese medicine, and Chinese food during their recovery and rehabilitation. To optimise Chinese stroke survivors' and caregivers' community re-integration, healthcare professionals should provide timely and accessible education and be aware of the role of Chinese diet and traditional medicine in stroke survivors' rehabilitation. © 2014 John Wiley & Sons Ltd.

Exploration of Self-Regulation in the Natural Swimming of the Paramecium’s Cilium

DTIC Science & Technology

2012-02-01

aquatic environments. These animals propel themselves, albeit with limited maneuverability, by the synchronous motion of numerous tiny cilia...microtubule pairs are the source of cilium hardness during the power stroke ; there is a critical phase near the end of the power stroke where one cross...return stroke ; therefore, in each beat cycle, there must be a reattachment process of the cross-bridge links and re-hardening of the cilium during the

Electron Microscopic Recording of the Power and Recovery Strokes of Individual Myosin Heads Coupled with ATP Hydrolysis: Facts and Implications.

PubMed

Sugi, Haruo; Chaen, Shigeru; Akimoto, Tsuyoshi

2018-05-04

The most straightforward way to get information on the performance of individual myosin heads producing muscle contraction may be to record their movement, coupled with ATP hydrolysis, electron-microscopically using the gas environmental chamber (EC). The EC enables us to visualize and record ATP-induced myosin head movement in hydrated skeletal muscle myosin filaments. When actin filaments are absent, myosin heads fluctuate around a definite neutral position, so that their time-averaged mean position remains unchanged. On application of ATP, myosin heads are found to move away from, but not towards, the bare region, indicating that myosin heads perform a recovery stroke (average amplitude, 6 nm). After exhaustion of ATP, myosin heads return to their neutral position. In the actin⁻myosin filament mixture, myosin heads form rigor actin myosin linkages, and on application of ATP, they perform a power stroke by stretching adjacent elastic structures because of a limited amount of applied ATP ≤ 10 µM. The average amplitude of the power stroke is 3.3 nm and 2.5 nm at the distal and the proximal regions of the myosin head catalytic domain (CAD), respectively. The power stroke amplitude increases appreciably at low ionic strength, which is known to enhance Ca 2+ -activated force in muscle. In both the power and recovery strokes, myosin heads return to their neutral position after exhaustion of ATP.

Goal-Directed Fluid Therapy Based on Stroke Volume Variation in Patients Undergoing Major Spine Surgery in the Prone Position: A Cohort Study.

PubMed

Bacchin, Maria Renata; Ceria, Chiara Marta; Giannone, Sandra; Ghisi, Daniela; Stagni, Gaetano; Greggi, Tiziana; Bonarelli, Stefano

2016-09-15

A retrospective observational study. The aim of this study was to test whether a goal-directed fluid therapy (GDFT) protocol, based on stroke volume variation (SVV), applied in major spine surgery performed in the prone position, would be effective in reducing peri-operative red blood cells transfusions. Recent literature shows that optimizing perioperative fluid therapy is associated with lower complication rates and faster recovery. Data from 23 patients who underwent posterior spine arthrodesis surgery and whose intraoperative fluid administration were managed with the GDFT protocol were retrospectively collected and compared with data from 23 matched controls who underwent the same surgical procedure in the same timeframe, and who received a liberal intraoperative fluid therapy. Patients in the GDFT group received less units of transfused red blood cells (primary endpoint) in the intra (0 vs. 2.0, P = 0.0 4) and postoperative period (2.0 vs. 4.0, P = 0.003). They also received a lower amount of intraoperative crystalloids, had fewer blood losses, and lower intraoperative peak lactate. In the postoperative period, patients in the GDFT group had fewer pulmonary complications and blood losses from surgical drains, needed less blood product transfusions, had a shorter intensive care unit stay, and a faster return of bowel function. We found no difference in the total length of stay among the two groups. Our study shows that application of a GDFT based on SVV in major spine surgery is feasible and can lead to reduced blood losses and transfusions, better postoperative respiratory performance, shorter ICU stay, and faster return of bowel function. 3.

A unified radiative magnetohydrodynamics code for lightning-like discharge simulations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Qiang, E-mail: cq0405@126.com; Chen, Bin, E-mail: emcchen@163.com; Xiong, Run

2014-03-15

A two-dimensional Eulerian finite difference code is developed for solving the non-ideal magnetohydrodynamic (MHD) equations including the effects of self-consistent magnetic field, thermal conduction, resistivity, gravity, and radiation transfer, which when combined with specified pulse current models and plasma equations of state, can be used as a unified lightning return stroke solver. The differential equations are written in the covariant form in the cylindrical geometry and kept in the conservative form which enables some high-accuracy shock capturing schemes to be equipped in the lightning channel configuration naturally. In this code, the 5-order weighted essentially non-oscillatory scheme combined with Lax-Friedrichs fluxmore » splitting method is introduced for computing the convection terms of the MHD equations. The 3-order total variation diminishing Runge-Kutta integral operator is also equipped to keep the time-space accuracy of consistency. The numerical algorithms for non-ideal terms, e.g., artificial viscosity, resistivity, and thermal conduction, are introduced in the code via operator splitting method. This code assumes the radiation is in local thermodynamic equilibrium with plasma components and the flux limited diffusion algorithm with grey opacities is implemented for computing the radiation transfer. The transport coefficients and equation of state in this code are obtained from detailed particle population distribution calculation, which makes the numerical model is self-consistent. This code is systematically validated via the Sedov blast solutions and then used for lightning return stroke simulations with the peak current being 20 kA, 30 kA, and 40 kA, respectively. The results show that this numerical model consistent with observations and previous numerical results. The population distribution evolution and energy conservation problems are also discussed.« less

Aerothermodynamic environments for Mars entry, Mars return, and lunar return aerobraking missions

NASA Astrophysics Data System (ADS)

Rochelle, W. C.; Bouslog, S. A.; Ting, P. C.; Curry, D. M.

1990-06-01

The aeroheating environments to vehicles undergoing Mars aerocapture, earth aerocapture from Mars, and earth aerocapture from the moon are presented. An engineering approach for the analysis of various types of vehicles and trajectories was taken, rather than performing a benchmark computation for a specific point at a selected time point in a trajectory. The radiation into Mars using the Mars Rover Sample Return (MRSR) 2-ft nose radius bionic remains a small contributor of heating for 6 to 10 km/sec; however, at 12 km/sec it becomes comparable with the convection. For earth aerocapture, returning from Mars, peak radiation for the MRSR SRC is only 25 percent of the peak convection for the 12-km/sec trajectory. However, when large vehicles are considered with this trajectory, peak radiation can become 2 to 4 times higher than the peak convection. For both Mars entry and return, a partially ablative Thermal Protection System (TPS) would be required, but for Lunar Transfer Vehicle return an all-reusable TPS can be used.

[Neuroplasticity as a basis for early rehabilitation of stroke patients].

PubMed

Putilina, M V

2011-01-01

The review is devoted to the current state of the problem of early rehabilitation of stroke patients. The rate of primary disability in patients after stroke is 3.2 per 10000 population but only 20% of previously working patients return to work. Early rehabilitation is treatment actions during a period following stroke. Adequate treatment during this period may decrease the extent of brain damage and improve disease outcome. The complexity of rehabilitation consists in using several complementary pharmacological and non-pharmacological rehabilitation measures. Appearance of new techniques of rehabilitation treatment aimed at neuroplasticity stimulation increases treatment potential of rehabilitative technologies.

Aerobic fitness in women and responses to lower body negative pressure.

PubMed

Frey, M A; Mathes, K L; Hoffler, G W

1987-12-01

High aerobic fitness may be associated with impaired responsiveness to orthostatic challenge. This could be detrimental to astronauts returning from spaceflight. Thus, we examined the cardiovascular responses of a group of 45 healthy women to graded lower body negative pressure (LBNP) through 5 min at -50 mm Hg or until they become presyncopal. The ages (range = 23-43 years, mean = 30.4) and peak aerobic capacities (range = 23.0-55.3 ml.kg-1.min-1, mean = 37.8) of these subjects paralleled those of the women astronauts. We monitored heart rate, stroke volume, cardiac output, Heather index of contractility, arterial pressure, peripheral resistance, change in calf circumference, and thoracic impedance (ZO)--a measure of fluid in the chest. The women in this study exhibited the same response pattern to LBNP as previously reported for male subjects. VO2peak of the six subjects who became presyncopal was not different from VO2peak of the tolerant subjects. At rest, only systolic and mean arterial pressures were significantly correlated with VO2peak. Percent changes in calf circumference (i.e. fluid accumulation in the legs) at -30 and -40 mm Hg were the only responses to LBNP significantly related to VO2peak. The greater pooling of blood in the legs during LBNP by women with higher aerobic fitness, and lower percent body fat may be related to more muscle tissue and vasculature in the legs of the more fit subjects. These data indicated that orthostatic tolerance is not related to aerobic capacity in women, and orthostatic tolerance need not be a concern to aerobically fit women astronauts.

Improvements to a High Spectral Resolution, Radiation-Hydrodynamics Model of a Lightning Return Stroke and Comparisons with Measured Spectra and Inferred Plasma Properties

NASA Astrophysics Data System (ADS)

Edwards, J. D.; Dreike, P.; Smith, M. W.; Clemenson, M. D.; Zollweg, J. D.

2015-12-01

We describe developments to a 1-D cylindrical, radiation-hydrodynamics model of a lightning return stroke that simulates lighting spectra with 1 Angstrom resolution in photon wavelength. In previous calculations we assumed standard density air in the return stroke channel and the resulting optical spectrum was that of an optically thick emitter, unlike measured spectra that are optically thin. In this work, we improve our model by initializing our simulation assuming that the leader-heated channel is pre-expanded to a density of 0.01-0.05 ambient and near pressure equilibrium with the surrounding ambient air and by implementing a time-dependent, external heat source to incorporate the effects of continuing current. By doing so, our simulated spectra, illustrated in the attached figure, show strong spectral emission characteristics at wavelengths similar to spectra measured by Orville (1968). In this poster, we describe our model and compare our simulated results with spectra measured by Orville (1968) and Smith (2015). We also use spectroscopic methods to compute physical properties of the plasma channel, e.g. temperature, from Smith's measurements and compare these with our simulated results.

Update Direct-Strike Lightning Environment for Stockpile-to-Target Sequence

DOE Office of Scientific and Technical Information (OSTI.GOV)

Uman, M A; Rakov, V A; Elisme, J O

2008-10-01

The University of Florida has surveyed all relevant publications reporting lightning characteristics and presents here an up-to-date version of the direct-strike lightning environment specifications for nuclear weapons published in 1989 by R. J. Fisher and M. A. Uman. Further, we present functional expressions for current vs. time, current derivative vs. time, second current derivative vs. time, charge transfer vs. time, and action integral (specific energy) vs. time for first return strokes, for subsequent return strokes, and for continuing currents; and we give sets of constants for these expressions so that they yield approximately the median and extreme negative lightning parametersmore » presented in this report. Expressions for the median negative lightning waveforms are plotted. Finally, we provide information on direct-strike lightning damage to metals such as stainless steel, which could be used as components of storage containers for nuclear waste materials; and we describe UF's new experimental research program to add to the sparse data base on the properties of positive lightning. Our literature survey, referred to above, is included in four Appendices. The following four sections (II, III, IV, and V) of this final report deal with related aspects of the research: Section II. Recommended Direct-Strike Median and Extreme Parameters; Section III. Time-Domain Waveforms for First Strokes, Subsequent Strokes, and Continuing Currents; Section IV. Damage to Metal Surfaces by Lightning Currents; and Section V. Measurement of the Characteristics of Positive Lightning. Results of the literature search used to derive the material in Section II and Section IV are found in the Appendices: Appendix 1. Return Stroke Current, Appendix 2. Continuing Current, Appendix 3. Positive Lightning, and Appendix 4. Lightning Damage to Metal Surfaces.« less

Clinical MRS studies of the brain

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hubesch, B.; Marinier, D.S.; Hetherington, H.P.

1989-12-01

Image-guided {sup 31}P and 1H magnetic resonance localized spectroscopy was performed on patients with brain tumors, temporal lobe epilepsy, chronic brain stroke, and deep white matter lesions. Absolute molar concentrations of metabolites, peak area ratios, and pH were obtained. The important findings were that {sup 31}P metabolite concentrations were significantly reduced in tumors, infarcts, and deep white matter lesions. Similarly, {sup 1}H metabolite intensities were reduced in chronic stroke. In the seizure foci of epilepsy patients, in tumors, and in chronic stroke, the pH was more alkaline than the normal pH. Peak area ratios were altered in tumors (reduction ofmore » phosphocreatine/inorganic phosphate) and in chronic stroke (large increases in Cr/NAA and Cho/NAA). Finally, the spectroscopic imaging technique offers a versatile alternative to the single point techniques, producing spectra or images of the spatial distribution of individual {sup 31}P metabolites.« less

Dynamic Modulation of Microglia/Macrophage Polarization by miR-124 after Focal Cerebral Ischemia.

PubMed

Hamzei Taj, Somayyeh; Kho, Widuri; Aswendt, Markus; Collmann, Franziska M; Green, Claudia; Adamczak, Joanna; Tennstaedt, Annette; Hoehn, Mathias

2016-12-01

Mononuclear phagocytes respond to ischemic stroke dynamically, undergoing an early anti-inflammatory and protective phenotype followed by the pro-inflammatory and detrimental type. These dual roles of microglia/macrophages suggest the need of subtle adjustment of their polarization state instead of broad suppression. The most abundant brain-specific miRNA, miR-124, promotes neuronal differentiation but can also modulate microglia activation and keeps them in a quiescent state. We addressed whether the intracerebral injection of miR-124 in a mouse model of ischemic stroke before or after the peak phase of the pro-inflammatory polarization modifies the pro-/anti- inflammatory balance. In the sub-acute phase, 48 h after stroke, liposomated miR-124 shifted the predominantly pro-inflammatory polarized microglia/macrophages toward the anti-inflammatory phenotype. The altered immune response improved neurological deficit at day 6 after stroke. When miR-124 was injected 10 days after stroke, the pro-/anti- inflammatory ratio was still significantly reduced although to a lower degree and had no effect on recovery at day 14. This study indicates that miR-124 administration before the peak of the pro-inflammatory process of stroke is most effective in support of increasing the rehabilitation opportunity in the sub-acute phases of stroke. Our findings highlight the important role of immune cells after stroke and the therapeutic relevance of their polarization balance.

Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial

PubMed Central

2014-01-01

Background The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient’s home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. Methods/Design This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants’ quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services. Study/trial registration ClinicalTrials.gov: NCT01848080 PMID:24479760

Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial.

PubMed

Tousignant, Michel; Corriveau, Hélène; Kairy, Dahlia; Berg, Katherine; Dubois, Marie-France; Gosselin, Sylvie; Swartz, Richard H; Boulanger, Jean-Martin; Danells, Cynthia

2014-01-30

The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient's home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants' quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services. ClinicalTrials.gov: NCT01848080.

Socioeconomic factors' effect on return to work after first stroke.

PubMed

Glader, E-L; Jonsson, B; Norrving, B; Eriksson, M

2017-06-01

The objective of this nationwide study was to analyze how functional status and socioeconomic status affect return to work (RTW) among younger patients with first-time stroke in a Sweden. This register-based cohort study included employed patients aged 25-55 with first-time stroke between 2008 and 2011 and primary outcome was RTW within 1 year after stroke. Data regarding functional status and employment status were retrieved from the Swedish Stroke Register, Riksstroke, and socioeconomic data (income, education, and country of birth) from Statistics Sweden. We included 2539 patients who had answered the question on RTW, and 1880 (74.0%) had RTW within 12 months. Patients with low income (69.9% in lowest income group vs 79.9% in highest group, P<.001), patients born in countries outside the Nordic countries (Sweden 75.5%, Nordic countries 74.3%, European countries 61.7%, other countries 57.3%, P<.001), and the youngest patients (25-34, 63.1%; 35-44, 75.9%; 45-55, 74.3%; P=.008) were less likely to RTW. Pain, low mood, and answering the questionnaire with help were more common in low socioeconomic groups, and when adjusting for these variables, together with age and sex, income and country of birth were no longer independent predictors for RTW. Patients with low socioeconomic status less often RTW 1 year after stroke.Impaired functional status after stroke is more common in patients with lower socioeconomic status and mediates socioeconomic differences in RTW. Improvement of functional status should be targeted to facilitate RTW among stroke patients with low socioeconomic status. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Aphasia and Auditory Processing after Stroke through an International Classification of Functioning, Disability and Health Lens

PubMed Central

Purdy, Suzanne C.; Wanigasekara, Iruni; Cañete, Oscar M.; Moore, Celia; McCann, Clare M.

2016-01-01

Aphasia is an acquired language impairment affecting speaking, listening, reading, and writing. Aphasia occurs in about a third of patients who have ischemic stroke and significantly affects functional recovery and return to work. Stroke is more common in older individuals but also occurs in young adults and children. Because people experiencing a stroke are typically aged between 65 and 84 years, hearing loss is common and can potentially interfere with rehabilitation. There is some evidence for increased risk and greater severity of sensorineural hearing loss in the stroke population and hence it has been recommended that all people surviving a stroke should have a hearing test. Auditory processing difficulties have also been reported poststroke. The International Classification of Functioning, Disability and Health (ICF) can be used as a basis for describing the effect of aphasia, hearing loss, and auditory processing difficulties on activities and participation. Effects include reduced participation in activities outside the home such as work and recreation and difficulty engaging in social interaction and communicating needs. A case example of a young man (M) in his 30s who experienced a left-hemisphere ischemic stroke is presented. M has normal hearing sensitivity but has aphasia and auditory processing difficulties based on behavioral and cortical evoked potential measures. His principal goal is to return to work. Although auditory processing difficulties (and hearing loss) are acknowledged in the literature, clinical protocols typically do not specify routine assessment. The literature and the case example presented here suggest a need for further research in this area and a possible change in practice toward more routine assessment of auditory function post-stroke. PMID:27489401

The Relationship Between Propulsive Force in Tethered Swimming and 200-m Front Crawl Performance.

PubMed

Santos, Karini B; Bento, Paulo C B; Pereira, Gleber; Rodacki, André L F

2016-09-01

Santos, KB, Bento, PCB, Pereira, G, and Rodacki, ALF. The relationship between propulsive force in tethered swimming and 200-m front crawl performance. J Strength Cond Res 30(9): 2500-2507, 2016-The aims of this study were to determine whether propulsive force (peak force, mean force, impulse, and rate of force development) and stroke rate change during 2 minutes of front crawl tethered swimming and to correlate them with the stroke rate and swimming velocity in 200-m front crawl swimming. Twenty-one swimmers (21.6 ± 4.8 years, 1.78 ± 0.06 m, 71.7 ± 8.1 kg), with 200-m front crawl swimming performance equivalent to 78% of the world record (140.4 ± 10.1 seconds), were assessed during 2 minutes of maximal front crawl tethered swimming (propulsive forces and stroke rate) and 200-m front crawl swimming (stroke rate and clean velocity). Propulsive forces decreased between the beginning and the middle instants (∼20%; p ≤ 0.05) but remained stable between the middle and the end instants (∼6%; p > 0.05). The peak force was positively correlated with the clean velocity in the 200-m front crawl swimming (mean r = 0.61; p < 0.02). The stroke rates of the tethered swimming and 200-m front crawl swimming were positively correlated (r = 45; p≤ 0.01) at the middle instant. Therefore, the propulsive force and stroke rate changed throughout the 2 minutes of tethered swimming, and the peak force is the best propulsive force variable tested that correlated with 200-m front crawl swimming performance.

Reduction of genu recurvatum through adjustment of plantarflexion resistance of an articulated ankle-foot orthosis in individuals post stroke

PubMed Central

Kobayashi, Toshiki; Orendurff, Michael S.; Singer, Madeline L.; Gao, Fan; Daly, Wayne K.; Foreman, K. Bo

2016-01-01

Background Genu recurvatum (knee hyperextension) is a common issue for individuals post stroke. Ankle-foot orthoses are used to improve genu recurvatum, but evidence is limited concerning their effectiveness. Therefore, the aim of this study was to investigate the effect of changing the plantarflexion resistance of an articulated ankle-foot orthosis on genu recurvatum in patients post stroke. Methods Gait analysis was performed on 6 individuals post stroke with genu recurvatum using an articulated ankle-foot orthosis whose plantarflexion resistance was adjustable at four levels. Gait data were collected using a Bertec split-belt instrumented treadmill in a 3-dimensional motion analysis laboratory. Gait parameters were extracted and plotted for each subject under the four plantarflexion resistance conditions of the ankle-foot orthosis. Gait parameters included: a) peak ankle plantarflexion angle, b) peak ankle dorsiflexion moment, c) peak knee extension angle and d) peak knee flexion moment. A non-parametric Friedman test was performed followed by a post-hoc Wilcoxon Signed-Rank test for statistical analyses. Findings All the gait parameters demonstrated statistically significant differences among the four resistance conditions of the AFO. Increasing the amount of plantarflexion resistance of the ankle-foot orthosis generally reduced genu recurvatum in all subjects. However, individual analyses showed that the responses to the changes in the plantarflexion resistance of the AFO were not necessarily linear, and appear unique to each subject. Interpretations The plantarflexion resistance of an articulated AFO should be adjusted to improve genu recurvatum in patients post stroke. Future studies should investigate what clinical factors would influence the individual differences. PMID:27136122

Multifactorial analysis of factors affecting recurrence of stroke in Japan.

PubMed

Omori, Toyonori; Kawagoe, Masahiro; Moriyama, Michiko; Yasuda, Takeshi; Ito, Yasuhiro; Hyakuta, Takeshi; Nagatsuka, Kazuyuki; Matsumoto, Masayasu

2015-03-01

Data on factors affecting stroke recurrence are relatively limited. The authors examined potential factors affecting stroke recurrence, retrospectively. The study participants were 1087 patients who were admitted to stroke centers suffering from first-ever ischemic stroke and returned questionnaires with usable information after discharge. The authors analyzed the association between clinical parameters of the patients and their prognosis. Recurrence rate of during an average of 2 years after discharge was 21.3%, and there were differences among stroke subtypes. It was found that the disability level of the patients after discharge correlated well with the level at discharge (r s = 0.66). Multivariate logistic regression analysis of the data shows that modified Rankin Scale score, National Institute of Health Stroke Scale score, gender, age, and family history had statistically significant impacts on stroke recurrence, and the impact was different depending on subtypes. These findings suggest that aggressive and persistent health education for poststroke patients and management of risk factors are essential to reduce stroke recurrence. © 2012 APJPH.

Patent foramen ovale (PFO), stroke and pregnancy.

PubMed

Chen, Lei; Deng, Wenjun; Palacios, Igor; Inglessis-Azuaje, Ignacio; McMullin, David; Zhou, Dong; Lo, Eng H; Buonanno, Ferdinando; Ning, MingMing

2016-06-01

Patent foramen ovale (PFO)-related stroke is increasingly recognized as an important etiology of ischemic embolic stroke-accounting for up to 50% of strokes previously considered 'cryptogenic' or with an unknown mechanism. As a 'back door to the brain,' PFO can allow venous clots to enter arterial circulation via interatrial right-to-left shunting, potentially resulting in ischemic stroke. We observe that clinically, PFO-related stroke affects women of childbearing age, and that pregnancy-owing to major changes in hemocoagulative, hormonal, and cardiovascular parameters-can enhance stroke risks. However, no systematic study has been performed and little is known regarding complications, pregnancy outcomes and treatment for PFO-related stroke during pregnancy. To identify and characterize the complications and clinical outcomes related to PFOs during pregnancy, we performed a literature review and analysis from all reported cases of pregnancy with PFO-related complications in the medical literature from 1970 to 2015. We find that during pregnancy and post-partum, PFO is associated with complications affecting multiple organs, including the brain, heart and lung. The three principal complications reported are stroke, pulmonary emboli and myocardial infarction. In contrast to other pregnancy-related stroke etiologies, which peak during later pregnancy and postpartum, PFO-related stroke peaks during early pregnancy (first and second trimester-60%), and most patients had good neurological outcome (77%). In patients with PFO with recurrent stroke during pregnancy, additional key factors include high-risk PFO morphology (atrial septal aneurysm), larger right-to-left shunt, multiple gestation and concurrent hypercoagulability. Compared to strokes of other etiologies during pregnancy, most PFO stroke patients experienced uneventful delivery (93%) of healthy babies with a good clinical outcome. We conclude with recommended clinical treatment strategies for pregnant patients with PFO suggested by the data from these cases, and the clinical experience of our Cardio-Neurology Clinic. Copyright © 2016 American Federation for Medical Research.

Improved walking ability with wearable robot-assisted training in patients suffering chronic stroke.

PubMed

Li, Lifang; Ding, Li; Chen, Na; Mao, Yurong; Huang, Dongfeng; Li, Le

2015-01-01

Wearable robotic devices provide safe and intensive rehabilitation, enabling repeated motions for motor function recovery in stroke patients. The aim of this small case series was to demonstrate the training effects of a three-week robotic leg orthosis, and to investigate possible mechanisms of the sensory-motor alterations and improvements by using gait analysis and EMG. Three survivors of chronic strokes participated in robot-assisted gait therapy for three weeks. EMG signals from the rectus femoris (RF), tibialis anterior (TA), biceps femoris (BF), and medial gastrocnemius (MG), as well as kinetics and kinematics data of the lower limb, were recorded before and after the training. The normalized root mean squared (RMS) values of the muscles, the joint moments, joint angles, and the results of two clinical scales (Berg Balance scale, BBS, and the lower extremity subscale of Fugl-Meyer assessment, LE-FMA) were used for analysis. All participants experienced improved balance and functional performances and increased BBS and LE-FMA scores. The EMG results showed there was an increase of the normalized RMS values of the MG and BF on the affected side. Additionally, EMG activities of the agonist and antagonist pair (i.e. RF and BF) appeared to return to similar levels after training. The peak moment of hip flexor, knee extensor, and plantar flexor, which all contributed to push-off power, were found to have increased after training. In summary, the three-week training period using the wearable RLO improved the three participants' gait performance by regaining push-off power and improved muscle activation and walking speed.

Measurement of Electromagnetic Properties of Lightning with 10 Nanosecond Resolution

NASA Technical Reports Server (NTRS)

Baum, C. E.; Breen, E. L.; Oneill, J. P.; Moore, C. B.; Hall, D. L.

1980-01-01

Electromagnetic data recorded from lightning strikes are presented. The data analysis reveals general characteristics of fast electromagnetic fields measured at the ground including rise times, amplitudes, and time patterns. A look at the electromagnetic structure of lightning shows that the shortest rise times in the vicinity of 30 ns are associated with leader leader streamers. Lightning location is based on electromagnetic field characteristics and is compared to a nearby sky camera. The fields from both leaders and return strokes were measured and are discussed. The data were obtained during 1978 and 1979 from lightning strikes occuring within 5 kilometers of an underground metal instrumentation room located on South Baldy peak near Langmuir Laboratory, New Mexico. The computer controlled instrumentation consisted of sensors previously used for measuring the nuclear electromagnetic pulse (EMP) and analog-digital recorders with 10 ns sampling, 256 levels of resolution, and 2 kilobytes of internal memory.

Response of lightning energy and total electron content with sprites over Antarctic Peninsula

NASA Astrophysics Data System (ADS)

Suparta, W.; Yusop, N.

2017-05-01

This paper investigates the response of the lightning energy with the total electron content (TEC) derived from GPS over Antarctic Peninsula during St Patrick’s geomagnetic storm. During this event, sprite as one of the mesospheric transient luminous events (TLEs) associated with positive cloud-to-ground (+CG) lightning discharges can be generated. In this work, GPS and lightning data for the period from 14 to 20 March 2015 is analyzed. Geomagnetic activity and electric field data are also processed to relate the geomagnetic storm and lightning. Results show that during St Patrick’s geomagnetic storm, the lighting energy was produced up to ∼257 kJ. The ionospheric TEC was obtained 60 TECU, 38 TECU and 78 TECU between 18:00 and 21:00 UT for OHI3, PALV and ROTH stations, respectively. The peak of lightning energy was observed 14 hours after peaked of TEC. Sprite possibly generated through the electrical coupling process between the top cloud, middle and upper atmosphere with the DC electric field found to be ∼10 mVm-1 which leading to the sprite generation after the return strokes on 18 March 2015.

CT Perfusion in Acute Stroke: "Black Holes" on Time-to-Peak Image Maps Indicate Unsalvageable Brain.

PubMed

Meagher, Ruairi; Shankar, Jai Jai Shiva

2016-11-01

CT perfusion is becoming important in acute stroke imaging to determine optimal patient-management strategies. The purpose of this study was to examine the predictive value of time-to-peak image maps and, specifically, a phenomenon coined a "black hole" for assessing infarcted brain tissue at the time of scan. Acute stroke patients were screened for the presence of black holes and their follow-up imaging (noncontrast CT or MR) was reviewed to assess for infarcted brain tissue. Of the 23 patients with signs of acute ischemia on CT perfusion, all had black holes. The black holes corresponded with areas of infarcted brain on follow-up imaging (specificity 100%). Black holes demonstrated significantly lower cerebral blood volumes (P < .001) and cerebral blood flow (P < .001) compared to immediately adjacent tissue. Black holes on time-to-peak image maps represent areas of unsalvageable brain. Copyright © 2016 by the American Society of Neuroimaging.

The Effects of Twitter Sentiment on Stock Price Returns.

PubMed

Ranco, Gabriele; Aleksovski, Darko; Caldarelli, Guido; Grčar, Miha; Mozetič, Igor

2015-01-01

Social media are increasingly reflecting and influencing behavior of other complex systems. In this paper we investigate the relations between a well-known micro-blogging platform Twitter and financial markets. In particular, we consider, in a period of 15 months, the Twitter volume and sentiment about the 30 stock companies that form the Dow Jones Industrial Average (DJIA) index. We find a relatively low Pearson correlation and Granger causality between the corresponding time series over the entire time period. However, we find a significant dependence between the Twitter sentiment and abnormal returns during the peaks of Twitter volume. This is valid not only for the expected Twitter volume peaks (e.g., quarterly announcements), but also for peaks corresponding to less obvious events. We formalize the procedure by adapting the well-known "event study" from economics and finance to the analysis of Twitter data. The procedure allows to automatically identify events as Twitter volume peaks, to compute the prevailing sentiment (positive or negative) expressed in tweets at these peaks, and finally to apply the "event study" methodology to relate them to stock returns. We show that sentiment polarity of Twitter peaks implies the direction of cumulative abnormal returns. The amount of cumulative abnormal returns is relatively low (about 1-2%), but the dependence is statistically significant for several days after the events.

Intensive aerobic cycling training with lower limb weights in Chinese patients with chronic stroke: discordance between improved cardiovascular fitness and walking ability.

PubMed

Jin, Hong; Jiang, Yibo; Wei, Qin; Wang, Bilei; Ma, Genshan

2012-01-01

To evaluate the effect of aerobic cycling training with lower limb weights on cardiovascular fitness (peak VO(2)) and walking ability in chronic stroke survivors, and to investigate the relationship between changes in these parameters. 133 Chinese patients with chronic hemiparetic stroke (mean age 58 years) were randomized to either 8-week (5×/week) aerobic cycling training with lower limb weights group (n = 68) or a low-intensity overground walking group (n = 65). Peak VO(2), 6-minute walk distance (6MWD), knee muscle strength, balance and spasticity were measured before and after intervention. Cycling training increased peak VO(2) (24% vs. 3%, p < 0.001), 6MWD (2.7% vs. 0.5%, p < 0.001), paretic (11% vs. 1.6%, p < 0.001) and nonparetic knee strength (16% vs. 1.0%, p < 0.001). In the cycling group, percent changes in peak VO(2) were positively associated with those in paretic (r = 0.491, p < 0.001) and nonparetic knee strength (r = 0.432, p < 0.001). Increased 6MWD correlated significantly with improved balance, spasticity and paretic knee strength by the stepwise regression analysis (r(2) = 0.342, p = 0.004), but not fitness gains. The enhanced cardiovascular fitness after aerobic cycling training in Chinese patients with chronic stroke is not associated with the increased walking ability. Unparallel improvements in these parameters related different determinants may have implications for intervention strategy.

Mechanical energy absorber

NASA Technical Reports Server (NTRS)

Wesselski, Clarence J. (Inventor)

1993-01-01

An energy absorbing system for controlling the force where a moving object engages a stationary stop and where the system utilized telescopic tubular members, energy absorbing diaphragm elements, force regulating disc springs, and a return spring to return the telescoping member to its start position after stroking is presented. The energy absorbing system has frusto-conical diaphragm elements frictionally engaging the shaft and are opposed by a force regulating set of disc springs. In principle, this force feedback mechanism serves to keep the stroking load at a reasonable level even if the friction coefficient increases greatly. This force feedback device also serves to desensitize the singular and combined effects of manufacturing tolerances, sliding surface wear, temperature changes, dynamic effects, and lubricity.

Observation of Long Ionospheric Recoveries from Lightning-induced Electron Precipitation Events

NASA Astrophysics Data System (ADS)

Mohammadpour Salut, M.; Cohen, M.

2015-12-01

Lightning strokes induces lower ionospheric nighttime disturbances which can be detected through Very Low Frequency (VLF) remote sensing via at least two means: (1) direct heating and ionization, known as an Early event, and (2) triggered precipitation of energetic electrons from the radiation belts, known as Lightning-induced Electron Precipitation (LEP). For each, the ionospheric recover time is typically a few minutes or less. A small class of Early events have been identified as having unusually long ionospheric recoveries (10s of minutes), with the underlying mechanism still in question. Our study shows for the first time that some LEP events also demonstrate unusually long recovery. The VLF events were detected by visual inspection of the recorded data in both the North-South and East-West magnetic fields. Data from the National Lightning Detection Network (NLDN) are used to determine the location and peak current of the lightning responsible for each lightning-associated VLF perturbation. LEP or Early VLF events are determined by measuring the time delay between the causative lightning discharges and the onset of all lightning-associated perturbations. LEP events typically possess an onset delay greater than ~ 200 msec following the causative lightning discharges, while the onset of Early VLF events is time-aligned (<20 msec) with the lightning return stroke. Nonducted LEP events are distinguished from ducted events based on the location of the causative lightning relative to the precipitation region. From 15 March to 20 April and 15 October to 15 November 2011, a total of 385 LEP events observed at Indiana, Montana, Colorado and Oklahoma VLF sites, on the NAA, NLK and NML transmitter signals. 46 of these events exhibited a long recovery. It has been found that the occurrence rate of ducted long recovery LEP events is higher than nonducted. Of the 46 long recovery LEP events, 33 events were induced by ducted whistlers, and 13 events were associated with nonducted obliquely propagating whistler waves. The occurrence of high peak current lightning strokes is a prerequisite for long recovery LEP events.

Changing Face of Stroke: Implications for Occupational Therapy Practice

PubMed Central

Wolf, Timothy J.; Baum, Carolyn; Connor, Lisa Tabor

2010-01-01

Stroke is one of the most life-altering syndromes affecting the world population. Rehabilitation for people experiencing stroke is focused almost exclusively on self-care activities and being able to return home and has little to no focus on work rehabilitation or community reintegration. The Cognitive Rehabilitation Research Group (CRRG) at the Washington University School of Medicine in St. Louis was formed with the vision of improving everyday life for people after stroke by translating knowledge from neuroscience into treatment programs for productive living. Descriptive analysis of the intake assessment from the CRRG Clinical Core (N = 7,740) revealed three important findings: The age at stroke is decreasing, most strokes are neurologically mild to moderate in nature, and discharge placement decisions are being made largely on the basis of measures of impairment. The changes in the stroke population require occupational therapy to expand rehabilitation beyond the acute management of stroke to address full participation in work, family, and community life. PMID:19785261

Correlations between ankle-foot impairments and dropped foot gait deviations among stroke survivors.

PubMed

Chisholm, Amanda E; Perry, Stephen D; McIlroy, William E

2013-01-01

The purpose of this paper is to 1) evaluate the relationship between ankle kinematics during gait and standardized measures of ankle impairments among sub-acute stroke survivors, and 2) compare the degree of stroke-related ankle impairment between individuals with and without dropped foot gait deviations. Fifty-five independently ambulating stroke survivors participated in this study. Dropped foot was defined as decreased peak dorsiflexion during the swing phase and reduced ankle joint motion in stance. Standardized outcome measures included the Chedoke-McMaster Stroke Assessment (motor impairment), Modified Ashworth Scale (spasticity), Medical Research Council (muscle strength), passive and active range of motion, and isometric muscle force. Foot impairment was not related to peak dorsiflexion during swing (r=-0.17, P=0.247) and joint motion during stance (r=0.05, P=0.735). Active (r=0.45, P<0.001) and passive (r=0.48, P<0.001) range of motion was associated with stance phase joint motion. Peak dorsiflexion during swing was related to isometric dorsiflexor muscle force (r=-0.32, P=0.039). Individuals with dropped foot demonstrated greater motor impairment, plantarflexor spasticity and ankle muscle weakness compared to those without dropped foot. Our investigation suggests that ankle-foot impairments are related to ankle deviations during gait, as indicated by greater impairment among individuals with dropped foot. These findings contribute to a better understanding of gait-specific ankle deviations, and may lead to the development of a more effective clinical assessment of dropped foot impairment. © 2013.

Outperforming hummingbirds' load-lifting capability with a lightweight hummingbird-like flapping-wing mechanism.

PubMed

Leys, Frederik; Reynaerts, Dominiek; Vandepitte, Dirk

2016-08-15

The stroke-cam flapping mechanism presented in this paper closely mimics the wing motion of a hovering Rufous hummingbird. It is the only lightweight hummingbird-sized flapping mechanism which generates a harmonic wing stroke with both a high flapping frequency and a large stroke amplitude. Experiments on a lightweight prototype of this stroke-cam mechanism on a 50 mm-long wing demonstrate that a harmonic stroke motion is generated with a peak-to-peak stroke amplitude of 175° at a flapping frequency of 40 Hz. It generated a mass lifting capability of 5.1 g, which is largely sufficient to lift the prototype's mass of 3.39 g and larger than the mass-lifting capability of a Rufous hummingbird. The motor mass of a hummingbird-like robot which drives the stroke-cam mechanism is considerably larger (about five times) than the muscle mass of a hummingbird with comparable load-lifting capability. This paper presents a flapping wing nano aerial vehicle which is designed to possess the same lift- and thrust-generating principles of the Rufous hummingbird. The application is indoor flight. We give an overview of the wing kinematics and some specifications which should be met to develop an artificial wing, and also describe the applications of these in the mechanism which has been developed in this work. © 2016. Published by The Company of Biologists Ltd.

Outperforming hummingbirds’ load-lifting capability with a lightweight hummingbird-like flapping-wing mechanism

PubMed Central

Reynaerts, Dominiek; Vandepitte, Dirk

2016-01-01

ABSTRACT The stroke-cam flapping mechanism presented in this paper closely mimics the wing motion of a hovering Rufous hummingbird. It is the only lightweight hummingbird-sized flapping mechanism which generates a harmonic wing stroke with both a high flapping frequency and a large stroke amplitude. Experiments on a lightweight prototype of this stroke-cam mechanism on a 50 mm-long wing demonstrate that a harmonic stroke motion is generated with a peak-to-peak stroke amplitude of 175° at a flapping frequency of 40 Hz. It generated a mass lifting capability of 5.1 g, which is largely sufficient to lift the prototype's mass of 3.39 g and larger than the mass-lifting capability of a Rufous hummingbird. The motor mass of a hummingbird-like robot which drives the stroke-cam mechanism is considerably larger (about five times) than the muscle mass of a hummingbird with comparable load-lifting capability. This paper presents a flapping wing nano aerial vehicle which is designed to possess the same lift- and thrust-generating principles of the Rufous hummingbird. The application is indoor flight. We give an overview of the wing kinematics and some specifications which should be met to develop an artificial wing, and also describe the applications of these in the mechanism which has been developed in this work. PMID:27444790

Strength Training for Skeletal Muscle Endurance after Stroke

PubMed Central

Ivey, Frederick M.; Prior, Steven J.; Hafer-Macko, Charlene E.; Katzel, Leslie I.; Macko, Richard F.; Ryan, Alice S.

2018-01-01

Background and Purpose Initial studies support the use of strength training (ST) as a safe and effective intervention after stroke. Our previous work shows that relatively aggressive, higher intensity ST translates into large effect sizes for paretic and non-paretic leg muscle volume, myostatin expression, and maximum strength post-stroke. An unanswered question pertains to how our unique ST model for stroke impacts skeletal muscle endurance (SME). Thus, we now report on ST-induced adaptation in the ability to sustain isotonic muscle contraction. Methods Following screening and baseline testing, hemiparetic stroke participants were randomized to either ST or an attention-matched stretch control group (SC). Those in the ST group trained each leg individually to muscle failure (20 repetition sets, 3× per week for 3 months) on each of three pneumatic resistance machines (leg press, leg extension, and leg curl). Our primary outcome measure was SME, quantified as the number of submaximal weight leg press repetitions possible at a specified cadence. The secondary measures included one-repetition maximum strength, 6-minute walk distance (6MWD), 10-meter walk speeds, and peak aerobic capacity (VO2 peak). Results ST participants (N = 14) had significantly greater SME gains compared with SC participants (N = 16) in both the paretic (178% versus 12%, P < .01) and non-paretic legs (161% versus 12%, P < .01). These gains were accompanied by group differences for 6MWD (P < .05) and VO2 peak (P < .05). Conclusion Our ST regimen had a large impact on the capacity to sustain submaximal muscle contraction, a metric that may carry more practical significance for stroke than the often reported measures of maximum strength. PMID:27865696

Cardiorespiratory fitness, cognition and brain structure after TIA or minor ischemic stroke.

PubMed

Boss, H Myrthe; Van Schaik, Sander M; Witkamp, Theo D; Geerlings, Mirjam I; Weinstein, Henry C; Van den Berg-Vos, Renske M

2017-10-01

Background It is not known whether cardiorespiratory fitness is associated with better cognitive performance and brain structure in patients with a TIA or minor ischemic stroke. Aims To examine the association between cardiorespiratory fitness, cognition and brain structure in patients with a TIA and minor stroke. Methods The study population consisted of patients with a TIA or minor stroke with a baseline measurement of the peak oxygen consumption, a MRI scan of brain and neuropsychological assessment. Composite z-scores were calculated for the cognitive domains attention, memory and executive functioning. White matter hyperintensities, microbleeds and lacunes were rated visually. The mean apparent diffusion coefficient was measured in regions of interest in frontal and occipital white matter and in the centrum semiovale as a marker of white matter structure. Normalized brain volumes were estimated by use of Statistical Parametric Mapping. Results In 84 included patients, linear regression analysis adjusted for age, sex and education showed that a higher peak oxygen consumption was associated with higher cognitive z-scores, a larger grey matter volume (B = 0.15 (95% CI 0.05; 0.26)) and a lower mean apparent diffusion coefficient (B = -.004 (95% CI -.007; -.001)). We found no association between the peak oxygen consumption and severe white matter hyperintensities, microbleeds, lacunes and total brain volume. Conclusions These data suggest that cardiorespiratory fitness is associated with better cognitive performance, greater grey matter volume and greater integrity of the white matter in patients with a TIA or minor ischemic stroke. Further prospective trials are necessary to define the effect of cardiorespiratory fitness on cognition and brain structure in patients with TIA or minor stroke.

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation.

PubMed

Yoshida, Kuniko; Obokata, Masaru; Kurosawa, Koji; Sorimachi, Hidemi; Kurabayashi, Masahiko; Negishi, Kazuaki

2016-10-01

Embolic stroke in atrial fibrillation is more prevalent in women than in men, yet the basis for this difference remains unclear. This study seeks to elucidate whether there are any sex differences in the relationships between stroke risk (CHADS 2 score, CHA 2 DS 2 -VASc score without a sex category, and estimated stroke rate) and left atrial (LA) anatomy or mechanics in patients with atrial fibrillation. LA emptying fraction and global peak atrial longitudinal strain were assessed in 414 subjects with paroxysmal or persistent atrial fibrillation (156 women and 258 men). Linear regression models with an interaction term were performed to test the effect of sex difference on associations between the embolic risk and LA function or anatomy. Sensitivity analyses were performed in 228 age, heart rate, and rhythm-matched subjects (114 women and men). Women were older and had larger LA volumes and lower LA mechanics than men. Significant negative association between the CHADS 2 score and LA emptying fraction was only demonstrated in women with a significant interaction between sexes. Similar significant interactions were found in global peak atrial longitudinal strain but not in LA volume. These findings were corroborated in the comparisons against CHA 2 DS 2 -VASc score without a sex category and the estimated stroke rate. Sensitivity analyses in the matched subgroup also confirmed the robustness of these sex differences in LA emptying fraction, but less so in global peak atrial longitudinal strain. Significant sex interactions on the association between global LA function and risk stratification schemes exist, which may be a reason for the higher prevalence of embolic stroke in women. © 2016 American Heart Association, Inc.

High shear rate flow in a linear stroke magnetorheological energy absorber

NASA Astrophysics Data System (ADS)

Hu, W.; Wereley, N. M.; Hiemenz, G. J.; Ngatu, G. T.

2014-05-01

To provide adaptive stroking load in the crew seats of ground vehicles to protect crew from blast or impact loads, a magnetorheological energy absorber (MREA) or shock absorber was developed. The MREA provides appropriate levels of controllable stroking load for different occupant weights and peak acceleration because the viscous stroking load generated by the MREA force increases with velocity squared, thereby reducing its controllable range at high piston velocity. Therefore, MREA behavior at high piston velocity is analyzed and validated experimentally in order to investigate the effects of velocity and magnetic field on MREA performance. The analysis used to predict the MREA force as a function of piston velocity squared and applied field is presented. A conical fairing is mounted to the piston head of the MREA in order reduce predicted inlet flow loss by 9% at nominal velocity of 8 m/s, which resulted in a viscous force reduction of nominally 4%. The MREA behavior is experimentally measured using a high speed servo-hydraulic testing system for speeds up to 8 m/s. The measured MREA force is used to validate the analysis, which captures the transient force quite accurately, although the peak force is under-predicted at the peak speed of 8 m/s.

Can overestimation of walking ability increase the risk of falls in people in the subacute stage after stroke on their return home?

PubMed

Morone, G; Iosa, M; Pratesi, L; Paolucci, S

2014-03-01

Falls are common in patients who have had a stroke who return home after neurorehabilitation. Some studies have found that walking speed inversely correlates with the risk of falls. This study examined whether comparison between comfortable self-selected walking speed and maximum maintainable speed is informative with regard to the risk of falls in patients with stroke. A prospective cohort study was performed with 75 ambulant stroke patients. At discharge, the Barthel Index score and performance at the 10-m and 6-min walking tests were assessed. Number of falls was recorded by telephone interview every two months for one year. Regression analysis was performed to identify factors that were related to the risk of falls. Using forward multiple linear regression, only the ratio between walking speeds on the 6-min and 10-m tests was linked to the number of falls in the year after discharge (R=-0.451, p<0.001, OR=0.046). Patients who chose a walking speed for short distances that was not maintainable long term fell more frequently. A discrepancy between short and long-term walking speed can help in identifying subjects in the subacute stage after stroke with an increased risk of suffering a fall. Copyright © 2014 Elsevier B.V. All rights reserved.

Cardiorespiratory responses to orthostasis and the effects of propranolol

NASA Technical Reports Server (NTRS)

Loeppky, J. A.

1975-01-01

Cardiac output and gas exchange were determined serially using the single-breath method of Kim et al. before, during, and after orthostasis on six subjects after beta-adrenergic blockage and in duplicate controls. In the latter, heart rate increased and pulse pressure dropped immediately on tilting to 60 deg and remained stable while cardiac output and stroke volume declined gradually over 21 min upright. On propranolol, heart rate was 10 bpm lower supine and 20 bpm less at 60 deg but cardiac output was only slightly lower before and following tilt-up. However, after 15 min upright, stroke volume and cardiac output recovered on propranolol exceeding the controls after 21 min without change in heart rate. Returning to supine, heart rate dropped in all tests with a transitory increase in stroke volume, cardiac output and arteriovenous O2 difference. At the same time, apparent O2 uptake increased temporarily, reflecting the return of pooled venous blood to the lungs. Orthostatic tolerance did not appear to be affected by beta-adrenergic blockade.

The channel radius and energy of cloud-to-ground lightning discharge plasma with multiple return strokes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Xuejuan; Yuan, Ping; Cen, Jianyong

2014-03-15

Using the spectra of a cloud-to-ground (CG) lightning flash with multiple return strokes and combining with the synchronous radiated electrical field information, the linear charge density, the channel radius, the energy per unit length, the thermal energy, and the energy of dissociation and ionization in discharge channel are calculated with the aid of an electrodynamic model of lightning. The conclusion that the initial radius of discharge channel is determined by the duration of the discharge current is confirmed. Moreover, the correlativity of several parameters has been analyzed first. The results indicate that the total intensity of spectra is positive correlatedmore » to the channel initial radius. The ionization and thermal energies have a linear relationship, and the dissociation energy is correlated positively to the ionization and thermal energies, the energy per unit length is in direct proportion to the square of initial radius in different strokes of one CG lightning.« less

Influence of post-stroke spasticity on EMG-force coupling and force steadiness in biceps brachii.

PubMed

Carlyle, Jennilee K; Mochizuki, George

2018-02-01

Individuals with spasticity after stroke experience a decrease in force steadiness which can impact function. Alterations in the strength of EMG-force coupling may contribute to the reduction in force steadiness observed in spasticity. The aim was to determine the extent to which force steadiness and EMG-force coupling is affected by post-stroke spasticity. This cross-sectional study involved individuals with upper limb spasticity after stroke. Participants were required to generate and maintain isometric contractions of the elbow flexors at varying force levels. Coefficient of variation of force, absolute force, EMG-force cross-correlation function peak and peak latency was measured from both limbs with surface electromyography and isometric dynamometry. Statistically significant differences were observed between the affected and less affected limbs for all outcome measures. Significant main effects of force level were also observed. Force steadiness was not statistically significantly correlated with EMG-force coupling; however, both force steadiness and absolute force were associated with the level of impairment as measured by the Chedoke McMaster Stroke Assessment Scale. Spasticity after stroke uncouples the relationship between EMG and force and is associated with reduced force steadiness during isometric contractions; however, these features of control are not associated in individuals with spasticity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Grip type and task goal modify reach-to-grasp performance in post-stroke hemiparesis.

PubMed

Schaefer, Sydney Y; DeJong, Stacey L; Cherry, Kendra M; Lang, Catherine E

2012-04-01

This study investigated whether grip type and/or task goal influenced reaching and grasping performance in poststroke hemiparesis. Sixteen adults with poststroke hemiparesis and twelve healthy adults reached to and grasped a cylindrical object using one of two grip types (3-finger or palmar) to achieve one of two task goals (hold or lift). Performance of the stroke group was characteristic of hemiparetic limb movement during reach-to-grasp, with more curved handpaths and slower velocities compared with the control group. These effects were present regardless of grip type or task goal. Other measures of reaching (reach time and reach velocity at object contact) and grasping (peak thumb-index finger aperture during the reach and peak grip force during the grasp) were differentially affected by grip type, task goal, or both, despite the presence of hemiparesis, providing new evidence that changes in motor patterns after stroke may occur to compensate for stroke-related motor impairment.

The Effects of Twitter Sentiment on Stock Price Returns

PubMed Central

Ranco, Gabriele; Aleksovski, Darko; Caldarelli, Guido; Grčar, Miha; Mozetič, Igor

2015-01-01

Social media are increasingly reflecting and influencing behavior of other complex systems. In this paper we investigate the relations between a well-known micro-blogging platform Twitter and financial markets. In particular, we consider, in a period of 15 months, the Twitter volume and sentiment about the 30 stock companies that form the Dow Jones Industrial Average (DJIA) index. We find a relatively low Pearson correlation and Granger causality between the corresponding time series over the entire time period. However, we find a significant dependence between the Twitter sentiment and abnormal returns during the peaks of Twitter volume. This is valid not only for the expected Twitter volume peaks (e.g., quarterly announcements), but also for peaks corresponding to less obvious events. We formalize the procedure by adapting the well-known “event study” from economics and finance to the analysis of Twitter data. The procedure allows to automatically identify events as Twitter volume peaks, to compute the prevailing sentiment (positive or negative) expressed in tweets at these peaks, and finally to apply the “event study” methodology to relate them to stock returns. We show that sentiment polarity of Twitter peaks implies the direction of cumulative abnormal returns. The amount of cumulative abnormal returns is relatively low (about 1–2%), but the dependence is statistically significant for several days after the events. PMID:26390434

Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke

PubMed Central

Nascimento, Lucas R.; Teixeira-Salmela, Luci F.; Polese, Janaine C.; Ada, Louise; Faria, Christina D. C. M.; Laurentino, Glória E. C.

2014-01-01

OBJECTIVES: To examine the strength deficits of the shoulder complex after stroke and to characterize the pattern of weakness according to type of movement and type of isokinetic parameter. METHOD: Twelve chronic stroke survivors and 12 age-matched healthy controls had their shoulder strength measured using a Biodex isokinetic dynamometer. Concentric measures of peak torque and work during shoulder movements were obtained in random order at speeds of 60°/s for both groups and sides. Type of movement was defined as scapulothoracic (protraction and retraction), glenohumeral (shoulder internal and external rotation) or combined (shoulder flexion and extension). Type of isokinetic parameter was defined as maximum (peak torque) or sustained (work). Strength deficits were calculated using the control group as reference. RESULTS: The average strength deficit for the paretic upper limb was 52% for peak torque and 56% for work. Decreases observed in the non-paretic shoulder were 21% and 22%, respectively. Strength deficit of the scapulothoracic muscles was similar to the glenohumeral muscles, with a mean difference of 6% (95% CI -5 to 17). Ability to sustain torque throughout a given range of motion was decreased as much as the peak torque, with a mean difference of 4% (95% CI -2 to 10). CONCLUSIONS: The findings suggest that people after stroke might benefit from strengthening exercises directed at the paretic scapulothoracic muscles in addition to exercises of arm elevation. Clinicians should also prescribe different exercises to improve the ability to generate force and the ability to sustain the torque during a specific range of motion. PMID:25003280

Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial.

PubMed

Macko, Richard F; Ivey, Frederick M; Forrester, Larry W; Hanley, Daniel; Sorkin, John D; Katzel, Leslie I; Silver, Kenneth H; Goldberg, Andrew P

2005-10-01

Physical inactivity propagates disability after stroke through physical deconditioning and learned nonuse. We investigated whether treadmill aerobic training (T-AEX) is more effective than conventional rehabilitation to improve ambulatory function and cardiovascular fitness in patients with chronic stroke. Sixty-one adults with chronic hemiparetic gait after ischemic stroke (>6 months) were randomized to 6 months (3x/week) progressive T-AEX or a reference rehabilitation program of stretching plus low-intensity walking (R-CONTROL). Peak exercise capacity (Vo2 peak), o2 consumption during submaximal effort walking (economy of gait), timed walks, Walking Impairment Questionnaire (WIQ), and Rivermead Mobility Index (RMI) were measured before and after 3 and 6 months of training. Twenty-five patients completed T-AEX and 20 completed R-CONTROL. Only T-AEX increased cardiovascular fitness (17% versus 3%, delta% T-AEX versus R-CONTROL, P<0.005). Group-by-time analyses revealed T-AEX improved ambulatory performance on 6-minute walks (30% versus 11%, P<0.02) and mobility function indexed by WIQ distance scores (56% versus 12%, P<0.05). In the T-AEX group, increasing training velocity predicted improved Vo2 peak (r=0.43, P<0.05), but not walking function. In contrast, increasing training session duration predicted improved 6-minute walk (r=0.41, P<0.05), but not fitness gains. T-AEX improves both functional mobility and cardiovascular fitness in patients with chronic stroke and is more effective than reference rehabilitation common to conventional care. Specific characteristics of training may determine the nature of exercise-mediated adaptations.

Effects of Daily Physical Activity Level on Manual Wheelchair Propulsion Technique in Full-Time Manual Wheelchair Users During Steady-State Treadmill Propulsion.

PubMed

Dysterheft, Jennifer; Rice, Ian; Learmonth, Yvonne; Kinnett-Hopkins, Dominque; Motl, Robert

2017-07-01

To examine whether differences in propulsion technique as a function of intraindividual variability occur as a result of shoulder pain and physical activity (PA) level in full-time manual wheelchair users (MWUs). Observational study. Research laboratory. Adults (N=14) with spinal cord injury (mean age: 30.64±11.08) who used a wheelchair for >80% of daily ambulation and were free of any condition that could be worsened by PA. Not applicable. PA level was measured using the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), and shoulder pain was measured using the Wheelchair User's Shoulder Pain Index (WUSPI) survey. Mean and intraindividual variability propulsion metrics were measured for propulsion analysis. WUSPI scores indicated participants experienced low levels of shoulder pain. The results of the Spearman rank-order correlation revealed that PASIPD scores were significantly related to mean contact angle (r s =-.57) and stroke frequency (r s =.60) as well as to coefficient of variation of peak force (r s =.63), peak torque (r s =.59), contact angle (r s =.73), and stroke frequency (r s =.60). WUSPI scores were significantly correlated with only mean peak force (P=.02). No significant correlations were observed between PASIPD, WUSPI, and body mass index scores. Differences in propulsion technique were observed on the basis of PA levels. Participants with higher PASIPD scores used a more injurious stroke technique when propelling at higher speeds. This may indicate that active individuals who use injurious stroke mechanics may be at higher risk of injury. A strong relation was found between peak propulsion forces and shoulder pain. Rehabilitation professionals should emphasize the use of a protective stroke technique in both inactive and active MWUs during exercise and faster propulsion. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Lightning data study in conjunction with geostationary satellite data

NASA Technical Reports Server (NTRS)

Auvine, Brian; Martin, David W.

1987-01-01

During the summer of 1985, cloud-to-ground stroke lightning were collected. Thirty minute samples of lightning were compared with GOES IR fractional cold cloud coverage computed for three temperature thresholds (213, 243, and 273 K) twice daily (morning and evening). It was found that satellite measurements of cold cloud have a relationship to the flashrate and, in a more limited way, to the polarity and numbers of return strokes. Results varied little by location. Lightning, especially positive strokes, was found to be correlated with fractional cloud coverage, especially for clouds at or below 213 K. Other data and correlations are discussed.

Radio frequency observations of lightning discharges by the forte satellite.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shao, X.; Jacobson, A. R.; Light, T.

2002-01-01

FORTE-observed VHF signatures for different lightning discharges are presented. For in-cloud discharges, a pulse pair is typically recorded and is named a 'transionospheric pulse pair' (TIPP). Many intense TIPPs are coherent and polarized, whereas initial and dart leaders do not show a recognizable degree of polarization. TIPPs are optically weaker than cloud-to-ground (CG) strokes, and stronger VHF TIPPs are optically darker. About 10% of CG strokes, mostly over seawater, produce extremely narrow, powerful VHF pulses at the very beginning of the return strokes. These narrow pulses are found to form an upward beam pattern.

Lost Productivity in Stroke Survivors: An Econometrics Analysis.

PubMed

Vyas, Manav V; Hackam, Daniel G; Silver, Frank L; Laporte, Audrey; Kapral, Moira K

2016-01-01

Stroke leads to a substantial societal economic burden. Loss of productivity among stroke survivors is a significant contributor to the indirect costs associated with stroke. We aimed to characterize productivity and factors associated with employability in stroke survivors. We used the Canadian Community Health Survey 2011-2012 to identify stroke survivors and employment status. We used multivariable logistic models to determine the impact of stroke on employment and on factors associated with employability, and used Heckman models to estimate the effect of stroke on productivity (number of hours worked/week and hourly wages). We included data from 91,633 respondents between 18 and 70 years and identified 923 (1%) stroke survivors. Stroke survivors were less likely to be employed (adjusted OR 0.39, 95% CI 0.33-0.46) and had hourly wages 17.5% (95% CI 7.7-23.7) lower compared to the general population, although there was no association between work hours and being a stroke survivor. We found that factors like older age, not being married, and having medical comorbidities were associated with lower odds of employment in stroke survivors in our sample. Stroke survivors are less likely to be employed and they earn a lower hourly wage than the general population. Interventions such as dedicated vocational rehabilitation and policies targeting return to work could be considered to address this lost productivity among stroke survivors. © 2016 S. Karger AG, Basel.

Stroke survivors over-estimate their medication self-administration (MSA) ability, predicting memory loss.

PubMed

Barrett, A M; Galletta, Elizabeth E; Zhang, Jun; Masmela, Jenny R; Adler, Uri S

2014-01-01

Medication self-administration (MSA) may be cognitively challenging after stroke, but guidelines are currently lacking for identifying high-functioning stroke survivors who may have difficulty with this task. Complicating this matter, stroke survivors may not be aware of their cognitive problems (cognitive anosognosia) and may over-estimate their MSA competence. The authors wished to evaluate medication self-administration and MSA self-awareness in 24 consecutive acute stroke survivors undergoing inpatient rehabilitation, to determine if they would over-estimate their medication self-administration and if this predicted memory disorder. Stroke survivors were tested on the Hopkins Medication Schedule and also their memory, naming mood and dexterity were evaluated, comparing their performance to 17 matched controls. The anosognosia ratio indicated MSA over-estimation in stroke survivors compared with controls--no other over-estimation errors were noted relative to controls. A strong correlation was observed between over-estimation of MSA ability and verbal memory deficit, suggesting that formally assessing MSA and MSA self-awareness may help detect cognitive deficits. Assessing medication self-administration and MSA self-awareness may be useful in rehabilitation and successful community-return after stroke.

The Role of Citicoline in Neuroprotection and Neurorepair in Ischemic Stroke

PubMed Central

Álvarez-Sabín, José; Román, Gustavo C.

2013-01-01

Advances in acute stroke therapy resulting from thrombolytic treatment, endovascular procedures, and stroke units have improved significantly stroke survival and prognosis; however, for the large majority of patients lacking access to advanced therapies stroke mortality and residual morbidity remain high and many patients become incapacitated by motor and cognitive deficits, with loss of independence in activities of daily living. Therefore, over the past several years, research has been directed to limit the brain lesions produced by acute ischemia (neuroprotection) and to increase the recovery, plasticity and neuroregenerative processes that complement rehabilitation and enhance the possibility of recovery and return to normal functions (neurorepair). Citicoline has therapeutic effects at several stages of the ischemic cascade in acute ischemic stroke and has demonstrated efficiency in a multiplicity of animal models of acute stroke. Long-term treatment with citicoline is safe and effective, improving post-stroke cognitive decline and enhancing patients’ functional recovery. Prolonged citicoline administration at optimal doses has been demonstrated to be remarkably well tolerated and to enhance endogenous mechanisms of neurogenesis and neurorepair contributing to physical therapy and rehabilitation. PMID:24961534

Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke

PubMed Central

Gottesman, Rebecca F; Hillis, Argye E

2013-01-01

Stroke remains a primary cause of morbidity throughout the world mainly because of its effect on cognition. Individuals can recover from physical disability resulting from stroke, but might be unable to return to their previous occupations or independent life because of cognitive impairments. Cognitive dysfunction ranges from focal deficits, resulting directly from an area of infarction or from hypoperfusion in adjacent tissue, to more global cognitive dysfunction. Global dysfunction is likely to be related to other underlying subclinical cerebrovascular disease, such as white-matter disease or subclinical infarcts. Study of cognitive dysfunction after stroke is complicated by varying definitions and lack of measurement of cognition before stroke. Additionally, stroke can affect white-matter connectivity, so newer imaging techniques, such as diffusion-tensor imaging and magnetisation transfer imaging, that can be used to assess this subclinical injury are important tools in the assessment of cognitive dysfunction after stroke. As research is increasingly focused on the role of preventable risk factors in the development of dementia, the role of stroke in the development of cognitive impairment and dementia could be another target for prevention. PMID:20723846

Experimental and analytical investigation on metal damage suffered from simulated lightning currents

NASA Astrophysics Data System (ADS)

Yakun, LIU; Zhengcai, FU; Quanzhen, LIU; Baoquan, LIU; Anirban, GUHA

2017-12-01

The damage of two typical metal materials, Al alloy 3003 and steel alloy Q235B, subjected to four representative lightning current components are investigated by laboratory and analytical studies to provide fundamental data for lightning protection. The four lightning components simulating the natural lightning consist of the first return stroke, the continuing current of interval stroke, the long continuing current, and the subsequent stroke, with amplitudes 200 kA, 8 kA, 400 A, and 100 kA, respectively. The damage depth and area suffered from different lightning components are measured by the ultrasonic scanning system. And the temperature rise is measured by the thermal imaging camera. The results show that, for both Al 3003 and steel Q235B, the first return stroke component results in the largest damage area with damage depth 0.02 mm uttermost. The long continuing current component leads to the deepest damage depth of 3.3 mm for Al 3003 and much higher temperature rise than other components. The correlation analysis between damage results and lightning parameters indicates that the damage depth has a positive correlation with charge transfer. The damage area is mainly determined by the current amplitude and the temperature rise increases linearly with the charge transfer larger.

Optical power and energy radiated by natural lightning

NASA Astrophysics Data System (ADS)

Quick, Mason G.; Krider, E. Philip

2013-02-01

Calibrated measurements of the visible and near-infrared radiation produced by both negative and positive cloud-to-ground (CG) lightning strokes have been made at distances of 5 to 32 km in southern Arizona (AZ) and the central Great Plains using a photodiode sensor with a flat spectral response between 0.4 and 1.0 µm. Time-correlated video images (60 fps) of the channel development provided information about the types of strokes that were detected and reports from the U.S. National Lightning Detection Network indicated their locations, polarities, and estimates of their peak current. In our sample of negative strokes that were suitable for analysis, there were 23 first (or only) strokes (FS), 19 subsequent strokes that created new ground contacts (NGC), and 101 subsequent strokes that re-illuminated a preexisting channel (PEC). We also analyzed 10 positive strokes (in nine flashes), and 73 of the larger impulses that were radiated by intracloud discharges (CPs). Assuming that these events can be approximated as isotropic sources and that the effects of atmospheric extinction are negligible, the peak optical power (Po), total optical energy (Eo), and characteristic widths of the sources (tcw = Eo/Po) have been computed. Median values of Po for negative FS, NGC, and PEC strokes were 1.8 × 1010 W, 1.1 × 1010 W, and 4.4 × 109 W, respectively. Median values of Eo were 3.6 × 106 J, 3.5 × 106 J, and 1.2 × 106 J, respectively. The median characteristic widths of negative FS, NGC, and PEC strokes were 229 µs, 244 µs, and 283 µs, respectively. Positive CG strokes produced a median Po, Eo, and tcw of 1.9 × 1010 W, 9.3 × 106 J, and 497 µs, respectively. Estimates of the space-and-time-average power per unit length (ℓo) in the lower portion of negative FS, NGC, and PEC channels had medians of 2.8 × 106 W/m, 3.2 × 106 W/m, and 1.4 × 106 W/m, respectively, and the median ℓo for four positive strokes was 8.8 × 106 W/m. Median values for the estimated peak electromagnetic power (PEM) radiated at early times in the strokes are 2.0 × 109 W, 2.5 × 109 W, 1.0 × 109 W, and 9.1 × 109 W for FS, NGC, PEC and positive strokes, respectively. CP events produced a median Po, Eo, and tcw of 2.0 × 109 W, 0.7 × 106 J, and 311 µs, respectively, and are in good agreement with aircraft and satellite measurements. The values of Po, Eo, and ℓo for negative CG strokes in AZ are significantly larger than prior measurements in Florida, likely because there is less atmospheric extinction in our dataset, and due to extinction, all the above values of Po, Eo, and ℓo are lower limits at the source.

Lightning Magnetic Field Measurements around Langmuir Laboratory

NASA Astrophysics Data System (ADS)

Stock, M.; Krehbiel, P. R.; Rison, W.; Aulich, G. D.; Edens, H. E.; Sonnenfeld, R. G.

2010-12-01

In the absence of artificial conductors, underground lightning transients are produced by diffusion of the horizontal surface magnetic field of a return stroke vertically downward into the conducting earth. The changing magnetic flux produces an orthogonal horizontal electric field, generating a dispersive, lossy transverse electromagnetic wave that penetrates a hundred meters or more into the ground according to the skin depth of the medium. In turn, the electric field produces currents that flow toward or away from the channel to ground depending on the stroke polarity. The underground transients can produce large radial horizontal potential gradients depending on the distance from the discharge and depth below the surface. In this study we focus on the surface excitation field. The goal of the work is to compare measurements of surface magnetic field waveforms B(t) at different distances from natural lightning discharges with simple and detailed models of the return stroke fields. In addition to providing input to the diffusion mechanism, the results should aid in further understanding return stroke field generation processes. The observational data are to be obtained using orthogonal sets of straightened Rogowski coils to measure magnetic field waveforms in N-S and E-W directions. The waveforms are sampled at 500 kS/s over 1.024 second time intervals and recorded directly onto secure digital cards. The instrument operates off of battery power for several days or weeks at a time in remote, unattended locations and measures magnetic field strengths of up to several tens of amperes/meter. The observations are being made in conjunction with collocated slow electric field change measurements and under good 3-D lightning mapping array (LMA) and fast electric field change coverage.

A systematic review investigating fatigue, psychological and cognitive impairment following TIA and minor stroke: protocol paper.

PubMed

Moran, Grace M; Fletcher, Benjamin; Calvert, Melanie; Feltham, Max G; Sackley, Catherine; Marshall, Tom

2013-09-08

Approximately 20,000 people have a transient ischemic attack (TIA) and 23,375 have a minor stroke in England each year. Fatigue, psychological and cognitive impairments are well documented post-stroke. Evidence suggests that TIA and minor stroke patients also experience these impairments; however, they are not routinely offered relevant treatment. This systematic review aims to: (1) establish the prevalence of fatigue, anxiety, depression, post-traumatic stress disorder (PTSD) and cognitive impairment following TIA and minor stroke and to investigate the temporal course of these impairments; (2) explore impact on quality of life (QoL), change in emotions and return to work; (3) identify where further research is required and to potentially inform an intervention study. A systematic review of MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane libraries and grey literature between January 1993 and April 2013 will be undertaken. Two reviewers will conduct screening search results, study selection, data extraction and quality assessment. Studies of adult TIA and minor stroke participants containing any of the outcomes of interest; fatigue, anxiety, depression, PTSD or cognitive impairment will be included. Studies at any time period after TIA/minor stroke, including those with any length of follow-up, will be included to investigate the temporal course of impairments. QoL, change in emotions and return to work will also be documented. The proportion of TIA or minor stroke participants experiencing each outcome will be reported.If appropriate, a meta-analysis will pool results of individual outcomes. Studies will be grouped and analyzed according to their follow-up timeframe into short-term (< 3 months after TIA/minor stroke), medium-term (3 to 12 months) and long term (> 12 months). Sub-analysis of studies with a suitable control group will be conducted. Exploratory sub-analysis of memory and attention domains of cognitive impairment will be conducted. The current treatment goal for TIA and minor stroke patients is secondary stroke prevention. If these patients do experience fatigue, psychological or cognitive impairments then this treatment alone is unlikely to be sufficient. The results of this comprehensive review will increase understanding of treatment needs for this patient group, identify where further research is required and potentially inform an intervention trial.

Contemporary Trends and Predictors of Postacute Service Use and Routine Discharge Home After Stroke

PubMed Central

Prvu Bettger, Janet; McCoy, Lisa; Smith, Eric E.; Fonarow, Gregg C.; Schwamm, Lee H.; Peterson, Eric D.

2015-01-01

Background Returning home after the hospital is a primary aim for healthcare; however, additional postacute care (PAC) services are sometimes necessary for returning stroke patients to their pre‐event status. Recent trends in hospital discharge disposition specifying PAC use have not been examined across age groups or health insurance types. Methods and Results We examined trends in discharge to inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home with home health (HH), and home without services for 849 780 patients ≥18 years of age with ischemic or hemorrhagic stroke at 1687 hospitals participating in Get With The Guidelines—Stroke. Multivariable analysis was used to identify factors associated with discharge to any PAC (IRF, SNF, or HH) versus discharge home without services. From 2003 to 2011, there was a 2.1% increase (unadjusted P=0.001) in PAC use after a stroke hospitalization. Change was greatest in SNF use, an 8.3% decrease over the period. IRF and HH increased 6.9% and 3.6%, respectively. The 2 strongest clinical predictors of PAC use after acute care were patients not ambulating on the second day of their hospital stay (ambulation odds ratio [OR], 3.03; 95% confidence interval [CI], 2.86 to 3.23) and those who failed a dysphagia screen or had an order restricting oral intake (OR, 2.48; 95% CI, 2.37 to 2.59). Conclusions Four in 10 stroke patients are discharged home without services. Although little has changed overall in PAC use since 2003, further research is needed to explain the shift in service use by type and its effect on outcomes. PMID:25713291

Contemporary trends and predictors of postacute service use and routine discharge home after stroke.

PubMed

Prvu Bettger, Janet; McCoy, Lisa; Smith, Eric E; Fonarow, Gregg C; Schwamm, Lee H; Peterson, Eric D

2015-02-23

Returning home after the hospital is a primary aim for healthcare; however, additional postacute care (PAC) services are sometimes necessary for returning stroke patients to their pre-event status. Recent trends in hospital discharge disposition specifying PAC use have not been examined across age groups or health insurance types. We examined trends in discharge to inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home with home health (HH), and home without services for 849 780 patients ≥18 years of age with ischemic or hemorrhagic stroke at 1687 hospitals participating in Get With The Guidelines-Stroke. Multivariable analysis was used to identify factors associated with discharge to any PAC (IRF, SNF, or HH) versus discharge home without services. From 2003 to 2011, there was a 2.1% increase (unadjusted P=0.001) in PAC use after a stroke hospitalization. Change was greatest in SNF use, an 8.3% decrease over the period. IRF and HH increased 6.9% and 3.6%, respectively. The 2 strongest clinical predictors of PAC use after acute care were patients not ambulating on the second day of their hospital stay (ambulation odds ratio [OR], 3.03; 95% confidence interval [CI], 2.86 to 3.23) and those who failed a dysphagia screen or had an order restricting oral intake (OR, 2.48; 95% CI, 2.37 to 2.59). Four in 10 stroke patients are discharged home without services. Although little has changed overall in PAC use since 2003, further research is needed to explain the shift in service use by type and its effect on outcomes. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

The NASA Lightning Nitrogen Oxides Model (LNOM): Recent Updates and Applications

NASA Technical Reports Server (NTRS)

Koshak, William; Peterson, Harold; Biazar, Arastoo; Khan, Maudood; Wang, Lihua; Park, Yee-Hun

2011-01-01

Improvements to the NASA Marshall Space Flight Center Lightning Nitrogen Oxides Model (LNOM) and its application to the Community Multiscale Air Quality (CMAQ) modeling system are presented. The LNOM analyzes Lightning Mapping Array (LMA) and National Lightning Detection Network(tm) (NLDN) data to estimate the raw (i.e., unmixed and otherwise environmentally unmodified) vertical profile of lightning NOx (= NO + NO2). Lightning channel length distributions and lightning 10-m segment altitude distributions are also provided. In addition to NOx production from lightning return strokes, the LNOM now includes non-return stroke lightning NOx production due to: hot core stepped and dart leaders, stepped leader corona sheath, K-changes, continuing currents, and M-components. The impact of including LNOM-estimates of lightning NOx for an August 2006 run of CMAQ is discussed.

Test of the principle of operation of a wideband magnetic direction finder for lightning return strokes

NASA Technical Reports Server (NTRS)

Herrman, B. D.; Uman, M. A.; Brantley, R. D.; Krider, E. P.

1976-01-01

The principle of operation of a wideband crossed-loop magnetic-field direction finder is studied by comparing the bearing determined from the NS and EW magnetic fields at various times up to 155 microsec after return stroke initiation with the TV-determined lightning channel base direction. For 40 lightning strokes in the 3 to 12 km range, the difference between the bearings found from magnetic fields sampled at times between 1 and 10 microsec and the TV channel-base data has a standard deviation of 3-4 deg. Included in this standard deviation is a 2-3 deg measurement error. For fields sampled at progressively later times, both the mean and the standard deviation of the difference between the direction-finder bearing and the TV bearing increase. Near 150 microsec, means are about 35 deg and standard deviations about 60 deg. The physical reasons for the late-time inaccuracies in the wideband direction finder and the occurrence of these effects in narrow-band VLF direction finders are considered.

Calculating the electron temperature in the lightning channel by continuous spectrum

NASA Astrophysics Data System (ADS)

Xiangcheng, DONG; Jianhong, CHEN; Xiufang, WEI; Ping, YUAN

2017-12-01

Based on the theory of plasma continuous radiation, the relationship between the emission intensity of bremsstrahlung and recombination radiation and the plasma electron temperature is obtained. During the development process of a return stroke of ground flash, the intensity of continuous radiation spectrum is separated on the basis of the spectrums with obviously different luminous intensity at two moments. The electron temperature of the lightning discharge channel is obtained through the curve fitting of the continuous spectrum intensity. It is found that electron temperature increases with the increase of wavelength and begins to reduce after the peak. The peak temperature of the two spectra is close to 25 000 K. To be compared with the result of discrete spectrum, the electron temperature is fitted by the O I line and N II line of the spectrum respectively. The comparison shows that the high temperature value is in good agreement with the temperature of the lightning core current channel obtained from the ion line information, and the low temperature at the high band closes to the calculation result of the atomic line, at a low band is lower than the calculation of the atomic line, which reflects the temperature of the luminous channel of the outer corona.

The effect of ankle-foot orthosis plantarflexion stiffness on ankle and knee joint kinematics and kinetics during first and second rockers of gait in individuals with stroke

PubMed Central

Singer, Madeline L.; Kobayashi, Toshiki; Lincoln, Lucas S.; Orendurff, Michael S.; Foreman, K. Bo

2014-01-01

Background Stiffness of an ankle-foot orthosis plays an important role in improving gait in patients with a history of stroke. To address this, the aim of this case series study was to determine the effect of increasing plantarflexion stiffness of an ankle-foot orthosis on the sagittal ankle and knee joint angle and moment during the first and second rockers of gait. Methods Gait data were collected in 5 subjects with stroke at a self-selected walking speed under two plantarflexion stiffness conditions (0.4 Nm/deg and 1.3 Nm/deg) using a stiffness-adjustable experimental ankle-foot orthosis on a Bertec split-belt fully instrumented treadmill in a 3-dimensional motion analysis laboratory. Findings By increasing the plantarflexion stiffness of the ankle-foot orthosis, peak plantarfexion angle of the ankle was reduced and peak dorsiflexion moment was generally increased in the first rocker as hypothesized. Two subjects demonstrated increases in both peak knee flexion angle and peak knee extension moment in the second rocker as hypothesized. The two subjects exhibited minimum contractility during active plantarflexion, while the other three subjects could actively plantarflex their ankle joint. Interpretation It was suggested that those with the decreased ability to actively plantarflex their ankle could not overcome excessive plantarflexion stiffness at initial contact of gait, and as a result exhibited compensation strategies at the knee joint. Providing excessively stiff ankle-foot orthoses might put added stress on the extensor muscles of the knee joint, potentially creating fatigue and future pathologies in some patients with stroke. PMID:25241248

Examination of sustained gait speed during extended walking in individuals with chronic stroke.

PubMed

Altenburger, Peter A; Dierks, Tracy A; Miller, Kristine K; Combs, Stephanie A; Van Puymbroeck, Marieke; Schmid, Arlene A

2013-12-01

To determine if individuals with chronic stroke were able to sustain their peak gait speed during the 6-minute walk test (6MWT), and to explore this sustainability across community ambulation potential subgroups. Prospective cross-sectional study. University-based research laboratory, hospitals, and stroke support groups. A sample of individuals with chronic stroke (N=48) completed a series of questionnaires and physical outcome measures, including gait mat assessment, during a single visit. Not applicable; 1-time cross-sectional data collection. During the 6MWT, we measured peak gait speed and end gait speed to assess sustainability, along with beginning gait speed, total distance walked, and rating of perceived exertion. We also assessed maximum gait speed during the 10-meter walk test (10MWT). Finally, we examined these gait outcomes across the subgroups. During the 6MWT, peak gait speed declined from .89m/s (SD=.38) to an end speed of .82m/s (SD=.36), whereas perceived exertion increased from 7.7 (SD=2.6) to 11.8 (SD=3.6). This peak gait speed was slower than the 10MWT maximum speed of 1.06m/s (SD=.51), but faster than the 6MWT beginning speed of .81m/s (SD=.34). The unlimited community ambulator subgroup was the primary contributor to sustainability differences. Predicting community ambulation potential based on the discrete gait speed from the 10MWT and endurance based on the average from the 6MWT might be incomplete if gait speed sustainability is not also assessed. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Characteristics of exercise training interventions to improve cardiorespiratory fitness after stroke: a systematic review with meta-analysis.

PubMed

Marsden, Dianne L; Dunn, Ashlee; Callister, Robin; Levi, Christopher R; Spratt, Neil J

2013-01-01

Cardiorespiratory fitness is low after stroke. Improving fitness has the potential to improve function and reduce secondary cardiovascular events. . This review with meta-analysis aims to identify characteristics and determine the effectiveness of interventions to improve cardiorespiratory fitness after stroke. A systematic search and review with meta-analysis was undertaken. Key inclusion criteria were the following: peer-reviewed articles published in English, adult stroke survivors, an intervention with the potential to improve cardiorespiratory fitness, and peak oxygen consumption (VO2peak) assessed preintervention and postintervention via a progressive aerobic exercise test. From 3209 citations identified, 28 studies were included, reporting results for 920 participants. Studies typically included chronic, ambulant participants with mild to moderate deficits; used an aerobic or mixed (with an aerobic component) intervention; and prescribed 3 sessions per week for 30 to 60 minutes per session at a given intensity. Baseline VO2peak values were low (8-23 mL/kg/min). Meta-analysis of the 12 randomized controlled trials demonstrated overall improvements in VO2peak of 2.27 (95% confidence interval = 1.58, 2.95) mL/kg/min postintervention. A similar 10% to 15% improvement occurred with both aerobic and mixed interventions and in shorter (≤ 3 months) and longer (>3 months) length programs. Only 1 study calculated total dose received and only 1 included long-term follow-up. The results demonstrate that interventions with an aerobic component can improve cardiorespiratory fitness poststroke. Further investigation is required to determine effectiveness in those with greater impairment and comorbidities, optimal timing and dose of intervention, whether improvements can be maintained in the longer term, and whether improved fitness results in better function and reduced risk of subsequent cardiovascular events.

The effects of upper and lower limb position on symmetry of vertical ground reaction force during sit-to-stand in chronic stroke subjects

PubMed Central

Lee, Jae Hong; Min, Dong Ki; Choe, Han Seong; Lee, Jin Hwan; Shin, So Hong

2018-01-01

[Purpose] The purpose of this study was to evaluate the influence of arm and leg posture elements on symmetrical weight bearing during Sit to Stand tasks in chronic stroke patients. [Subjects and Methods] The subjects were diagnosed with stroke and 22 patients (15 males and 7 females) participated in this study. All participants performed Sit to Stand tasks on three foot postures and two arm postures. Two force plates were used to measure peak of vertical ground reaction force and symmetrical ratio to peak Fz. The data were analyzed using independent t-test and two-way repeated ANOVA. [Results] The results of this study are as follows: 1) Peak Fz placed more weight in non-paretic leg during Sit to Stand. 2) A symmetrical ratio to Peak Fz indicated significant difference between foot and arm posture, and had non-paretic limb supported on a step and paretic at ground level (STP) and grasped arm posture that lock fingers together with shoulder flexion by 90°(GA) (0.79 ± 0.09). [Conclusion] These results suggest that STP posture of the legs and GA posture of the arms should be able to increase the use of the paretic side during Sit to Stand behavior and induce normal Sit to Stand mechanism through the anterior tilt of the hip in clinical practices, by which loads onto the knee joint and the ankle joint can be reduced, and the trunk righting response can be promoted by making the back fully stretched. The outcome of this study is expected to be a reference for exercise or prognosis of Sit to Stand in stroke patients. PMID:29545686

Polygenic overlap between kidney function and large artery atherosclerotic stroke

PubMed Central

Holliday, Elizabeth G.; Traylor, Matthew; Malik, Rainer; Bevan, Stephen; Maguire, Jane; Koblar, Simon A.; Sturm, Jonathan; Hankey, Graeme J.; Oldmeadow, Christopher; McEvoy, Mark; Sudlow, Cathie; Rothwell, Peter M.; Coresh, Josef; Hamet, Pavel; Tremblay, Johanne; Turner, Stephen T.; de Andrade, Mariza; Rao, Madhumathi; Schmidt, Reinhold; Crick, Peter A.; Robino, Antonietta; Peralta, Carmen A.; Jukema, J. Wouter; Mitchell, Paul; Rosas, Sylvia E.; Wang, Jie Jin; Scott, Rodney J.; Dichgans, Martin; Mitchell, Braxton D.; Linda Kao, W. H.; Fox, Caroline S.; Levi, Christopher; Attia, John; Markus, Hugh S

2014-01-01

Background and Purpose Epidemiological studies show strong associations between kidney dysfunction and risk of ischaemic stroke, the mechanisms of which are incompletely understood. We investigated whether these associations may reflect shared heritability due to a common polygenic basis and whether this differed for ischaemic stroke subtypes. Methods Polygenic models were derived using GWAS meta-analysis results for three kidney traits: estimated glomerular filtration rate using serum creatinine (eGFRcrea: N=73,998), eGFR using cystatin C (eGFRcys: N=22,937) and urinary albumin to creatinine ratio (UACR: N=31,580). For each, SNPs passing ten P-value thresholds were used to form profile scores in 4,561 ischaemic stroke cases and 7,094 controls from the UK, Germany and Australia. Scores were tested for association with ischaemic stroke and its three aetiological subtypes: large artery atherosclerosis (LAA), cardioembolism (CE) and small vessel disease (SVD). Results Polygenic scores correlating with higher eGFRcrea were associated with reduced risk of LAA, with five scores reaching P<0.05 (peak P=0.004) and all showing the epidemiologically expected direction of effect. A similar pattern was observed for polygenic scores reflecting higher UACR, of which three associated with LAA (peak P=0.01) and all showed the expected directional association. One UACR-based score also associated with SVD (P=0.03). The global pattern of results was unlikely to have occurred by chance (P=0.02). Conclusions This study suggests possible polygenic correlation between renal dysfunction and ischaemic stroke. The shared genetic components may be specific to stroke subtypes, particularly large artery atherosclerotic stroke. Further study of the genetic relationships between these disorders appears merited. PMID:25352485

Laboratory measurement of apixaban using anti-factor Xa assays in acute ischemic stroke patients with non-valvular atrial fibrillation.

PubMed

Shin, Hyoshim; Cho, Min-Chul; Kim, Rock Bum; Kim, Chang-Hun; Choi, Nack-Cheon; Kim, Soo-Kyung; Koh, Eun-Ha

2018-02-01

Apixaban is effective and safe for preventing stroke, and its usage has increased exponentially in recent years. However, data concerning the therapeutic range of apixaban is limited. This study determined the trough and peak levels of apixaban-specific anti-factor Xa activity (AFXaA) in acute ischemic stroke patients with non-valvular atrial fibrillation (NVAF) in Korea. The study included 85 patients who received apixaban. Blood samples were taken to measure the trough and peak levels of AFXaA using a chromogenic anti-factor assay, as well as prothrombin time (PT) and activated partial thromboplastin time (aPTT). We also reviewed complications such as major bleeding of patients treated with apixaban. In patients given a 5.0-mg apixaban dose, the median trough and peak levels of AFXaA were 104.5 and 202.0 ng/mL. In patients given a 2.5-mg apixaban dose, the median trough and peak AFXaA levels were 76.0 and 151.0 ng/mL. The PT showed a positive correlation with increased AFXaA activity at both levels (Trough R = 0.486, Peak R = 0.592), but the aPTT had no relationship with AFXaA activity at both levels (Trough R = 0.181, Peak R = 0.129). Two cases with intracranial bleeding belonged to the highest AFXaA quartile (Trough, p = 0.176; Peak, p = 0.053). In conclusion, we determined the trough and peak levels of AFXaA in patients with NVAF while being treated with the apixaban in Korea. Our results could be used as a starting point when setting the reference ranges for laboratories using anti-Xa assay. Large-scale studies are needed to establish the reference range for AFXaA in patients with NVAF.

Dysphagia in Stroke: A New Solution

PubMed Central

Langdon, Claire; Blacker, David

2010-01-01

Dysphagia is extremely common following stroke, affecting 13%–94% of acute stroke sufferers. It is associated with respiratory complications, increased risk of aspiration pneumonia, nutritional compromise and dehydration, and detracts from quality of life. While many stroke survivors experience a rapid return to normal swallowing function, this does not always happen. Current dysphagia treatment in Australia focuses upon prevention of aspiration via diet and fluid modifications, compensatory manoeuvres and positional changes, and exercises to rehabilitate paretic muscles. This article discusses a newer adjunctive treatment modality, neuromuscular electrical stimulation (NMES), and reviews the available literature on its efficacy as a therapy for dysphagia with particular emphasis on its use as a treatment for dysphagia in stroke. There is a good theoretical basis to support the use of NMES as an adjunctive therapy in dysphagia and there would appear to be a great need for further well-designed studies to accurately determine the safety and efficacy of this technique. PMID:20721336

Activity limitations and participation restrictions experienced by people with stroke in Musanze district in Rwanda.

PubMed

Urimubenshi, Gerard

2015-09-01

Stroke is a major cause of long-term disability. Information regarding the limitations in activity and participation experienced by patients with stroke in a specific setting such as Musanze district in Rwanda would assist to develop the rehabilitation programmes that would take into consideration the functional challenges experienced post stroke. To explore the activity limitations and participation restrictions experienced by people with stroke in Musanze district in Rwanda. A qualitative phenomenological approach using in-depth face-to-face interviews with 10 participants was employed to gather the data that was analyzed using a qualitative thematic approach. The themes that arose as activity limitations included limitations in walking, self care, and domestic life activities. The themes related to participation restrictions as expressed by the participants were inability to return to previous occupation, decreased social interactions and inability to participate in religious activities. The current study findings highlight the need for interventions to improve the functional status of stroke survivors.

Chronic post-stroke oropharyngeal dysphagia is associated with impaired cortical activation to pharyngeal sensory inputs.

PubMed

Cabib, C; Ortega, O; Vilardell, N; Mundet, L; Clavé, P; Rofes, L

2017-11-01

The role of afferent sensory pathways in the pathophysiology of post-stroke oropharyngeal dysphagia is not known. We hypothesized that patients with chronic post-stroke dysphagia (PSD) would show impaired sensory cortical activation in the ipsilesional hemisphere. We studied 28 chronic unilateral post-stroke patients [17 PSD and 11 post-stroke non-dysphagic patients (PSnD)] and 11 age-matched healthy volunteers. Event-related sensory-evoked potentials to pharyngeal stimulation (pSEP) and sensory thresholds were assessed. We analyzed pSEP peak latency and amplitude (N1, P1, N2 and P2), and neurotopographic stroke characteristics from brain magnetic resonance imaging. Healthy volunteers presented a highly symmetric bihemispheric cortical pattern of brain activation at centroparietal areas (N1-P1 and N2-P2) to pharyngeal stimuli. In contrast, an asymmetric pattern of reduced ipsilesional activation was found in PSD (N2-P2; P = 0.026) but not in PSnD. PSD presented impaired safety of swallow (penetration-aspiration score: 4.3 ± 1.6), delayed laryngeal vestibule closure (360.0 ± 70.0 ms) and higher National Institute of Health Stroke Scale (7.0 ± 6.2 vs. 1.9 ± 1.4, P = 0.001) and Fazekas scores (3.0 ± 1.4 vs. 2.0 ± 1.1; P < 0.05) than PSnD. pSEP showed a unilateral delay at stroke site exclusively for PSD (peak-latency interhemispheric difference vs. PSnD: N1, 6.5 ± 6.7 vs. 1.1 ± 1.0 ms; N2, 32.0 ± 15.8 vs. 4.5 ± 4.9 ms; P < 0.05). Chronic post-stroke oropharyngeal dysphagia is associated with stroke severity and degree of leukoaraoisis. Impaired conduction and cortical integration of pharyngeal sensory inputs at stroke site are key features of chronic PSD. These findings highlight the role of sensory pathways in the pathophysiology of post-stroke oropharyngeal dysphagia and offer a potential target for future treatments. © 2017 EAN.

Exertion fatigue and chronic fatigue are two distinct constructs in people post-stroke.

PubMed

Tseng, Benjamin Y; Billinger, Sandra A; Gajewski, Byron J; Kluding, Patricia M

2010-12-01

Post-stroke fatigue is a common and neglected issue despite the fact that it impacts daily functions, quality of life, and has been linked with a higher mortality rate because of its association with a sedentary lifestyle. The purpose of this study was to identify the contributing factors of exertion fatigue and chronic fatigue in people post-stroke. Twenty-one post-stroke people (12 males, 9 females; 59.5 ± 10.3 years of age; time after stroke 4.1 ± 3.5 years) participated in the study. The response variables included exertion fatigue and chronic fatigue. Participants underwent a standardized fatigue-inducing exercise on a recumbent stepper. Exertion fatigue level was assessed at rest and immediately after exercise using the Visual Analog Fatigue Scale. Chronic fatigue was measured by the Fatigue Severity Scale. The explanatory variables included aerobic fitness, motor control, and depressive symptoms measured by peak oxygen uptake, Fugl-Meyer motor score, and the Geriatric Depression Scale, respectively. Using forward stepwise regression, we found that peak oxygen uptake was an independent predictor of exertion fatigue (P = 0.006), whereas depression was an independent predictor of chronic fatigue (P = 0.002). Exertion fatigue and chronic fatigue are 2 distinct fatigue constructs, as identified by 2 different contributing factors.

Participation in Leisure Activity and Exercise of Chronic Stroke Survivors Using Community-Based Rehabilitation Services in Seongnam City

PubMed Central

Yi, Tae Im; Lee, Ko Eun; Ha, Seung A

2015-01-01

Objective To clarify how participation in leisure activities and exercise by chronic stroke survivors differs before and after a stroke. Methods Sixty chronic stroke survivors receiving community-based rehabilitation services from a health center in Seongnam City were recruited. They completed a questionnaire survey regarding their demographic characteristics and accompanying diseases, and on the status of their leisure activities and exercise. In addition, their level of function (Korean version of Modified Barthel Index score), risk of depression (Beck Depression Inventory), and quality of life (SF-8) were measured. Results After their stroke, most of the respondents had not returned to their pre-stroke levels of leisure activity participation. The reported number of leisure activities declined from a mean of 3.9 activities before stroke to 1.9 activities post-stroke. In addition, many participants became home-bound, sedentary, and non-social after their stroke. The most common barriers to participation in leisure activities were weakness and poor balance, lack of transportation, and cost. The respondents reported a mean daily time spent on exercise of 2.6±1.3 hours. Pain was the most common barrier to exercise participation. Conclusion Chronic stroke survivors need information on leisure activities and appropriate pain management. PMID:25932420

Effect of wearing clothes on oxygen uptake and ratings of perceived exertion while swimming.

PubMed

Choi, S W; Kurokawa, T; Ebisu, Y; Kikkawa, K; Shiokawa, M; Yamasaki, M

2000-07-01

For a comparative study between swimming in swimwear (control-sw) and swimming in clothes (clothes-sw), oxygen uptake (VO2) and ratings of perceived exertion (RPE) were measured. The subjects were six male members of a university swimming team. Three swimming strokes--the breaststroke, the front crawl stroke and the elementary backstroke--were applied. With regards to clothes-sw, swimmers wore T-shirts, sportswear (shirt and pants) over swimwear and running shoes. In both cases of control-sw and clothes-sw, the VO2 was increased exponentially with increased swimming speed. The VO2 of the subjects during the clothed tests did not exceed 1.4 times of that in the case of control-sw at swimming speeds below 0.3 m/s. As swimming speeds increased, VO2 difference in both cases increased. Consequently, VO2 in the clothed tests was equal to 1.5-1.6 times and 1.5-1.8 times of that in the swimwear tests at speeds of 0.5 and 0.7 m/s, respectively. At speeds below 0.6 m/s in clothes-sw, the breaststroke showed lower VO2 than the front crawl stroke, and the elementary backstroke showed higher VO2 than the other two swimming strokes. RPE increased linearly with %peak VO2. In addition, any RPE differences among the three swimming strokes were not shown in the control-sw tests. At an exercise intensity above 60 %peak VO2, clothed swimmers showed slightly higher RPE in the front crawl stroke compared to that in the two other swimming strokes.

Virtual Reality for Upper Limb Rehabilitation in Subacute and Chronic Stroke: A Randomized Controlled Trial.

PubMed

Kiper, Pawel; Szczudlik, Andrzej; Agostini, Michela; Opara, Jozef; Nowobilski, Roman; Ventura, Laura; Tonin, Paolo; Turolla, Andrea

2018-05-01

To evaluate the effectiveness of reinforced feedback in virtual environment (RFVE) treatment combined with conventional rehabilitation (CR) in comparison with CR alone, and to study whether changes are related to stroke etiology (ie, ischemic, hemorrhagic). Randomized controlled trial. Hospital facility for intensive rehabilitation. Patients (N=136) within 1 year from onset of a single stroke (ischemic: n=78, hemorrhagic: n=58). The experimental treatment was based on the combination of RFVE with CR, whereas control treatment was based on the same amount of CR. Both treatments lasted 2 hours daily, 5d/wk, for 4 weeks. Fugl-Meyer upper extremity scale (F-M UE) (primary outcome), FIM, National Institutes of Health Stroke Scale (NIHSS), and Edmonton Symptom Assessment Scale (ESAS) (secondary outcomes). Kinematic parameters of requested movements included duration (time), mean linear velocity (speed), and number of submovements (peak) (secondary outcomes). Patients were randomized in 2 groups (RFVE with CR: n=68, CR: n=68) and stratified by stroke etiology (ischemic or hemorrhagic). Both groups improved after treatment, but the experimental group had better results than the control group (Mann-Whitney U test) for F-M UE (P<.001), FIM (P<.001), NIHSS (P≤.014), ESAS (P≤.022), time (P<.001), speed (P<.001), and peak (P<.001). Stroke etiology did not have significant effects on patient outcomes. The RFVE therapy combined with CR treatment promotes better outcomes for upper limb than the same amount of CR, regardless of stroke etiology. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Oxygen uptake during functional activities after stroke—Reliability and validity of a portable ergospirometry system

PubMed Central

Brurok, Berit; Tjønna, Arnt Erik; Tørhaug, Tom; Askim, Torunn

2017-01-01

Background People with stroke have a low peak aerobic capacity and experience increased effort during performance of daily activities. The purpose of this study was to examine test-retest reliability of a portable ergospirometry system in people with stroke during performance of functional activities in a field-test. Secondary aims were to examine the proportion of oxygen consumed during the field-test in relation to the peak-test and to analyse the correlation between the oxygen uptake during the field-test and peak-test in order to support the validity of the field-test. Methods With simultaneous measurement of oxygen consumption, participants performed a standardized field-test consisting of five activities; walking over ground, stair walking, stepping over obstacles, walking slalom between cones and from a standing position lifting objects from one height to another. All activities were performed in self-selected speed. Prior to the field-test, a peak aerobic capacity test was performed. The field-test was repeated minimum 2 and maximum 14 days between the tests. ICC2,1 and Bland Altman tests (Limits of Agreement, LoA) were used to analyse test-retest reliability. Results In total 31 participants (39% women, mean (SD) age 54.5 (12.7) years and 21.1 (14.3) months’ post-stroke) were included. The ICC2,1 was ≥ 0.80 for absolute V̇O2, relative V̇O2, minute ventilation, CO2, respiratory exchange ratio, heart rate and Borgs rating of perceived exertion. ICC2,1 for total time to complete the field-test was 0.99. Mean difference in steady state V̇O2 during Test 1 and Test 2 was -0.40 (2.12) The LoAs were -3.75 and 4.51. Participants spent 60.7% of their V̇O2peak performing functional activities. Correlation between field-test and peak-test was 0.689, p = 0.001 for absolute and 0.733, p = 0.001 for relative V̇O2. Conclusions This study presents first evidence on reliability of oxygen uptake during performance of functional activities after stroke, showing very good test-retest reliability. The secondary analysis showed that the amount of energy spent during the field-test relative to the peak-test was high and the correlation between the two test was good, supporting the validity of this method. PMID:29065164

[The education influence on effects of rehabilitation in patients after stroke].

PubMed

Dudka, Sabina; Winczewski, Piotr; Janczewska, Katarzyna; Kubsik, Anna; Woldańska-Okońska, Marta

2016-11-25

Patients after stroke face a new situation where some educational and pedagogical actions should be reinitiated. Stroke often causes a break away from the previous lifestyle. It the acute phase it excludes the possibility of employment or performance of household duties that were carried out before or indulging in previously preferred ways of spending free time. Patients often abandon the habits that they developed before stroke, inclusive of hygienic habits. Therefore, it is an important objective of rehabilitation to reinstate in stroke patients behaviours characteristic of their peers, which would mark the beginning of their own care for health. The pedagogic and educational activities should lead to a transformation in the patient. This could be one of the factors in facilitating the patient's return to previous forms of activity. The aim of this study was to analyze progress in patient's rehabilitation and satisfaction, to assess impact of health education on higher satisfaction and better knowledge in stroke patients as well as on their recovery. Another aim was to assess the factors that maximize the patients' chances of returning to the labor market. The study involved 30 patients after stroke, 8 women and 22 men, over 40 years of age, who underwent either early or late rehabilitation, the type of which affected the time of treatment. The minimal duration of the patient's stay was 21 days, in which time an individually tailored way of education, rehabilitation, treatment and care was implemented. The study used a questionnaire and the Bartel and the Rankin scales. The subject of the analysis consisted of 22 questions that were based on hypotheses. They assessed the facts, the sources of information, knowledge and subjective feelings of the patients concerning the education carried out by the rehabilitation team and its impact on the patients' rehabilitation. A highly significant (p<0,01) improvement to patients' health and an increase in their knowledge were observed in the rehabilitation. During the rehabilitation patients gained a significant improvement to their health, which resulted in more independence in daily living. The implemented health education has an effect on the scope of the patients' knowledge during and after rehabilitation, which translates into a higher satisfaction from the patient's education. The acquired knowledge and skills increase the chances of the patient to return to activities and participation in social life at a satisfactory level. The members of the rehabilitation team, especially the physicians, play an important role in health education of patients.

Some properties of negative cloud-to-ground flashes from observations of a local thunderstorm based on accurate-stroke-count studies

NASA Astrophysics Data System (ADS)

Zhu, Baoyou; Ma, Ming; Xu, Weiwei; Ma, Dong

2015-12-01

Properties of negative cloud-to-ground (CG) lightning flashes, in terms of number of strokes per flash, inter-stroke intervals and the relative intensity of subsequent and first strokes, were presented by accurate-stroke-count studies based on all 1085 negative flashes from a local thunderstorm. The percentage of single-stroke flashes and stroke multiplicity evolved significantly during the whole life cycle of the study thunderstorm. The occurrence probability of negative CG flashes decreased exponentially with the increasing number of strokes per flash. About 30.5% of negative CG flashes contained only one stroke and number of strokes per flash averaged 3.3. In a subset of 753 negative multiple-stroke flashes, about 41.4% contained at least one subsequent stroke stronger than the corresponding first stroke. Subsequent strokes tended to decrease in strength with their orders and the ratio of subsequent to first stroke peaks presented a geometric mean value of 0.52. Interestingly, negative CG flashes of higher multiplicity tended to have stronger initial strokes. 2525 inter-stroke intervals showed a more or less log-normal distribution and gave a geometric mean value of 62 ms. For CG flashes of particular multiplicity geometric mean inter-stroke intervals tended to decrease with the increasing number of strokes per flash, while those intervals associated with higher order strokes tended to be larger than those associated with low order strokes.

Individualised home-based rehabilitation after stroke in eastern Finland--the client's perspective.

PubMed

Reunanen, Merja A T; Järvikoski, Aila; Talvitie, Ulla; Pyöriä, Outi; Härkäpää, Kristiina

2016-01-01

Reintegration into society is one of the main purposes of post-stroke rehabilitation. The experiences of clients returning home after a stroke have been studied before. There is, however, little knowledge about activities carried out during home-based rehabilitation interventions and about the involvement of clients in the process. This study focused on clients' experiences of a 3-month individualised, home-based rehabilitation programme supervised by a multidisciplinary team. The data were collected in 2009-2010, and it was based on interviews with 14 clients (48-83 years of age) conducted approximately 7 months after stroke. In the thematic analysis, five main topics describing the goals and functions of the home-based rehabilitation were identified as follows: (i) learning strategies for solving problems in daily activities at home and in the community; (ii) receiving exercise coaching; (iii) exploring community services and facilities; (iv) having a dialogue with professionals; and (v) engaging in activities aimed at returning to work. Implementing rehabilitation activities in the home environment seemed to enhance the participants' active involvement and their ability to evaluate themselves and to set goals for their recovery. Work was an important goal for clients of working age, but work-related tasks were not sufficiently integrated with home-based rehabilitation. A challenge for local communities is to provide health promotion and recreation services that are also suitable for persons with limited functioning. © 2015 John Wiley & Sons Ltd.

High Speed Video Observations of Natural Lightning and Their Implications to Fractal Description of Lightning

NASA Astrophysics Data System (ADS)

Liu, N.; Tilles, J.; Boggs, L.; Bozarth, A.; Rassoul, H.; Riousset, J. A.

2016-12-01

Recent high speed video observations of triggered and natural lightning flashes have significantly advanced our understanding of lightning initiation and propagation. For example, they have helped resolve the initiation of lightning leaders [Stolzenburg et al., JGR, 119, 12198, 2014; Montanyà et al, Sci. Rep., 5, 15180, 2015], the stepping of negative leaders [Hill et al., JGR, 116, D16117, 2011], the structure of streamer zone around the leader [Gamerota et al., GRL, 42, 1977, 2015], and transient rebrightening processes occurring during the leader propagation [Stolzenburg et al., JGR, 120, 3408, 2015]. We started an observational campaign in the summer of 2016 to study lightning by using a Phantom high-speed camera on the campus of Florida Institute of Technology, Melbourne, FL. A few interesting natural cloud-to-ground and intracloud lightning discharges have been recorded, including a couple of 8-9 stroke flashes, high peak current flashes, and upward propagating return stroke waves from ground to cloud. The videos show that the propagation of the downward leaders of cloud-to-ground lightning discharges is very complex, particularly for the high-peak current flashes. They tend to develop as multiple branches, and each of them splits repeatedly. For some cases, the propagation characteristics of the leader, such as speed, are subject to sudden changes. In this talk, we present several selected cases to show the complexity of the leader propagation. One of the effective approaches to characterize the structure and propagation of lightning leaders is the fractal description [Mansell et al., JGR, 107, 4075, 2002; Riousset et al., JGR, 112, D15203, 2007; Riousset et al., JGR, 115, A00E10, 2010]. We also present a detailed analysis of the high-speed images of our observations and formulate useful constraints to the fractal description. Finally, we compare the obtained results with fractal simulations conducted by using the model reported in [Riousset et al., 2007, 2010].

Factors associated with community reintegration in the first year after stroke: a qualitative meta-synthesis.

PubMed

Walsh, Mary E; Galvin, Rose; Loughnane, Cliona; Macey, Chris; Horgan, N Frances

2015-01-01

Although acute stroke care has improved survival, many individuals report dissatisfaction with community reintegration after stroke. The aim of this qualitative meta-synthesis was to examine the barriers and facilitators of community reintegration in the first year after stroke from the perspective of people with stroke. A systematic literature search was conducted. Papers that used qualitative methods to explore the experiences of individuals with stroke around community reintegration in the first year after stroke were included. Two reviewers independently assessed the methodological quality of papers. Themes, concepts and interpretations were extracted from each study, compared and meta-synthesised. From the 18 included qualitative studies four themes related to community reintegration in the first year after stroke were identified: (i) the primary effects of stroke, (ii) personal factors, (iii) social factors and (iv) relationships with professionals. This review suggests that an individual's perseverance, adaptability and ability to overcome emotional challenges can facilitate reintegration into the community despite persisting effects of their stroke. Appropriate support from family, friends, the broader community and healthcare professionals is important. Therapeutic activities should relate to meaningful activities and should be tailored to the individual stroke survivor. Stroke survivors feel that rehabilitation in familiar environments and therapeutic activities that reflect real-life could help their community re-integration. In addition to the physical sequelae of stroke, emotional consequences of stroke should be addressed during rehabilitation. Healthcare professionals can provide clear and locally relevant advice to facilitate aspects of community reintegration, including the return to driving and work.

Dynamic balance during walking adaptability tasks in individuals post-stroke.

PubMed

Vistamehr, Arian; Balasubramanian, Chitralakshmi K; Clark, David J; Neptune, Richard R; Fox, Emily J

2018-06-06

Maintaining dynamic balance during community ambulation is a major challenge post-stroke. Community ambulation requires performance of steady-state level walking as well as tasks that require walking adaptability. Prior studies on balance control post-stroke have mainly focused on steady-state walking, but walking adaptability tasks have received little attention. The purpose of this study was to quantify and compare dynamic balance requirements during common walking adaptability tasks post-stroke and in healthy adults and identify differences in underlying mechanisms used for maintaining dynamic balance. Kinematic data were collected from fifteen individuals with post-stroke hemiparesis during steady-state forward and backward walking, obstacle negotiation, and step-up tasks. In addition, data from ten healthy adults provided the basis for comparison. Dynamic balance was quantified using the peak-to-peak range of whole-body angular-momentum in each anatomical plane during the paretic, nonparetic and healthy control single-leg-stance phase of the gait cycle. To understand differences in some of the key underlying mechanisms for maintaining dynamic balance, foot placement and plantarflexor muscle activation were examined. Individuals post-stroke had significant dynamic balance deficits in the frontal plane across most tasks, particularly during the paretic single-leg-stance. Frontal plane balance deficits were associated with wider paretic foot placement, elevated body center-of-mass, and lower soleus activity. Further, the obstacle negotiation task imposed a higher balance requirement, particularly during the trailing leg single-stance. Thus, improving paretic foot placement and ankle plantarflexor activity, particularly during obstacle negotiation, may be important rehabilitation targets to enhance dynamic balance during post-stroke community ambulation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Doppler aortic flow velocity measurement in healthy children.

PubMed Central

Sohn, S.; Kim, H. S.

2001-01-01

To determine normal values for Doppler parameters of left ventricular function, ascending aortic blood flow velocity was measured by pulsed wave Doppler echocardiography in 63 healthy children with body surface area (BSA) < 1 m(2) (age < 10 yr). Peak velocity was independent of sex, but increased with body size. Mean acceleration was related to peak velocity (r = 0.75, p < 0.0001). Both stroke distance and ejection time had strong negative correlations with heart rate and positive correlations with BSA, suggesting that these parameters should be evaluated in relation to heart rate and body size. Mean intra- and interobserver variability for peak velocity, ejection time, stroke and minute distance ranged from 3 to 7%, whereas variability for acceleration time was 9 to 13%. These data may be used as reference values for the assessment of hemodynamic states in young children with cardiac disease. PMID:11306737

Intravenous lipid emulsion alters the hemodynamic response to epinephrine in a rat model.

PubMed

Carreiro, Stephanie; Blum, Jared; Jay, Gregory; Hack, Jason B

2013-09-01

Intravenous lipid emulsion (ILE) is an adjunctive antidote used in selected critically ill poisoned patients. These patients may also require administration of advanced cardiac life support (ACLS) drugs. Limited data is available to describe interactions of ILE with standard ACLS drugs, specifically epinephrine. Twenty rats with intra-arterial and intravenous access were sedated with isoflurane and split into ILE or normal saline (NS) pretreatment groups. All received epinephrine 15 μm/kg intravenously (IV). Continuous mean arterial pressure (MAP) and heart rate (HR) were monitored until both indices returned to baseline. Standardized t tests were used to compare peak MAP, time to peak MAP, maximum change in HR, time to maximum change in HR, and time to return to baseline MAP/HR. There was a significant difference (p = 0.023) in time to peak MAP in the ILE group (54 s, 95 % CI 44-64) versus the NS group (40 s, 95 % CI 32-48) and a significant difference (p = 0.004) in time to return to baseline MAP in ILE group (171 s, 95 % CI 148-194) versus NS group (130 s, 95 % CI 113-147). There were no significant differences in the peak change in MAP, peak change in HR, time to minimum HR, or time to return to baseline HR between groups. ILE-pretreated rats had a significant difference in MAP response to epinephrine; ILE delayed the peak effect and prolonged the duration of effect of epinephrine on MAP, but did not alter the peak increase in MAP or the HR response.

Preferential location for arterial dissection presenting as golf-related stroke.

PubMed

Choi, M H; Hong, J M; Lee, J S; Shin, D H; Choi, H A; Lee, K

2014-02-01

Golf-related stroke has not been systematically reviewed. The purpose of our study was to describe in detail this particular stroke syndrome. Seven patients were analyzed at a university hospital and 7 patients were reviewed from MEDLINE literature. General demographics, symptom onset, neurologic signs, radiologic findings, and outcome were investigated. A total of 14 patients including 7 patients from the MEDLINE search were analyzed; all were men, with a mean age of 46.9 ± 12.8 years. Symptom onset was classified as during the golf swing (n = 9), unknown (n = 3), and after playing golf (n = 2). Most patients (n = 12) showed involvement of the vertebral artery and 2 patients showed involvement of the internal carotid artery (P = .008). Nine dissections were found on the right side, 3 on the left side, and 2 were bilateral (P = .046). Twelve patients had extracranial involvement and 2 patients had intracranial involvement (P = .008). Seven patients returned to normal, 5 returned to independence, 1 had unknown status, and 1 died. The anatomic preference of golf-related craniocervical arterial dissection is associated with the extracranial and vertebrobasilar system with a right-sided tendency as the result of stereotypical rotational movement during a golf swing.

The development and implementation of the structured training programme for caregivers of inpatients after stroke (TRACS) intervention: the London Stroke Carers Training Course.

PubMed

Forster, Anne; Dickerson, Josie; Melbourn, Anne; Steadman, Jayne; Wittink, Margreet; Young, John; Kalra, Lalit; Farrin, Amanda

2015-03-01

To describe the content and delivery of the adapted London Stroke Carers Training Course intervention evaluated in the Training Caregivers after Stroke (TRACS) trial. The London Stroke Carers Training Course is a structured training programme for caregivers of inpatients who are likely to return home after their stroke. The course was delivered by members of the multidisciplinary team while the patient was in the stroke unit with one recommended 'follow through' session after discharge home. The intervention consists of 14 training components (six mandatory) that were identified as important knowledge/skills that caregivers would need to be able to care for the stroke patient after discharge home. Following national training days, the London Stroke Carers Training Course was disseminated to intervention sites by the cascade method of implementation. The intervention was adapted for implementation across a range of stroke units. Training days were well attended (median 2.5 and 2.0 attendees per centre for the first and second days, respectively) and the feedback positive, demonstrating 'face validity' for the intervention. However cascading of this training to other members of the multidisciplinary team was not consistent, with 7/18 centres recording no cascade training. The adapted London Stroke Carers Training Course provided a training programme that could be delivered in a standardised, structured way in a variety of stroke unit settings throughout the UK. The intervention was well received by stroke unit staff, however, the cascade method of implementation was not as effective as we would have wished. © The Author(s) 2014.

American College of Sports Medicine Roundtable on Exertional Heat Stroke - Return to Duty/Return to Play: Conference Proceedings

DTIC Science & Technology

2010-01-01

individuals with EHS experience long-term complica- tions that may include multisystem organ (liver, kidney, muscle ) and neurologic damage, as well as... reduced exercise capacity and heat intolerance (12,52,57,69). Animal and human research suggest late or untreated EHS may result in organ damage that...collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and

Stroke unit care benefits patients with intracerebral hemorrhage: systematic review and meta-analysis.

PubMed

Langhorne, Peter; Fearon, Patricia; Ronning, Ole M; Kaste, Markku; Palomaki, Heikki; Vemmos, Kostos; Kalra, Lalit; Indredavik, Bent; Blomstrand, Christian; Rodgers, Helen; Dennis, Martin S; Al-Shahi Salman, Rustam

2013-11-01

Patients with any type of stroke managed in organized inpatient (stroke unit) care are more likely to survive, return home, and regain independence. However, it is uncertain whether these benefits apply equally to patients with intracerebral hemorrhage and ischemic stroke. We conducted a secondary analysis of a systematic review of controlled clinical trials comparing stroke unit care with general ward care, including only trials published after 1990 that could separately report outcomes for patients with intracerebral hemorrhage and ischemic stroke. We performed random-effects meta-analyses and tested for subgroup interactions by stroke type. We identified 13 trials (3570 patients) of modern stroke unit care that recruited patients with intracerebral hemorrhage and ischemic stroke, of which 8 trials provided data on 2657 patients. Stroke unit care reduced death or dependency (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.471-0.92; P=0.0009; I2=60%) with no difference in benefits for patients with intracerebral hemorrhage (RR, 0.79; 95% CI, 0.61-1.00) than patients with ischemic stroke (RR, 0.82; 95% CI, 0.70-0.97; Pinteraction=0.77). Stroke unit care reduced death (RR, 0.79; 95% CI, 0.64-0.97; P=0.02; I2=49%) to a greater extent for patients with intracerebral hemorrhage (RR, 0.73; 95% CI, 0.54-0.97) than patients with ischemic stroke (RR, 0.82; 95%, CI 0.61-1.09), but this difference was not statistically significant (Pinteraction=0.58). Patients with intracerebral hemorrhage seem to benefit at least as much as patients with ischemic stroke from organized inpatient (stroke unit) care.

Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery

PubMed Central

Hatem, Samar M.; Saussez, Geoffroy; della Faille, Margaux; Prist, Vincent; Zhang, Xue; Dispa, Delphine; Bleyenheuft, Yannick

2016-01-01

Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients' mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation. PMID:27679565

Influence of handrim wheelchair propulsion training in adolescent wheelchair users, a pilot study.

PubMed

Dysterheft, Jennifer L; Rice, Ian M; Rice, Laura A

2015-01-01

Ten full-time adolescent wheelchair users (ages 13-18) completed a total of three propulsion trials on carpet and tile surfaces, at a self-selected velocity, and on a concrete surface, at a controlled velocity. All trials were performed in their personal wheelchair with force and moment sensing wheels attached bilaterally. The first two trials on each surface were used as pre-intervention control trials. The third trial was performed after receiving training on proper propulsion technique. Peak resultant force, contact angle, stroke frequency, and velocity were recorded during all trials for primary analysis. Carpet and tile trials resulted in significant increases in contact angle and peak total force with decreased stroke frequency after training. During the velocity controlled trials on concrete, significant increases in contact angle occurred, as well as decreases in stroke frequency after training. Overall, the use of a training video and verbal feedback may help to improve short-term propulsion technique in adolescent wheelchair users and decrease the risk of developing upper limb pain and injury.

The electric field distributions in anatomical head models during transcranial direct current stimulation for post-stroke rehabilitation.

PubMed

Manoli, Zoi; Parazzini, Marta; Ravazzani, Paolo; Samaras, Theodoros

2017-01-01

The lack of knowledge of the electric field distribution inside the brain of stroke patients receiving transcranial direct current stimulation (tDCS) calls for estimating it computationally. Moreover, the impact on this distribution of a novel clinical management approach which involves secondary motor areas (SMA) in stroke rehabilitation needs to be evaluated. Finally, the differences in the electric field distributions due to gender and age need to be investigated. This work presents the development of two different anatomical models (young adult female and elderly male) with an ischemic stroke region of spherical volume 10 cm 3 or 50 cm 3 , using numerical models of the Virtual Population (ViP). The stroke phase was considered as acute or chronic, resulting in different electrical properties of the area. Two different electrode montages were used - One over the lesion area and the contralateral supra-orbital region and the other over the SMA and the contralateral supra-orbital region. A quasi-electrostatic solver was used to numerically solve the Laplace equation with the finite-difference technique. Both the 99th percentile of the electric field intensity distribution ("E peak value") and the percentage of the tissue volumes with electric field intensity over 50% and 70% of the E peak value were assessed inside the target areas of the primary motor cortex (M1) and the SMA, as well as in other brain tissues (hypothalamus and cerebellum). In the acute phase of an ischemic stroke, the normalized electric field intensity distributions do not differ noticeably compared to those in the brain of a healthy person (mean square difference < 2%). The difference becomes larger (up to 4.5%) for the chronic phase of a large ischemic lesion. Moreover, the maximum values of the induced electric field in the tissues in the SMA are almost equal for both electrode montages. The peak values of the electric field distribution ("E peak values") in cerebellum and hypothalamus for both electrode montages are rather small but different from those of healthy patients. The largest difference of 21% decrease with respect to a healthy subject was noticed in the elder adult model with a large chronic lesion. The comparison of the different electrode montages shows that the use of a stimulating electrode over the affected area creates larger values of the electric field in M1, by up to 26% for a small chronic lesion in the young female model. On the contrary, the montage does not affect considerably (change less than 8%) the E peak values in the SMA. This implies that for exciting M1, the M1-Fp2 montage should be favored. The presence and the phase of an ischemic stroke lesion, as well as the configuration of electrode montages affect the distribution and the maximum value of the electric field induced in tissues. Moreover, patients whom seem to benefit most from tDCS are those in the chronic phase of an ischemic stroke, since contrasts in the tissue conductivity result in a higher electric field induced around the lesion volume, which could stimulate the remaining healthy tissue in the area. © 2016 American Association of Physicists in Medicine.

Anesthesia-Induced Hypothermia Attenuates Early-Phase Blood-Brain Barrier Disruption but Not Infarct Volume following Cerebral Ischemia.

PubMed

Liu, Yu-Cheng; Lee, Yu-Da; Wang, Hwai-Lee; Liao, Kate Hsiurong; Chen, Kuen-Bao; Poon, Kin-Shing; Pan, Yu-Ling; Lai, Ted Weita

2017-01-01

Blood-brain barrier (BBB) disruption is thought to facilitate the development of cerebral infarction after a stroke. In a typical stroke model (such as the one used in this study), the early phase of BBB disruption reaches a peak 6 h post-ischemia and largely recovers after 8-24 h, whereas the late phase of BBB disruption begins 48-58 h post-ischemia. Because cerebral infarct develops within 24 h after the onset of ischemia, and several therapeutic agents have been shown to reduce the infarct volume when administered at 6 h post-ischemia, we hypothesized that attenuating BBB disruption at its peak (6 h post-ischemia) can also decrease the infarct volume measured at 24 h. We used a mouse stroke model obtained by combining 120 min of distal middle cerebral arterial occlusion (dMCAo) with ipsilateral common carotid arterial occlusion (CCAo). This model produced the most reliable BBB disruption and cerebral infarction compared to other models characterized by a shorter duration of ischemia or obtained with dMCAO or CCAo alone. The BBB permeability was measured by quantifying Evans blue dye (EBD) extravasation, as this tracer has been shown to be more sensitive for the detection of early-phase BBB disruption compared to other intravascular tracers that are more appropriate for detecting late-phase BBB disruption. We showed that a 1 h-long treatment with isoflurane-anesthesia induced marked hypothermia and attenuated the peak of BBB disruption when administered 6 h after the onset of dMCAo/CCAo-induced ischemia. We also demonstrated that the inhibitory effect of isoflurane was hypothermia-dependent because the same treatment had no effect on ischemic BBB disruption when the mouse body temperature was maintained at 37°C. Importantly, inhibiting the peak of BBB disruption by hypothermia had no effect on the volume of brain infarct 24 h post-ischemia. In conclusion, inhibiting the peak of BBB disruption is not an effective neuroprotective strategy, especially in comparison to the inhibitors of the neuronal death signaling cascade; these, in fact, can attenuate the infarct volume measured at 24 h post-ischemia when administered at 6 h in our same stroke model.

Electromagnetic fields radiated from a lightning return stroke - Application of an exact solution to Maxwell's equations

NASA Technical Reports Server (NTRS)

Le Vine, D. M.; Meneghini, R.

1978-01-01

A solution is presented for the electromagnetic fields radiated by an arbitrarily oriented current filament over a conducting ground plane in the case where the current propagates along the filament at the speed of light, and this solution is interpreted in terms of radiation from lightning return strokes. The solution is exact in the fullest sense; no mathematical approximations are made, and the governing differential equations and boundary conditions are satisfied. The solution has the additional attribute of being specified in closed form in terms of elementary functions. This solution is discussed from the point of view of deducing lightning current wave forms from measurements of the electromagnetic fields and understanding the effects of channel tortuosity on the radiated fields. In addition, it is compared with two approximate solutions, the traditional moment approximation and the Fraunhofer approximation, and a set of criteria describing their applicability are presented and interpreted.

Why Flash Type Matters: A Statistical Analysis

NASA Astrophysics Data System (ADS)

Mecikalski, Retha M.; Bitzer, Phillip M.; Carey, Lawrence D.

2017-09-01

While the majority of research only differentiates between intracloud (IC) and cloud-to-ground (CG) flashes, there exists a third flash type, known as hybrid flashes. These flashes have extensive IC components as well as return strokes to ground but are misclassified as CG flashes in current flash type analyses due to the presence of a return stroke. In an effort to show that IC, CG, and hybrid flashes should be separately classified, the two-sample Kolmogorov-Smirnov (KS) test was applied to the flash sizes, flash initiation, and flash propagation altitudes for each of the three flash types. The KS test statistically showed that IC, CG, and hybrid flashes do not have the same parent distributions and thus should be separately classified. Separate classification of hybrid flashes will lead to improved lightning-related research, because unambiguously classified hybrid flashes occur on the same order of magnitude as CG flashes for multicellular storms.

Simulation of radiation from lightning return strokes - The effects of tortuosity

NASA Technical Reports Server (NTRS)

Levine, D. M.; Meneghini, R.

1978-01-01

A Monte Carlo simulation has been developed for the electromagnetic fields radiated from a tortuous lightning channel. This was done using a piecewise linear model for the channel and employing for each element the field radiated by a traveling wave on an arbitrarily oriented filament over a conducting plane. The simulation reproduces experimental data reasonably well and has been used to study the effects of tortuosity on the fields radiated by return strokes. Tortuosity can significantly modify the radiated waveform, tending to render it less representative of the current pulse and more nearly unipolar than one would expect based on the theory for a long straight channel. In the frequency domain the effect of tortuosity is an increase in high frequency energy as compared with an equivalent straight channel. The extent of this increase depends on the mean length of the elements comprising the channel and can be significant.

Drift stabilizer for reciprocating free-piston devices

DOEpatents

Ward, William C.; Corey, John A.; Swift, Gregory W.

2003-05-20

A free-piston device has a stabilized piston drift. A piston having a frequency of reciprocation over a stroke length and with first and second sides facing first and second variable volumes, respectively, for containing a working fluid defining an acoustic wavelength at the frequency of reciprocation. A bypass tube waveguide connects the first and second variable volumes at all times during reciprocation of the piston. The waveguide has a relatively low impedance for steady flow and a relatively high impedance for oscillating flow at the frequency of reciprocation of the piston, so that steady flow returns fluid leakage from about the piston between the first and second volumes while oscillating flow is not diverted through the waveguide. Thus, net leakage about the piston is returned during each stroke of the piston while oscillating leakage is not allowed and pressure buildup on either the first or second side of the piston is avoided to provide a stable piston location.

Occupational therapy practice in predriving assessment post stroke in the Irish context: findings from a nominal group technique meeting.

PubMed

Stapleton, Tadhg; Connelly, Deirdre

2010-01-01

Practice in the area of predriving assessment for people with stroke varies, and research findings are not always easily transferred into the clinical setting, particularly when such assessment is not conducted within a dedicated driver assessment programme. This article explores the clinical predriving assessment practices and recommendations of a group of Irish occupational therapists for people with stroke. A consensus meeting of occupational therapists was facilitated using a nominal group technique (NGT) to identify specific components of cognition, perception, and executive function that may influence fitness to return to driving and should be assessed prior to referral for on-road evaluation. Standardised assessments for use in predriving assessment were recommended. Thirteen occupational therapists speed of processing; perceptual components of spatial awareness, depth perception, and visual inattention; and executive components of planning, problem solving, judgment, and self-awareness. Consensus emerged for the use of the following standardised tests: Behavioural Assessment of Dysexecutive Syndrome (BADS), Test of Everyday Attention (TEA), Brain Injury Visual Assessment Battery for Adults (biVABA), Rivermead Perceptual Assessment Battery (RPAB), and Motor Free Visual Perceptual Test (MVPT). Tests were recommended that gave an indication of the patient's underlying component skills in the area of cognition, perception, and executive functions considered important for driving. Further research is needed in this area to develop clinical practice guidelines for occupational therapists for the assessment of fitness to return to driving after stroke.

Task-oriented treadmill exercise training in chronic hemiparetic stroke

PubMed Central

Ivey, Frederick M.; Hafer-Macko, Charlene E.; Macko, Richard F.

2010-01-01

Patients with stroke have elevated hemiparetic gait costs secondary to low activity levels and are often severely deconditioned. Decrements in peak aerobic capacity affect functional ability and cardiovascular-metabolic health and may be partially mediated by molecular changes in hemiparetic skeletal muscle. Conventional rehabilitation is time delimited in the subacute stroke phase and does not provide adequate aerobic intensity to reverse the profound detriments to fitness and function that result from stroke. Hence, we have studied progressive full body weight-support treadmill (TM) training as an adjunct therapy in the chronic stroke phase. Task-oriented TM training has produced measurable changes in fitness, function, and indices of cardiovascular-metabolic health after stroke, but the precise mechanisms for these changes remain under investigation. Further, the optimal dose of this therapy has yet to be identified for individuals with stroke and may vary as a function of deficit severity and outcome goals. This article summarizes the functional and metabolic decline caused by inactivity after stroke and provides current evidence that supports the use of TM training during the chronic stroke phase, with protocols and inclusion/exclusion criteria described. Our research findings are discussed in relation to associated research. PMID:18566943

Design and experimental investigations on six-stroke SI engine using acetylene with water injection.

PubMed

Gupta, Keshav; Suthar, Kishanlal; Jain, Sheetal Kumar; Agarwal, Ghanshyam Das; Nayyar, Ashish

2018-06-02

In the present study, a four-stroke cycle gasoline engine is redesigned and converted into a six-stroke cycle engine and experimental study has been conducted using gasoline and acetylene as fuel with water injection at the end of the recompression stroke. Acetylene has been used as an alternative fuel along with gasoline and performance of the six-stroke spark ignition (SI) engine with these two fuels has been studied separately and compared. Brake power and thermal efficiency are found to be 5.18 and 1.55% higher with acetylene as compared to gasoline in the six-stroke engine. However, thermal efficiency is found to be 45% higher with acetylene in the six-stroke engine as compared to four-stroke SI engine. The CO and HC emissions were found to be reduced by 13.33 and 0.67% respectively with acetylene as compared to gasoline due to better combustion of acetylene. The NO x emission was reduced by 5.65% with acetylene due to lower peak temperature by water injection. The experimental results showed better engine performance and emissions with acetylene as fuel in the six-stroke engine.

Three-Dimensional Reconstruction of Cloud-to-Ground Lightning Using High-Speed Video and VHF Broadband Interferometer

NASA Astrophysics Data System (ADS)

Li, Yun; Qiu, Shi; Shi, Lihua; Huang, Zhengyu; Wang, Tao; Duan, Yantao

2017-12-01

The time resolved three-dimensional (3-D) spatial reconstruction of lightning channels using high-speed video (HSV) images and VHF broadband interferometer (BITF) data is first presented in this paper. Because VHF and optical radiations in step formation process occur with time separation no more than 1 μs, the observation data of BITF and HSV at two different sites provide the possibility of reconstructing the time resolved 3-D channel of lightning. With the proposed procedures for 3-D reconstruction of leader channels, dart leaders as well as stepped leaders with complex multiple branches can be well reconstructed. The differences between 2-D speeds and 3-D speeds of leader channels are analyzed by comparing the development of leader channels in 2-D and 3-D space. Since return stroke (RS) usually follows the path of previous leader channels, the 3-D speeds of the return strokes are first estimated by combination with the 3-D structure of the preceding leaders and HSV image sequences. For the fourth RS, the ratios of the 3-D to 2-D RS speeds increase with height, and the largest ratio of the 3-D to 2-D return stroke speeds can reach 2.03, which is larger than the result of triggered lightning reported by Idone. Since BITF can detect lightning radiation in a 360° view, correlated BITF and HSV observations increase the 3-D detection probability than dual-station HSV observations, which is helpful to obtain more events and deeper understanding of the lightning process.

Lightning Characteristics and Lightning Strike Peak Current Probabilities as Related to Aerospace Vehicle Operations

NASA Technical Reports Server (NTRS)

Johnson, Dale L.; Vaughan, William W.

1998-01-01

A summary is presented of basic lightning characteristics/criteria for current and future NASA aerospace vehicles. The paper estimates the probability of occurrence of a 200 kA peak lightning return current, should lightning strike an aerospace vehicle in various operational phases, i.e., roll-out, on-pad, launch, reenter/land, and return-to-launch site. A literature search was conducted for previous work concerning occurrence and measurement of peak lighting currents, modeling, and estimating probabilities of launch vehicles/objects being struck by lightning. This paper presents these results.

Vagus nerve stimulation during rehabilitative training improves forelimb strength following ischemic stroke.

PubMed

Khodaparast, N; Hays, S A; Sloan, A M; Hulsey, D R; Ruiz, A; Pantoja, M; Rennaker, R L; Kilgard, M P

2013-12-01

Upper limb impairment is a common debilitating consequence of ischemic stroke. Physical rehabilitation after stroke enhances neuroplasticity and improves limb function, but does not typically restore normal movement. We have recently developed a novel method that uses vagus nerve stimulation (VNS) paired with forelimb movements to drive specific, long-lasting map plasticity in rat primary motor cortex. Here we report that VNS paired with rehabilitative training can enhance recovery of forelimb force generation following infarction of primary motor cortex in rats. Quantitative measures of forelimb function returned to pre-lesion levels when VNS was delivered during rehab training. Intensive rehab training without VNS failed to restore function back to pre-lesion levels. Animals that received VNS during rehab improved twice as much as rats that received the same rehabilitation without VNS. VNS delivered during physical rehabilitation represents a novel method that may provide long-lasting benefits towards stroke recovery. © 2013.

Tips for Daily Living

MedlinePlus

... Stories of Returning to School or Work Tough Work If You Can Get It Home Modifications Mental Health Tips for Maintaining a Positive Outlook and Well-Being Recreation Can Increase Awareness Improving Memory Submitting Your Story Stroke families put the ‘connection’ ...

The Nottingham Fatigue After Stroke (NotFAST) study: results from follow-up six months after stroke.

PubMed

Hawkins, Louise; Lincoln, Nadina B; Sprigg, Nikola; Ward, Nick S; Mistri, Amit; Tyrrell, Pippa; Worthington, Esme; Drummond, Avril

2017-12-01

Background Post-stroke fatigue is common and disabling. Objectives The aim of NotFAST was to examine factors associated with fatigue in stroke survivors without depression, six months after stroke. Methods Participants were recruited from four UK stroke units. Those with high levels of depressive symptoms (score ≥7 on Brief Assessment Schedule Depression Cards) or aphasia were excluded. Follow-up assessment was conducted at six months after stroke. They were assessed on the Fatigue Severity Scale, Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Barthel Index, Beck Anxiety Index, Brief Assessment Schedule Depression Cards, Impact of Event Scale-Revised, and Sleep Hygiene Index. Results Of the 371 participants recruited, 263 (71%) were contacted at six months after stroke and 213 (57%) returned questionnaires. Approximately half (n = 109, 51%) reported fatigue at six months. Of those reporting fatigue initially (n = 88), 61 (69%) continued to report fatigue. 'De novo' (new) fatigue was reported by 48 (38%) of those not fatigued initially. Lower Nottingham Extended Activities of Daily Living scores and higher Beck Anxiety Index scores were independently associated with fatigue at six months. Conclusions Half the stroke survivors reported fatigue at six months post-stroke. Reduced independence in activities of daily living and higher anxiety levels were associated with the level of fatigue. Persistent and delayed onset fatigue may affect independence and participation in rehabilitation, and these findings should be used to inform the development of appropriate interventions.

Critical early thrombolytic and endovascular reperfusion therapy for acute ischemic stroke victims: a call for adjunct neuroprotection.

PubMed

Lapchak, Paul A

2015-10-01

Today, there is an enormous amount of excitement in the field of stroke victim care due to the recent success of MR. CLEAN, SWIFT PRIME, ESCAPE, EXTEND-IA, and REVASCAT endovascular trials. Successful intravenous (IV) recombinant tissue plasminogen activator (rt-PA) clinical trials [i.e., National Institute of Neurological Disorders and Stroke (NINDS) rt-PA trial, Third European Cooperative Acute Stroke Study (ECASSIII), and Third International Stroke study (IST-3)] also need to be emphasized. In the recent endovascular and thrombolytic trials, there is statistically significant improvement using both the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Score (mRS) scale, but neither approach promotes complete recovery in patients enrolled within any particular NIHSS or mRS score tier. Absolute improvement (mRS 0-2 at 90 days) with endovascular therapy is 13.5-31 %, whereas thrombolytics alone also significantly improve patient functional independence, but to a lesser degree (NINDS rt-PA trial 13 %). This article has 3 main goals: (1) first to emphasize the utility and cost-effectiveness of rt-PA to treat stroke; (2) second to review the recent endovascular trials with respect to efficacy, safety, and cost-effectiveness as a stroke treatment; and (3) to further consider and evaluate strategies to develop novel neuroprotective drugs. A thesis will be put forth so that future stroke trials and therapy development can optimally promote recovery so that stroke victims can return to "normal" life.

Fuel system for rotary distributor fuel injection pump

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klopfer, K.H.; Kelly, W.W.

1993-06-01

In a fuel injection pump having a drive shaft, a pump rotor driven by the drive shaft, reciprocating pumping means with periodic intake and pumping strokes to periodically receive an intake charge of fuel and deliver fuel at high pressure for fuel injection is described; a distributor head with a plurality of angularly spaced distributor outlets, the pump rotor providing a distributor rotor with a distributor port connected to the pumping means, the distributor rotor being rotatably mounted in the distributor head for sequential registration of the distributor port with the distributor outlets for distributing said high pressure delivery ofmore » fuel thereto; a fuel system for supplying fuel to the pumping means, having an end chamber at one end of the pump rotor and a fuel supply pump driven by the drive shaft and having an inlet and outlet, the supply pump outlet being connected to the end chamber for supplying fuel thereto, and a pressure regulator for regulating the fuel pressure in the end chamber; and a control valve connected between the pumping means and the end chamber and selectively opened during the intake strokes to supply fuel to the pumping means from the end chamber and during the pumping strokes to spill fuel from the pumping means into the end chamber to terminate said high pressure delivery of fuel; the improvement wherein the fuel system comprises a fuel return passage connected in series with the end chamber downstream thereof, wherein the pressure regulator is mounted in the return passage for regulating the upstream fuel pressure, including the upstream fuel pressure within the end chamber, and is connected for conducting excess fuel for return to the supply pump inlet, and wherein the supply pump is driven by the drive shaft to supply fuel at a rate exceeding the rate of said high pressure delivery of fuel for fuel injection and to provide excess fuel flow continuously through the end chamber and return passage to the pressure regulator.« less

Characteristics of the April 2007 Flood at 10 Streamflow-Gaging Stations in Massachusetts

USGS Publications Warehouse

Zarriello, Phillip J.; Carlson, Carl S.

2009-01-01

A large 'nor'easter' storm on April 15-18, 2007, brought heavy rains to the southern New England region that, coupled with normal seasonal high flows and associated wet soil-moisture conditions, caused extensive flooding in many parts of Massachusetts and neighboring states. To characterize the magnitude of the April 2007 flood, a peak-flow frequency analysis was undertaken at 10 selected streamflow-gaging stations in Massachusetts to determine the magnitude of flood flows at 5-, 10-, 25-, 50-, 100-, 200-, and 500-year return intervals. The magnitude of flood flows at various return intervals were determined from the logarithms of the annual peaks fit to a Pearson Type III probability distribution. Analysis included augmenting the station record with longer-term records from one or more nearby stations to provide a common period of comparison that includes notable floods in 1936, 1938, and 1955. The April 2007 peak flow was among the highest recorded or estimated since 1936, often ranking between the 3d and 5th highest peak for that period. In general, the peak-flow frequency analysis indicates the April 2007 peak flow has an estimated return interval between 25 and 50 years; at stations in the northeastern and central areas of the state, the storm was less severe resulting in flows with return intervals of about 5 and 10 years, respectively. At Merrimack River at Lowell, the April 2007 peak flow approached a 100-year return interval that was computed from post-flood control records and the 1936 and 1938 peak flows adjusted for flood control. In general, the magnitude of flood flow for a given return interval computed from the streamflow-gaging station period-of-record was greater than those used to calculate flood profiles in various community flood-insurance studies. In addition, the magnitude of the updated flood flow and current (2008) stage-discharge relation at a given streamflow-gaging station often produced a flood stage that was considerably different than the flood stage indicated in the flood-insurance study flood profile at that station. Equations for estimating the flow magnitudes for 5-, 10-, 25-, 50-, 100-, 200-, and 500-year floods were developed from the relation of the magnitude of flood flows to drainage area calculated from the six streamflow-gaging stations with the longest unaltered record. These equations produced a more conservative estimate of flood flows (higher discharges) than the existing regional equations for estimating flood flows at ungaged rivers in Massachusetts. Large differences in the magnitude of flood flows for various return intervals determined in this study compared to results from existing regional equations and flood insurance studies indicate a need for updating regional analyses and equations for estimating the expected magnitude of flood flows in Massachusetts.

Atrial Fibrillation Ablation and its Impact on Stroke.

PubMed

Graves, Kevin G; Jacobs, Victoria; May, Heidi T; Cutler, Michael J; Day, John D; Bunch, T Jared

2018-01-24

Atrial fibrillation (AF) is a commonly encountered arrhythmia, which is not yet fully understood. Catheter ablation has shown to be an effective strategy for rhythm management and several small or retrospective studies have shown that stroke rates are decreased in ablated AF patients compared to those medically managed. Several studies even show that ablation returns stroke risk to that of non-AF patients. Large scale, prospective trials will further illuminate this connection and provide mechanistic understanding of the role of the procedure versus the process of selection for the procedure and peri- and post-procedural therapy and management. Furthermore, modification of risk factors associated with AF show a significant increase in the sustained success of AF ablation and can also moderate the progression of AF.

Functional and motor outcome 5 years after stroke is equivalent to outcome at 2 months: follow-up of the collaborative evaluation of rehabilitation in stroke across Europe.

PubMed

Meyer, Sarah; Verheyden, Geert; Brinkmann, Nadine; Dejaeger, Eddy; De Weerdt, Willy; Feys, Hilde; Gantenbein, Andreas R; Jenni, Walter; Laenen, Annouschka; Lincoln, Nadina; Putman, Koen; Schuback, Birgit; Schupp, Wilfried; Thijs, Vincent; De Wit, Liesbet

2015-06-01

Recovery of patients within the first 6 months after stroke is well documented, but there has been little research on long-term recovery. The aim of this study was to analyze functional and motor recovery between admission to rehabilitation centres and 5 years after stroke. This follow-up of the Collaborative Evaluation of Rehabilitation in Stroke Across Europe study, included patients from 4 European rehabilitation centres. Patients were assessed on admission, at 2 and 6 months, and 5 years after stroke, using the Barthel Index, Rivermead Motor Assessment Gross Function, Leg and Trunk function, and Arm function. Linear mixed models were used, corrected for baseline characteristics. To account for the drop-out during follow-up, the analysis is likelihood-based (assumption of missingness at random). A total of 532 patients were included in this study, of which 238 were followed up at 5 years post stroke. Mean age at stroke onset was 69 (±10 SD) years, 53% were men, 84% had ischemic strokes, and 53% had left-sided motor impairment. Linear mixed model analysis revealed a significant deterioration for all 4 outcomes between 6 months and 5 years (P<0.0001). Scores at 2 months were not statistically significant different from scores at 5 years after stroke. Higher age (P<0.0001) and increasing stroke severity on admission (P<0.0001) negatively affected long-term functional and motor recovery. Five-year follow-up revealed deterioration in functional and motor outcome, with a return to the level measured at 2 months. Increasing age and increasing stroke severity negatively affected recovery up to 5 years after stroke. © 2015 American Heart Association, Inc.

Multi-center prediction of hemorrhagic transformation in acute ischemic stroke using permeability imaging features.

PubMed

Scalzo, Fabien; Alger, Jeffry R; Hu, Xiao; Saver, Jeffrey L; Dani, Krishna A; Muir, Keith W; Demchuk, Andrew M; Coutts, Shelagh B; Luby, Marie; Warach, Steven; Liebeskind, David S

2013-07-01

Permeability images derived from magnetic resonance (MR) perfusion images are sensitive to blood-brain barrier derangement of the brain tissue and have been shown to correlate with subsequent development of hemorrhagic transformation (HT) in acute ischemic stroke. This paper presents a multi-center retrospective study that evaluates the predictive power in terms of HT of six permeability MRI measures including contrast slope (CS), final contrast (FC), maximum peak bolus concentration (MPB), peak bolus area (PB), relative recirculation (rR), and percentage recovery (%R). Dynamic T2*-weighted perfusion MR images were collected from 263 acute ischemic stroke patients from four medical centers. An essential aspect of this study is to exploit a classifier-based framework to automatically identify predictive patterns in the overall intensity distribution of the permeability maps. The model is based on normalized intensity histograms that are used as input features to the predictive model. Linear and nonlinear predictive models are evaluated using a cross-validation to measure generalization power on new patients and a comparative analysis is provided for the different types of parameters. Results demonstrate that perfusion imaging in acute ischemic stroke can predict HT with an average accuracy of more than 85% using a predictive model based on a nonlinear regression model. Results also indicate that the permeability feature based on the percentage of recovery performs significantly better than the other features. This novel model may be used to refine treatment decisions in acute stroke. Copyright © 2013 Elsevier Inc. All rights reserved.

A flexible electrostatic kinetic energy harvester based on electret films of electrospun nanofibers

NASA Astrophysics Data System (ADS)

Lu, Y.; Capo-Chichi, M.; Leprince-Wang, Y.; Basset, P.

2018-01-01

This paper reports a paper-based electrostatic kinetic energy harvester (e-KEH) implementing multilayered electret films based on electrospun nanofibrous material. It is the first time that a fully flexible electret-based e-KEH is reported. The proposed electret, PVDF-PTFD nanofibrous covered by Parylene C, has a faster stabilization of surface potential than a planar thin film of Parylene C, and a higher stability of charge storage. With a maximum force of 0.5 N and a 3-layer electret, the device capacitance increases from 25 to 100 pF during a pressing operation. Working with the optimal resistive load of 16 MΩ, the device pressed manually delivers a peak instantaneous power up to 45.6 μW and an average energy of 54 nJ/stroke, corresponding to a peak instantaneous power density of 7.3 μW cm-2 and an average energy density of 8.6 nJ cm-2/stroke. Within 450 manual strokes, a 10 nF capacitor is charged up to 8.5 V by the prototype through a full-wave diode bridge. On a 1 μF capacitor, the energy delivery of 9.9 nJ/stroke has been obtained with a 10 Hz pressing movement excited by a vibrator with a maximum force of 0.5 N.

New evidence for therapies in stroke rehabilitation.

PubMed

Dobkin, Bruce H; Dorsch, Andrew

2013-06-01

Neurologic rehabilitation aims to reduce impairments and disabilities so that persons with serious stroke can return to participation in usual self-care and daily activities as independently as feasible. New strategies to enhance recovery draw from a growing understanding of how types of training, progressive task-related practice of skills, exercise for strengthening and fitness, neurostimulation, and drug and biological manipulations can induce adaptations at multiple levels of the nervous system. Recent clinical trials provide evidence for a range of new interventions to manage walking, reach and grasp, aphasia, visual field loss, and hemi-inattention.

Kinesthetic deficits after perinatal stroke: robotic measurement in hemiparetic children.

PubMed

Kuczynski, Andrea M; Semrau, Jennifer A; Kirton, Adam; Dukelow, Sean P

2017-02-15

While sensory dysfunction is common in children with hemiparetic cerebral palsy (CP) secondary to perinatal stroke, it is an understudied contributor to disability with limited objective measurement tools. Robotic technology offers the potential to objectively measure complex sensorimotor function but has been understudied in perinatal stroke. The present study aimed to quantify kinesthetic deficits in hemiparetic children with perinatal stroke and determine their association with clinical function. Case-control study. Participants were 6-19 years of age. Stroke participants had MRI confirmed unilateral perinatal arterial ischemic stroke or periventricular venous infarction, and symptomatic hemiparetic cerebral palsy. Participants completed a robotic assessment of upper extremity kinesthesia using a robotic exoskeleton (KINARM). Four kinesthetic parameters (response latency, initial direction error, peak speed ratio, and path length ratio) and their variabilities were measured with and without vision. Robotic outcomes were compared across stroke groups and controls and to clinical measures of sensorimotor function. Forty-three stroke participants (23 arterial, 20 venous, median age 12 years, 42% female) were compared to 106 healthy controls. Stroke cases displayed significantly impaired kinesthesia that remained when vision was restored. Kinesthesia was more impaired in arterial versus venous lesions and correlated with clinical measures. Robotic assessment of kinesthesia is feasible in children with perinatal stroke. Kinesthetic impairment is common and associated with stroke type. Failure to correct with vision suggests sensory network dysfunction.

Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis

PubMed Central

2012-01-01

Background Previous studies have shown the beneficial effects of aerobic exercise in chronic stroke. Most motor and functional recovery occurs in the first months after stroke. Improving cardiovascular capacity may have potential to precipitate recovery during early stroke rehabilitation. Currently, little is known about the effects of early cardiovascular exercise in stroke survivors. The aim of this systematic review was to evaluate the effectiveness of cardiovascular exercise early after stroke. Methods A systematic literature search was performed. For this review, randomized and non-randomized prospective controlled cohort studies using a cardiovascular, cardiopulmonary or aerobic training intervention starting within 6 months post stroke were considered. The PEDro scale was used to detect risk of bias in individual studies. Inter-rater agreement was calculated (kappa). Meta-analysis was performed using a random-effects model. Results A total of 11 trials were identified for inclusion. Inter-rater agreement was considered to be “very good” (Kappa: 0.81, Standard Error: 0.06, CI95%: 0.70–0.92), and the methodological quality was “good” (7 studies) to “fair” (4 studies). Peak oxygen uptake data were available for 155 participants. Pooled analysis yielded homogenous effects favouring the intervention group (standardised mean difference (SMD) = 0.83, CI95% = 0.50–1.16, Z = 4.93, P < 0.01). Walking endurance assessed with the 6 Minute Walk Test comprised 278 participants. Pooled analysis revealed homogenous effects favouring the cardiovascular training intervention group (SMD = 0.69, CI95% = 0.45–0.94, Z = 5.58, P < 0.01). Gait speed, measured in 243 participants, did not show significant results (SMD = 0.51, CI95% = −0.25–1.26, Z = 1.31, P = 0.19) in favour of early cardiovascular exercise. Conclusion This meta-analysis shows that stroke survivors may benefit from cardiovascular exercise during sub-acute stages to improve peak oxygen uptake and walking distance. Thus, cardiovascular exercise should be considered in sub-acute stroke rehabilitation. However, concepts to influence and evaluate aerobic capacity in severely affected individuals with sub-acute stroke, as well as in the very early period after stroke, are lacking. Further research is needed to develop appropriate methods for cardiovascular rehabilitation early after stroke and to evaluate long-term effects of cardiovascular exercise on aerobic capacity, physical functioning, and quality-of-life. PMID:22727172

Effects of stroke education using an animated cartoon and a manga on elementary school children.

PubMed

Sakamoto, Yuki; Yokota, Chiaki; Miyashita, Fumio; Amano, Tatsuo; Shigehatake, Yuya; Oyama, Satoshi; Itagaki, Naruhiko; Okumura, Kosuke; Toyoda, Kazunori; Minematsu, Kazuo

2014-08-01

Stroke education for the youth is expected to reduce prehospital delay by informing the bystander of appropriate action to take and providing knowledge to prevent onset of stroke in future. Previously, we developed effective teaching materials consisting of an animated cartoon and a Manga for junior high school students. The aim of this study was to evaluate the feasibility and effectiveness of our educational materials for stroke education taught by schoolteachers to elementary school children. Using our teaching materials, a 30-minute lesson was given by trained general schoolteachers. Questionnaires on stroke knowledge (symptoms and risk factors) and action to take on identification of suspected stroke symptoms were filled out by school children before, immediately after, and at 3 months after completion of the lesson. A total of 219 children (aged 10 or 11 years) received the stroke lesson. Stroke knowledge significantly increased immediately after the lesson compared with before (symptoms, P < .001; risk factors, P < .001); however, correct answer rates decreased at 3 months immediately after completion of the lesson (symptoms, P = .002; risk factors, P = .045). The proportion of the number of children calling emergency medical service on identifying stroke symptoms was higher immediately after the lesson than baseline (P = .007) but returned to the baseline at 3 months after the lesson. Stroke lesson by schoolteachers using our teaching materials consisting of an animated cartoon and a Manga that was previously used for junior high school students was feasible for elementary school children. However, revision of the materials is required for better retention of stroke knowledge for children. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Effects of short term water immersion on peripheral reflex excitability in hemiplegic and healthy individuals: A preliminary study

PubMed Central

Cronin, N.J.; Valtonen, A.M.; Waller, B.; Pöyhönen, T.; Avela, J.

2016-01-01

Background: Reflex excitability is increased in hemiplegic patients compared to healthy controls. One challenge of stroke rehabilitation is to decrease the effects of hyperreflexia, which may be possible with water immersion. Methods/Aims: The present study examined the effects of acute water immersion on electrically-evoked Hmax:Mmax ratios (a measure of reflex excitability) in 7 hyperreflexive hemiplegic patients and 7 age-matched healthy people. Hmax:Mmax ratios were measured from soleus on dry land (L1), immediately after (W1) and 5 minutes after immersion (W5), and again after five minutes on land (L5). Results: Water immersion led to an acute increase in Hmax:Mmax ratio in both groups. However, after returning to dry land, there was a non-significant decrease in the Hmax:Mmax ratio of 8% in the hemiplegic group and 10% in healthy controls compared to pre-immersion values. Interpretation: A short period of water immersion can decrease peripheral reflex excitability after returning to dry land in both healthy controls and post-stroke patients, although longer immersion periods may be required for sustainable effects. Water immersion may offer promise as a low-risk, non-invasive and non-pharmaceutical method of decreasing hyperreflexivity, and could thus support aquatic rehabilitation following stroke. PMID:26944824

Effects of short term water immersion on peripheral reflex excitability in hemiplegic and healthy individuals: A preliminary study.

PubMed

Cronin, N J; Valtonen, A M; Waller, B; Pöyhönen, T; Avela, J

2016-03-01

Reflex excitability is increased in hemiplegic patients compared to healthy controls. One challenge of stroke rehabilitation is to decrease the effects of hyperreflexia, which may be possible with water immersion. Methods/Aims: The present study examined the effects of acute water immersion on electrically-evoked Hmax:Mmax ratios (a measure of reflex excitability) in 7 hyperreflexive hemiplegic patients and 7 age-matched healthy people. Hmax:Mmax ratios were measured from soleus on dry land (L1), immediately after (W1) and 5 minutes after immersion (W5), and again after five minutes on land (L5). Water immersion led to an acute increase in Hmax:Mmax ratio in both groups. However, after returning to dry land, there was a non-significant decrease in the Hmax:Mmax ratio of 8% in the hemiplegic group and 10% in healthy controls compared to pre-immersion values. A short period of water immersion can decrease peripheral reflex excitability after returning to dry land in both healthy controls and post-stroke patients, although longer immersion periods may be required for sustainable effects. Water immersion may offer promise as a low-risk, non-invasive and non-pharmaceutical method of decreasing hyperreflexivity, and could thus support aquatic rehabilitation following stroke.

Mechanisms of decreased left ventricular preload during continuous positive pressure ventilation in ARDS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dhainaut, J.F.; Devaux, J.Y.; Monsallier, J.F.

1986-07-01

Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied the changes in cardiac output induced by continuous positive pressure ventilation in eight patients with the adult respiratory distress syndrome. We measured cardiac output by thermodilution, and biventricular ejection fraction by equilibrium gated blood pool scintigraphy. Biventricular end-diastolic volumes weremore » then calculated by dividing stroke volume by ejection fraction. As positive end-expiratory pressure increased from 0 to 20 cm H/sub 2/O, stroke volume and biventricular end-diastolic volumes fell about 25 percent, and biventricular ejection fraction remained unchanged. At 20 cm H/sub 2/O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance.« less

An Exertional Heat Stroke Survivor's Return to Running: An Integrated Approach on the Treatment, Recovery, and Return to Activity.

PubMed

Adams, William M; Hosokawa, Yuri; Huggins, Robert A; Mazerolle, Stephanie M; Casa, Douglas J

2016-08-01

Evidence-based best practices for the recognition and treatment of exertional heat stroke (EHS) indicate that rectal thermometry and immediate, aggressive cooling via cold-water immersion ensure survival from this medical condition. However, little is known about the recovery, medical follow-up, and return to activity after an athlete has suffered EHS. To highlight the transfer of evidenced-based research into clinical practice by chronicling the treatment, recovery, and return to activity of a runner who suffered an EHS during a warm-weather road race. Case study. Warm-weather road race. 53-y-old recreationally active man. A runner's treatment, recovery, and return to activity from EHS and 2014 Falmouth Road Race performance. Runner's perceptions and experiences with EHS, body temperature, heart rate, hydration status, exercise intensity. The runner successfully completed the 2014 Falmouth Road Race without incident of EHS. Four dominant themes emerged from the data: predisposing factors, ideal treatment, lack of medical follow-up, and patient education. The first theme identified 3 predisposing factors that contributed to the runner's EHS: hydration, sleep loss, and lack of heat acclimatization. The runner received ideal treatment using evidence-based best practices. A lack of long-term medical care following the EHS with no guidance on the runner's return to full activity was observed. The runner knew very little about EHS before the 2013 race, which drove him to seek knowledge as to why he suffered EHS. Using this newly learned information, he successfully completed the 2014 Falmouth Road Race without incident. This case supports prior literature examining the factors that predispose individuals to EHS. Although evidence-based best practices regarding prompt recognition and treatment of EHS ensure survival, this case highlights the lack of medical follow-up and physician-guided return to activity after EHS.

Longitudinal development of physical and performance parameters during biological maturation of young male swimmers.

PubMed

Lätt, Evelin; Jürimäe, Jaak; Haljaste, Kaja; Cicchella, Antonio; Purge, Priit; Jürimäe, Toivo

2009-02-01

The aim of the study was to examine the development of specific physical, physiological, and biomechanical parameters in 29 young male swimmers for whom measurements were made three times for two consecutive years. During the 400-m front-crawl swimming, the energy cost of swimming, and stroking parameters were assessed. Peak oxygen consumption (VO2 peak) was assessed by means of the backward-extrapolation technique recording VO2 during the first 20 sec. of recovery period after a maximal trial of 400-m distance. Swimming performance at different points of physical maturity was mainly related to the increases in body height and arm-span values from physical parameters, improvement in sport-specific VO2 peak value from physiological characteristics, and improvement in stroke indices on biomechanical parameters. In addition, biomechanical factors characterised best the 400-m swimming performance followed by physical and physiological factors during the 2-yr. study period for the young male swimmers.

Lightning Strike Peak Current Probabilities as Related to Space Shuttle Operations

NASA Technical Reports Server (NTRS)

Johnson, Dale L.; Vaughan, William W.

2000-01-01

A summary is presented of basic lightning characteristics/criteria applicable to current and future aerospace vehicles. The paper provides estimates on the probability of occurrence of a 200 kA peak lightning return current, should lightning strike an aerospace vehicle in various operational phases, i.e., roll-out, on-pad, launch, reenter/land, and return-to-launch site. A literature search was conducted for previous work concerning occurrence and measurement of peak lighting currents, modeling, and estimating the probabilities of launch vehicles/objects being struck by lightning. This paper presents a summary of these results.

'Getting back to real living': A qualitative study of the process of community reintegration after stroke.

PubMed

Wood, Jennifer P; Connelly, Denise M; Maly, Monica R

2010-11-01

To examine the process of community reintegration over the first year following stroke, from the patient's perspective. Qualitative, longitudinal, grounded theory study involving ten participants. During the first year post discharge from inpatient rehabilitation, 46 one-on-one semi-structured interviews were conducted with ten participants. Interviews were completed with participants before discharge from inpatient stroke rehabilitation and in their homes at two weeks, three months, six months and one year post discharge. Analysis was guided by grounded theory methods described by Corbin and Strauss. Four women and six men (mean age 59.6 ± 18.0, all with left hemiparesis and without aphasia) who had sustained their first hemispheric stroke and were returning to the community following inpatient rehabilitation. The process of community reintegration after stroke involved transitioning through a series of goals: gaining physical function, establishing independence, adjusting expectations and getting back to real living. The ultimate challenge for stroke survivors during this process of community reintegration was to create a balance between their expectations of themselves and their physical capacity to engage in meaningful roles. Over the first year after stroke, participants reported that the process of community reintegration was marked by ongoing changes in their goals. Formal and informal caregivers need to work with stroke survivors living in the community to facilitate realistic and achievable goal setting. Tools which identify meaningful activities should also be incorporated to provide stroke survivors with the opportunity to contribute and engage with others in the community.

Handrim wheelchair propulsion training effect on overground propulsion using biomechanical real-time visual feedback.

PubMed

Rice, Ian M; Pohlig, Ryan T; Gallagher, Jerri D; Boninger, Michael L

2013-02-01

To compare the effects of 2 manual wheelchair propulsion training programs on handrim kinetics, contact angle, and stroke frequency collected during overground propulsion. Randomized controlled trial comparing handrim kinetics between 3 groups: a control group that received no training, an instruction-only group that reviewed a multimedia presentation, and a feedback group that reviewed the multimedia presentation and real-time visual feedback. Research laboratory. Full-time manual wheelchair users (N=27) with spinal cord injury living in the Pittsburgh area. Propulsion training was given 3 times over 3 weeks, and data were collected at baseline, immediately after training, and at 3 months. Contact angle, stroke frequency, peak resultant force, and peak rate of rise of resultant force. Both feedback and instruction-only groups improved their propulsion biomechanics across all surfaces (carpet, tile, and ramp) at both target and self-selected speeds compared with the control group. While controlling for velocity, both intervention groups showed long-term reductions in the peak rate or rise of resultant force, stroke frequency, and increased contact angle. Long-term wheelchair users in both intervention groups significantly improved many aspects of their propulsion technique immediately after training and 3 months from baseline. Furthermore, training with a low-cost instructional video and slide presentation was an effective training tool alone. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The Sandia transportable triggered lightning instrumentation facility

NASA Technical Reports Server (NTRS)

Schnetzer, George H.; Fisher, Richard J.

1991-01-01

Development of the Sandia Transportable Triggered Lightning Instrumentation Facility (SATTLIF) was motivated by a requirement for the in situ testing of a munitions storage bunker. Transfer functions relating the incident flash currents to voltages, currents, and electromagnetic field values throughout the structure will be obtained for use in refining and validating a lightning response computer model of this type of structure. A preliminary shakedown trial of the facility under actual operational conditions was performed during summer of 1990 at the Kennedy Space Center's (KSC) rocket-triggered lightning test site. A description is given of the SATTLIF, which is readily transportable on a single flatbed truck of by aircraft, and its instrumentation for measuring incident lightning channel currents and the responses of the systems under test. Measurements of return-stroke current peaks obtained with the SATTLIF are presented. Agreement with data acquired on the same flashes with existing KSC instrumentation is, on average, to within approximately 7 percent. Continuing currents were measured with a resolution of approximately 2.5 A. This field trial demonstrated the practicality of using a transportable triggered lightning facility for specialized test applications.

Establishing research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus.

PubMed

Turner, Grace M; Backman, Ruth; McMullan, Christel; Mathers, Jonathan; Marshall, Tom; Calvert, Melanie

2018-01-01

What is the problem and why is this important? Mini-strokes are similar to full strokes, but symptoms last less than 24 h. Many people (up to 70%) have long-term problems after a mini-stroke, such as anxiety; depression; problems with brain functioning (like memory loss); and fatigue (feeling tired). However, the current healthcare pathway only focuses on preventing another stroke and care for other long-term problems is not routinely given. Without proper treatment, people with long-term problems after a mini-stroke could have worse quality of life and may find it difficult to return to work and their social activities. What is the aim of the research? We wanted to understand the research priorities of patients, health care professionals and key stakeholders relating to the long-term impact of mini-stroke. How did we address the problem? We invited patients, clinicians, researchers and other stakeholders to attend a meeting. At the meeting people discussed the issues relating to the long-term impact of mini-stroke and came to an agreement on their research priorities. There were three stages: (1) people wrote down their individual research suggestions; (2) in smaller groups people came to an agreement on what their top research questions were; and (3) the whole group agreed final research priorities. What did we find? Eleven people attended who were representatives for patients, GPs, stroke consultants, stroke nurses, psychologists, the Stroke Association (charity) and stroke researchers, The group agreed on eleven research questions which they felt were the most important to improve health and well-being for people who have had a mini-stroke.The eleven research questions encompass a range of categories, including: understanding the existing care patients receive (according to diagnosis and geographical location); exploring what optimal care post-TIA/minor stroke should comprise (identifying and treating impairments, information giving and support groups) and how that care should be delivered (clinical setting and follow-up pathway); impact on family members; and education/training for health care professionals. Background Clinical management after transient ischaemic attack (TIA) and minor stroke focuses on stroke prevention. However, evidence demonstrates that many patients experience ongoing residual impairments. Residual impairments post-TIA and minor stroke may affect patients' quality of life and return to work or social activities. Research priorities of patients, health care professionals and key stakeholders relating to the long-term impact of TIA and minor stroke are unknown. Methods Our objective was to establish the top shared research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus. A one-day priority setting consensus meeting took place with representatives from different stakeholder groups in October 2016 (Birmingham, UK). Nominal group technique was used to establish research priorities. This involved three stages: (i) gathering research priorities from individual stakeholders; (ii) interim prioritisation in three subgroups; and (iii) final priority setting. Results The priority setting consensus meeting was attended by 11 stakeholders. The individual stakeholders identified 34 different research priorities. During the interim prioritisation exercise, the three subgroups generated 24 unique research priorities which were discussed as a whole group. Following the final consensus discussion, 11 shared research priorities were unanimously agreed.The 11 research questions encompass a range of categories, including: understanding the existing care patients receive (according to diagnosis and geographical location); exploring what optimal care post-TIA/minor stroke should comprise (identifying and treating impairments, information giving and support groups) and how that care should be delivered (clinical setting and follow-up pathway); impact on family members; and education/training for health care professionals. Conclusions Eleven different research priorities were established through stakeholder-centred consensus. These research questions could usefully inform the research agenda and policy decisions for TIA and minor stroke. Inclusion of stakeholders in setting research priorities is important to increase the relevance of research and reduce research waste.

The Role of Heat Tolerance Testing in Recovery and Return to Duty

DTIC Science & Technology

2008-10-01

CV diseases Hyperthyroidism Pheochromocytoma Infectious diseases Diabetes mellitus Psychiatric illness Parkinsonism Congenital abnormalities: CF...environments. To assess the heat tolerance status of prior heat stroke patient. Heat tolerance test (HTT) “HTT was effective in evaluating the heat tolerance

Return period adjustment for runoff coefficients based on analysis in undeveloped Texas watersheds

USGS Publications Warehouse

Dhakal, Nirajan; Fang, Xing; Asquith, William H.; Cleveland, Theodore G.; Thompson, David B.

2013-01-01

The rational method for peak discharge (Qp) estimation was introduced in the 1880s. The runoff coefficient (C) is a key parameter for the rational method that has an implicit meaning of rate proportionality, and the C has been declared a function of the annual return period by various researchers. Rate-based runoff coefficients as a function of the return period, C(T), were determined for 36 undeveloped watersheds in Texas using peak discharge frequency from previously published regional regression equations and rainfall intensity frequency for return periods T of 2, 5, 10, 25, 50, and 100 years. The C(T) values and return period adjustments C(T)/C(T=10  year) determined in this study are most applicable to undeveloped watersheds. The return period adjustments determined for the Texas watersheds in this study and those extracted from prior studies of non-Texas data exceed values from well-known literature such as design manuals and textbooks. Most importantly, the return period adjustments exceed values currently recognized in Texas Department of Transportation design guidance when T>10  years.

Test-retest intra-rater reliability of grip force in patients with stroke.

PubMed

Hammer, Ann; Lindmark, Birgitta

2003-07-01

Coefficients of repeatability and reproducibility can be guides in differentiating between real changes and measurement error. The aim was to evaluate test-retest intra-rater reliability of a clinical procedure measuring grip force with Grippit in stroke patients, to assess relationship between grip force of the hands and between sustained and peak grip force. Eighteen patients were tested using the Grippit at two occasions one hour apart. Each occasion comprised three consecutive trials per hand. The paretic hand needs to score a 50 N change within and between occasions to exceed the measurement error in 95% of the observations, irrespective of calculation method. Expressed by CV(within) the measurement error was 10%. There was no learning or fatigue effect during measuring. There was a wide variation between subjects but the mean ratio between sides was 0.66. The mean ratio between sustained and peak grip force was 0.80-0.84. The measurement errors were acceptable and the instrument can be recommended for the use in stroke patients at a department of rehabilitation medicine.

Influence of Handrim Wheelchair Propulsion Training in Adolescent Wheelchair Users, A Pilot Study

PubMed Central

Dysterheft, Jennifer L.; Rice, Ian M.; Rice, Laura A.

2015-01-01

Ten full-time adolescent wheelchair users (ages 13–18) completed a total of three propulsion trials on carpet and tile surfaces, at a self-selected velocity, and on a concrete surface, at a controlled velocity. All trials were performed in their personal wheelchair with force and moment sensing wheels attached bilaterally. The first two trials on each surface were used as pre-intervention control trials. The third trial was performed after receiving training on proper propulsion technique. Peak resultant force, contact angle, stroke frequency, and velocity were recorded during all trials for primary analysis. Carpet and tile trials resulted in significant increases in contact angle and peak total force with decreased stroke frequency after training. During the velocity controlled trials on concrete, significant increases in contact angle occurred, as well as decreases in stroke frequency after training. Overall, the use of a training video and verbal feedback may help to improve short-term propulsion technique in adolescent wheelchair users and decrease the risk of developing upper limb pain and injury. PMID:26042217

Left ventricular pressure and volume data acquisition and analysis using LabVIEW.

PubMed

Cassidy, S C; Teitel, D F

1997-03-01

To automate analysis of left ventricular pressure-volume data, we used LabVIEW to create applications that digitize and display data recorded from conductance and manometric catheters. Applications separate data into cardiac cycles, calculate parallel conductance, and calculate indices of left ventricular function, including end-systolic elastance, preload-recruitable stroke work, stroke volume, ejection fraction, stroke work, maximum and minimum derivative of ventricular pressure, heart rate, indices of relaxation, peak filling rate, and ventricular chamber stiffness. Pressure-volume loops can be graphically displayed. These analyses are exported to a text-file. These applications have simplified and automated the process of evaluating ventricular function.

Validation of the Neurological Fatigue Index for stroke (NFI-Stroke)

PubMed Central

2012-01-01

Background Fatigue is a common symptom in Stroke. Several self-report scales are available to measure this debilitating symptom but concern has been expressed about their construct validity. Objective To examine the reliability and validity of a recently developed scale for multiple sclerosis (MS) fatigue, the Neurological Fatigue Index (NFI-MS), in a sample of stroke patients. Method Six patients with stroke participated in qualitative interviews which were analysed and the themes compared for equivalence to those derived from existing data on MS fatigue. 999 questionnaire packs were sent to those with a stroke within the past four years. Data from the four subscales, and the Summary scale of the NFI-MS were fitted to the Rasch measurement model. Results Themes identified by stroke patients were consistent with those identified by those with MS. 282 questionnaires were returned and respondents had a mean age of 67.3 years; 62% were male, and were on average 17.2 (SD 11.4, range 2–50) months post stroke. The Physical, Cognitive and Summary scales all showed good fit to the model, were unidimensional, and free of differential item functioning by age, sex and time. The sleep scales failed to show adequate fit in their current format. Conclusion Post stroke fatigue appears to be represented by a combination of physical and cognitive components, confirmed by both qualitative and quantitative processes. The NFI-Stroke, comprising a Physical and Cognitive subscale, and a 10-item Summary scale, meets the strictest measurement requirements. Fit to the Rasch model allows conversion of ordinal raw scores to a linear metric. PMID:22587411

tPA variant tPA-A296-299 Prevents impairment of cerebral autoregulation and necrosis of hippocampal neurons after stroke by inhibiting upregulation of ET-1.

PubMed

Armstead, William M; Hekierski, Hugh; Yarovoi, Serge; Higazi, Abd Al-Roof; Cines, Douglas B

2018-01-01

Tissue-type plasminogen activator (tPA) is neurotoxic and exacerbates uncoupling of cerebral blood flow (CBF) and metabolism after stroke, yet it remains the sole FDA-approved drug for treatment of ischemic stroke. Upregulation of c-Jun-terminal kinase (JNK) after stroke contributes to tPA-mediated impairment of autoregulation, but the role of endothelin-1 (ET-1) is unknown. Based on the Glasgow Coma Scale, impaired autoregulation is linked to adverse outcomes after TBI, but correlation with hippocampal histopathology after stroke has not been established. We propose that given after stroke, tPA activates N-Methyl-D-Aspartate receptors (NMDA-Rs) and upregulates ET-1 in a JNK dependent manner, imparing autoregulation and leading to histopathology. After stroke, CBF was reduced in the hippocampus and reduced further during hypotension, which did not occur in hypotensive sham pigs, indicating impairment of autoregulation. Autoregulation and necrosis of hippocampal CA1 and CA3 neurons were further impaired by tPA, but were preserved by the ET-1 antagonist BQ 123 and tPA-A, 296-299 a variant that is fibrinolytic but does not bind to NMDA-Rs. Expression of ET-1 was increased by stroke and potentiated by tPA but returned to sham levels by tPA-A 296-299 and the JNK antagonist SP600125. Results show that JNK releases ET-1 after stroke. Tissue-type plasminogen activator -A 296-299 prevents impairment of cerebral autoregulation and histopathology after stroke by inhibiting upregulation of ET-1. © 2017 Wiley Periodicals, Inc.

On the mechanism of X-ray production by dart leaders of lightning flashes

NASA Astrophysics Data System (ADS)

Cooray, Vernon; Dwyer, Joseph; Rakov, V.; Rahman, Mahbubur

2010-07-01

Radiation with energies up to about 250 keV associated with the dart leader phase of rocket-triggered lightning were reported by Dwyer et al. (2004). The mechanism of X-ray generation by dart leaders, however, is unknown at present. Recently, Cooray et al. (2009a) developed physical concepts and mathematical techniques necessary to calculate the electric field associated with the tip of dart leaders. We have utilized the results of these calculations together with the energy dependent frictional force on electrons, as presented by Moss et al. (2006), to evaluate the maximum energy an electron will receive in accelerating in the dart-leader-tip electric field. The main assumptions made in performing the calculations are: (a) the dart leader channel is straight and vertical; (b) the path of the electrons are straight inside the channel; and (c) the decay of the channel temperature is uniform along the length of the dart leader. In the calculation, we have taken into account the fact that the electric field is changing both in space and time and that the gas in the defunct return stroke channel is at atmospheric pressure and at elevated temperature (i.e. reduced gas density). The results of the calculation show that for a given dart leader current there is a critical defunct-return-stroke-channel temperature above which the cold electron runaway becomes feasible. For a typical dart leader, this temperature is around 2500 K. This critical temperature decreases with increase in dart leader current. Since the temperature of the defunct return stroke channel may lie in the range of 2000-4000 K, the results show that the electric field at the tip of dart leaders is capable of accelerating electrons to MeV energy levels.

Feasibility of cardiopulmonary exercise testing and training using a robotics-assisted tilt table in dependent-ambulatory stroke patients.

PubMed

Saengsuwan, Jittima; Huber, Celine; Schreiber, Jonathan; Schuster-Amft, Corina; Nef, Tobias; Hunt, Kenneth J

2015-09-26

We evaluated the feasibility of an augmented robotics-assisted tilt table (RATT) for incremental cardiopulmonary exercise testing (CPET) and exercise training in dependent-ambulatory stroke patients. Stroke patients (Functional Ambulation Category ≤ 3) underwent familiarization, an incremental exercise test (IET) and a constant load test (CLT) on separate days. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and real-time visual feedback to guide the exercise work rate was used. Feasibility assessment considered technical feasibility, patient tolerability, and cardiopulmonary responsiveness. Eight patients (4 female) aged 58.3 ± 9.2 years (mean ± SD) were recruited and all completed the study. For IETs, peak oxygen uptake (V'O2peak), peak heart rate (HRpeak) and peak work rate (WRpeak) were 11.9 ± 4.0 ml/kg/min (45 % of predicted V'O2max), 117 ± 32 beats/min (72 % of predicted HRmax) and 22.5 ± 13.0 W, respectively. Peak ratings of perceived exertion (RPE) were on the range "hard" to "very hard". All 8 patients reached their limit of functional capacity in terms of either their cardiopulmonary or neuromuscular performance. A ventilatory threshold (VT) was identified in 7 patients and a respiratory compensation point (RCP) in 6 patients: mean V'O2 at VT and RCP was 8.9 and 10.7 ml/kg/min, respectively, which represent 75 % (VT) and 85 % (RCP) of mean V'O2peak. Incremental CPET provided sufficient information to satisfy the responsiveness criteria and identification of key outcomes in all 8 patients. For CLTs, mean steady-state V'O2 was 6.9 ml/kg/min (49 % of V'O2 reserve), mean HR was 90 beats/min (56 % of HRmax), RPEs were > 2, and all patients maintained the active work rate for 10 min: these values meet recommended intensity levels for bouts of training. The augmented RATT is deemed feasible for incremental cardiopulmonary exercise testing and exercise training in dependent-ambulatory stroke patients: the approach was found to be technically implementable, acceptable to the patients, and it showed substantial cardiopulmonary responsiveness. This work has clinical implications for patients with severe disability who otherwise are not able to be tested.

Test-retest reliability and four-week changes in cardiopulmonary fitness in stroke patients: evaluation using a robotics-assisted tilt table.

PubMed

Saengsuwan, Jittima; Berger, Lucia; Schuster-Amft, Corina; Nef, Tobias; Hunt, Kenneth J

2016-09-06

Exercise testing devices for evaluating cardiopulmonary fitness in patients with severe disability after stroke are lacking, but we have adapted a robotics-assisted tilt table (RATT) for cardiopulmonary exercise testing (CPET). Using the RATT in a sample of patients after stroke, this study aimed to investigate test-retest reliability and repeatability of CPET and to prospectively investigate changes in cardiopulmonary outcomes over a period of four weeks. Stroke patients with all degrees of disability underwent 3 separate CPET sessions: 2 tests at baseline (TB1 and TB2) and 1 test at follow up (TF). TB1 and TB2 were at least 24 h apart. TB2 and TF were 4 weeks apart. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and a real-time visual feedback system was used to guide the patients' exercise work rate during CPET. Test-retest reliability and repeatability of CPET variables were analysed using paired t-tests, the intraclass correlation coefficient (ICC), the coefficient of variation (CoV), and Bland and Altman limits of agreement. Changes in cardiopulmonary fitness during four weeks were analysed using paired t-tests. Seventeen sub-acute and chronic stroke patients (age 62.7 ± 10.4 years [mean ± SD]; 8 females) completed the test sessions. The median time post stroke was 350 days. There were 4 severely disabled, 1 moderately disabled and 12 mildly disabled patients. For test-retest, there were no statistically significant differences between TB1 and TB2 for most CPET variables. Peak oxygen uptake, peak heart rate, peak work rate and oxygen uptake at the ventilatory anaerobic threshold (VAT) and respiratory compensation point (RCP) showed good to excellent test-retest reliability (ICC 0.65-0.94). For all CPET variables, CoV was 4.1-14.5 %. The mean difference was close to zero in most of the CPET variables. There were no significant changes in most cardiopulmonary performance parameters during the 4-week period (TB2 vs TF). These findings provide the first evidence of test-retest reliability and repeatability of the principal CPET variables using the novel RATT system and testing methodology, and high success rates in identification of VAT and RCP: good to excellent test-retest reliability and repeatability were found for all submaximal and maximal CPET variables. Reliability and repeatability of the main CPET parameters in stroke patients on the RATT were comparable to previous findings in stroke patients using standard exercise testing devices. The RATT has potential to be used as an alternative exercise testing device in patients who have limitations for use of standard exercise testing devices.

Lightning activity related to satellite and radar observations of a mesoscale convective system over Texas on 7 8 April 2002

NASA Astrophysics Data System (ADS)

Dotzek, Nikolai; Rabin, Robert M.; Carey, Lawrence D.; MacGorman, Donald R.; McCormick, Tracy L.; Demetriades, Nicholas W.; Murphy, Martin J.; Holle, Ronald L.

2005-07-01

A multi-sensor study of the leading-line, trailing-stratiform (LLTS) mesoscale convective system (MCS) that developed over Texas in the afternoon of 7 April 2002 is presented. The analysis relies mainly on operationally available data sources such as GOES East satellite imagery, WSR-88D radar data and NLDN cloud-to-ground flash data. In addition, total lightning information in three dimensions from the LDAR II network in the Dallas-Ft. Worth region is used. GOES East satellite imagery revealed several ring-like cloud top structures with a diameter of about 100 km during MCS formation. The Throckmorton tornadic supercell, which had formed just ahead of the developing linear MCS, was characterized by a high CG+ percentage below a V-shaped cloud top overshoot north of the tornado swath. There were indications of the presence of a tilted electrical dipole in this storm. Also this supercell had low average CG- first stroke currents and flash multiplicities. Interestingly, especially the average CG+ flash multiplicity in the Throckmorton storm showed oscillations with an estimated period of about 15 min. Later on, in the mature LLTS MCS, the radar versus lightning activity comparison revealed two dominant discharge regions at the back of the convective leading edge and a gentle descent of the upper intracloud lightning region into the trailing stratiform region, apparently coupled to hydrometeor sedimentation. There was evidence for an inverted dipole in the stratiform region of the LLTS MCS, and CG+ flashes from the stratiform region had high first return stroke peak currents.

Nox2 Knockout Delays Infarct Progression and Increases Vascular Recovery through Angiogenesis in Mice following Ischaemic Stroke with Reperfusion

PubMed Central

McCann, Sarah K.; Dusting, Gregory J.; Roulston, Carli L.

2014-01-01

Evidence suggests the NADPH oxidases contribute to ischaemic stroke injury and Nox2 is the most widely studied subtype in the context of stroke. There is still conjecture however regarding the benefits of inhibiting Nox2 to improve stroke outcome. The current study aimed to examine the temporal effects of genetic Nox2 deletion on neuronal loss after ischaemic stroke using knockout (KO) mice with 6, 24 and 72 hour recovery. Transient cerebral ischaemia was induced via intraluminal filament occlusion and resulted in reduced infarct volumes in Nox2 KO mice at 24 h post-stroke compared to wild-type controls. No protection was evident at either 6 h or 72 h post-stroke, with both genotypes exhibiting similar volumes of damage. Reactive oxygen species were detected using dihydroethidium and were co-localised with neurons and microglia in both genotypes using immunofluorescent double-labelling. The effect of Nox2 deletion on vascular damage and recovery was also examined 24 h and 72 h post-stroke using an antibody against laminin. Blood vessel density was decreased in the ischaemic core of both genotypes 24 h post-stroke and returned to pre-stroke levels only in Nox2 KO mice by 72 h. Overall, these results are the first to show that genetic Nox2 deletion merely delays the progression of neuronal loss after stroke but does not prevent it. Additionally, we show for the first time that Nox2 deletion increases re-vascularisation of the damaged brain by 72 h, which may be important in promoting endogenous brain repair mechanisms that rely on re-vascularisation. PMID:25375101

Landing Characteristics of a Reentry Capsule with a Torus-Shaped Air Bag for Load Alleviation

NASA Technical Reports Server (NTRS)

McGehee, John R.; Hathaway, Melvin E.

1960-01-01

An experimental investigation has been made to determine the landing characteristics of a conical-shaped reentry capsule by using torus-shaped air bags for impact-load alleviation. An impact bag was attached below the large end of the capsule to absorb initial impact loads and a second bag was attached around the canister to absorb loads resulting from impact on the canister when the capsule overturned. A 1/6-scale dynamic model of the configuration was tested for nominal flight paths of 60 deg. and 90 deg. (vertical), a range of contact attitudes from -25 deg. to 30 deg., and a vertical contact velocity of 12.25 feet per second. Accelerations were measured along the X-axis (roll) and Z-axis (yaw) by accelerometers rigidly installed at the center of gravity of the model. Actual flight path, contact attitudes, and motions were determined from high-speed motion pictures. Landings were made on concrete and on water. The peak accelerations along the X-axis for landings on concrete were in the order of 3Og for a 0 deg. contact attitude. A horizontal velocity of 7 feet per second, corresponding to a flight path of 60 deg., had very little effect upon the peak accelerations obtained for landings on concrete. For contact attitudes of -25 deg. and 30 deg. the peak accelerations along the Z-axis were about +/- l5g, respectively. The peak accelerations measured for the water landings were about one-third lower than the peak accelerations measured for the landings on concrete. Assuming a rigid body, computations were made by using Newton's second law of motion and the force-stroke characteristics of the air bag to determine accelerations for a flight path of 90 deg. (vertical) and a contact attitude of 0 deg. The computed and experimental peak accelerations and strokes at peak acceleration were in good agreement for the model. The special scaling appears to be applicable for predicting full-scale time and stroke at peak acceleration for a landing on concrete from a 90 deg. flight path at a 0 deg. It appears that the full-scale approximately the same as those obtained from the model for the range of attitudes and flight paths investigated.

Air Pollution Is Associated With Ischemic Stroke via Cardiogenic Embolism.

PubMed

Chung, Jong-Won; Bang, Oh Young; Ahn, Kangmo; Park, Sang-Soon; Park, Tai Hwan; Kim, Jae Guk; Ko, Youngchai; Lee, SooJoo; Lee, Kyung Bok; Lee, Jun; Kang, Kyusik; Park, Jong-Moo; Cho, Yong-Jin; Hong, Keun-Sik; Nah, Hyun-Wook; Kim, Dae-Hyun; Cha, Jae-Kwan; Ryu, Wi-Sun; Kim, Dong-Eog; Kim, Joon-Tae; Choi, Jay Chol; Oh, Mi-Sun; Yu, Kyung-Ho; Lee, Byung-Chul; Lee, Ji Sung; Lee, Juneyoung; Park, Hong-Kyun; Kim, Beom Joon; Han, Moon-Ku; Bae, Hee-Joon

2017-01-01

The aim of the study was to assessed the impact of short-term exposure to air pollution on ischemic stroke subtype, while focusing on stroke caused via cardioembolism. From a nationwide, multicenter, prospective, stroke registry database, 13 535 patients with acute ischemic stroke hospitalized to 12 participating centers were enrolled in this study. Data on the hourly concentrations of particulate matter <10 μm, nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), ozone (O 3 ), and carbon monoxide (CO) were collected from 181 nationwide air pollution surveillance stations. The average values of these air pollutants over the 7 days before stroke onset from nearest air quality monitoring station in each patient were used to determine association with stroke subtype. The primary outcome was stroke subtype, including large artery atherosclerosis, small-vessel occlusion, cardioembolism, and stroke of other or undetermined cause. Particulate matter <10 μm and SO 2 concentrations were independently associated with an increased risk of cardioembolic stroke, as compared with large artery atherosclerosis and noncardioembolic stroke. In stratified analyses, the proportion of cases of cardioembolic stroke was positively correlated with the particulate matter <10 μm, NO 2 , and SO 2 quintiles. Moreover, seasonal and geographic factors were related to an increased proportion of cardioembolic stroke, which may be attributed to the high levels of air pollution. Our findings suggest that the short-term exposure to air pollutants is associated with cardioembolic stroke, and greater care should be taken for those susceptible to cerebral embolism during peak pollution periods. Public and environmental health policies to reduce air pollution could help slow down global increasing trends of cardioembolic stroke. © 2016 American Heart Association, Inc.

A Teaching Procedure for the Diatype Analyzer

ERIC Educational Resources Information Center

Pringle, Girard F.; O'Brien, Michael James

1973-01-01

The Diatype Analyzer is a motor-driven typewriting device which attaches to the carriage of the typewriter and is used to diagnose students' typewriting difficulties (rhythm, difficult strokes, concentration, carriage return, operation of the shift key or space bar) more exactly than by teacher examination. (AG)

Stroke Volume During Concomitant Apnea and Exercise: Influence of Gravity and Venous Return

NASA Astrophysics Data System (ADS)

Hoffmann, Uwe; Drager, Tobias; Steegmanns, Ansgar; Koesterer, Thomas; Linnarsson, Dag

2008-06-01

The responses of the cardiovascular system to intensive exercise (hiP) and combined stimuli by hiP and breath-hold (hiP-BH) for 20 s were examined during changing gravity (parabolic flight) and constant gravity (1g). The basic response to microgravity (μg) during low-intensity exercise was an increase in cardiac output (CO) and stroke volume (SV) as a result of augmented venous return. When onset of hiP was superimposed, the initial augmentation of CO and SV were increased further. In contrast, when BH was added, the increases of CO and SV were slowed. We propose that this was due to a transient increase of the pulmonary blood volume with the combination of μg and BH at large lung volume, creating a temporary imbalance between right ventricular input and left ventricular output. In addition, the BH- induced relative bradycardia may have contributed to a prolongation of the right-to- left indirect ventricular interdependence.

Stepped-to-dart Leaders in Cloud-to-ground Lightning

NASA Astrophysics Data System (ADS)

Stolzenburg, M.; Marshall, T. C.; Karunarathne, S.; Karunarathna, N.; Warner, T.; Orville, R. E.

2013-12-01

Using time-correlated high-speed video (50,000 frames per second) and fast electric field change (5 MegaSamples per second) data for lightning flashes in East-central Florida, we describe an apparently rare type of subsequent leader: a stepped leader that finds and follows a previously used channel. The observed 'stepped-to-dart leaders' occur in three natural negative ground flashes. Stepped-to-dart leader connection altitudes are 3.3, 1.6 and 0.7 km above ground in the three cases. Prior to the stepped-to-dart connection, the advancing leaders have properties typical of stepped leaders. After the connection, the behavior changes almost immediately (within 40-60 us) to dart or dart-stepped leader, with larger amplitude E-change pulses and faster average propagation speeds. In this presentation, we will also describe the upward luminosity after the connection in the prior return stroke channel and in the stepped leader path, along with properties of the return strokes and other leaders in the three flashes.

Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke: A Meta-Analysis With Meta-Regression.

PubMed

Boyne, Pierce; Welge, Jeffrey; Kissela, Brett; Dunning, Kari

2017-03-01

To assess the influence of dosing parameters and patient characteristics on the efficacy of aerobic exercise (AEX) poststroke. A systematic review was conducted using PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Academic Search Complete. Studies were selected that compared an AEX group with a nonaerobic control group among ambulatory persons with stroke. Extracted outcome data included peak oxygen consumption (V˙o 2 peak) during exercise testing, walking speed, and walking endurance (6-min walk test). Independent variables of interest were AEX mode (seated or walking), AEX intensity (moderate or vigorous), AEX volume (total hours), stroke chronicity, and baseline outcome scores. Significant between-study heterogeneity was confirmed for all outcomes. Pooled AEX effect size estimates (AEX group change minus control group change) from random effects models were V˙o 2 peak, 2.2mL⋅kg -1 ⋅min -1 (95% confidence interval [CI], 1.3-3.1mL⋅kg -1 ⋅min -1 ); walking speed, .06m/s (95% CI, .01-.11m/s); and 6-minute walk test distance, 29m (95% CI, 15-42m). In meta-regression, larger V˙o 2 peak effect sizes were significantly associated with higher AEX intensity and higher baseline V˙o 2 peak. Larger effect sizes for walking speed and the 6-minute walk test were significantly associated with a walking AEX mode. In contrast, seated AEX did not have a significant effect on walking outcomes. AEX significantly improves aerobic capacity poststroke, but may need to be task specific to affect walking speed and endurance. Higher AEX intensity is associated with better outcomes. Future randomized studies are needed to confirm these results. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

An Approach to the Lightning Overvoltage Protection of Medium Voltage Lines in Severe Lightning Areas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Omidiora, M. A.; Lehtonen, M.

2008-05-08

This paper deals with the effect of shield wires on lightning overvoltage reduction and the energy relief of MOV (Metal Oxide Varistor) arresters from direct strokes to distribution lines. The subject of discussion is the enhancement of lightning protection in Finnish distribution networks where lightning is most severe. The true index of lightning severity in these areas is based on the ground flash densities and return stroke data collected from the Finnish meteorological institute. The presented test case is the IEEE 34-node test feeder injected with multiple lightning strokes and simulated with the Alternative Transients Program/Electromagnetic Transients program (ATP/EMTP). Themore » response of the distribution line to lightning strokes was modeled with three different cases: no protection, protection with surge arresters and protection with a combination of shield wire and arresters. Simulations were made to compare the resulting overvoltages on the line for all the analyzed cases.« less

Ball Machine Usage in Tennis: Movement Initiation and Swing Timing While Returning Balls from a Ball Machine and from a Real Server

PubMed Central

Carboch, Jan; Süss, Vladimir; Kocib, Tomas

2014-01-01

Practicing with the use of a ball machine could handicap a player compared to playing against an actual opponent. Recent studies have shown some differences in swing timing and movement coordination, when a player faces a ball projection machine as opposed to a human opponent. We focused on the time of movement initiation and on stroke timing during returning tennis serves (simulated by a ball machine or by a real server). Receivers’ movements were measured on a tennis court. In spite of using a serving ball speed from 90 kph to 135 kph, results showed significant differences in movement initiation and backswing duration between serves received from a ball machine and serves received from a real server. Players had shorter movement initiation when they faced a ball machine. Backswing duration was longer for the group using a ball machine. That demonstrates different movement timing of tennis returns when players face a ball machine. Use of ball machines in tennis practice should be limited as it may disrupt stroke timing. Key points Players have shorter initial move time when they are facing the ball machine. Using the ball machine results in different swing timing and movement coordination. The use of the ball machine should be limited. PMID:24790483

Ball machine usage in tennis: movement initiation and swing timing while returning balls from a ball machine and from a real server.

PubMed

Carboch, Jan; Süss, Vladimir; Kocib, Tomas

2014-05-01

Practicing with the use of a ball machine could handicap a player compared to playing against an actual opponent. Recent studies have shown some differences in swing timing and movement coordination, when a player faces a ball projection machine as opposed to a human opponent. We focused on the time of movement initiation and on stroke timing during returning tennis serves (simulated by a ball machine or by a real server). Receivers' movements were measured on a tennis court. In spite of using a serving ball speed from 90 kph to 135 kph, results showed significant differences in movement initiation and backswing duration between serves received from a ball machine and serves received from a real server. Players had shorter movement initiation when they faced a ball machine. Backswing duration was longer for the group using a ball machine. That demonstrates different movement timing of tennis returns when players face a ball machine. Use of ball machines in tennis practice should be limited as it may disrupt stroke timing. Key pointsPlayers have shorter initial move time when they are facing the ball machine.Using the ball machine results in different swing timing and movement coordination.The use of the ball machine should be limited.

Ontogenetic changes in the olfactory antennules of the shore crab, Hemigrapsus oregonensis, maintain sniffing function during growth

PubMed Central

Waldrop, Lindsay D.; Hann, Miranda; Henry, Amy K.; Kim, Agnes; Punjabi, Ayesha; Koehl, M. A. R.

2015-01-01

Malacostracan crustaceans capture odours using arrays of chemosensory hairs (aesthetascs) on antennules. Lobsters and stomatopods have sparse aesthetascs on long antennules that flick with a rapid downstroke when water flows between the aesthetascs and a slow return stroke when water is trapped within the array (sniffing). Changes in velocity only cause big differences in flow through an array in a critical range of hair size, spacing and speed. Crabs have short antennules bearing dense arrays of flexible aesthetascs that splay apart during downstroke and clump together during return. Can crabs sniff, and when during ontogeny are they big enough to sniff? Antennules of Hemigrapsus oregonensis representing an ontogenetic series from small juveniles to adults were used to design dynamically scaled physical models. Particle image velocimetry quantified fluid flow through each array and showed that even very small crabs capture a new water sample in their arrays during the downstroke and retain that sample during return stroke. Comparison with isometrically scaled antennules suggests that reduction in aesthetasc flexural stiffness during ontogeny, in addition to increase in aesthetasc number and decrease in relative size, maintain sniffing as crabs grow. Sniffing performance of intermediate-sized juveniles was worse than for smaller and larger crabs. PMID:25411408

Ontogenetic changes in the olfactory antennules of the shore crab, Hemigrapsus oregonensis, maintain sniffing function during growth.

PubMed

Waldrop, Lindsay D; Hann, Miranda; Henry, Amy K; Kim, Agnes; Punjabi, Ayesha; Koehl, M A R

2015-01-06

Malacostracan crustaceans capture odours using arrays of chemosensory hairs (aesthetascs) on antennules. Lobsters and stomatopods have sparse aesthetascs on long antennules that flick with a rapid downstroke when water flows between the aesthetascs and a slow return stroke when water is trapped within the array (sniffing). Changes in velocity only cause big differences in flow through an array in a critical range of hair size, spacing and speed. Crabs have short antennules bearing dense arrays of flexible aesthetascs that splay apart during downstroke and clump together during return. Can crabs sniff, and when during ontogeny are they big enough to sniff? Antennules of Hemigrapsus oregonensis representing an ontogenetic series from small juveniles to adults were used to design dynamically scaled physical models. Particle image velocimetry quantified fluid flow through each array and showed that even very small crabs capture a new water sample in their arrays during the downstroke and retain that sample during return stroke. Comparison with isometrically scaled antennules suggests that reduction in aesthetasc flexural stiffness during ontogeny, in addition to increase in aesthetasc number and decrease in relative size, maintain sniffing as crabs grow. Sniffing performance of intermediate-sized juveniles was worse than for smaller and larger crabs. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke.

PubMed

Leddy, Abigail L; Connolly, Mark; Holleran, Carey L; Hennessy, Patrick W; Woodward, Jane; Arena, Ross A; Roth, Elliot J; Hornby, T George

2016-10-01

Impairments in metabolic capacity and economy (O2cost) are hallmark characteristics of locomotor dysfunction following stroke. High-intensity (aerobic) training has been shown to improve peak oxygen consumption in this population, with fewer reports of changes in O2cost. However, particularly in persons with subacute stroke, inconsistent gains in walking function are observed with minimal associations with gains in metabolic parameters. The purpose of this study was to evaluate changes in aerobic exercise performance in participants with subacute stroke following high-intensity variable stepping training as compared with conventional therapy. A secondary analysis was performed on data from a randomized controlled trial comparing high-intensity training with conventional interventions, and from the pilot study that formed the basis for the randomized controlled trial. Participants 1 to 6 months poststroke received 40 or fewer sessions of high-intensity variable stepping training (n = 21) or conventional interventions (n = 12). Assessments were performed at baseline (BSL), posttraining, and 2- to 3-month follow-up and included changes in submaximal (Equation is included in full-text article.)O2 ((Equation is included in full-text article.)O2submax) and O2cost at fastest possible treadmill speeds and peak speeds at BSL testing. Significant improvements were observed in (Equation is included in full-text article.)O2submax with less consistent improvements in O2cost, although individual responses varied substantially. Combined changes in both (Equation is included in full-text article.)O2submax and (Equation is included in full-text article.)O2 at matched peak BSL speeds revealed stronger correlations to improvements in walking function as compared with either measure alone. High-intensity stepping training may elicit significant improvements in (Equation is included in full-text article.)O2submax, whereas changes in both peak capacity and economy better reflect gains in walking function. Providing high-intensity training to improve locomotor and aerobic exercise performance may increase the efficiency of rehabilitation sessions.Video Abstract available for more insights from the authors (see Supplemental Digital Content, http://links.lww.com/JNPT/A142).

The kinematic determinants of anuran swimming performance: an inverse and forward dynamics approach.

PubMed

Richards, Christopher T

2008-10-01

The aims of this study were to explore the hydrodynamic mechanism of Xenopus laevis swimming and to describe how hind limb kinematics shift to control swimming performance. Kinematics of the joints, feet and body were obtained from high speed video of X. laevis frogs (N=4) during swimming over a range of speeds. A blade element approach was used to estimate thrust produced by both translational and rotational components of foot velocity. Peak thrust from the feet ranged from 0.09 to 0.69 N across speeds ranging from 0.28 to 1.2 m s(-1). Among 23 swimming strokes, net thrust impulse from rotational foot motion was significantly higher than net translational thrust impulse, ranging from 6.1 to 29.3 N ms, compared with a range of -7.0 to 4.1 N ms from foot translation. Additionally, X. laevis kinematics were used as a basis for a forward dynamic anuran swimming model. Input joint kinematics were modulated to independently vary the magnitudes of foot translational and rotational velocity. Simulations predicted that maximum swimming velocity (among all of the kinematics patterns tested) requires that maximal translational and maximal rotational foot velocity act in phase. However, consistent with experimental kinematics, translational and rotational motion contributed unequally to total thrust. The simulation powered purely by foot translation reached a lower peak stroke velocity than the pure rotational case (0.38 vs 0.54 m s(-1)). In all simulations, thrust from the foot was positive for the first half of the power stroke, but negative for the second half. Pure translational foot motion caused greater negative thrust (70% of peak positive thrust) compared with pure rotational simulation (35% peak positive thrust) suggesting that translational motion is propulsive only in the early stages of joint extension. Later in the power stroke, thrust produced by foot rotation overcomes negative thrust (due to translation). Hydrodynamic analysis from X. laevis as well as forward dynamics give insight into the differential roles of translational and rotational foot motion in the aquatic propulsion of anurans, providing a mechanistic link between joint kinematics and swimming performance.

High-speed plasma imaging: A lightning bolt

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wurden, G.A.; Whiteson, D.O.

Using a gated intensified digital Kodak Ektapro camera system, the authors captured a lightning bolt at 1,000 frames per second, with 100-{micro}s exposure time on each consecutive frame. As a thunder storm approaches while darkness descended (7:50 pm) on July 21, 1994, they photographed lightning bolts with an f22 105-mm lens and 100% gain on the intensified camera. This 15-frame sequence shows a cloud to ground stroke at a distance of about 1.5 km, which has a series of stepped leaders propagating downwards, following by the upward-propagating main return stroke.

Exertional Heat Stroke and American Football: What the Team Physician Needs to Know.

PubMed

Sylvester, Jillian E; Belval, Luke N; Casa, Douglas J; O'Connor, Francis G

Football is recognized as a leading contributor to sports injury secondary to the contact collision nature of the endeavor. While direct deaths from head and spine injury remain a significant contributor to the number of catastrophic injuries, indirect deaths (systemic failure) predominate. Exertional heat stroke has emerged as one of the leading indirect causes of death in high school and collegiate football. This review details for the team physician the unique challenge of exercising in the heat to the football player, and the prevention, diagnosis, management, and return-to-play issues pertinent to exertional heat illnesses.

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability.

PubMed

Slawski, Diana E; Salahuddin, Hisham; Shawver, Julie; Kenmuir, Cynthia L; Tietjen, Gretchen E; Korsnack, Andrea; Zaidi, Syed F; Jumaa, Mouhammad A

2018-04-01

The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review. The data included baseline characteristics, time to treatment, the rate of revascularization, procedural complications, mortality, and 90-day good outcome defined as a modified Rankin Scale (mRS) score of 0-2 or return to baseline. Of the 96 patients, 50 had mild baseline disability (mRS score 0-1) and 46 had moderate disability (mRS score 2-4). Recanalization was achieved in 84% of the patients, and the rate of symptomatic hemorrhage was 6%. At 90 days, 34% of the patients had a good outcome. There were no significant differences in good outcome between those with mild and those with moderate baseline disability (43 vs. 24%, p = 0.08), between those aged ≤85 and those aged > 85 years (40.8 vs. 26.1%, p = 0.19), and between those treated within and those treated beyond 8 h (39 vs. 20%, p = 0.1). The mortality rate was 38.5% at 90 days. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale (NIHSS) predicted good outcome regardless of baseline disability ( p < 0.001 and p = 0.009, respectively). Advanced age, baseline disability, and delayed treatment are associated with sub-optimal outcomes after MT. However, redefining good outcome to include return to baseline functioning demonstrates that one-third of this patient population benefits from MT, suggesting the real-life utility of this treatment.

“Living With a Ball and Chain”: The Experience of Stroke for Individuals and Their Caregivers in Rural Appalachian Kentucky

PubMed Central

Danzl, Megan M.; Hunter, Elizabeth G.; Campbell, Sarah; Sylvia, Violet; Kuperstein, Janice; Maddy, Katherine; Harrison, Anne

2013-01-01

Purpose Individuals in rural Appalachian Kentucky face health disparities and are at increased risk for negative health outcomes and poor quality of life secondary to stroke. The purpose of this study is to describe the experience of stroke for survivors and their caregivers in this region. A description of their experiences is paramount to developing tailored interventions and ultimately improving health care and support. Methods An interprofessional research team used a qualitative descriptive study design and interviewed 13 individuals with stroke and 12 caregivers, representing 10 rural Appalachian Kentucky counties. The transcripts were analyzed using qualitative content analysis. Findings A descriptive summary of the participants’ experience of stroke is presented within the following structure: 1) Stroke onset, 2) Transition through the health care continuum (including acute care, inpatient rehabilitation, and community-based rehabilitation), and 3) Reintegration into life and rural communities. Conclusions The findings provide insight for rural health care providers and community leaders to begin to understand the experience of stroke in terms of stroke onset, transition through the health care continuum, return to home, and community reintegration. An understanding of these experiences may lead to discussions of how to improve service provision, facilitate reintegration, support positive health outcomes and improve quality of life for stroke survivors and their caregivers. The findings also indicate areas in need of future research including investigation of the effects of support groups, local health navigators to improve access to information and services, involvement of faith communities, proactive screening for management of mental health needs, and caregiver respite services. PMID:24088211

An International Standard Set of Patient-Centered Outcome Measures After Stroke.

PubMed

Salinas, Joel; Sprinkhuizen, Sara M; Ackerson, Teri; Bernhardt, Julie; Davie, Charlie; George, Mary G; Gething, Stephanie; Kelly, Adam G; Lindsay, Patrice; Liu, Liping; Martins, Sheila C O; Morgan, Louise; Norrving, Bo; Ribbers, Gerard M; Silver, Frank L; Smith, Eric E; Williams, Linda S; Schwamm, Lee H

2016-01-01

Value-based health care aims to bring together patients and health systems to maximize the ratio of quality over cost. To enable assessment of healthcare value in stroke management, an international standard set of patient-centered stroke outcome measures was defined for use in a variety of healthcare settings. A modified Delphi process was implemented with an international expert panel representing patients, advocates, and clinical specialists in stroke outcomes, stroke registers, global health, epidemiology, and rehabilitation to reach consensus on the preferred outcome measures, included populations, and baseline risk adjustment variables. Patients presenting to a hospital with ischemic stroke or intracerebral hemorrhage were selected as the target population for these recommendations, with the inclusion of transient ischemic attacks optional. Outcome categories recommended for assessment were survival and disease control, acute complications, and patient-reported outcomes. Patient-reported outcomes proposed for assessment at 90 days were pain, mood, feeding, selfcare, mobility, communication, cognitive functioning, social participation, ability to return to usual activities, and health-related quality of life, with mobility, feeding, selfcare, and communication also collected at discharge. One instrument was able to collect most patient-reported subdomains (9/16, 56%). Minimum data collection for risk adjustment included patient demographics, premorbid functioning, stroke type and severity, vascular and systemic risk factors, and specific treatment/care-related factors. A consensus stroke measure Standard Set was developed as a simple, pragmatic method to increase the value of stroke care. The set should be validated in practice when used for monitoring and comparisons across different care settings. © 2015 The Authors.

Utility loss and indirect costs after stroke in Sweden.

PubMed

Lindgren, Peter; Glader, Eva-Lotta; Jönsson, Bengt

2008-04-01

Currently little data exist on the development of quality of life over time in patients suffering from stroke, in particular using instruments that can be adapted in economic studies. The purpose of the study was to assess the utility loss and indirect costs following a stroke in Sweden. A cross-sectional mail survey. In collaboration with the National Stroke registry (RIKS-STROKE), a questionnaire consisting of the EuroQol-5D and questions regarding the present working status and the status prior to the stroke was mailed to patients below 76 years of age at six participating centres. The questionnaire was mailed to 393 patients in total, divided into groups with 3, 6, 9 or 12 months having passed since the stroke. The EuroQol-5D scores were converted to utility scores using the UK social tariff. Indirect costs were valued according to the average salary+employer contributions. A total of 275 questionnaires (70%) were returned. Utility scores were similar over time: 0.65, 0.75, 0.63, and 0.67 at 3, 6, 9 and 12 months, respectively. Regression analyses revealed a tendency for lower utility scores among women, but no significant differences overall. Among patients in the working ages, a stroke caused 18.5 work weeks lost, corresponding to an indirect cost of 120,000 Swedish Kronor (SEK) (13,200euro, 95% confidence interval 82,541-160,050 SEK, 9080-17 605euro). Stroke causes a significant reduction in utility and causes high indirect costs. A substantial improvement was not noted over time, which is important to consider in economic models.

Tracks of a non-main path traveler: 2011 Thomas Willis Lecture.

PubMed

Hallenbeck, John M

2012-02-01

After an unconventional beginning in stroke research, I veered off the main path repeatedly to view problems from a different perspective. In this lecture summary, I would like to return to several points along the byways that led to research with some continuity.

Effect of early and late rehabilitation onset in a chronic rat model of ischemic stroke- assessment of motor cortex signaling and gait functionality over time.

PubMed

Nielsen, Rasmus K; Samson, Katrine L; Simonsen, Daniel; Jensen, Winnie

2013-11-01

The aim of the present study was to investigate the effects of ischemic stroke and onset of subsequent rehabilitation of gait function in rats. Nine male Sprague-Dawley rats were instrumented with a 16-channel intracortical (IC) electrode array. An ischemic stroke was induced within the hindlimb area of the left motor cortex. The rehabilitation consisted of a repetitive training paradigm over 28 days, initiated on day one ("Early-onset", 5 rats) and on day seven, ("Late-onset", 4 rats). Data were obtained from IC microstimulation tests, treadmill walking tests, and beam walking tests. Results revealed an expansion of the hindlimb representation within the motor cortex area and an increased amount of cortical firing rate modulation for the "Early-onset" group but not for the "Late-onset" group. Kinematic data revealed a significant change for both intervention groups. However, this difference was larger for the "Early-onset" group. Results from the beam walking test showed functional performance deficits following stroke which returned to pre-stroke level after the rehabilitative training. The results from the present study indicate the existence of a critical time period following stroke where onset of rehabilitative training may be more effective and related to a higher degree of true recovery.

Recovered vs. not-recovered from post-stroke aphasia: The contributions from the dominant and non-dominant hemispheres

PubMed Central

Szaflarski, Jerzy P.; Allendorfer, Jane B.; Banks, Christi; Vannest, Jennifer; Holland, Scott K.

2013-01-01

Purpose Several adult studies have documented the importance of the peri-stroke areas to aphasia recovery. But, studies examining the differences in patterns of cortical participation in language comprehension in patients who have (LMCA-R) or have not recovered (LMCA-NR) from left middle cerebral artery infarction have not been performed up to date. Methods In this study, we compare cortical correlates of language comprehension using fMRI and semantic decision/tone decision task in 9 LMCA-R and 18 LMCA-NR patients matched at the time of stroke for age and handedness. We examine the cortical correlates of language performance by correlating intra- and extra-scanner measures of linguistic performance with fMRI activation and stroke volumes. Results Our analyses show that LMCA-R at least 1 year after stroke show a return to typical fMRI language activation patterns and that there is a compensatory reorganization of language function in LMCA-NR patients with shifts to the right hemispheric brain regions. Further, with increasing strength of the left-hemispheric fMRI signal shift there are associated improvements in performance as tested with standardized linguistic measures. A negative correlation between the size of the stroke and performance on some of the linguistic tests is also observed. Conclusions This right-hemispheric shift as a mechanism of post-stroke recovery in adults appears to be an ineffective mode of language function recovery with increasing right-hemispheric shift associated with lower language performance. Thus, normalization of the post-stroke language activation patterns is needed for better language performance while shifts of the activation patterns to the non-dominant (right) hemisphere and/or large stroke size are associated with decreased linguistic abilities after stroke. PMID:23482065

Sexual function in post-stroke patients: considerations for rehabilitation.

PubMed

Rosenbaum, Talli; Vadas, Dor; Kalichman, Leonid

2014-01-01

While the rehabilitation goals of post-stroke patients include improving quality of life and returning to functional activities, the extent to which sexual activity is addressed as part of the standard rehabilitation process is unknown. Moreover, the specific sexual concerns of stroke patients, including the effect of stroke on intimate relationships and sexuality of the partner, the ability to physically engage in sex, and the effect of psychological components such as role identity, depression, and anxiety on sexuality, all warrant examination by rehabilitation professionals. The aim of this study is to examine the existing literature on sexuality and stroke patients in order to better understand how the sexual lives of stroke patients and their partners are affected and to provide recommendations to rehabilitation professionals for addressing sexuality as part of treatment. Narrative review, PubMed, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2012) were searched for the key words "stroke," "sexual dysfunction," "sexuality," "quality of life," and their combination. All relevant articles in English and secondary references were reviewed. We report the results of the literature review. Sexual dysfunction and decreased sexual satisfaction are common in the post-stroke population and are related to physical, psychosocial, and relational factors. However, they are not adequately addressed in post-stroke rehabilitation. As sexual function is an important component to quality of life and activities of daily living, physicians and rehabilitation specialists, including physical, occupational, and speech therapists, should receive training in addressing sexuality in the treatment of post-stroke patients. Sexologists and sex therapists should be an integral part of the rehabilitation team. © 2013 International Society for Sexual Medicine.

Patients' expectations of coming home with Very Early Supported Discharge and home rehabilitation after stroke - an interview study.

PubMed

Nordin, Åsa; Sunnerhagen, Katharina S; Axelsson, Åsa B

2015-11-16

An Early Supported Discharge (ESD) and rehabilitation from a coordinated team in the home environment is recommended in several high-income countries for patients with mild to moderate symptoms after stroke. Returning home from the hospital takes place very early in Sweden today (12 days post stroke), thus the term Very Early Supported Discharge (VESD) is used in the current study. The aim of this study was to describe patients' expectations of coming home very early after stroke with support and rehabilitations at home. This is an interview study nested within a randomized controlled trial; Gothenburg Very Early Supported Discharge (GOTVED), comparing VESD containing a home rehabilitation intervention from a coordinated team to conventional care after stroke. Ten participants (median age 69) with mild to moderate stroke symptoms (NHISS 0 to 8 points) were recruited from the intervention group in GOTVED. Interviews were conducted 0-5 days before discharge and the material was analyzed with qualitative content analysis. Four main categories containing 11 subcategories were found. The VESD team was expected to provide "Support towards independency", by helping the participants to manage and feel safe at home as well as to regain earlier abilities. The very early discharge gave rise to expectations of coming home to "A new and unknown situation", causing worries not to manage at home and to leave the safe environment at the ward. A fear to suffer a recurrent stroke when being out of reach of immediate professional help was also pronounced. In contrast to these feelings of insecurity and fear, "Returning to one's own setting" described the participants longing home, where they would become autonomous and capable people again. They expected this to facilitate recovery and rehabilitation. "A new everyday life" waited for the participants at home and this was expected to be challenging. Different strategies to deal with these challenges were described. The participants described mixed expectations such as insecurity and fear, and on the other hand, longing to come home. Moreover, they had a high degree of confidence in the expected support of the VESD team. The health professionals at the hospital may build on this trust to reduce the patients' insecurity for coming home. In addition, it may be beneficial to explore the patients' expectations thoroughly in front of discharge, as certain feelings and thoughts could complicate or support the home coming process. Thus, a greater attention on such expectations may facilitate the patient's transition from hospital to home after stroke.

Comparison of cardiovascular function during the early hours of bed rest and space flight

NASA Technical Reports Server (NTRS)

Lathers, C. M.; Charles, J. B.

1994-01-01

This paper reviews the cardiovascular responses of six healthy male subjects to 6 hours in a 5 degrees head-down bed rest model of weightlessness, and compares these responses to those obtained when subjects were positioned in head-up tilts of 10 degrees, 20 degrees, and 42 degrees, simulating 1/6, 1/3, and 2/3 G, respectively. Thoracic fluid index, cardiac output, stroke volume, and peak flow were measured using impedance cardiography. Cardiac dimensions and volumes were determined from two-dimensional guided M-mode echocardiograms in the left lateral decubitus position at 0, 2, 4, and 6 hours. Cardiovascular response to a stand test were compared before and after bed rest. The impedance values were related to tilt angle for the first 2 hours of tilt; however, after 3 hours, at all four angles, values began to converge, indicating that cardiovascular homeostatic mechanisms seek a common adapted state, regardless of effective gravity level (tilt angle) up to 2/3 G. Echocardiography revealed that left ventricular end-diastolic and end-systolic volume, stroke volume, ejection fraction, heart rate, and cardiac output had returned to control values by hour 6 for all tilt angles. The lack of a significant immediate change in left ventricular end-diastolic volume, despite decrements in stroke volume (P < .05) and heart rate (not significant), indicates that multiple factors may play a role in the adaptation to simulated hypogravity. The echocardiography data indicated that no angle of tilt, whether head-down or head-up for 4 to 6 hours, mimicked exactly the changes in cardiovascular function recorded after 4 to 6 hours of space flight. Changes in left ventricular end-diastolic volume during space flight and tilt may be similar, but follow a different time course. Nevertheless, head-down tilt at 5 degrees for 6 hours mimics some (stroke volume, systolic and diastolic blood pressure, mean arterial blood pressure, and total resistance), but not all, of the changes occurring in an equivalent time of space flight. The magnitude of the change in the mean heart rate response to standing was greater after six hours of tilt at -5 degrees or 10 degrees. Thus, results from the stand test after 6 hours of bed rest at -5 degrees and 10 degrees, but not at 20 degrees or 42 degrees, are similar to those obtained after space flight.

Modeling of transmission line exposure to direct lightning strokes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rizk, F.A.M.

1990-10-01

The paper introduces a new model for assessing the exposure of free-standing structures and horizontal conductors above flat ground to direct lightning strokes. The starting point of this work is a recently developed criterion for positive leader inception, modified to account for positive leaders initiated under the influence of a negative descending lightning stroke. Subsequent propagation of the positive leader is analyzed to define the point of encounter of the two leaders which determines the attractive radius of a structure or the attractive lateral distance of a conductor. These parameters are investigated for a wide range of heights and return-strokemore » currents. A method for analyzing shielding failure and determining the critical shielding angle is also described. The predictions of the model are compared with field observations and previously developed models.« less

A Functional Return-to-Play Progression After Exertional Heat Stroke in a High School Football Player.

PubMed

Lopez, Rebecca M; Tanner, Patrick; Irani, Sarah; Mularoni, P Patrick

2018-03-01

  To present a functional return-to-play (RTP) progression after exertional heat stroke (EHS) in a 17-year-old high school football defensive end (height = 185 cm, mass = 145.5 kg).   The patient had no pertinent medical history but moved to a warm climate several days before the EHS occurred. After completing an off-season conditioning test (14- × 110-yd [12.6- × 99.0-m] sprints) on a warm afternoon (temperature = approximately 34°C [93°F], relative humidity = 53%), the patient collapsed. An athletic trainer (AT) was called to the field, where he found the patient conscious but exhibiting central nervous system dysfunction. Emergency medical services were summoned and immediately transported the patient to the hospital.   Exertional heat stroke, heat exhaustion, exertional sickling, rhabdomyolysis, and cardiac arrhythmia.   The patient was immediately transported to a hospital, where his oral temperature was 39.6°C (103.3°F). He was transferred to a children's hospital and treated for rhabdomyolysis, transaminitis, and renal failure. He was hospitalized for 11 days. After a physician's clearance once the laboratory results normalized, an RTP progression was completed. The protocol began with light activity and progressed over 3 weeks to full football practice. During activity, an AT monitored the patient's gastrointestinal temperature, heart rate, rating of perceived exertion, fluid consumption, and sweat losses.   Documentation of RTP guidelines for young athletes is lacking. We used a protocol intended for the football setting to ensure the athlete was heat tolerant, had adequate physical fitness, and could safely RTP. Despite his EHS, he recovered fully, with no lasting effects, and successfully returned to compete in the final 5 games of the season.   Using a gradual RTP progression and close monitoring, a high school defensive end successfully returned to football practice and games after EHS. This case demonstrates the feasibility of implementing a safe RTP protocol after EHS and may serve as a guide to ATs working in the high school setting. This case also highlights the need for more research in this area.

State-changes in the swimmeret system: a neural circuit that drives locomotion

PubMed Central

Tschuluun, N.; Hall, W. M.; Mulloney, B.

2009-01-01

Summary The crayfish swimmeret system undergoes transitions between a silent state and an active state. In the silent state, no patterned firing occurs in swimmeret motor neurons. In the active state, bursts of spikes in power stroke motor neurons alternate periodically with bursts of spikes in return stroke motor neurons. In preparations of the isolated crayfish central nervous system (CNS), the temporal structures of motor patterns expressed in the active state are similar to those expressed by the intact animal. These transitions can occur spontaneously, in response to stimulation of command neurons, or in response to application of neuromodulators and transmitter analogues. We used single-electrode voltage clamp of power-stroke exciter and return-stroke exciter motor neurons to study changes in membrane currents during spontaneous transitions and during transitions caused by bath-application of carbachol or octopamine (OA). Spontaneous transitions from silence to activity were marked by the appearance of a standing inward current and periodic outward currents in both types of motor neurons. Bath-application of carbachol also led to the development of these currents and activation of the system. Using low Ca2+–high Mg2+ saline to block synaptic transmission, we found that the carbachol-induced inward current included a direct response by the motor neuron and an indirect component. Spontaneous transitions from activity to silence were marked by disappearance of the standing inward current and the periodic outward currents. Bath-application of OA led promptly to the disappearance of both currents, and silenced the system. OA also acted directly on both types of motor neurons to cause a hyperpolarizing outward current that would contribute to silencing the system. PMID:19880720

State-changes in the swimmeret system: a neural circuit that drives locomotion.

PubMed

Tschuluun, N; Hall, W M; Mulloney, B

2009-11-01

The crayfish swimmeret system undergoes transitions between a silent state and an active state. In the silent state, no patterned firing occurs in swimmeret motor neurons. In the active state, bursts of spikes in power stroke motor neurons alternate periodically with bursts of spikes in return stroke motor neurons. In preparations of the isolated crayfish central nervous system (CNS), the temporal structures of motor patterns expressed in the active state are similar to those expressed by the intact animal. These transitions can occur spontaneously, in response to stimulation of command neurons, or in response to application of neuromodulators and transmitter analogues. We used single-electrode voltage clamp of power-stroke exciter and return-stroke exciter motor neurons to study changes in membrane currents during spontaneous transitions and during transitions caused by bath-application of carbachol or octopamine (OA). Spontaneous transitions from silence to activity were marked by the appearance of a standing inward current and periodic outward currents in both types of motor neurons. Bath-application of carbachol also led to the development of these currents and activation of the system. Using low Ca(2+)-high Mg(2+) saline to block synaptic transmission, we found that the carbachol-induced inward current included a direct response by the motor neuron and an indirect component. Spontaneous transitions from activity to silence were marked by disappearance of the standing inward current and the periodic outward currents. Bath-application of OA led promptly to the disappearance of both currents, and silenced the system. OA also acted directly on both types of motor neurons to cause a hyperpolarizing outward current that would contribute to silencing the system.

From monitoring physiological functions to using psychological strategies. Nurses' view of caring for the aneurysmal subarachnoid haemorrhage patient.

PubMed

Hedlund, Mathilde; Ronne-Engstrom, Elisabeth; Ekselius, Lisa; Carlsson, Marianne

2008-02-01

The aims of this study were: (1) to describe nurses' views of the physical and supportive needs of patients who have suffered a subarachnoid haemorrhage (SAH), (2) to describe nurses' views of changes in social circumstances and (3) changes in the mental condition of patients after SAH. As patients with SAH are generally younger and predominantly female compared with other stroke groups they may have different needs of nursing support to facilitate adaptation. Caring for persons surviving stroke involves advanced nursing skills such as monitoring neurological functions in neurointensive care and providing physical care during rehabilitation. Explorative descriptive design. Semi-structured interviews were performed with 18 nurses in neurointensive and rehabilitation care. A qualitative latent content analysis was conducted. Nurses viewed patients' need for support as a process ranging from highly advanced technological care to 'softer' more emotional care. However, shortages in the communication between neurointesive and rehabilitation nurses regarding this support were acknowledged. Changes in social circumstances and mental conditions were viewed both as obstacles and advantages regarding return to everyday life. Nurses also viewed that the characteristics of the group with SAH was not particularly different from the group with other types of stroke. Support to patients with SAH is viewed as a process carried out by nurses at neurointensive care units and rehabilitation units. Shortages in communication, regarding this support, were acknowledged. Obstacles and advantages with respect to returning to everyday life could apply to any stroke group, which could make it more difficult for nurses to detect the specific needs of patients with SAH. The communication between neurointensive nurses and rehabilitation nurses regarding support to patients with SAH is not satisfactory. Occasionally the specific needs of patients with SAH are not recognized.

Development of a prognostic scale for severely hemiplegic stroke patients in a rehabilitation hospital.

PubMed

Hirano, Yoshitake; Nitta, Osamu; Hayashi, Takeshi; Takahashi, Hidetoshi; Miyazaki, Yasuhiro; Kigawa, Hiroshi

2017-07-01

For patients with severe hemiplegia in a rehabilitation hospital, early prediction of the functional prognosis and outcomes is challenging. The purpose of this study was to create and verify a prognostic scale in severely hemiplegic stroke patients and allowing for prediction of (1) the ability to walk at the time of hospital discharge, (2) the ability to carry out activities of daily living (ADL), and (3) feasibility of home discharge. The study was conducted on 80 severely hemiplegic stroke patients. A prognostic scale was created as an analysis method using the following items: mini-mental state examination (MMSE) at the time of admission, modified NIH stroke scale (m-NIHSS); trunk control test (TCT); and the ratio of the knee extensor strength on the non-paralyzed side to the body weight (KES/BW-US). We verified the reliability and validity of this scale. We established a prognostic scale using the MMSE, m-NIHSS, TCT, and KES/BW-US. A score of 56.8 or higher on the prognostic scale suggested that the patient would be able to walk and that assistance with ADL would be unnecessary at the time of hospital discharge. In addition, a score of 41.3 points indicated that the patient's return home was feasible. The reliability and the results were in good agreement. These findings showed that the ability or inability to walk was predictable in 85%, the need of assistance with ADL in 82.5%, and the feasibility of home return in 76.3% of cases. At the time of admission, four evaluation items permitted the prediction of three outcomes at time of discharge. Our formula predicts three outcomes with an accuracy of more than 76%. Copyright © 2017 Elsevier B.V. All rights reserved.

Staying married after stroke: a constructivist grounded theory qualitative study.

PubMed

Anderson, Sharon; Keating, Norah C; Wilson, Donna M

2017-10-01

Marriages are one of the most powerful predictors of health and longevity, yet research in stroke has focused separately on survivors' experience of impairments and how spouses deal with caregiving. The purpose of this constructivist grounded theory study was to understand the key themes related to reconstruction or breakdown of marriages after stroke. In semi-structured interviews, 18 couples in long-term marriages discussed how their marriages were reconstructed or broke down after one member of the couple returned home after being hospitalized for a stroke. Constant comparison methods were used to compare the experiences of 12 couples in which both partners indicated their relationship was going well with 6 couples who either separated or remained in parallel marriages. Analysis revealed an overarching process of reconstructing compatible role-identities and three themes related to the reconstruction or breakdown of the marital identity: feeling overwhelmed, resolving conflict, and perceiving value in the marriage. Our findings highlight that marriages are contexts in which survivors and spouses can recalibrate their role-identities. Marriage relationships are not peripheral to survivors' and spouses' outcomes after stroke; rather, marriage is fundamental to the management of impairments and to the well-being of the couple.

Seasonal variation and trends in stroke hospitalizations and mortality in a South American community hospital.

PubMed

Díaz, Alejandro; Gerschcovich, Eliana Roldan; Díaz, Adriana A; Antía, Fabiana; Gonorazky, Sergio

2013-10-01

Numerous studies have reported the presence of temporal variations in biological processes. Seasonal variation (SV) in stroke has been widely studied, but little data have been published on this phenomenon in the Southern Hemisphere, and there have been no studies reported from Argentina. The goals of the present study were to describe the SV of admissions and deaths for stroke and examine trends in stroke morbidity and mortality over a 3-year period in a community hospital in Argentina. Hospital discharge reports from the electronic database of vital statistics between 1999 and 2001 were examined retrospectively. Patients who had a main discharge diagnosis of stroke (ischemic or hemorrhagic) or cerebrovascular accident (International Classification of Diseases, Ninth Revision codes 431, 432, 434, and 436) were selected. The study sample included 1382 hospitalizations by stroke (3.5% of all admissions). In-hospital mortality demonstrated a winter peak (25.5% vs 17% in summer; P = .001). The crude seasonal stroke attack rate (ischemic and hemorrhagic) was highest in winter (164 per 100,000 population; 95% CI, 159-169 per 100,000) and lowest in summer (124 per 100,000; 95% CI, 120-127 per 100,000; P = .008). Stroke admissions followed a seasonal pattern, with a winter-spring predominance (P = .008). Our data indicate a clear SV in stroke deaths and admissions in this region of Argentina. The existence of SV in stroke raises a different hypothesis about the rationale of HF admissions and provides information for the organization of care and resource allocation. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Identifying patients with poststroke mild cognitive impairment by pattern recognition of working memory load-related ERP.

PubMed

Li, Xiaoou; Yan, Yuning; Wei, Wenshi

2013-01-01

The early detection of subjects with probable cognitive deficits is crucial for effective appliance of treatment strategies. This paper explored a methodology used to discriminate between evoked related potential signals of stroke patients and their matched control subjects in a visual working memory paradigm. The proposed algorithm, which combined independent component analysis and orthogonal empirical mode decomposition, was applied to extract independent sources. Four types of target stimulus features including P300 peak latency, P300 peak amplitude, root mean square, and theta frequency band power were chosen. Evolutionary multiple kernel support vector machine (EMK-SVM) based on genetic programming was investigated to classify stroke patients and healthy controls. Based on 5-fold cross-validation runs, EMK-SVM provided better classification performance compared with other state-of-the-art algorithms. Comparing stroke patients with healthy controls using the proposed algorithm, we achieved the maximum classification accuracies of 91.76% and 82.23% for 0-back and 1-back tasks, respectively. Overall, the experimental results showed that the proposed method was effective. The approach in this study may eventually lead to a reliable tool for identifying suitable brain impairment candidates and assessing cognitive function.

Preliminary lightning observations over Greece

NASA Astrophysics Data System (ADS)

Chronis, Themis G.

2012-02-01

The first Precision Lightning Network, monitoring the Cloud-to-Ground (CG) lightning stroke activity over Greece and surrounding waters is operated and maintained by the Hellenic National Meteorological Service. This paper studies the regional (land/water interface), seasonal and diurnal variability of the CG strokes as a function of density, polarity and peak current. Additional investigation uniquely links the CG stroke current to sea surface salinity and cloud electrical capacitance. In brief, this study's major findings area as follows: (1) The seasonal maps of thunder days agree well with the regional climatic convective characteristics of the study area, (2) the CG diurnal variability is consistent with the global lightning activity observations over land and ocean, (3) the maxima of monthly averaged CG counts are located over land and water during typical summer and fall months respectively for both polarities, (4) CG peak currents show a distinct seasonality with larger currents during relatively colder months and smaller currents during summer months, and (5) strong linear trends between -CGs and sea surface salinity; (6) this trend is absent for +CGs data analysis of the employed database relate to the thunderstorm's RC constant and agrees with previous numerical modeling studies.

A home-based program of transcutaneous electrical nerve stimulation and task-related trunk training improves trunk control in patients with stroke: a randomized controlled clinical trial.

PubMed

Chan, Bill K S; Ng, Shamay S M; Ng, Gabriel Y F

2015-01-01

Impaired trunk motor control is common after stroke. Combining transcutaneous electrical nerve stimulation (TENS) with task-related trunk training (TRTT) has been shown to enhance the recovery of lower limb motor function. This study investigated whether combining TENS with TRTT would enhance trunk control after stroke. Methods. Thirty-seven subjects with stroke were recruited into a randomized controlled clinical trial. Subjects were randomly assigned to any one of the three 6-week home-based training groups: (1) TENS + TRTT, (2) placebo TENS + TRTT, or (3) control without active training. The outcome measures included isometric peak trunk flexion torque and extension torque; forward seated and lateral seated reaching distance to the affected and unaffected side; and Trunk Impairment Scale (TIS) scores. All outcome measures were assessed at baseline, after 3 and 6 weeks of training, and 4 weeks after training ended at follow-up. Both the TENS + TRTT and the placebo-TENS + TRTT groups had significantly greater improvements in isometric peak trunk flexion torque and extension torque, lateral seated reaching distance to affected and unaffected side, and TIS score than the control group after 3 weeks of training. The TENS + TRTT group had significantly greater and earlier improvement in its mean TIS score than the other 2 groups. Home-based TRTT is effective for improving trunk muscle strength, sitting functional reach and trunk motor control after stroke in subjects without somatosensory deficits. The addition of TENS to the trunk augments the effectiveness of the exercise in terms of TIS scores within the first 3 weeks of training. © The Author(s) 2014.

Temporal profile of body temperature in acute ischemic stroke: relation to infarct size and outcome.

PubMed

Geurts, Marjolein; Scheijmans, Féline E V; van Seeters, Tom; Biessels, Geert J; Kappelle, L Jaap; Velthuis, Birgitta K; van der Worp, H Bart

2016-11-21

High body temperatures after ischemic stroke have been associated with larger infarct size, but the temporal profile of this relation is unknown. We assess the relation between temporal profile of body temperature and infarct size and functional outcome in patients with acute ischemic stroke. In 419 patients with acute ischemic stroke we assessed the relation between body temperature on admission and during the first 3 days with both infarct size and functional outcome. Infarct size was measured in milliliters on CT or MRI after 3 days. Poor functional outcome was defined as a modified Rankin Scale score ≥3 at 3 months. Body temperature on admission was not associated with infarct size or poor outcome in adjusted analyses. By contrast, each additional 1.0 °C in body temperature on day 1 was associated with 0.31 ml larger infarct size (95% confidence interval (CI) 0.04-0.59), on day 2 with 1.13 ml larger infarct size(95% CI, 0.83-1.43), and on day 3 with 0.80 ml larger infarct size (95% CI, 0.48-1.12), in adjusted linear regression analyses. Higher peak body temperatures on days two and three were also associated with poor outcome (adjusted relative risks per additional 1.0 °C in body temperature, 1.52 (95% CI, 1.17-1.99) and 1.47 (95% CI, 1.22-1.77), respectively). Higher peak body temperatures during the first days after ischemic stroke, rather than on admission, are associated with larger infarct size and poor functional outcome. This suggests that prevention of high temperatures may improve outcome if continued for at least 3 days.

Effect of body mass index on hemiparetic gait.

PubMed

Sheffler, Lynne R; Bailey, Stephanie Nogan; Gunzler, Douglas; Chae, John

2014-10-01

To evaluate the relationship between body mass index (BMI) and spatiotemporal, kinematic, and kinetic gait parameters in chronic hemiparetic stroke survivors. Secondary analysis of data collected in a randomized controlled trial comparing two 12-week ambulation training treatments. Academic medical center. Chronic hemiparetic stroke survivors (N = 108, >3 months poststroke) Linear regression analyses were performed of BMI, and selected pretreatment gait parameters were recorded using quantitative gait analysis. Spatiotemporal, kinematic, and kinetic gait parameters. A series of linear regression models that controlled for age, gender, stroke type (ischemic versus hemorrhagic), interval poststroke, level of motor impairment (Fugl-Meyer score), and walking speed found BMI to be positively associated with step width (m) (β = 0.364, P < .001), positively associated with peak hip abduction angle of the nonparetic limb during stance (deg) (β = 0.177, P = .040), negatively associated with ankle dorsiflexion angle at initial contact of the paretic limb (deg) (β = -0.222, P = .023), and negatively associated with peak ankle power at push-off (W/kg) of the paretic limb (W/kg)(β = -0.142, P = .026). When walking at a similar speed, chronic hemiparetic stroke subjects with a higher BMI demonstrated greater step width, greater hip hiking of the paretic lower limb, less paretic limb dorsiflexion at initial contact, and less paretic ankle power at push-off as compared to stroke subjects with a lower BMI and similar level of motor impairment. Further studies are necessary to determine the clinical relevance of these findings with respect to rehabilitation strategies for gait dysfunction in hemiparetic patients with higher BMIs. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Reliability of Peak Exercise Stroke Volume Assessment by Impedance Cardiography in Patients with Residual Right Outflow Tract Lesions After Congenital Heart Disease Repair.

PubMed

Legendre, Antoine; Bonnet, D; Bosquet, L

2018-01-01

Global ventricular response to exercise may be useful in follow-up of patients with residual right outflow tract lesions after congenital heart disease repair. In this context, impedance cardiography is considered accurate for stroke volume (SV) measurement during exercise testing, however, to date, only partial assessment of its reliability has been reported. We retrospectively evaluated relative and absolute reliability of peak SV by impedance cardiography during exercise using intraclass correlation (ICC) and standard error of measurement (SEM) in this population. Peak SV was measured in 30 young patients (mean age 14.4 years ± 2.1) with right ventricular outflow tract reconstruction who underwent two cardiopulmonary exercise tests at a mean one-year interval. SV was measured using a signal morphology impedance cardiography analysis device (PhysioFlow ® ) and was indexed to body surface area. ICC of peak indexed SV measurement was 0.80 and SEM was 10.5%. High heterogeneity was seen when comparing patients according to peak indexed SV; in patients with peak SV < 50 ml/m 2 (15 patients), ICC rose to 0.95 and SEM dropped to 2.7%, while in patients with a peak SV > 50 ml/m 2 relative and absolute reliability decreased (ICC = 0.45, SEM = 12.2%). Peak exercise SV assessment by a PhysioFlow ® device represents a highly reliable method in patients with residual right outflow tract lesions after congenital heart disease repair, especially in patients with peak SV < 50 ml/m 2 . In this latter group, a peak SV decrease > 7.3% (corresponding to the minimum "true" difference) should be considered a clinically-relevant decrease in global ventricular performance and taken into account when deciding whether to perform residual lesion removal.

Potential benefits of maximal exercise just prior to return from weightlessness

NASA Technical Reports Server (NTRS)

Convertino, Victor A.

1987-01-01

The purpose of this study was to determine whether performance of a single maximal bout of exercise during weightlessness within hours of return to earth would enhance recovery of aerobic fitness and physical work capacities under a 1G environment. Ten healthy men were subjected to a 10-d bedrest period in the 6-deg headdown position. A graded maximal supine cycle ergometer test was performed before and at the end of bedrest to simulate exercise during weightlessness. Following 3 h of resumption of the upright posture, a second maximal exercise test was performed on a treadmill to measure work capacity under conditions of 1G. Compared to before bedrest, peak oxygen consumption, V(O2), decreased by 8.7 percent and peak heart rate (HR) increased by 5.6 percent in the supine cycle test at the end of bedrest. However, there were no significant changes in peak V(O2) and peak HR in the upright treadmill test following bedrest. These data suggest that one bout of maximal leg exercise prior to return from 10 d of weightlessness may be adequate to restore preflight aerobic fitness and physical work capacity.

Effects of Twice-Weekly Intense Aerobic Exercise in Early Subacute Stroke: A Randomized Controlled Trial.

PubMed

Sandberg, Klas; Kleist, Marie; Falk, Lars; Enthoven, Paul

2016-08-01

To examine the effects of 12 weeks of twice-weekly intensive aerobic exercise on physical function and quality of life after subacute stroke. Randomized controlled trial. Ambulatory care. Patients (N=56; 28 women) aged ≥50 years who had a mild stroke (98% ischemic) and were discharged to independent living and enrolled 20 days (median) after stroke onset. Sixty minutes of group aerobic exercise, including 2 sets of 8 minutes of exercise with intensity up to exertion level 14 or 15 of 20 on the Borg rating of perceived exertion scale, twice weekly for 12 weeks (n=29). The nonintervention group (n=27) received no organized rehabilitation or scheduled physical exercise. Primary outcome measures included aerobic capacity on the standard ergometer exercise stress test (peak work rate) and walking distance on the 6-minute walk test (6MWT). Secondary outcome measures included maximum walking speed for 10m, balance on the timed Up and Go (TUG) test and single leg stance (SLS), health-related quality of life on the European Quality of Life Scale (EQ-5D), and participation and recovery after stroke on the Stroke Impact Scale (SIS) version 2.0 domains 8 and 9. Participants were evaluated pre- and postintervention. Patient-reported measures were also evaluated at 6-month follow-up. The following improved significantly more in the intervention group (pre- to postintervention): peak work rate (group × time interaction, P=.006), 6MWT (P=.011), maximum walking speed for 10m (P<.001), TUG test (P<.001), SLS right and left (eyes open) (P<.001 and P=.022, respectively), and SLS right (eyes closed) (P=.019). Aerobic exercise was associated with improved EQ-5D scores (visual analog scale, P=.008) and perceived recovery (SIS domain 9, P=.002). These patient-reported improvements persisted at 6-month follow-up. Intensive aerobic exercise twice weekly early in subacute mild stroke improved aerobic capacity, walking, balance, health-related quality of life, and patient-reported recovery. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Combined strength and endurance training in competitive swimmers.

PubMed

Aspenes, Stian; Kjendlie, Per-Ludvik; Hoff, Jan; Helgerud, Jan

2009-01-01

A combined intervention of strength and endurance training is common practice in elite swimming training, but the scientific evidence is scarce. The influences between strength and endurance training have been investigated in other sports but the findings are scattered. Some state the interventions are negative to each other, some state there is no negative relationship and some find bisected and supplementary benefits from the combination when training is applied appropriately. The aim of this study was to investigate the impact of a combined intervention among competitive swimmers. 20 subjects assigned to a training intervention group (n = 11) or a control group (n = 9) from two different teams completed the study. Anthropometrical data, tethered swimming force, land strength, performance in 50m, 100m and 400m, work economy, peak oxygen uptake, stroke length and stroke rate were investigated in all subjects at pre- and post-test. A combined intervention of maximal strength and high aerobic intensity interval endurance training 2 sessions per week over 11 weeks in addition to regular training were used, while the control group continued regular practice with their respective teams. The intervention group improved land strength, tethered swimming force and 400m freestyle performance more than the control group. The improvement of the 400m was correlated with the improvement of tethered swimming force in the female part of the intervention group. No change occurred in stroke length, stroke rate, performance in 50m or 100m, swimming economy or peak oxygen uptake during swimming. Two weekly dry-land strength training sessions for 11 weeks increase tethered swimming force in competitive swimmers. This increment further improves middle distance swimming performance. 2 weekly sessions of high- intensity interval training does not improve peak oxygen uptake compared with other competitive swimmers. Key pointsTwo weekly sessions of dry land strength training improves the swimming force.Two weekly sessions of high-intensity endurance training did not cause improved endurance capacity.It may seem that dry land strength training can improve middle distance performance.

Stroke survivors' levels of community reintegration, quality of life, satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area.

PubMed

Kusambiza-Kiingi, Adrian; Maleka, Douglas; Ntsiea, Veronica

2017-01-01

Stroke survivors are discharged home before they are functionally independent and return home with activity limitations that would not be manageable without a caregiver. To determine stroke survivors' levels of community reintegration, quality of life (QOL), satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. This was a cross-sectional study using the following outcome measures: Maleka Stroke Community Reintegration Measure, Stroke-specific quality of life scale, Caregiver strain index and Physical therapy patient satisfaction questionnaire. A total of 108 stroke survivors and 45 caregivers participated in this study. The average age of the stroke survivors was 54 years (standard deviation = 12.73) and 58% ( n = 62) had moderate to full community reintegration. They were happy with physiotherapy services but not with parking availability and cost of services. The QOL was poor with the lowest scores for energy and highest scores for vision and language domains. Twenty five (55%) caregivers were strained. A positive correlation was found between community reintegration and satisfaction with services ( r = 0.27, p < 0.0001) and QOL ( r = 0.51, p < 0.0001). A negative correlation was found between community reintegration and caregiver strain ( r = -0.37, p < 0.0001). Most stroke survivors are reintegrated into their communities except in the areas of work and education and have poor QOL and most of their caregivers are strained; however, they are satisfied with physiotherapy services.

Stroke survivors’ levels of community reintegration, quality of life, satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area

PubMed Central

Kusambiza-Kiingi, Adrian; Maleka, Douglas

2017-01-01

Background Stroke survivors are discharged home before they are functionally independent and return home with activity limitations that would not be manageable without a caregiver. Aim To determine stroke survivors’ levels of community reintegration, quality of life (QOL), satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. Method This was a cross-sectional study using the following outcome measures: Maleka Stroke Community Reintegration Measure, Stroke-specific quality of life scale, Caregiver strain index and Physical therapy patient satisfaction questionnaire. Results A total of 108 stroke survivors and 45 caregivers participated in this study. The average age of the stroke survivors was 54 years (standard deviation = 12.73) and 58% (n = 62) had moderate to full community reintegration. They were happy with physiotherapy services but not with parking availability and cost of services. The QOL was poor with the lowest scores for energy and highest scores for vision and language domains. Twenty five (55%) caregivers were strained. A positive correlation was found between community reintegration and satisfaction with services (r = 0.27, p < 0.0001) and QOL (r = 0.51, p < 0.0001). A negative correlation was found between community reintegration and caregiver strain (r = -0.37, p < 0.0001). Conclusion Most stroke survivors are reintegrated into their communities except in the areas of work and education and have poor QOL and most of their caregivers are strained; however, they are satisfied with physiotherapy services. PMID:28730068

The long-term nutritional status in stroke patients and its predictive factors.

PubMed

Paquereau, Julie; Allart, Etienne; Romon, Monique; Rousseaux, Marc

2014-07-01

Malnutrition is common in the first few months after stroke and contributes to a poor overall outcome. We analyzed long-term weight changes and their predictive factors. A total of 71 first-ever stroke patients were included in the study and examined (1) their weight on admission to the acute stroke unit (usual weight [UW]), on admission to the rehabilitation unit, on discharge from the rehabilitation unit, and then 1 year or more after the stroke (median time: 2.5 years), (2) the presence of malnutrition after stroke, and (3) possible predictive factors, namely, sociodemographic factors, clinical characteristics (concerning the stroke, the patient's current neurologic status and the presence of diabetes mellitus and depression), and the present nutritional state (including eating difficulties, anorexia, and changes in food intake and food preferences). Body weight fell (4.0 kg) during the patients' stay in the stroke unit, increased moderately in the rehabilitation unit (2.0 kg), and returned to the UW by the long-term measurement. However, at the last observation, 40.1% of the patients weighed markedly less than their UW, 38.0% weighed markedly more, and 21.1% were relatively stable. Predictors of weight change were a change in preferences for sweet food products and a change in food intake. Malnutrition was frequent (47.9%) and associated with reduced food intake, residence in an institution, and diabetes mellitus. Malnutrition was highly prevalent, with an important role of change in food intake and food preferences, which could result from brain lesions and specific regimens. Living in an institution needs consideration, as its negative effects can be prevented. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

What is the value of conducting a trial of r-tPA for the treatment of mild stroke patients?

PubMed

Guzauskas, Gregory F; Chen, Er; Lalla, Deepa; Yu, Elaine; Tayama, Darren; Veenstra, David L

2017-02-01

Background The Phase IIIb, Double-Blind, Multicenter Study to Evaluate the Efficacy and Safety of Alteplase in Patients With Mild Stroke: Rapidly Improving Symptoms and Minor Neurologic Deficits (PRISMS) trial will assess r-tPA in ischemic stroke patients who present with mild deficits (i.e. mild stroke). Aims To assess PRISMS's societal value in clarifying the optimal care for patients with mild ischemic stroke. Methods A value of information (VOI) decision model was developed to compare the outcomes of mild stroke patients treated vs. not treated with r-tPA. Model inputs were derived from a subset of Third International Stroke Trial patients, a recent meta-analysis of r-tPA trials, expert opinion, and other published sources. VOI analyses were also used to assess the expected US societal value of the PRISMS trial and the expected value of reducing uncertainty in key trial estimates. Results The expected net societal value of the PRISMS trial was approximately $210 million ($160 m-$260 m), representing a six-fold return on investment. The value of reducing uncertainty in r-tPA efficacy was approximately $150 million ($100 m-$200 m), while reducing uncertainty in r-tPA safety (increased risk for symptomatic intracranial hemorrhage) did not add additional value in comparison. Conclusions Developing a better understanding of the outcomes of r-tPA treatment in patients with mild ischemic stroke will provide tremendous societal value by clarifying current uncertainty around treatment effectiveness. Enrollment in the PRISMS trial for patients presenting with mild ischemic stroke within 0-3 h of symptom onset should be highly encouraged.

Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians.

PubMed

Streit, Sven; Baumann, Philippe; Barth, Jürgen; Mattle, Heinrich P; Arnold, Marcel; Bassetti, Claudio L; Meli, Damian N; Fischer, Urs

2015-01-01

Transient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates. We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients. Of the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care. Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

Neural correlates of brain state in chronic ischemia and stroke: combined resting state electroencephalogram and transcranial Doppler ultrasonographic study.

PubMed

Martynova, Olga V; Portnova, Galina V; Gladun, Ksenya V

2017-02-08

Clinical neurology is constantly searching for reliable indices of ischemic brain damage to prevent a possible development of stroke. We suggest that resting state electroencephalogram (rsEEG) with respect to other clinical data may provide important information about the severity of ischemia. We carried out correlation analysis of rsEEG, data of transcranial Doppler ultrasonography of head vessels, and clinical assessment scores collected from healthy volunteers and four groups of patients with mild chronic microvascular ischemia (CMI-1), moderate CMI (CMI-2), severe atrophy of the cerebral hemisphere, ischemic stroke in the left middle cerebral artery stroke, and ischemic stroke in the right middle cerebral artery stroke. Using independent component analysis and k-mean clustering of EEG data, we observed prominent changes in rsEEG reflected in specific distributions of spectral peaks in all groups of patients. We found a significant correlation of EEG spectral distribution and the blood flow velocity in coronal arteries, which was also affected by the severity of ischemia and the localization of stroke. Moreover, EEG spectral distribution was more indicative of early stages of ischemia than the blood flow velocity. Our data support the hypothesis that rsEEG may reflect altered neural activity caused by ischemic brain damage.

Effects of unilateral robotic limb loading on gait characteristics in subjects with chronic stroke.

PubMed

Khanna, Ira; Roy, Anindo; Rodgers, Mary M; Krebs, Hermano I; Macko, Richard M; Forrester, Larry W

2010-05-21

Hemiparesis after stroke often leads to impaired ankle motor control that impacts gait function. In recent studies, robotic devices have been developed to address this impairment. While capable of imparting forces to assist during training and gait, these devices add mass to the paretic leg which might encumber patients' gait pattern. The purpose of this study was to assess the effects of the added mass of one of these robots, the MIT's Anklebot, while unpowered, on gait of chronic stroke survivors during overground and treadmill walking. Nine chronic stroke survivors walked overground and on a treadmill with and without the anklebot mounted on the paretic leg. Gait parameters, interlimb symmetry, and joint kinematics were collected for the four conditions. Repeated-measures analysis of variance (ANOVA) tests were conducted to examine for possible differences across four conditions for the paretic and nonparetic leg. The added inertia and friction of the unpowered anklebot had no statistically significant effect on spatio-temporal parameters of gait, including paretic and nonparetic step time and stance percentage, in both overground and treadmill conditions. Noteworthy, interlimb symmetry as characterized by relative stance duration was greater on the treadmill than overground regardless of loading conditions. The presence of the unpowered robot loading reduced the nonparetic knee peak flexion on the treadmill and paretic peak dorsiflexion overground (p < 0.05). Our results suggest that for these subjects the added inertia and friction of this backdriveable robot did not significantly alter their gait pattern.

Relationship between somatosensory event-related potential N140 aberrations and hemispatial agnosia in patients with stroke: a preliminary study.

PubMed

Ueno, Tomoyuki; Hada, Yasushi; Shimizu, Yukiyo; Yamada, Thoru

2018-06-01

The somatosensory event-related potential N140 is thought to be related to selective attention. This study aimed to compare the somatosensory event-related potential N140 in healthy subjects to that in patients with stroke to determine whether N140 and attentiveness are associated in patients with stroke with or without hemispatial agnosia. Normal somatosensory event-related potential N140 values were determined using data from ten healthy subjects. Fifteen patients with stroke were divided into two groups based on the presence of hemispatial neglect. Somatosensory event-related potential N140 components were compared between the two groups. Stimulation of the affected limb in the hemispatial agnosia group resulted in significantly longer N140 latency at the contralateral vs. the ipsilateral electrode. This was the inverse of the relationship observed in normal subjects, with stimulation of the intact side in patients with hemispatial agnosia, and with stimulation of both the intact and affected sides in patients without agnosia. In the hemispatial agnosia group, the peak latency of N140 following stimulation of the affected side was significantly longer than it was following stimulation of the intact side and when compared to that in patients without agnosia. In addition, abnormal N140 peak latencies were observed at the Cz and ipsilateral electrodes in patients with hemispatial agnosia following stimulation of the intact side. These findings suggest that somatosensory event-related potential N140 is independently generated in each hemisphere and may reflect cognitive attention.

Sarcopenia and Physical Function in Middle-Aged and Older Stroke Survivors.

PubMed

Ryan, Alice S; Ivey, Frederick M; Serra, Monica C; Hartstein, Joseph; Hafer-Macko, Charlene E

2017-03-01

To determine the prevalence of sarcopenia in stroke survivors using different methodologies, and compare a subset of the stroke group to age-, sex-, and body mass index (BMI)-matched nonstroke control counterparts. Cohort study. A Veterans Affairs medical center and a university hospital. Mild to moderately disabled participants >6 months after onset of stroke aged 40 to 84 years (N=190, 61% men, 57% African American; mean BMI ± SEM, 29±1kg/m 2 ). Not applicable. Dual-energy x-ray absorptiometry scans to assess appendicular lean mass (ALM). Rates of sarcopenia were determined using 4 established methods: (1) ALM/height 2 (ALM/ht 2 ); (2) European Working Group on Sarcopenia in Older Persons; (3) International Working Group on Sarcopenia; and (4) ALM/BMI. Sarcopenia prevalence in our stroke cohort ranged between 14% and 18%. The stroke survivor subset (n=38) matched one-for-one with control counterparts for race, sex, age ±4 years and BMI ±2.5kg/m 2 had higher prevalence rates compared with their nonstroke counterparts (13.2% vs 5.3%, P<.0001). ALM/ht 2 was related to 6-minute walking speed (r=.28, P<.01) and peak oxygen consumption (L/min: r=.58, P<.0001) for the stroke group. Stroke survivors show an elevated prevalence of sarcopenia when considering age, sex, and race compared with nonstroke individuals. Published by Elsevier Inc.

Mobile tablet-based therapies following stroke: A systematic scoping review of administrative methods and patient experiences

PubMed Central

Ramsay, Tim; Johnson, Dylan; Dowlatshahi, Dar

2018-01-01

Background and purpose Stroke survivors are often left with deficits requiring rehabilitation to recover function and yet, many are unable to access rehabilitative therapies. Mobile tablet-based therapies (MTBTs) may be a resource-efficient means of improving access to timely rehabilitation. It is unclear what MTBTs have been attempted following stroke, how they were administered, and how patients experienced the therapies. The review summarizes studies of MTBTs following stroke in terms of administrative methods and patient experiences to inform treatment feasibility. Methods Articles were eligible if they reported the results of an MTBT attempted with stroke participants. Six research databases were searched along with grey literature sources, trial registries, and article references. Intervention administration details and patient experiences were summarized. Results The search returned 903 articles of which 23 were eligible for inclusion. Most studies were small, observational, and enrolled chronic stroke patients. Interventions commonly targeted communication, cognition, or fine-motor skills. Therapies tended to be personalized based on patient deficits using commercially available applications. The complexity of therapy instructions, fine-motor requirements, and unreliability of internet or cellular connections were identified as common barriers to tablet-based care. Conclusions Stroke patients responded positively to MTBTs in both the inpatient and home settings. However, some support from therapists or caregivers may be required for patients to overcome barriers to care. Feasibility studies should continue to identify the administrative methods that minimize barriers to care and maximize patient adherence to prescribed therapy regiments. PMID:29360872

Quercetin protects against heat stroke-induced myocardial injury in male rats: Antioxidative and antiinflammatory mechanisms.

PubMed

Lin, Xiaojing; Lin, Cheng-Hsien; Zhao, Tingbao; Zuo, Dan; Ye, Zhujun; Liu, Lin; Lin, Mao-Tsun

2017-03-01

Heat stroke is characterized by hyperthermia, systemic inflammation, and multiple organ failure including arterial hypotension. This definition can be fulfilled by a rat model of heat stroke used in the present study. Anesthetized animals were exposed to heat exposure (43 °C for 70 min) and then returned to room temperature (26 °C) for recovery. One hour before heat exposure, an intraperitoneal dose of quercetin (30 mg/kg) or vehicle (normal saline 1 ml/kg) was administered to the experimental groups of rats. Additional injection was administered immediately after the onset of heat stroke. Immediately after the onset of heat stroke. Vehicle-treated rats displayed (i) hyperthermia; (ii) suppressed left ventricular function; (iii) decreased contents of cardiac total antioxiant capacity (e.g., superoxide dismutase, glutathione peroxidase, catalase); (iv) increased contents of cardiac oxidative capacity malondialdehyde and thiobarbituric acid reactive substances; (v) increased cardiac levels of pro-inflammatory cytokines tumor necrosis factor-α and interleukin-6; and (vi) decreased cardiac levels of an anti-inflammatory cytokine interleukin 10. Histopathologic and survival observation provided supportive evidence for biochemical analyses. These heat stroke reactions all can be significantly attenuated by quercetin therapy. Our data suggest that quercetin therapy might improve outcomes of heat stroke in rats by attenuating excessive hyperthermia as well as myocardial injury. The protective effects of quercetin could be attributed to anti-lipid peroxidative, anti-oxidant, and anti-inflammatory properties. Copyright © 2017 Elsevier B.V. All rights reserved.

The Importance of Patient Involvement in Stroke Rehabilitation

PubMed Central

2016-01-01

Objective To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. Method Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. Results The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. Conclusions The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs. PMID:27285997

The effectiveness of culturally tailored video narratives on medication understanding and use self-efficacy among stroke patients: A randomized controlled trial study protocol.

PubMed

Appalasamy, Jamuna Rani; Tha, Kyi Kyi; Quek, Kia Fatt; Ramaiah, Siva Seeta; Joseph, Joyce Pauline; Md Zain, Anuar Zaini

2018-06-01

A substantial number of the world's population appears to end with moderate to severe long-term disability after stroke. Persistent uncontrolled stroke risk factor leads to unpredicted recurrent stroke event. The increasing prevalence of stroke across ages in Malaysia has led to the adaptation of medication therapy adherence clinic (MTAC) framework. The stroke care unit has limited patient education resources especially for patients with medication understanding and use self-efficacy. Nevertheless, only a handful of studies have probed into the effectiveness of video narrative at stroke care centers. This is a behavioral randomized controlled trial of patient education intervention with video narratives for patients with stroke lacking medication understanding and use self-efficacy. The study will recruit up to 200 eligible stroke patients at the neurology tertiary outpatient clinic, whereby they will be requested to return for follow-up approximately 3 months once for up to 12 months. Consenting patients will be randomized to either standard patient education care or intervention with video narratives. The researchers will ensure control of potential confounding factors, as well as unbiased treatment review with prescribed medications only obtained onsite. The primary analysis outcomes will reflect the variances in medication understanding and use self-efficacy scores, as well as the associated factors, such as retention of knowledge, belief and perception changes, whereas stroke risk factor control, for example, self-monitoring and quality of life, will be the secondary outcomes. The study should be able to determine if video narrative can induce a positive behavioral change towards stroke risk factor control via enhanced medication understanding and use self-efficacy. This intervention is innovative as it combines health belief, motivation, and role model concept to trigger self-efficacy in maintaining healthy behaviors and better disease management. ACTRN (12618000174280).

Exertional heat stroke and acute liver failure: a late dysfunction

PubMed Central

Carvalho, Ana Sofia; Rodeia, Simão C; Silvestre, Joana; Póvoa, Pedro

2016-01-01

Heat stroke (HS) is defined as a severe elevation of core body temperature along with central nervous system dysfunction. Exertional heat stroke (EHS) with acute liver failure (ALF) is a rare condition. The authors report the case of a 25-year-old man with a history of cognitive enhancers’ intake who developed hyperthermia and neurological impairment while running an outdoor marathon. The patient was cooled and returned to normal body temperature after 6 h. He subsequently developed ALF and was transferred to the intensive care unit. Over-the-counter drug intake may have been related to heat intolerance and contributed to the event. The patient was successfully treated with conservative measures. In the presence of EHS, it is crucial to act promptly with aggressive total body cooling, in order to prevent progression of the clinical syndrome. Liver function must also be monitored, since it can be a late organ dysfunction. PMID:26969359

Sport simulation as a form of implicit motor training in a geriatric athlete after stroke: a case report.

PubMed

Young, Sonia N; VanWye, William R; Wallmann, Harvey W

2018-06-25

To describe the use of sport simulation activities as a form of implicit motor learning training with a geriatric former athlete following a stroke. An active 76-year-old former professional male softball player presented to outpatient physical therapy with medical history of right stroke with left hemiparesis 2 weeks following onset of symptoms of impaired balance, coordination, gait, and motor planning. Initial physical therapy included gait, balance, and coordination training. Additional sport-related balance and coordination activities were later added to the treatment plan. After approximately 3 weeks of treatment, the patient was able to return to work and had dramatically improved balance, coordination, and gait with sport simulation activities. Implicit motor learning techniques were incorporated through sport and job task simulation activities along with task-oriented neuromuscular reeducation. The patient demonstrated improvements with gait, balance, gross motor function, and decreased fall risk.

Progressive exercise preconditioning protects against circulatory shock during experimental heatstroke.

PubMed

Hung, Ching-Hsia; Chang, Nen-Chung; Cheng, Bor-Chih; Lin, Mao-Tsun

2005-05-01

Heat shock protein (HSP) 72 expression protects against arterial hypotension in rat heatstroke. HSP72 can also be induced in multiple organs, including hearts from rats with endurance exercise. We validated the hypothesis that progressive exercise preconditioning may confer cardiovascular protection during heatstroke by inducing the overexpression of HSP72 in multiple organs. To deal with the matter, we assessed the effects of heatstroke on mean arterial pressure, heart rate, cardiac output, stroke volume, total peripheral vascular resistance, colonic temperature, blood gases, and serum or tissue levels of tumor necrosis factor-alpha (TNF-alpha) in urethane-anesthetized rats pretreated without or with progressive exercise training for 1, 2, or 3 weeks. In addition, HSP72 expression in multiple organs was determined in different groups of animals. Heatstroke was induced by exposing the rats to a high blanket temperature (43 degrees C); the moment at which mean arterial pressure decreased from the peak value was taken as the time of heatstroke onset. Previous exercise training for 3 weeks, but not 1 or 2 weeks, conferred significant protection against hyperthermia, arterial hypotension, decreased cardiac output, decreased stroke volume, decreased peripheral vascular resistance, and increased levels of serum or tissue TNF-alpha during heatstroke and correlated with overexpression of HSP72 in multiple organs, including heart, liver, and adrenal gland. However, 10 days after 3 weeks of progressive exercise training, when HSP72 expression in multiple organs returned to basal values, the beneficial effects exerted by 3 weeks of exercise training were no longer observed. These results strongly suggest that HSP72 preconditioning with progressive exercise training protects against hyperthermia, circulatory shock, and TNF-alpha overproduction during heatstroke.

Re-emergence of modular brain networks in stroke recovery.

PubMed

Siegel, Joshua S; Seitzman, Benjamin A; Ramsey, Lenny E; Ortega, Mario; Gordon, Evan M; Dosenbach, Nico U F; Petersen, Steven E; Shulman, Gordon L; Corbetta, Maurizio

2018-04-01

Studies of stroke have identified local reorganization in perilesional tissue. However, because the brain is highly networked, strokes also broadly alter the brain's global network organization. Here, we assess brain network structure longitudinally in adult stroke patients using resting state fMRI. The topology and boundaries of cortical regions remain grossly unchanged across recovery. In contrast, the modularity of brain systems i.e. the degree of integration within and segregation between networks, was significantly reduced sub-acutely (n = 107), but partially recovered by 3 months (n = 85), and 1 year (n = 67). Importantly, network recovery correlated with recovery from language, spatial memory, and attention deficits, but not motor or visual deficits. Finally, in-depth single subject analyses were conducted using tools for visualization of changes in brain networks over time. This exploration indicated that changes in modularity during successful recovery reflect specific alterations in the relationships between different networks. For example, in a patient with left temporo-parietal stroke and severe aphasia, sub-acute loss of modularity reflected loss of association between frontal and temporo-parietal regions bi-hemispherically across multiple modules. These long-distance connections then returned over time, paralleling aphasia recovery. This work establishes the potential importance of normalization of large-scale modular brain systems in stroke recovery. Copyright © 2017. Published by Elsevier Ltd.

Flood return level analysis of Peaks over Threshold series under changing climate

NASA Astrophysics Data System (ADS)

Li, L.; Xiong, L.; Hu, T.; Xu, C. Y.; Guo, S.

2016-12-01

Obtaining insights into future flood estimation is of great significance for water planning and management. Traditional flood return level analysis with the stationarity assumption has been challenged by changing environments. A method that takes into consideration the nonstationarity context has been extended to derive flood return levels for Peaks over Threshold (POT) series. With application to POT series, a Poisson distribution is normally assumed to describe the arrival rate of exceedance events, but this distribution assumption has at times been reported as invalid. The Negative Binomial (NB) distribution is therefore proposed as an alternative to the Poisson distribution assumption. Flood return levels were extrapolated in nonstationarity context for the POT series of the Weihe basin, China under future climate scenarios. The results show that the flood return levels estimated under nonstationarity can be different with an assumption of Poisson and NB distribution, respectively. The difference is found to be related to the threshold value of POT series. The study indicates the importance of distribution selection in flood return level analysis under nonstationarity and provides a reference on the impact of climate change on flood estimation in the Weihe basin for the future.

Damage to metallic samples produced by measured lightning currents

NASA Technical Reports Server (NTRS)

Fisher, Richard J.; Schnetzer, George H.

1991-01-01

A total of 10 sample disks of 2024-T3 aluminum and 4130 ferrous steel were exposed to rocket-triggered lightning currents at the Kennedy Space Center test site. The experimental configuration was arranged so that the samples were not exposed to the preliminary streamer, wire-burn, or following currents that are associated with an upward-initiated rocket-triggered flash but which are atypical of naturally initiated lightning. Return-stroke currents and continuing currents actually attaching to the sample were measured, augmented by close-up video recordings of approximately 3 feet of the channel above the sample and by 16-mm movies with 5-ms resolution. From these data it was possible to correlate individual damage spots with streamer, return-stroke, and continuing currents that produced them. Substantial penetration of 80-mil aluminum was produced by a continuing current of submedian amplitude and duration, and full penetration of a 35-mil steel sample occurred under an eightieth percentile continuing current. The primary purpose of the data acquired in these experiments is for use in improving and quantifying the fidelity of laboratory simulations of lightning burnthrough.

Measured responses of internal enclosures and cables due to burnthrough penetration of weapon cases by lightning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schnetzer, G.H.; Fisher, R.J.; Dinallo, M.A.

1994-08-01

The electrical effects of lightning penetration of the outer case of a weapon on internal structures, such as a firing set housing, and on samples of a flat, flexline detonator cable have been investigated experimentally. Maximum open-circuit voltages measured on either simulated structures (126 V) or the cable (46 V) located directly behind the point of penetration were well below any level that is foreseen to create a threat to nuclear safety. On the other hand, it was found that once full burnthrough of the barrier occurred, significant fractions of the incident continuing currents coupled to both the simulated internalmore » structure (up to 300 A) or to the cable sample (69 A) when each was electrically connected internally to case ground. No occurrence was observed of the injection of large amplitude currents from return strokes occurring after barrier penetration. Under circumstances in which small volumes of trapped gases exist behind penetration sites, rapid heating of the gas by return strokes occurring after burnthrough has been shown to produced large mechanical impulses to the adjacent surfaces.« less

Lightning spectra at 100,000 fps

NASA Astrophysics Data System (ADS)

McHarg, M. G.; Harley, J.; Haaland, R. K.; Edens, H. E.; Stenbaek-Nielsen, H.

2016-12-01

A fundamental understanding of lightning can be inferred from the spectral emissions resulting from the leader and return stroke channel. We examine an event recorded at 00:58:07 on 19 July 2015 at Langmuir Laboratory. We recorded lightning spectra using a 100 line per mm grating in front of a Phantom V2010 camera with an 85mm Nikon lens recording at 100,000 frames per second. Coarse resolution spectra (approximately 5nm resolution) are produced from approximately 400 nm to 800 nm for each frame. Electric field data from the Langmuir Electric Field Array for the 03:19:19 event show 10 V/m changes in the electric field associated with multiple return strokes visible in the spectral data. We used the spectral data to compare temperatures at the top, middle and bottom of the lightning channel. Lightning Mapping Array data at Langmuir for the 00:58:07 event show a complex flash extending 10 km in the East-West plane and 6 km in the North-South plane. The imagery data imply that this is a bolt-from-the-blue event.

Gait training of patients after stroke using an electromechanical gait trainer combined with simultaneous functional electrical stimulation.

PubMed

Tong, Raymond K Y; Ng, Maple F W; Li, Leonard S W; So, Elaine F M

2006-09-01

This case report describes the implementation of gait training intervention that used an electromechanical gait trainer with simultaneous functional electrical stimulation (FES) for 2 patients with acute ischemic stroke. Two individuals with post-stroke hemiplegia of less than 6 weeks' duration participated in a 4-week gait training program as an adjunct to physical therapy received at a hospital. After the 4-week intervention, both patients were discharged from the hospital, and they returned after 6 months for a follow-up evaluation. By the end of the 4-week intervention, both patients had shown improvements in scores on the Barthel Index, Berg Balance Scale, Functional Ambulation Categories Scale, 5-m timed walking test, and Motricity Index. In the 6-month follow-up evaluation, both patients continued to have improvements in all outcome measures. This case report shows that, following the use of an electromechanical gait trainer simultaneously with FES, patients after acute stroke had improvements in gait performance, functional activities, balance, and motor control in the long term.

Practice variation in the structure of stroke rehabilitation in four rehabilitation centres in the Netherlands.

PubMed

Groeneveld, Iris F; Meesters, Jorit J L; Arwert, Henk J; Roux-Otter, Nienke; Ribbers, Gerard M; van Bennekom, Coen A M; Goossens, Paulien H; Vliet Vlieland, Thea P M

2016-03-01

To describe practice variation in the structure of stroke rehabilitation in 4 specialized multidisciplinary rehabilitation centres in the Netherlands. A multidisciplinary expert group formulated a set of 23 elements concerning the structure of inpatient and outpatient stroke rehabilitation, categorized into 4 domains: admission-related (n = 7), treatment-related (n = 10), client involvement-related (n = 2), and facilities-related (n = 4). In a cross-sectional study in 4 rehabilitation centres data on the presence and content of these elements were abstracted from treatment programmes and protocols. In a structured expert meeting consensus was reached on the presence of practice variation per element. Practice variation was observed in 22 of the 23 structure elements. The element "strategies for patient involvement" appeared similar in all rehabilitation centres, whereas differences were found in the elements regarding admission, exclusion and discharge criteria, patient subgroups, care pathways, team meetings, clinical assessments, maximum time to admission, aftercare and return to work modules, health professionals, treatment facilities, and care-giver involvement. Practice variation was found in a wide range of aspects of the structure of stroke rehabilitation.

Decreased peak arteriovenous oxygen difference during treadmill exercise testing in individuals infected with the human immunodeficiency virus.

PubMed

Cade, W Todd; Fantry, Lori E; Nabar, Sharmila R; Keyser, Randall E

2003-11-01

To determine if arteriovenous oxygen difference was lower in asymptomatic individuals with human immunodeficiency virus (HIV) infection than in sedentary but otherwise healthy controls. Quasi-experimental cross-sectional. Clinical exercise laboratory. Fifteen subjects (10 men, 5 women) with HIV and 15 healthy gender- and activity level-matched controls (total N=30). Participants performed an incremental maximal exercise treadmill test to exhaustion. Electrocardiogram, metabolic, and noninvasive cardiac output measurements were evaluated at rest and throughout the tests. Data were analyzed by using analysis of covariance. Peak oxygen consumption (Vo(2)), cardiac output, stroke volume, and arteriovenous oxygen difference. The arteriovenous oxygen difference was determined indirectly using the Fick equation. Peak VO(2) was significantly lower (P<.0005) in participants with HIV (24.6+/-1.2mL.kg(-1).min(-1)) compared with controls (32.0+/-1.2mL.kg(-1).min(-1)). There were no significant intergroup differences in cardiac output or stroke volume at peak exercise. Peak arteriovenous oxygen difference was significantly lower (P<.04) in those infected with HIV (10.8+/-0.5 volume %) than in controls (12.4+/-0.5 volume %). The observed deficit in aerobic capacity in the participants with HIV appeared to be the result of a peripheral tissue oxygen extraction or utilization limitation. In addition to deconditioning, potential mechanisms for this significant attenuation may include HIV infection and inflammation, highly active antiretroviral therapy medication regimens, or a combination of these factors.

TGFβ signaling in the brain increases with aging and signals to astrocytes and innate immune cells in the weeks after stroke.

PubMed

Doyle, Kristian P; Cekanaviciute, Egle; Mamer, Lauren E; Buckwalter, Marion S

2010-10-11

TGFβ is both neuroprotective and a key immune system modulator and is likely to be an important target for future stroke therapy. The precise function of increased TGF-β1 after stroke is unknown and its pleiotropic nature means that it may convey a neuroprotective signal, orchestrate glial scarring or function as an important immune system regulator. We therefore investigated the time course and cell-specificity of TGFβ signaling after stroke, and whether its signaling pattern is altered by gender and aging. We performed distal middle cerebral artery occlusion strokes on 5 and 18 month old TGFβ reporter mice to get a readout of TGFβ responses after stroke in real time. To determine which cell type is the source of increased TGFβ production after stroke, brain sections were stained with an anti-TGFβ antibody, colocalized with markers for reactive astrocytes, neurons, and activated microglia. To determine which cells are responding to TGFβ after stroke, brain sections were double-labelled with anti-pSmad2, a marker of TGFβ signaling, and markers of neurons, oligodendrocytes, endothelial cells, astrocytes and microglia. TGFβ signaling increased 2 fold after stroke, beginning on day 1 and peaking on day 7. This pattern of increase was preserved in old animals and absolute TGFβ signaling in the brain increased with age. Activated microglia and macrophages were the predominant source of increased TGFβ after stroke and astrocytes and activated microglia and macrophages demonstrated dramatic upregulation of TGFβ signaling after stroke. TGFβ signaling in neurons and oligodendrocytes did not undergo marked changes. We found that TGFβ signaling increases with age and that astrocytes and activated microglia and macrophages are the main cell types that undergo increased TGFβ signaling in response to post-stroke increases in TGFβ. Therefore increased TGFβ after stroke likely regulates glial scar formation and the immune response to stroke.

Tracking patterns of needs during a telephone follow-up programme for family caregivers of persons with stroke.

PubMed

Bakas, Tamilyn; Jessup, Nenette M; McLennon, Susan M; Habermann, Barbara; Weaver, Michael T; Morrison, Gwendolyn

2016-09-01

Programmes that address stroke family caregiver needs and skill-building are recommended based on the literature and patient care guidelines for stroke rehabilitation. The purpose of this study was to explore patterns of perceived needs and skill-building during a stroke caregiver intervention programme. Descriptive statistics were used to analyse data from 123 stroke caregivers enrolled in the intervention group of a randomised controlled clinical trial. Caregivers received eight weekly telephone sessions, with a booster session a month later. At each session, the Caregiver Needs and Concerns Checklist (CNCC) was used to identify and prioritise current needs that were then addressed through skill-building strategies. Perceived needs changed over time. Information about stroke was the highest priority need during Session 1. Managing survivor emotions and behaviours was the highest priority for Sessions 2 through 4. Caregivers generally waited until Sessions 5 through 9 to address their own emotional and physical health needs. Physical and instrumental care needs were relatively low but stable across all nine sessions. Skill-building was consistently high, though it peaked during Sessions 2 and 3. Tracking patterns of needs and skill-building suggest appropriate timing for targeting different types of family caregiver support during stroke rehabilitation. Implications for Rehabilitation Family caregivers of stroke survivors play an essential role in the rehabilitation process of the stroke survivor. Identifying and addressing the priority needs and concerns of stroke caregivers during the early discharge period enables caregivers to provide sustained support for the stroke survivor. Rehabilitation professionals are in a key position to address evolving caregiver needs and concerns as they transition to home settings with follow-up care.

Nogo receptor blockade overcomes remyelination failure after white matter stroke and stimulates functional recovery in aged mice

PubMed Central

Sozmen, Elif G.; Rosenzweig, Shira; Llorente, Irene L.; DiTullio, David J.; Machnicki, Michal; Vinters, Harry V.; Havton, Lief A.; Giger, Roman J.; Hinman, Jason D.

2016-01-01

White matter stroke is a distinct stroke subtype, accounting for up to 25% of stroke and constituting the second leading cause of dementia. The biology of possible tissue repair after white matter stroke has not been determined. In a mouse stroke model, white matter ischemia causes focal damage and adjacent areas of axonal myelin disruption and gliosis. In these areas of only partial damage, local white matter progenitors respond to injury, as oligodendrocyte progenitors (OPCs) proliferate. However, OPCs fail to mature into oligodendrocytes (OLs) even in regions of demyelination with intact axons and instead divert into an astrocytic fate. Local axonal sprouting occurs, producing an increase in unmyelinated fibers in the corpus callosum. The OPC maturation block after white matter stroke is in part mediated via Nogo receptor 1 (NgR1) signaling. In both aged and young adult mice, stroke induces NgR1 ligands and down-regulates NgR1 inhibitors during the peak OPC maturation block. Nogo ligands are also induced adjacent to human white matter stroke in humans. A Nogo signaling blockade with an NgR1 antagonist administered after stroke reduces the OPC astrocytic transformation and improves poststroke oligodendrogenesis in mice. Notably, increased white matter repair in aged mice is translated into significant poststroke motor recovery, even when NgR1 blockade is provided during the chronic time points of injury. These data provide a perspective on the role of NgR1 ligand function in OPC fate in the context of a specific and common type of stroke and show that it is amenable to systemic intervention to promote recovery. PMID:27956620

Nogo receptor blockade overcomes remyelination failure after white matter stroke and stimulates functional recovery in aged mice.

PubMed

Sozmen, Elif G; Rosenzweig, Shira; Llorente, Irene L; DiTullio, David J; Machnicki, Michal; Vinters, Harry V; Havton, Lief A; Giger, Roman J; Hinman, Jason D; Carmichael, S Thomas

2016-12-27

White matter stroke is a distinct stroke subtype, accounting for up to 25% of stroke and constituting the second leading cause of dementia. The biology of possible tissue repair after white matter stroke has not been determined. In a mouse stroke model, white matter ischemia causes focal damage and adjacent areas of axonal myelin disruption and gliosis. In these areas of only partial damage, local white matter progenitors respond to injury, as oligodendrocyte progenitors (OPCs) proliferate. However, OPCs fail to mature into oligodendrocytes (OLs) even in regions of demyelination with intact axons and instead divert into an astrocytic fate. Local axonal sprouting occurs, producing an increase in unmyelinated fibers in the corpus callosum. The OPC maturation block after white matter stroke is in part mediated via Nogo receptor 1 (NgR1) signaling. In both aged and young adult mice, stroke induces NgR1 ligands and down-regulates NgR1 inhibitors during the peak OPC maturation block. Nogo ligands are also induced adjacent to human white matter stroke in humans. A Nogo signaling blockade with an NgR1 antagonist administered after stroke reduces the OPC astrocytic transformation and improves poststroke oligodendrogenesis in mice. Notably, increased white matter repair in aged mice is translated into significant poststroke motor recovery, even when NgR1 blockade is provided during the chronic time points of injury. These data provide a perspective on the role of NgR1 ligand function in OPC fate in the context of a specific and common type of stroke and show that it is amenable to systemic intervention to promote recovery.

Variability of 4D flow parameters when subjected to changes in MRI acquisition parameters using a realistic thoracic aortic phantom.

PubMed

Montalba, Cristian; Urbina, Jesus; Sotelo, Julio; Andia, Marcelo E; Tejos, Cristian; Irarrazaval, Pablo; Hurtado, Daniel E; Valverde, Israel; Uribe, Sergio

2018-04-01

To assess the variability of peak flow, mean velocity, stroke volume, and wall shear stress measurements derived from 3D cine phase contrast (4D flow) sequences under different conditions of spatial and temporal resolutions. We performed controlled experiments using a thoracic aortic phantom. The phantom was connected to a pulsatile flow pump, which simulated nine physiological conditions. For each condition, 4D flow data were acquired with different spatial and temporal resolutions. The 2D cine phase contrast and 4D flow data with the highest available spatio-temporal resolution were considered as a reference for comparison purposes. When comparing 4D flow acquisitions (spatial and temporal resolution of 2.0 × 2.0 × 2.0 mm 3 and 40 ms, respectively) with 2D phase-contrast flow acquisitions, the underestimation of peak flow, mean velocity, and stroke volume were 10.5, 10 and 5%, respectively. However, the calculated wall shear stress showed an underestimation larger than 70% for the former acquisition, with respect to 4D flow, with spatial and temporal resolution of 1.0 × 1.0 × 1.0 mm 3 and 20 ms, respectively. Peak flow, mean velocity, and stroke volume from 4D flow data are more sensitive to changes of temporal than spatial resolution, as opposed to wall shear stress, which is more sensitive to changes in spatial resolution. Magn Reson Med 79:1882-1892, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

A kinetic analysis of manual wheelchair propulsion during start-up on select indoor and outdoor surfaces.

PubMed

Koontz, Alicia M; Cooper, Rory A; Boninger, Michael L; Yang, Yusheng; Impink, Bradley G; van der Woude, Lucas H V

2005-01-01

The objective of this study was to conduct a kinetic analysis of manual wheelchair propulsion during start-up on select indoor and outdoor surfaces. Eleven manual wheelchairs were fitted with a SMART(Wheel) and their users were asked to push on a course consisting of high- and low-pile carpet, indoor tile, interlocking concrete pavers, smooth level concrete, grass, hardwood flooring, and a sidewalk with a 5-degree grade. Peak resultant force, wheel torque, mechanical effective force, and maximum resultant force rate of rise were analyzed during start-up for each surface and normalized relative to their steady-state values on the smooth level concrete. Additional variables included peak velocity, distance traveled, and number of strokes in the first 5 s of the trial. We compared biomechanical data between surfaces using repeated-measures mixed models and paired comparisons with a Bonferroni adjustment. Applied resultant force (p = 0.0154), wheel torque (p < 0.0001), and mechanical effective force (p = 0.0047) were significantly different between surfaces. The kinetic values for grass, interlocking pavers, and ramp ascent were typically higher compared with tile, wood, smooth level concrete, and high- and low-pile carpet. Users were found to travel shorter distances up the ramp and across grass (p < 0.0025) and had a higher stroke count on the ramp (p = 0.0124). While peak velocity was not statistically different, average velocity was slower for the ramp and grass, which indicates greater wheelchair/user deceleration between strokes. The differences noted between surfaces highlight the importance of evaluating wheelchair propulsion ability over a range of surfaces.

[Sports and heat stroke].

PubMed

Yuzawa, Itsuki; Miyake, Yasufumi; Aruga, Tohru

2012-06-01

We described Characteristic of the heat stroke in the sports activity in Japan. It was common in teenage men, and 15 years old had a peak with a man, the woman. Most patients did not need specific treatment. Many happened from the end of July on the outdoors around 3:00 p.m. in mid-August. There are many in order of baseball, football, tennis, and a basketball. Running and cycling had high severity of illness. Probably, grasp of an environmental condition, suitable sportswear, suitable hydration, and condition management are the best things as preventive measures.

On the Viability of Diffusion MRI-Based Microstructural Biomarkers in Ischemic Stroke

PubMed Central

Boscolo Galazzo, Ilaria; Brusini, Lorenza; Obertino, Silvia; Zucchelli, Mauro; Granziera, Cristina; Menegaz, Gloria

2018-01-01

Recent tract-based analyses provided evidence for the exploitability of 3D-SHORE microstructural descriptors derived from diffusion MRI (dMRI) in revealing white matter (WM) plasticity. In this work, we focused on the main open issues left: (1) the comparative analysis with respect to classical tensor-derived indices, i.e., Fractional Anisotropy (FA) and Mean Diffusivity (MD); and (2) the ability to detect plasticity processes in gray matter (GM). Although signal modeling in GM is still largely unexplored, we investigated their sensibility to stroke-induced microstructural modifications occurring in the contralateral hemisphere. A more complete picture could provide hints for investigating the interplay of GM and WM modulations. Ten stroke patients and ten age/gender-matched healthy controls were enrolled in the study and underwent diffusion spectrum imaging (DSI). Acquisitions at three and two time points (tp) were performed on patients and controls, respectively. For all subjects and acquisitions, FA and MD were computed along with 3D-SHORE-based indices [Generalized Fractional Anisotropy (GFA), Propagator Anisotropy (PA), Return To the Axis Probability (RTAP), Return To the Plane Probability (RTPP), and Mean Square Displacement (MSD)]. Tract-based analysis involving the cortical, subcortical and transcallosal motor networks and region-based analysis in GM were successively performed, focusing on the contralateral hemisphere to the stroke. Reproducibility of all the indices on both WM and GM was quantitatively proved on controls. For tract-based, longitudinal group analyses revealed the highest significant differences across the subcortical and transcallosal networks for all the indices. The optimal regression model for predicting the clinical motor outcome at tp3 included GFA, PA, RTPP, and MSD in the subcortical network in combination with the main clinical information at baseline. Region-based analysis in the contralateral GM highlighted the ability of anisotropy indices in discriminating between groups mainly at tp1, while diffusivity indices appeared to be altered at tp2. 3D-SHORE indices proved to be suitable in probing plasticity in both WM and GM, further confirming their viability as a novel family of biomarkers in ischemic stroke in WM and revealing their potential exploitability in GM. Their combination with tensor-derived indices can provide more detailed insights of the different tissue modulations related to stroke pathology. PMID:29515362

Systolic and Diastolic Left Ventricular Mechanics during and after Resistance Exercise.

PubMed

Stöhr, Eric J; Stembridge, Mike; Shave, Rob; Samuel, T Jake; Stone, Keeron; Esformes, Joseph I

2017-10-01

To improve the current understanding of the impact of resistance exercise on the heart, by examining the acute responses of left ventricular (LV) strain, twist, and untwisting rate ("LV mechanics"). LV echocardiographic images were recorded in systole and diastole before, during and immediately after (7-12 s) double-leg press exercise at two intensities (30% and 60% of maximum strength, one-repetition maximum). Speckle tracking analysis generated LV strain, twist, and untwisting rate data. Additionally, beat-by-beat blood pressure was recorded and systemic vascular resistance (SVR) and LV wall stress were calculated. Responses in both exercise trials were statistically similar (P > 0.05). During effort, stroke volume decreased, whereas SVR and LV wall stress increased (P < 0.05). Immediately after effort, stroke volume returned to baseline, whereas SVR and wall stress decreased (P < 0.05). Similarly, acute exercise was accompanied by a significant decrease in systolic parameters of LV muscle mechanics (P < 0.05). However, diastolic parameters, including LV untwisting rate, were statistically unaltered (P > 0.05). Immediately after exercise, systolic LV mechanics returned to baseline levels (P < 0.05) but LV untwisting rate increased significantly (P < 0.05). A single, acute bout of double-leg press resistance exercise transiently reduces systolic LV mechanics, but increases diastolic mechanics after exercise, suggesting that resistance exercise has a differential impact on systolic and diastolic heart muscle function. The findings may explain why acute resistance exercise has been associated with reduced stroke volume but chronic exercise training may result in increased LV volumes.

Preliminary Examination of Pulse Shapes From GLAS Ocean Returns

NASA Astrophysics Data System (ADS)

Swift, T. P.; Minster, B.

2003-12-01

We have examined GLAS data collected over the Pacific ocean during the commission phase of the ICESat mission, in an area where sea state is well documented. The data used for this preliminary analysis were acquired during two passes along track 95, on March 18 and 26 of 2003, along the stretch offshore southern California. These dates were chosen for their lack of cloud cover; large (4.0 m) and small (0.7 m) significant wave heights, respectively; and the presence of waves emanating from single distant Pacific storms. Cloud cover may be investigated using MODIS images (http://acdisx.gsfc.nasa.gov/data/dataset/MODIS/), while models of significant wave heights and wave vectors for offshore California are archived by the Coastal Data Information Program (http://cdip.ucsd.edu/cdip_htmls/models.shtml). We find that the shape of deep-ocean GLAS pulse returns is diagnostic of the state of the ocean surface. A calm surface produces near-Gaussian, single-peaked shot returns. In contrast, a rough surface produces blurred shot returns which often feature multiple peaks; these peaks are typically separated by total path lengths on the order of one meter. Gaussian curves fit to rough-water returns are therefore less reliable and lead to greater measurement error; outliers in the ocean surface elevation product are mostly the result of poorly fit low-energy shot returns. Additionally, beat patterns and aliasing artifacts may arise from the sampling of deep-ocean wave trains by GLAS footprints separated by 140m. The apparent wavelength of such patterns depends not only on the wave frequency, but also on the angle between the ICESat ground track and the azimuth of the wave crests. We present a preliminary analysis of such patterns which appears to be consistent with a simple geometrical model.

Predicting fitness-to-drive following stroke using the Occupational Therapy - Driver Off Road Assessment Battery.

PubMed

Unsworth, Carolyn A; Baker, Anne; Lannin, Natasha; Harries, Priscilla; Strahan, Janene; Browne, Matthew

2018-02-28

It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy - Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke. Examine the predictive validity of the Occupational Therapy - Driver Off Road Assessment Battery for on-road performance among people with stroke. Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive. The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%). The three cognitive subtests from the Occupational Therapy - Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke. Implications for Rehabilitation: Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving. The Occupational Therapy - Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment. Scores on four of the Occupational Therapy - Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke.

Length bounds for connecting discharges in triggered lightning subsequent strokes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Idone, V.P.

1990-11-20

Highly time resolved streak recordings from nine subsequent strokes in four triggered flashes have been examined for evidence of the occurrence of upward connecting discharges. These photographic recordings were obtained with superior spatial and temporal resolution (0.3 m and 0.5 {lambda}s) and were examined with a video image analysis system to help delineate the separate leader and return stroke image tracks. Unfortunately, a definitive determination of the occurrence of connecting discharges in these strokes could not be made. The data did allow various determinations of an upper bound length for any possible connecting discharge in each stroke. Under the simplestmore » analysis approach possible, an 'absolute' upper bound set of lengths was measured that ranged from 12 to 27 m with a mean of 19 m; two other more involved analyses yielded arguably better upper bound estimates of 8-18 m and 7-26 m with means of 19 m; two other more involved analyses yielded arguably better upper bound estimates of 8-18 m and 7-26 m with means of 12 and 13 m, respectively. An additional set of low time-resolution telephoto recordings of the lowest few meters of channel revealed six strokes in these flashes with one or more upward unconnected channels originating from the lightning rod tip. The maximum length of unconnected channel seen in each of these strokes ranged from 0.2 to 1.6 m with a mean of 0.7 m. This latter set of observations is interpreted as indirect evidence that connecting discharges did occur in these strokes and that the lower bound for their length is about 1 m.« less

The Influence of Glove Type on Simulated Wheelchair Racing Propulsion: A Pilot Study.

PubMed

Rice, I; Dysterheft, J; Bleakney, A W; Cooper, R A

2016-01-01

Our purpose was to examine the influence of glove type on kinetic and spatiotemporal parameters at the handrim in elite wheelchair racers. Elite wheelchair racers (n=9) propelled on a dynamometer in their own racing chairs with a force and moment sensing wheel attached. Racers propelled at 3 steady state speeds (5.36, 6.26 & 7.60 m/s) and performed one maximal effort sprint with 2 different glove types (soft & solid). Peak resultant force, peak torque, impulse, contact angle, braking torque, push time, velocity, and stroke frequency were recorded for steady state and sprint conditions. Multiple nonparametric Wilcoxon matched pair's tests were used to detect differences between glove types, while effect sizes were calculated based on Cohen's d. During steady state trials, racers propelled faster, using more strokes and larger contact angle, while applying less impulse with solid gloves compared to soft gloves. During the sprint condition, racers achieved greater top end velocities, applying larger peak force, with less braking torque with solid gloves compared to soft gloves. Use of solid gloves may provide some performance benefits to wheelchair racers during steady state and top end velocity conditions. © Georg Thieme Verlag KG Stuttgart · New York.

Serum S100B is a useful surrogate marker for long-term outcomes in photochemically-induced thrombotic stroke rat models.

PubMed

Tanaka, Yu; Koizumi, Chie; Marumo, Toshiyuki; Omura, Tomohiro; Yoshida, Shigeru

2007-08-02

In recent years, serum S100B has been used as a secondary endpoint in some clinical trials, in which serum S100B has successfully indicated the benefits or harm done by the tested agents. Compared to clinical stroke studies, few experimental stroke studies report using serum S100B as a surrogate marker for estimating the long-term effects of neuroprotectants. This study sought to observe serum S100B kinetics in PIT stroke models and to clarify the association between serum S100B and both final infarct volumes and long-term neurological outcomes. Furthermore, to demonstrate that early elevations in serum S100B reflect successful neuroprotective treatment, a pharmacological study was performed with a non-competitive NMDA glutamate receptor antagonist, MK-801. Serum S100B levels were significantly elevated after PIT stroke, reaching peak values 48 h after the onset and declining thereafter. Single measurements of serum S100B as early as 48 h after PIT stroke correlated significantly with final infarct volumes and long-term neurological outcomes. Elevated serum S100B was significantly attenuated by MK-801, correlating significantly with long-term beneficial effects of MK-801 on infarct volumes and neurological outcomes. Our results showed that single measurements of serum S100B 48 h after PIT stroke would serve as an early and simple surrogate marker for long-term evaluation of histological and neurological outcomes in PIT stroke rat models.

Land-ocean contrast on electrical characteristics of lightning discharge derived from satellite optical measurements

NASA Astrophysics Data System (ADS)

Adachi, T.; Said, R.; Cummer, S. A.; Li, J.; Takahashi, Y.; Hsu, R.; Su, H.; Chen, A. B.; Mende, S. B.; Frey, H. U.

2010-12-01

Comparative studies on the electrical properties of oceanic and continental lightning are crucial to elucidate air discharge processes occurring under different conditions. Past studies however have primarily focused on continental lightning because of the limited coverage of ground-based instruments. Recent satellite measurements by FORMOSAT-2/ISUAL provided a new way to survey the global characteristics of lightning and transient luminous events regardless of land and ocean. In this study, we analyze ISUAL/spectrophotometer data to clarify the electrical properties of lightning on a global level. Based on the results obtained by Cummer et al. [2006] and Adachi et al. [2009], the OI-777.4nm emission intensity is used to infer lightning electrical parameters. Results show a clear land-ocean contrast on the parameters of lightning discharge: in oceanic lightning, peak luminosity is 60 % higher and the time scale of return stroke is 30 % shorter. These results suggest higher peak current in oceanic lightning, which is consistent with the fact that elves, EMP-driven phenomena, also tend to occur over the ocean [Chen et al., 2008]. Further analysis of lightning events occurring around the Caribbean Sea shows that the transition-line of lightning electrical properties is precisely located along the coastline. We suggest that the differences in these electrical properties may be due to the boundary conditions (conductivity, surface terrain, etc). In this talk, based on the calibration with NLDN and Duke magnetometer data, current moment change and charge moment change will be globally evaluated using a complete set of the ISUAL-observed lightning events.

Expertise of using striking techniques for power stroke in badminton.

PubMed

Zhu, Qin

2013-10-01

Two striking techniques (fast swing and angled striking) were examined to see if they allowed effective use of string tension for the power stroke in badminton. 12 participants (4 novices, 4 recreational, and 4 expert badminton players) were recorded by a fast-speed camera while striking a shuttlecock with racquets of 8 different string tensions. The peak speed of the shuttlecock, the racquet angle and the shuttlecock angle were analyzed. The results showed that expert players succeeded in using both striking techniques to overcome the constraint of string tension and produce a consistently superior stroke. Failure to use either striking technique resulted in inferior performance that was constrained by string tension. Expertise in badminton allows the necessary motor adjustments based on the affordance perception of the string tension.

Consistency of handwriting movements in dementia of the Alzheimer's type: a comparison with Huntington's and Parkinson's diseases.

PubMed

Slavin, M J; Phillips, J G; Bradshaw, J L; Hall, K A; Presnell, I

1999-01-01

Patients with dementia of the Alzheimer's type (DAT) and their matched controls wrote, on a computer graphics tablet, 4 consecutive, cursive letter 'l's, with varying levels of visual feedback: noninking pen and blank paper so that only the hand movements could be seen, noninking pen and lined paper to constrain their writing, goggles to occlude the lower visual field and eliminate all relevant visual feedback, and inking pen with full vision. The kinematic measures of stroke length, duration, and peak velocity were expressed in terms of consistency via a signal-to-noise ratio (M value of each parameter divided by its SD). Irrespective of medication or severity, DAT patients had writing strokes of significantly less consistent lengths than controls', and were disproportionately impaired by reduced visual feedback. Again irrespective of medication or severity, patients' strokes were of significantly less consistent duration, and significantly less consistent peak velocity than controls', independent of feedback conditions. Patients, unlike controls, frequently perseverated, producing more than 4 'l's, or multiple sets of responses, which was not differentially affected by level of visual feedback. The more variable performance of patients supports a degradation of the base motor program, and resembles that of Huntington's rather than Parkinson's disease patients. It may indeed reflect frontal rather than basal ganglia dysfunction.

Effect of a gravity-compensating orthosis on reaching after stroke: evaluation of the Therapy Assistant WREX.

PubMed

Iwamuro, Bridget T; Cruz, Erik G; Connelly, Lauri L; Fischer, Heidi C; Kamper, Derek G

2008-11-01

Within-subjects repeated-measures design evaluating reaching with and without the Therapy Assistant Wilmington Robotic Exoskeleton (WREX). Laboratory. Stroke survivors (N=10) with chronic upper-extremity hemiparesis. Not applicable. Arm movement kinematics (Optotrak Certus motion detection system), muscle activity for biceps, triceps, anterior deltoid, and brachioradialis muscles (bipolar surface electromyography). Significant improvements of reaching distance occurred for all subjects across all targets (P<.001) when using the Therapy Assistant WREX. While the self-selected peak speed of hand movement during the reach decreased significantly with the Therapy Assistant WREX (P<.001), use of the Therapy Assistant WREX led to improved quality of movement as signified by a decrease in jerk (P<.001) and a shift in the timing of the peak speed to an earlier point in the movement (P<.001). Electromyographic muscle activity analysis showed that use of the Therapy Assistant WREX led to a reduction in biceps activity across all targets during the reach (P<.05), in conjunction with a marginally significant reduction in activity of the anterior deltoid (P<.055). No changes were observed in triceps (P=.47) or brachioradialis activity (P=.28). By reducing requirements for shoulder activation, the Therapy Assistant WREX improved reaching performance among stroke survivors compared with free reaching, thereby potentially facilitating practice of functional tasks.

On the pulsating electric wind of a Single Dielectric Barrier Discharge (SDBD) plasma actuator

NASA Astrophysics Data System (ADS)

Vernet, Julie; Örlü, Ramis; Alfredsson, P. Henrik

2014-11-01

An experimental study is conducted on the electric wind produced by a Single Dielectric Barrier Discharge (SDBD) plasma actuator placed at the top of a half cylinder. Laser Doppler Velocimetry (LDV) measurements were performed and results show that increasing the driving voltage (6-16 kV peak-to-peak) and frequency (0.5-2 kHz) of the actuator increases the induced jet velocity (up to 4 m/s) and thus the momentum added by the actuator. The focus of the present study is on the phase-resolved behavior of the electric wind, in particular, its two strokes. Phase-averaged LDV data reveals that while the velocity during both strokes remains positive, there is nearly a factor of two in amplitude. The difference of behavior between the two strokes and its downstream and wall-normal evolution are mapped for various driving voltages. Results indicate that this difference is restricted to the vicinity of the actuator, thereby justifying the assumption of a steady force in simulations to model the induced force. The study is part of a larger investigation aiming at separation control on the A-pillar of a truck cabin. The support of the Swedish Energy Agency and SCANIA CV of the project Flow Research on Active and Novel Control Efficiency (FRANCE) is greatly acknowledged.

Efficient preloading of the ventricles by a properly timed atrial contraction underlies stroke work improvement in the acute response to cardiac resynchronization therapy

PubMed Central

Hu, Yuxuan; Gurev, Viatcheslav; Constantino, Jason; Trayanova, Natalia

2013-01-01

Background The acute response to cardiac resynchronization therapy (CRT) has been shown to be due to three mechanisms: resynchronization of ventricular contraction, efficient preloading of the ventricles by a properly timed atrial contraction, and mitral regurgitation reduction. However, the contribution of each of the three mechanisms to the acute response of CRT, specifically stroke work improvement, has not been quantified. Objective The goal of this study was to use an MRI-based anatomically accurate 3D model of failing canine ventricular electromechanics to quantify the contribution of each of the three mechanisms to stroke work improvement and identify the predominant mechanisms. Methods An MRI-based electromechanical model of the failing canine ventricles assembled previously by our group was further developed and modified. Three different protocols were used to dissect the contribution of each of the three mechanisms to stroke work improvement. Results Resynchronization of ventricular contraction did not lead to significant stroke work improvement. Efficient preloading of the ventricles by a properly timed atrial contraction was the predominant mechanism underlying stroke work improvement. Stroke work improvement peaked at an intermediate AV delay, as it allowed ventricular filling by atrial contraction to occur at a low diastolic LV pressure but also provided adequate time for ventricular filling before ventricular contraction. Diminution of mitral regurgitation by CRT led to stroke work worsening instead of improvement. Conclusion Efficient preloading of the ventricles by a properly timed atrial contraction is responsible for significant stroke work improvement in the acute CRT response. PMID:23928177

The Mataró Stroke Registry: a 10-year registry in a community hospital.

PubMed

Palomeras Soler, E; Fossas Felip, P; Casado Ruiz, V; Cano Orgaz, A; Sanz Cartagena, P; Muriana Batiste, D

2015-06-01

A prospective stroke registry leads to improved knowledge of the disease. We present data on the Mataró Hospital Registry. In February-2002 a prospective stroke registry was initiated in our hospital. It includes sociodemographic data, previous diseases, clinical, topographic, etiological and prognostic data. We have analyzed the results of the first 10 years. A total of 2,165 patients have been included, 54.1% male, mean age 73 years. The most frequent vascular risk factor was hypertension (65.4%). Median NIHSS on admission: 3 (interquartile range, 1-8). Stroke subtype: 79.7% ischemic strokes, 10.9% hemorrhagic, and 9.4% TIA. Among ischemic strokes, the etiology was cardioembolic in 26.5%, large-vessel disease in 23.7%, and small-vessel in 22.9%. The most frequent topography of hemorrhages was lobar (47.4%), and 54.8% were attributed to hypertension. The median hospital stay was 8 days. At discharge, 60.7% of patients were able to return directly to their own home, and 52.7% were independent for their daily life activities. After 3 months these percentages were 76.9% and 62.9%, respectively. Hospital mortality was 6.5%, and after 3 months 10.9%. Our patient's profile is similar to those of other series, although the severity of strokes was slightly lower. Length of hospital stay, short-term and medium term disability, and mortality rates are good, if we compare them with other series. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Driving simulation for evaluation and rehabilitation of driving after stroke.

PubMed

Akinwuntan, Abiodun Emmanuel; Wachtel, Jerry; Rosen, Peter Newman

2012-08-01

Driving is an important activity of daily living. Loss of driving privileges can lead to depression, decreased access to medical care, and increased healthcare costs. The ability to drive is often affected after stroke. In approximately 30% of stroke survivors, it is clear from the onset that driving will no longer be possible. Approximately 33% of survivors will be able to return to driving with little or no retraining, and 35% will require driving-related rehabilitation before they can resume safe driving again. The ability to drive is not routinely evaluated after stroke, and there is no established rehabilitation program for poststroke driving. When driving evaluation does occur, it is not always clear which tests are the most salient for accurately assessing poststroke driving ability. Investigators have examined the efficacy of various methodologies to predict driving performance after stroke and have found mixed results, with each method having unique weaknesses, including poor predictive ability, poor face validity, poor sensitivity or specificity, and limited reliability. Here we review common models of driving to gain insight into why single-construct visual or cognitive off-road measures are inadequate for evaluating driving, a complex and dynamic activity that involves timely interaction of multiple motor, visual, cognitive, and perceptual skills. We also examine the potential for driving simulators to overcome the problems currently faced in the evaluation and rehabilitation of driving after stroke. Finally, we offer suggestions for the future direction of simulator-based poststroke driving evaluation and training. Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Peak discharge, flood frequency, and peak stage of floods on Big Cottonwood Creek at U.S. Highway 50 near Coaldale, Colorado, and Fountain Creek below U.S. Highway 24 in Colorado Springs, Colorado, 2016

USGS Publications Warehouse

Kohn, Michael S.; Stevens, Michael R.; Mommandi, Amanullah; Khan, Aziz R.

2017-12-14

The U.S. Geological Survey (USGS), in cooperation with the Colorado Department of Transportation, determined the peak discharge, annual exceedance probability (flood frequency), and peak stage of two floods that took place on Big Cottonwood Creek at U.S. Highway 50 near Coaldale, Colorado (hereafter referred to as “Big Cottonwood Creek site”), on August 23, 2016, and on Fountain Creek below U.S. Highway 24 in Colorado Springs, Colorado (hereafter referred to as “Fountain Creek site”), on August 29, 2016. A one-dimensional hydraulic model was used to estimate the peak discharge. To define the flood frequency of each flood, peak-streamflow regional-regression equations or statistical analyses of USGS streamgage records were used to estimate annual exceedance probability of the peak discharge. A survey of the high-water mark profile was used to determine the peak stage, and the limitations and accuracy of each component also are presented in this report. Collection and computation of flood data, such as peak discharge, annual exceedance probability, and peak stage at structures critical to Colorado’s infrastructure are an important addition to the flood data collected annually by the USGS.The peak discharge of the August 23, 2016, flood at the Big Cottonwood Creek site was 917 cubic feet per second (ft3/s) with a measurement quality of poor (uncertainty plus or minus 25 percent or greater). The peak discharge of the August 29, 2016, flood at the Fountain Creek site was 5,970 ft3/s with a measurement quality of poor (uncertainty plus or minus 25 percent or greater).The August 23, 2016, flood at the Big Cottonwood Creek site had an annual exceedance probability of less than 0.01 (return period greater than the 100-year flood) and had an annual exceedance probability of greater than 0.005 (return period less than the 200-year flood). The August 23, 2016, flood event was caused by a precipitation event having an annual exceedance probability of 1.0 (return period of 1 year, or the 1-year storm), which is a statistically common (high probability) storm. The Big Cottonwood Creek site is downstream from the Hayden Pass Fire burn area, which dramatically altered the hydrology of the watershed and caused this statistically rare (low probability) flood from a statistically common (high probability) storm. The peak flood stage at the cross section closest to the U.S. Highway 50 culvert was 6,438.32 feet (ft) above the North American Datum of 1988 (NAVD 88).The August 29, 2016, flood at the Fountain Creek site had an estimated annual exceedance probability of 0.5505 (return period equal to the 1.8-year flood). The August 29, 2016, flood event was caused by a precipitation event having an annual exceedance probability of 1.0 (return period of 1 year, or the 1-year storm). The peak stage during this flood at the cross section closest to the U.S. Highway 24 bridge was 5,832.89 ft (NAVD 88).Slope-area indirect discharge measurements were carried out at the Big Cottonwood Creek and Fountain Creek sites to estimate peak discharge of the August 23, 2016, flood and August 29, 2016, flood, respectively. The USGS computer program Slope-Area Computation Graphical User Interface was used to compute the peak discharge by adding the surveyed cross sections with Manning roughness coefficient assignments to the high-water marks. The Manning roughness coefficients for each cross section were estimated in the field using the Cowan method.

[Time-series analysis on effect of air pollution on stroke mortality in Tianjin, China].

PubMed

Wang, De-zheng; Gu, Qing; Jiang, Guo-hong; Yang, De-yi; Zhang, Hui; Song, Gui-de; Zhang, Ying

2012-12-01

To investigate the effect of air pollution on stroke mortality in Tianjin, China, and to provide basis for stroke control and prevention. Total data of mortality surveillance were collected by Tianjin Centers for Disease Control and Prevention. Meteorological data and atmospheric pollution data were from Tianjin Meteorological Bureau and Tianjin Environmental Monitoring Center, respectively. Generalized additive Poisson regression model was used in time-series analysis on the relationship between air pollution and stroke mortality in Tianjin. Single-pollutant analysis and multi-pollutant analysis were performed after adjustment for confounding factors such as meteorological factors, long-term trend of death, "days of the week" effect and population. The crude death rates of stroke in Tianjin were from 136.67 in 2001 to 160.01/100000 in 2009, with an escalating trend (P = 0.000), while the standardized mortality ratios of stroke in Tianjin were from 138.36 to 99.14/100000, with a declining trend (P = 0.000). An increase of 10 µg/m³ in daily average concentrations of atmospheric SO₂, NO₂ and PM₁₀ led to 1.0105 (95%CI: 1.0060 ∼ 1.0153), 1.0197 (95%CI: 1.0149 ∼ 1.0246) and 1.0064 (95%CI: 1.0052 ∼ 1.0077), respectively, in relative risks of stroke mortality. SO₂ effect peaked after 1-day exposure, while NO₂ and PM₁₀ effects did within 1 day. Air pollution in Tianjin may increase the risk of stroke mortality in the population and induce acute onset of stroke. It is necessary to carry out air pollution control and allocate health resources rationally to reduce the hazard of stroke mortality.

Detection of VHF lightning from GPS orbit

DOE Office of Scientific and Technical Information (OSTI.GOV)

Suszcynsky, D. M.

2003-01-01

Satellite-based VHF' lightning detection is characterized at GPS orbit by using a VHF receiver system recently launched on the GPS SVN 54 satellite. Collected lightning triggers consist of Narrow Bipolar Events (80%) and strong negative return strokes (20%). The results are used to evaluate the performance of a future GPS-satellite-based VHF global lightning monitor.

Current to the ionosphere following a lightning stroke

NASA Technical Reports Server (NTRS)

Hale, L. C.; Baginski, M. E.

1987-01-01

A simple analytical expression for calculating the total current waveform to the ionosphere after a lightning stroke is derived. The validity of this expression is demonstrated by comparison with a more rigorous computer solution of Maxwell's equations. The analytic model demonstrates that the temporal variation of the current induced in the ionosphere and global circuit and the corresponding return current in the earth depends on the conductivity profile at intervening altitudes in the middle atmosphere. A conclusion is that capacitative coupling may provide tighter coupling between the lower atmosphere and the ionosphere than usually considered, in both directions, which may help to explain observations which seem to indicate that magnetospheric phenomena may in some instances trigger lightning.

Racquet string tension directly affects force experienced at the elbow: implications for the development of lateral epicondylitis in tennis players

PubMed Central

Mohandhas, Badri R; Makaram, Navnit; Drew, Tim S; Wang, Weijie; Arnold, Graham P

2016-01-01

Background Lateral epicondylitis (LE) occurs in almost half of all tennis players. Racket-string tension is considered to be an important factor influencing the development of LE. No literature yet exists that substantiates how string-tension affects force transmission to the elbow, as implicated in LE development. We establish a quantitative relationship between string-tension and elbow loading, analyzing tennis strokes using rackets with varying string-tensions. Methods Twenty recreational tennis players simulated backhand tennis strokes using three rackets strung at tensions of 200 N, 222 N and 245 N. Accelerometers recorded accelerations at the elbow, wrist and racket handle. Average peak acceleration was determined to correlate string-tension with elbow loading. Results Statistically significant differences (p < 0.05) were observed when average peak acceleration at the elbow at 200 N string-tension (acceleration of 5.58 m/s2) was compared with that at 222 N tension (acceleration of 6.83 m/s2) and 245 N tension (acceleration of 7.45 m/s2). The 200 N racket induced the least acceleration at the elbow. Conclusions Although parameters determining force transmission to the elbow during a tennis stroke are complex, the present study was able to control these parameters, isolating the effect of string-tension. Lower string-tensions transmit less force to the elbow in backhand strokes. Reducing string-tension should be considered favourably with respect to reducing the risk of developing LE. PMID:27583017

Surface Peroneal Nerve Stimulation in Lower Limb Hemiparesis: Effect on Quantitative Gait Parameters

PubMed Central

Sheffler, Lynne R.; Taylor, Paul N.; Bailey, Stephanie Nogan; Gunzler, Douglas D.; Buurke, Jaap H.; IJzerman, Maarten J.; Chae, John

2015-01-01

Objective To evaluate possible mechanisms for functional improvement and compare ambulation training with surface peroneal nerve stimulation (PNS) versus usual care (UC) via quantitative gait analysis. Design Randomized controlled clinical trial. Setting Teaching hospital of academic medical center. Participants 110 chronic stroke survivors (> 12-wks post-stroke) with unilateral hemiparesis. Interventions Subjects were randomized to a surface PNS device or UC intervention. Subjects were treated for 12-wks and followed for 6-months post-treatment. Main Outcome Measures Spatiotemporal, kinematic, and kinetic parameters of gait. Results Cadence (F3,153=5.81, p=.012), stride length (F3,179=20.01, p<.001), walking speed (F3,167=18.2, p<.001), anterior posterior ground reaction force (F3,164=6.61, p=.004), peak hip power in pre-swing (F3,156=8.76, p<.001), and peak ankle power at push-off (F3,149=6.38, p=.005) all improved with respect to time. However, peak ankle DF in swing (F3,184=4.99, p=.031) worsened. In general, the greatest change for all parameters occurred during the treatment period. There was no significant treatment group by time interaction effects for any of the spatiotemporal, kinematic, or kinetic parameters. Conclusions Gait training with PNS and usual care was associated with improvements in peak hip power in pre-swing and peak ankle power at push-off, which may have resulted in improved cadence, stride length, and walking speed; however, there were no differences between treatment groups. Both treatment groups also experienced a decrease in peak ankle DF in swing, though the clinical implications of this finding are unclear. PMID:25802966

System for detecting substructure microfractures and method therefore

NASA Technical Reports Server (NTRS)

Parthasarathy, S. P.; Narasimhan, K. Y. (Inventor)

1979-01-01

Bursts of signals at different frequencies are induced into substructure, adjacent to a borehole. The return signals from each burst of signals are normalized to compensate for the attenuation, experienced by more distant return signals. The peak amplitudes of return signals, above a selected level, are cut off, and an average signal is produced from the normalized amplitude-limited return signals of each burst. The averaged signals of the return signals of all the signal bursts at the different frequencies are processed to provide a combined signal, whose amplitude is related to the microfracture density of the substructure adjacent to the borehole.

Incidence of First Time Stroke: A Saudi Experience.

PubMed

Al-Shenqiti, Abdullah M; Ibrahim, Sameh R; Khaled, Osama A; Ali, Abdul Rahman H; Ahmed, Mostafa S

2017-01-01

Stroke is one of the major causes of morbidity and mortality throughout the world. A number of studies were conducted in Saudi Arabia. However, there were no studies conducted in Al-Madinah Al-Munawarah city. The aim of this study was to ascertain the incidence rate of first time stroke and the age-specific incidence in both genders in Al-Madinah Al-Munawarah city. A prospective hospital based study was conducted over a 1-year period (2014). The cases were included in the study when they were admitted with a diagnosis of cerebrovascular accident. A total 164 patients (91 men and 73 women) who had first time stroke were found in this study with no significant difference between them (p = 0.565). The crude incidence rate of stroke was 13.89 per 100,000 persons. The age-specific incidence rate increased with age in the current study, where the peak was in the age group of more than 75 years old for men and women. Total crude and the age-specific rates for first time stroke patients revealed in this study were markedly lower than the range reported from the developed countries. However, they were within the range that showed previously in Saudi Arabia and Arabian Peninsula countries. © 2017 S. Karger AG, Basel.

Cognitive-communication disorder following right hemisphere stroke: exploring rehabilitation access and outcomes.

PubMed

Hewetson, Ronelle; Cornwell, Petrea; Shum, David

2017-07-01

Rehabilitation positively influences return to activities and social roles in people with aphasia. The cognitive-communication disorder (CCD) found following a right hemisphere stroke has been less extensively researched with rehabilitation access and outcomes yet to be determined. To document rehabilitation access and outcomes for people with CCD post-stroke; and compare outcomes based on presence (viz CCD; aphasia) or absence of communication impairment. A retrospective chart audit was completed for patients with first onset unilateral stroke, with a hospital length of stay (LOS) of at least two days and a communication assessment by a speech pathologist. Data extracted included presence and severity of communication impairment, access to and LOS in a rehabilitation unit, and functional outcome measures recorded at rehabilitation discharge. The majority of the 115 patients who met inclusion criteria were living independently (n = 112, 97.4%) at the time of stroke. CCD (66%) was diagnosed with similar frequency to aphasia (68%). The presence of communication impairment did not result in significant differences in rehabilitation LOS and discharge destination when compared to hemispheric strokes without communication impairment. Severity of CCD was an independent predictor of functional gain by rehabilitation discharge. People with CCD require comparable access to rehabilitation as people with aphasia, and severity of CCD should be considered in determining rehabilitation LOS. A large number of people are discharged with ongoing CCD which warrants exploration of potential participation restrictions created by the communication impairment.

Statistical analysis of lightning electric field measured under Malaysian condition

NASA Astrophysics Data System (ADS)

Salimi, Behnam; Mehranzamir, Kamyar; Abdul-Malek, Zulkurnain

2014-02-01

Lightning is an electrical discharge during thunderstorms that can be either within clouds (Inter-Cloud), or between clouds and ground (Cloud-Ground). The Lightning characteristics and their statistical information are the foundation for the design of lightning protection system as well as for the calculation of lightning radiated fields. Nowadays, there are various techniques to detect lightning signals and to determine various parameters produced by a lightning flash. Each technique provides its own claimed performances. In this paper, the characteristics of captured broadband electric fields generated by cloud-to-ground lightning discharges in South of Malaysia are analyzed. A total of 130 cloud-to-ground lightning flashes from 3 separate thunderstorm events (each event lasts for about 4-5 hours) were examined. Statistical analyses of the following signal parameters were presented: preliminary breakdown pulse train time duration, time interval between preliminary breakdowns and return stroke, multiplicity of stroke, and percentages of single stroke only. The BIL model is also introduced to characterize the lightning signature patterns. Observations on the statistical analyses show that about 79% of lightning signals fit well with the BIL model. The maximum and minimum of preliminary breakdown time duration of the observed lightning signals are 84 ms and 560 us, respectively. The findings of the statistical results show that 7.6% of the flashes were single stroke flashes, and the maximum number of strokes recorded was 14 multiple strokes per flash. A preliminary breakdown signature in more than 95% of the flashes can be identified.

Exercise-induced changes in cardiovascular function after stroke: a randomized controlled trial

PubMed Central

Tang, Ada; Krassioukov, Andrei V; Madden, Kenneth M; Mohammadi, Azam; Tsang, Michael YC; Tsang, Teresa SM

2015-01-01

Background and aims Cardiovascular co-morbidities are prevalent after stroke, with heart disease, hypertension and impaired glucose tolerance present in the majority of cases. Exercise has the potential to mediate cardiovascular risk factors commonly present in people with stroke. This single-blinded randomized controlled trial compared the effects of high versus low intensity exercise on fitness, cardiovascular risk factors, and cardiac function after stroke. Methods Fifty participants (age 50–80y, >1y post-stroke) were randomized to a high-intensity Aerobic Exercise (AE) or low-intensity non-aerobic Balance/Flexibility (BF) program (6 months, 3 60-minute sessions/week). Outcomes assessed by VO2peak (primary outcome), arterial stiffness, ambulatory capacity, hemodynamics and cardiac function using echocardiography, and lipid, glucose and homocysteine levels. Assessors were blinded to group allocation. Results Twenty-three (92%) of 25 AE group participants (withdrawals unrelated to the intervention) and all BF group participants completed the program. One BF group participant experienced 2 non-injurious falls during class. No other adverse events occurred. There were no changes in VO2peak in either group (AE 16.9±7 to 17.4±7 ml•kg−1•min−1 vs. BF 16.9±6 to 16.6±5 ml•kg−1•min−1, P=0.45), but AE group demonstrated greater improvement in right atrial emptying fraction (AE 30±22 to 37±22% vs. BF 35±20 to 31±20%, P=0.04). Both groups demonstrated improvements in lipid profiles, glucose and homocysteine levels, and ambulatory capacity (P<0.04). Conclusions This was the first study to examine the effects of aerobic exercise after stroke on cardiovascular hemodynamics. High-intensity exercise improved right-sided function and early myocardial relaxation. Low-intensity exercise may also benefit plasma lipid, glucose and inflammatory markers, and ambulatory capacity. This study is an important step towards understanding mechanisms by which exercise may reduce cardiovascular risk and function. Clinical Trial Registration Information http://www.clinicaltrials.gov. Unique identifier: NCT01189045 PMID:24148695

Stroke outcomes in Northern Scotland: does rurality really matter?

PubMed

O'Neill, N P; Godden, D J

2003-01-01

Stroke is the third leading cause of death in Scotland after coronary heart disease and cancer and is a major cause of long-term disability. There is evidence in other clinical conditions such as asthma, diabetic retinopathy, and cancer that rural residents may have poorer outcomes, due to relative inaccessibility of health-service provision or because the disease is at a more advanced stage at diagnosis. However, the evidence-base for stroke care and outcomes in remote and rural areas is small and the subject matter is under-researched. This study was designed to examine, over a one-year period, the incidence and outcome of stroke occurring in the Highlands and Islands of Scotland, a large geographical area with many rural and remote settlements. The study explored whether stroke care and outcome was affected by remoteness and rurality. The study was a prospective, community-based, observational survey. Patients in Highland and the Islands (Orkney, Shetland and the Western Isles) suffering first-ever stroke during a 12-month period (from 1 May 2001 to 30 April 2002) were included. All practitioners from health and social care sectors, residential homes, voluntary and charitable organisations were encouraged to notify the researchers of any individual they suspected or knew had a first-ever stroke within the designated time period. Data on 'limitation in activities' (formerly 'level of disability') and service provision were collected using questionnaires and proformas at 1, 3 and 6 months post-stroke from several sources. These included individual patients and carers, health and social care professionals, residential homes, voluntary organisations, and charitable organisations. The analysis focused on location at time of follow up, limitation in activities and service provision. Outcomes were compared across different settlement categories. Settlements were classified as urban/accessible, remote rural and very remote, based on the Scottish Household Survey. In all, 303 patients with a suspected first-ever stroke were notified to the study. The resulting crude incidence of reported stroke was 1.1 per 1000. From the notifications, 239 patients were sent a consent form, of whom 118 agreed to participate in the study. The final dataset, after exclusions for incorrect diagnosis, deaths and other reasons, was derived from 85 patients. Among these, patients from remote rural and very remote settlements were over-represented, when compared to all patients notified. The majority of patients returned home from acute hospitals during the study period and the likelihood of returning home was not related to settlement category. However, a greater proportion of patients in remote rural settlements were admitted to community hospitals and remained there at 6 months. Approximately two-thirds had some degree of disability (or limitation in activities) after their stroke. One-third of patients classed themselves as independent across all time points. Overall, the Barthel Index score increased over time (ie, patients experienced a reduction in disability) with the average score at 1 month post-stroke being 82.5 (range 0-100), at 3 months 85 (range 5-100), and at 6 months 90 (range 5-100). Uptake of services was similar across all settlement categories, with low levels of use at 6-months post-stroke. In particular, few patients used social-support and stroke-specific services, for example Chest, Heart and Stroke Scotland, and Stroke Nurse services. The proportion of patients using any service at 1, 3 and 6 months did not differ between settlement categories. Rural patients did not therefore appear disadvantaged in service provision. The low incidence of reported stroke may have been due to a number of reasons including: death prior to notification; diagnostic uncertainty; stroke severity--failure to notify very mild or very severe stroke cases; and inadequate reporting of patients managed at home. The greater proportion of patients in remote rural settlements being admitted to community hospitals and remaining there at 6 months may reflect greater availability of community hospital places in this settlement category, but may also be influenced by stroke severity. The low uptake of rehabilitation and support services generally, combined with the relatively poor functional outcome of our patients, suggests that there may be an unmet need for rehabilitation. However, rural patients did not appear specifically disadvantaged. Our study indicates that patients developing a first-time stroke in remote and rural areas of the Highlands and Islands of Scotland are not disadvantaged compared to those in urban/accessible areas, with respect to outcome or to the utilization of health and social care services. However, functional outcomes could be improved for patients in all settlement categories.

Preliminary safety analysis of high-intensity interval training (HIIT) in persons with chronic stroke.

PubMed

Carl, Daniel L; Boyne, Pierce; Rockwell, Bradley; Gerson, Myron; Khoury, Jane; Kissela, Brett; Dunning, Kari

2017-03-01

The purpose of this study was to assess safety via electrocardiographic (ECG), blood pressure (BP), heart rate (HR), and orthopedic responses to 3 different high-intensity interval training (HIIT) protocols in persons with stroke. Eighteen participants (10 male; 61.9 + 8.3 years of age; 5.8 + 4.2 years poststroke) completed a symptom-limited graded exercise test (GXT) with ECG monitoring to screen for eligibility and determine HR peak. The 3 HIIT protocols involved repeated 30 s bursts of treadmill walking at maximum speed alternated with rest periods of 30 s (P30), 1 min (P60), or 2 min (P120). Sessions were performed in random order and included 5 min warm up, 20 min HIIT, and 5 min cool down. Variables measured included ECG activity, BP, HR, signs and symptoms of cardiovascular intolerance, and orthopedic concerns. Generalized linear mixed models and Tukey-Kramer adjustment were used to compare protocols using p < 0.05. No signs or symptoms of cardiovascular intolerance, significant arrhythmias, ST segment changes, or orthopedic responses resulted in early termination of any HIIT session. HIIT elicited HRs in excess of 88% of measured HR peak including 6 (P30), 8 (P60), and 2 (P120) participants eliciting a HR response above their GXT HR peak . Both maximum BP and HR were significantly higher in P30 and P60 relative to P120. Preliminary data indicate that persons with chronic stroke who have been prescreened with an ECG stress test, a symptom-limited GXT, and a harness for fall protection may safely participate in HIIT, generating substantially higher HRs than what is seen in traditional moderate intensity training.

Propulsion of the Water Flea, Daphnia magna: Experiments, Scaling, and Modelling

NASA Astrophysics Data System (ADS)

Skipper, A. N.; Murphy, D.; Webster, D. R.; Yen, J.

2016-02-01

The freshwater crustacean Daphnia magna is a widely studied zooplankton in relation to food webs, predator-prey interactions, and other biological/ecological considerations; however, their locomotion is poorly quantified and understood. These water fleas utilize a hop-and-sink mechanism that consists of making quick, impulsive jumps by beating their antennae to propel themselves forward ( 1 body length). The animals then sink for a period, during which they stretch out their antennae to increase drag and thereby reduce their sinking velocity. Time-resolved three-dimensional flow fields surrounding the animals were quantified with a unique infrared tomographic particle image velocity (tomo-PIV) system. Three-dimensional kinematics data were also extracted from the image sequences. In the current work, we compared body kinematics and flow disturbance among organisms of size in the range of 1.3 to 2.8 mm. The stroke cycle averaged 150 ms in duration, ranging from 100 to 180 ms; this period is generally evenly split between the power and recovery strokes. The range of peak hop velocity was 27.2 to 32.5 mm/s, and peak acceleration was in the range of 0.68 to 1.8 m/s2. The results showed a distinct relationship between peak hop speed (Vmax 14 BL/s) and body size; these data collapsed onto a single time-record curve during the power stroke when properly non-dimensionalized. The fluid flow induced by each antennae consisted of a viscous vortex ring that demonstrated a slow decay in the wake. The strength, size, and decay of the induced viscous vortex rings were compared as a function of organism size. Finally, the viscous vortex rings were analyzed in the context of a double Stokeslet model that consisted of two impulsively applied point forces separated by the animal width.

Pediatric stroke and transcranial direct current stimulation: methods for rational individualized dose optimization

PubMed Central

Gillick, Bernadette T.; Kirton, Adam; Carmel, Jason B.; Minhas, Preet; Bikson, Marom

2014-01-01

Background: Transcranial direct current stimulation (tDCS) has been investigated mainly in adults and doses may not be appropriate in pediatric applications. In perinatal stroke where potential applications are promising, rational adaptation of dosage for children remains under investigation. Objective: Construct child-specific tDCS dosing parameters through case study within a perinatal stroke tDCS safety and feasibility trial. Methods: 10-year-old subject with a diagnosis of presumed perinatal ischemic stroke and hemiparesis was identified. T1 magnetic resonance imaging (MRI) scans used to derive computerized model for current flow and electrode positions. Workflow using modeling results and consideration of dosage in previous clinical trials was incorporated. Prior ad hoc adult montages vs. de novo optimized montages provided distinct risk benefit analysis. Approximating adult dose required consideration of changes in both peak brain current flow and distribution which further tradeoff between maximizing efficacy and adding safety factors. Electrode size, position, current intensity, compliance voltage, and duration were controlled independently in this process. Results: Brain electric fields modeled and compared to values previously predicted models (Datta et al., 2011; Minhas et al., 2012). Approximating conservative brain current flow patterns and intensities used in previous adult trials for comparable indications, the optimal current intensity established was 0.7 mA for 10 min with a tDCS C3/C4 montage. Specifically 0.7 mA produced comparable peak brain current intensity of an average adult receiving 1.0 mA. Electrode size of 5 × 7 cm2 with 1.0 mA and low-voltage tDCS was employed to maximize tolerability. Safety and feasibility confirmed with subject tolerating the session well and no serious adverse events. Conclusion: Rational approaches to dose customization, with steps informed by computational modeling, may improve guidance for pediatric stroke tDCS trials. PMID:25285077

Anticipatory postural adjustments during sitting reach movement in post-stroke subjects.

PubMed

Pereira, Soraia; Silva, Cláudia C; Ferreira, Sílvia; Silva, Cláudia; Oliveira, Nuno; Santos, Rubim; Vilas-Boas, John P; Correia, Miguel V

2014-02-01

The study assessed the effect of velocity of arm movement on anticipatory postural adjustments (APAs) generation in the contralateral and ipsilateral muscles of individuals with stroke in seating. Ten healthy and eight post-stroke subjects were studied in sitting. The task consisted in reaching an object placed at scapular plane and mid-sternum height at self-selected and fast velocities. Electromyography was recorded from anterior deltoid (AD), upper (UT) and lower trapezius (LT) and latissimus dorsi (LD). While kinematic analysis was used to assess peak velocity and trunk displacement. Differences were found between the timing of APAs on ipsi and contralateral LD and LT in both movement speeds and in ipsilateral UT during movement of the non-affected arm at a self-selected velocity. A delay on the contralateral LD to reach movement with the non-affected arm at fast velocity was also observed. The trunk displacement was greater in post-stroke subjects. Individuals with stroke demonstrated a delay of APAs in the muscles on both sides of the body compared to healthy subjects. The delay was observed during performance of the reaching task with the fast and self-selected velocity. Copyright © 2013 Elsevier Ltd. All rights reserved.

Accuracy and reliability of observational gait analysis data: judgments of push-off in gait after stroke.

PubMed

McGinley, Jennifer L; Goldie, Patricia A; Greenwood, Kenneth M; Olney, Sandra J

2003-02-01

Physical therapists routinely observe gait in clinical practice. The purpose of this study was to determine the accuracy and reliability of observational assessments of push-off in gait after stroke. Eighteen physical therapists and 11 subjects with hemiplegia following a stroke participated in the study. Measurements of ankle power generation were obtained from subjects following stroke using a gait analysis system. Concurrent videotaped gait performances were observed by the physical therapists on 2 occasions. Ankle power generation at push-off was scored as either normal or abnormal using two 11-point rating scales. These observational ratings were correlated with the measurements of peak ankle power generation. A high correlation was obtained between the observational ratings and the measurements of ankle power generation (mean Pearson r=.84). Interobserver reliability was moderately high (mean intraclass correlation coefficient [ICC (2,1)]=.76). Intraobserver reliability also was high, with a mean ICC (2,1) of.89 obtained. Physical therapists were able to make accurate and reliable judgments of push-off in videotaped gait of subjects following stroke using observational assessment. Further research is indicated to explore the accuracy and reliability of data obtained with observational gait analysis as it occurs in clinical practice.

Vascular cognitive disorders and depression after first-ever stroke: the Fogarty-Mexico Stroke Cohort.

PubMed

Arauz, Antonio; Rodríguez-Agudelo, Yaneth; Sosa, Ana Luisa; Chávez, Mireya; Paz, Francisco; González, Margarita; Coral, Juliana; Díaz-Olavarrieta, Claudia; Román, Gustavo C

2014-01-01

Stroke is the major cause of vascular behavior and cognitive disorders worldwide. In developing countries, there is a dearth of information regarding the public health magnitude of stroke. The aim of the Fogarty-Mexico cohort was to assess the prevalence of vascular behavioral and cognitive disorders, ranging from mild vascular cognitive impairment (VCI) to vascular dementia (VaD), in a cohort of acute first-ever symptomatic stroke patients in Mexico. A total of 165 consecutive, first-ever stroke patients admitted to the National Institute of Neurology and Neurosurgery in Mexico City, were included in the cohort. Patients were eligible if they had an ischemic stroke, primary intracerebral hemorrhage, or cerebral venous thrombosis (CVT). Stroke diagnosis required the presence of an acute focal deficit lasting more than 24 h, confirmed by a corresponding lesion on CT/MRI. Stroke severity was established with the NIH Stroke Scale. The pre-stroke functional status was determined by the IQCODE. Three months after the occurrence of stroke, 110 survivor patients returned for follow-up and were able to undergo functional outcome (modified Rankin scale, Barthel index), along with neurological, psychiatric, neuropsychological, laboratory, and imaging assessments. We compared depression, demographic, and clinical and imaging features between patients with and without dementia, and between patients with VCI and those with intact cognition. Of the 110 patients (62% men, mean age 56 ± 17.8, education 7.7 ± 5.2 years) 93 (84%) had ischemic strokes, 14 (13%) intracerebral hemorrhage, and 3 (3%) CVT. The main risk factors were hypertension (50%), smoking (40%), hypercholesterolemia (29%), hyperhomocysteinemia (24%), and diabetes (22%). Clinical and neuropsychological evaluations demonstrated post-stroke depression in 56%, VCI in 41%, and VaD in 12%; 17% of the latter had pre-stroke functional impairment (IQCODE >3.5). Cognitive deficits included executive function in 69%, verbal memory in 49%, language in 38%, perception in 36%, and attention in 38%. Executive dysfunction occurred in 36% of non-demented subjects, 65% of them with mild-moderate deficits in daily living activities. Female gender (p ≤ 0.054), older age (mean age 65.6 years vs. 49.3, p < 0.001), diabetes (p ≤ 0.004), illiteracy and lower education (p ≤ 0.001), and PSD (p = 0.03) were significantly higher in VCI-VaD compared with cognitively intact post-stroke subjects. We could not demonstrate an association with lesion site and distribution of the cognitive deficits. The Fogarty-Mexico cohort recruited relatively young acute stroke patients, compared with other Mexican stroke cohorts. PSD and VCI occurred frequently but prevalence of VaD (12%) was lower than expected. A high prevalence of treatable stroke risk factors suggests that preventive interventions are advisable. © 2014 S. Karger AG, Basel.

Quantitative assessment of cerebrospinal fluid hydrodynamics using a phase-contrast cine MR image in hydrocephalus.

PubMed

Kim, D S; Choi, J U; Huh, R; Yun, P H; Kim, D I

1999-09-01

This investigation was undertaken to characterize CSF flow at the level of the aqueduct of Sylvius with a phase-contrast cine MR pulse sequence in 28 healthy volunteers. Sixteen patients with obstructive hydrocephalus and 11 patients with normal pressure hydrocephalus (NPH) were investigated with the same sequence before and after CSF diversion. The peak CSF flow velocity and stroke volume in the aqueduct increased significantly in the NPH group and decreased significantly in the obstructive hydrocephalus group. After lumboperitoneal shunting in the NPH group, the retrograde flow of CSF was anterogradely converted and the peak flow velocities decreased somewhat. The clinical diagnosis of NPH was well correlated with the results of cine MRI. After endoscopic III ventriculostomy in the obstructive hydrocephalus group we noted increased CSF flow velocity with markedly increased stroke volume at the prepontine cistern. Phase-contrast cine MR is useful in evaluating CSF dynamics in patients with hyperdynamic aqueductal CSF or aqueductal obstruction.

FDTD Modeling of LEMP Propagation in the Earth-Ionosphere Waveguide With Emphasis on Realistic Representation of Lightning Source

NASA Astrophysics Data System (ADS)

Tran, Thang H.; Baba, Yoshihiro; Somu, Vijaya B.; Rakov, Vladimir A.

2017-12-01

The finite difference time domain (FDTD) method in the 2-D cylindrical coordinate system was used to compute the nearly full-frequency-bandwidth vertical electric field and azimuthal magnetic field waveforms produced on the ground surface by lightning return strokes. The lightning source was represented by the modified transmission-line model with linear current decay with height, which was implemented in the FDTD computations as an appropriate vertical phased-current-source array. The conductivity of atmosphere was assumed to increase exponentially with height, with different conductivity profiles being used for daytime and nighttime conditions. The fields were computed at distances ranging from 50 to 500 km. Sky waves (reflections from the ionosphere) were identified in computed waveforms and used for estimation of apparent ionospheric reflection heights. It was found that our model reproduces reasonably well the daytime electric field waveforms measured at different distances and simulated (using a more sophisticated propagation model) by Qin et al. (2017). Sensitivity of model predictions to changes in the parameters of atmospheric conductivity profile, as well as influences of the lightning source characteristics (current waveshape parameters, return-stroke speed, and channel length) and ground conductivity were examined.

Breakup and then makeup: a predictive model of how cilia self-regulate hardness for posture control.

PubMed

Bandyopadhyay, Promode R; Hansen, Joshua C

2013-01-01

Functioning as sensors and propulsors, cilia are evolutionarily conserved organelles having a highly organized internal structure. How a paramecium's cilium produces off-propulsion-plane curvature during its return stroke for symmetry breaking and drag reduction is not known. We explain these cilium deformations by developing a torsional pendulum model of beat frequency dependence on viscosity and an olivo-cerebellar model of self-regulation of posture control. The phase dependence of cilia torsion is determined, and a bio-physical model of hardness control with predictive features is offered. Crossbridge links between the central microtubule pair harden the cilium during the power stroke; this stroke's end is a critical phase during which ATP molecules soften the crossbridge-microtubule attachment at the cilium inflection point where torsion is at its maximum. A precipitous reduction in hardness ensues, signaling the start of ATP hydrolysis that re-hardens the cilium. The cilium attractor basin could be used as reference for perturbation sensing.

Breakup and then makeup: a predictive model of how cilia self-regulate hardness for posture control

NASA Astrophysics Data System (ADS)

Bandyopadhyay, Promode R.; Hansen, Joshua C.

2013-06-01

Functioning as sensors and propulsors, cilia are evolutionarily conserved organelles having a highly organized internal structure. How a paramecium's cilium produces off-propulsion-plane curvature during its return stroke for symmetry breaking and drag reduction is not known. We explain these cilium deformations by developing a torsional pendulum model of beat frequency dependence on viscosity and an olivo-cerebellar model of self-regulation of posture control. The phase dependence of cilia torsion is determined, and a bio-physical model of hardness control with predictive features is offered. Crossbridge links between the central microtubule pair harden the cilium during the power stroke; this stroke's end is a critical phase during which ATP molecules soften the crossbridge-microtubule attachment at the cilium inflection point where torsion is at its maximum. A precipitous reduction in hardness ensues, signaling the start of ATP hydrolysis that re-hardens the cilium. The cilium attractor basin could be used as reference for perturbation sensing.

Breakup and then makeup: a predictive model of how cilia self-regulate hardness for posture control

PubMed Central

Bandyopadhyay, Promode R.; Hansen, Joshua C.

2013-01-01

Functioning as sensors and propulsors, cilia are evolutionarily conserved organelles having a highly organized internal structure. How a paramecium's cilium produces off-propulsion-plane curvature during its return stroke for symmetry breaking and drag reduction is not known. We explain these cilium deformations by developing a torsional pendulum model of beat frequency dependence on viscosity and an olivo-cerebellar model of self-regulation of posture control. The phase dependence of cilia torsion is determined, and a bio-physical model of hardness control with predictive features is offered. Crossbridge links between the central microtubule pair harden the cilium during the power stroke; this stroke's end is a critical phase during which ATP molecules soften the crossbridge-microtubule attachment at the cilium inflection point where torsion is at its maximum. A precipitous reduction in hardness ensues, signaling the start of ATP hydrolysis that re-hardens the cilium. The cilium attractor basin could be used as reference for perturbation sensing. PMID:23739771

An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 2: Functional Performance Tests Correlate With Return-to-Sport Outcomes.

PubMed

McGrath, Timothy M; Waddington, Gordon; Scarvell, Jennie M; Ball, Nick; Creer, Rob; Woods, Kevin; Smith, Damian; Adams, Roger

2017-02-01

Additional high-quality prospective studies are needed to better define the objective criteria used in relation to return-to-sport decisions after anterior cruciate ligament (ACL) reconstruction in active populations. To investigate prospectively the relationship between functional performance test results at 24 weeks postoperative and return-to-sport activity (Tegner activity score) at 12 and 24 months, respectively, after synthetic (ligament advanced reinforcement system [LARS]) and autograft (doubled semitendinosus/gracilis [2ST/2GR]) ACL reconstructions. Case series; Level of evidence, 4. A total of 64 patients who underwent ACL reconstruction (32 LARS, 32 2ST/2GR autograft; mean age, 27.9 years; body mass index [BMI], 24.9 kg/m 2 ) were assessed preoperatively and at staged intervals postoperatively up to 24 weeks for isokinetic testing of quadriceps and hamstring average power per repetition at 60 deg/s and 180 deg/s, a battery of hop tests, peak vertical ground-reaction force (vGRF), and time to peak vGRF (in seconds) during a step- and jump-down task onto a force platform and peak speed (m/s) using a global positioning system (GPS unit) during a running task. A cohort of 32 healthy matched participants (mean age, 26.31 years; BMI, 25.7 kg/m 2 ) were also tested to act as reference. Pearson correlation was calculated to assess correlation of each performance measure at 24 weeks postoperative with activity outcomes (Tegner score) at 12 and 24 months. The strongest correlation between physical performance tests and return-to-sport outcomes was observed with peak speed during running. Large correlations were also observed for hamstring isokinetic power and hop test for distance. Moderate correlations were observed for timed hop, peak vGRF during a jump-down task, and quadriceps isokinetic power. No statistical correlations were observed for time to peak vGRF during a step-down and jump-down task as well as peak vGRF during a step-down task. When the performance tests were pooled together, mean postoperative improvements of 24% were observed from preoperative to 24 weeks within the surgical cohort. For each performance test, preoperative level of function strongly correlated with performance levels on the same test at 24 weeks. The results of this study indicate that clinicians might seek to prioritize these tests and the rehabilitation themes they imply when seeking to maximize postoperative ACL activity outcomes. The observed strength between pre- and postoperative performance tests and return-to-sport outcomes within this study highlights the potential value of preoperative conditioning before undergoing ACL reconstruction. Future research should examine absolute predictive criterion thresholds for functional performance-based tests and reinjury risk reduction after ACL reconstruction.

Improved test methods for determining lightning-induced voltages in aircraft

NASA Technical Reports Server (NTRS)

Crouch, K. E.; Plumer, J. A.

1980-01-01

A lumped parameter transmission line with a surge impedance matching that of the aircraft and its return lines was evaluated as a replacement for earlier current generators. Various test circuit parameters were evaluated using a 1/10 scale relative geometric model. Induced voltage response was evaluated by taking measurements on the NASA-Dryden Digital Fly by Wire F-8 aircraft. Return conductor arrangements as well as other circuit changes were also evaluated, with all induced voltage measurements being made on the same circuit for comparison purposes. The lumped parameter transmission line generates a concave front current wave with the peak di/dt near the peak of the current wave which is more representative of lightning. However, the induced voltage measurements when scaled by appropriate scale factors (peak current or di/dt) resulting from both techniques yield comparable results.

Effects of transcranial direct current stimulation on hemichannel pannexin-1 and neural plasticity in rat model of cerebral infarction.

PubMed

Jiang, T; Xu, R X; Zhang, A W; Di, W; Xiao, Z J; Miao, J Y; Luo, N; Fang, Y N

2012-12-13

The aim of this study was to investigate the effects of transcranial direct current stimulation (TDCS) on hemichannel pannexin-1 (PX1) in cortical neurons and neural plasticity, and explore the optimal time window of TDCS therapy after stroke. Adult male Sprague-Dawley rats (n=90) were randomly assigned to sham operation, middle cerebral artery occlusion (MCAO), and TDCS groups, and underwent sham operation, unilateral middle cerebral artery (MCA) electrocoagulation, and unilateral MCA electrocoagulation plus TDCS (daily anodal and cathodal 10 Hz, 0.1 mA TDCS for 30 min beginning day 1 after stroke), respectively. Motor function was assessed using the beam walking test (BWT), and density of dendritic spines (DS) and PX1 mRNA expression were compared among groups on days 3, 7, and 14 after stroke. Effects of PX1 blockage on DS in hippocampal neurons after hypoxia-ischemia were observed. TDCS significantly improved motor function on days 7 and 14 after stroke as indicated by reduced BWT scores compared with the MCAO group. The density of DS was decreased after stroke; the TDCS group had increased DS density compared with the MCAO group on days 3, 7, and 14 (all P<0.0001). Cerebral infarction induced increased PX1 mRNA expression on days 3, 7, and 14 (P<0.0001), and the peak PX1 mRNA expression was observed on day 7. TDCS did not decrease the up-regulated PX1 mRNA expression after stroke on day 3, but did reduce the increased post-stroke PX1 mRNA expression on days 7 and 14 (P<0.0001). TDCS increased the DS density after stroke, indicating that it may promote neural plasticity after stroke. TDCS intervention from day 7 to day 14 after stroke demonstrated motor function improvement and can down-regulate the elevated PX1 mRNA expression after stroke. Copyright © 2012 IBRO. Published by Elsevier Ltd. All rights reserved.

Influence of stroke volume and exercise tolerance on peak oxygen pulse in patients with and without beta-adrenergic receptor blockers in patients with heart disease.

PubMed

Murata, Makoto; Adachi, Hitoshi; Oshima, Shigeru; Kurabayashi, Masahiko

2017-01-01

In a given individual, a consistent relationship exists between oxygen uptake (V˙O 2 ) and heart rate (HR) during exercise. The quotient of V˙O 2 and HR (V˙O 2 /HR) is called the oxygen pulse (O 2 pulse), and its value is dependent on stroke volume (SV). However, it is difficult to believe that the O 2 pulse would indicate the SV when HR has been modified as with the use of beta-adrenergic receptor blockers (BB). Until now, the effect of BB on peak O 2 pulse has not been precisely studied. We tried to clarify the effect of BB on the relationship between O 2 pulse and SV. Of 699 consecutive heart disease subjects who performed cardiopulmonary exercise tests (CPX) from 2012 to 2014, we enrolled 430 subjects who had sinus rhythm and could perform CPX until exhaustion. One hundred and fifty-seven subjects were taking BB. SV was evaluated during CPX using impedance cardiography, and we compared the peak O 2 pulse with peak SV between patients without BB (Group A) and with BB (Group B). The HRs at rest and peak exercise in Group A were greater than those in Group B (74.4±13.0/min vs. 71.8±11.3/min, p<0.01, 134.9±21.7/min vs. 124.9±23.6/min, p<0.01, respectively). The regression line of the peak O 2 pulse against the peak SV was steeper in Group B than in Group A. When we divided the patients into two groups according to the average values of the peak SV and peak V˙O 2 , O 2 pulse/SV ratio in Group B above the average was greater than that in Group A, whereas it was similar in the two groups that were below average. We found that the increase in the O 2 pulse was disproportionately greater than the SV that was measured by impedance cardiography when a BB was used in patients with preserved SV and exercise tolerance. Copyright © 2016. Published by Elsevier Ltd.

Cross-sectional survey of workload and burnout among Japanese physicians working in stroke care: the nationwide survey of acute stroke care capacity for proper designation of comprehensive stroke center in Japan (J-ASPECT) study.

PubMed

Nishimura, Kunihiro; Nakamura, Fumiaki; Takegami, Misa; Fukuhara, Schunichi; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Kataoka, Hiroharu; Miyamoto, Yoshihiro; Kitaoka, Kazuyo; Kada, Akiko; Iihara, Koji

2014-05-01

Burnout is common among physicians and affects the quality of care. We aimed to determine the prevalence of burnout among Japanese physicians working in stroke care and evaluate personal and professional characteristics associated with burnout. A cross-sectional design was used to develop and distribute a survey to 11 211 physicians. Physician burnout was assessed using the Maslach Burnout Inventory General Survey. The predictors of burnout and the relationships among them were identified by multivariable logistic regression analysis. A total of 2724 (25.3%) physicians returned the surveys. After excluding those who were not working in stroke care or did not complete the survey appropriately, 2564 surveys were analyzed. Analysis of the participants' scores revealed that 41.1% were burned out. Multivariable analysis indicated that number of hours worked per week is positively associated with burnout. Hours slept per night, day-offs per week, years of experience, as well as income, are inversely associated with burnout. Short Form 36 mental health subscale was also inversely associated with burnout. The primary risk factors for burnout are heavy workload, short sleep duration, relatively little experience, and low mental quality of life. Prospective research is required to confirm these findings and develop programs for preventing burnout. © 2014 American Heart Association, Inc.

Program interruptions and short-stay transfers represent potential targets for inpatient rehabilitation care-improvement efforts

PubMed Central

Middleton, Addie; Graham, James E.; Krishnan, Shilpa; Ottenbacher, Kenneth J.

2016-01-01

Objective To present comprehensive descriptive summaries of program interruptions and short-stay transfers among Medicare fee-for-service beneficiaries receiving inpatient rehabilitation following stroke, traumatic brain injury (TBI), and traumatic spinal cord injury (SCI). Design Retrospective cohort study of Medicare beneficiaries with any of the three conditions of interest who were admitted to inpatient rehabilitation directly from an acute hospital between July 1, 2012 and November 15, 2013. Results In the final sample (stroke: n=71 769; TBI: n=7109; SCI: n=659), program interruption rates were 0.9% (stroke), 0.8% (TBI), and 1.4% (SCI). Short-stay transfer rates were 22.3% (stroke), 21.8% (TBI), and 31.6% (SCI). 14.7% of short-stay transfers and 12.3% of interruptions resulting in a return to acute care were identified as potentially preventable among those with stroke, 10.2% of transfers and 11.7% of interruptions among those with TBI, and 3.8% of transfers and 11.1% of interruptions among those with SCI. Conclusions Broad healthcare policies aimed at improving quality and reducing costs are currently being implemented. Reducing program interruptions and short-stay transfers during inpatient rehabilitative care represents a potential target for care-improvement efforts. Future research focused on identifying modifiable risk factors for potentially undesirable outcomes will allow for targeted preventative interventions. PMID:27631389

Program Interruptions and Short-Stay Transfers Represent Potential Targets for Inpatient Rehabilitation Care-Improvement Efforts.

PubMed

Middleton, Addie; Graham, James E; Krishnan, Shilpa; Ottenbacher, Kenneth J

2016-11-01

The objective of this work was to present comprehensive descriptive summaries of program interruptions and short-stay transfers among Medicare fee-for-service beneficiaries receiving inpatient rehabilitation after stroke, traumatic brain injury (TBI), and traumatic spinal cord injury (SCI). Retrospective cohort study of Medicare beneficiaries with any of the 3 conditions of interest who were admitted to inpatient rehabilitation directly from an acute hospital between July 1, 2012, and November 15, 2013. In the final sample (stroke, n = 71 769; TBI, n = 7109; SCI, n = 659), program interruption rates were 0.9% (stroke), 0.8% (TBI), and 1.4% (SCI). Short-stay transfer rates were 22.3% (stroke), 21.8% (TBI), and 31.6% (SCI); 14.7% of short-stay transfers and 12.3% of interruptions resulting in a return to acute care were identified as potentially preventable among those with stroke; 10.2% of transfers and 11.7% of interruptions among those with TBI, and 3.8% of transfers and 11.1% of interruptions among those with SCI. Broad health care policies aimed at improving quality and reducing costs are currently being implemented. Reducing program interruptions and short-stay transfers during inpatient rehabilitative care represents a potential target for care-improvement efforts. Future research focused on identifying modifiable risk factors for potentially undesirable outcomes will allow for targeted preventative interventions.

Beneficial effects of footbaths in controlling spasticity after stroke

NASA Astrophysics Data System (ADS)

Matsumoto, Shuji; Shimodozono, Megumi; Etoh, Seiji; Shimozono, Yurika; Tanaka, Nobuyuki; Kawahira, Kazumi

2010-07-01

Footbaths are considered to provide beneficial thermal therapy for post-stroke patients with spasticity, but their anti-spastic effects have not been investigated comprehensively. The present study aimed to evaluate alterations in motor-neuron excitability using F-wave parameters in post-stroke patients with spastic hemiplegia. Subjects’ legs below the knee joint were immersed in water at 41°C and F-wave recordings were made over the abductor hallucis muscle before, immediately after, and 30 min after thermal treatment. Antidromic stimulation was performed on the tibial nerve at the ankle. Measurements included F-wave amplitude, F-wave/M-response ratio, changes in modified Ashworth scale (MAS), body temperature and surface-skin temperature. The mean values of both F-wave parameters were higher on the affected side before footbath treatment. In post-stroke patients, the mean values of F-wave parameters were significantly reduced after footbath treatment ( P < 0.01). The anti-spastic effects of footbath treatment were indicated by decreased F-wave parameters, in parallel with decreases in MAS. Body temperature was significantly increased both immediately after, and 30 min following footbath treatment in both groups, which appeared to play an important role in decreased spasticity. Surface-skin temperature increased immediately after footbath treatment in both groups and returned to baseline 30 min later. These findings demonstrate that the use of footbaths is an effective nonpharmacological anti-spastic treatment that might facilitate stroke rehabilitation.

Do measures of reactive balance control predict falls in people with stroke returning to the community?

PubMed

Mansfield, A; Wong, J S; McIlroy, W E; Biasin, L; Brunton, K; Bayley, M; Inness, E L

2015-12-01

To determine if reactive balance control measures predict falls after discharge from stroke rehabilitation. Prospective cohort study. Rehabilitation hospital and community. Independently ambulatory individuals with stroke who were discharged home after inpatient rehabilitation (n=95). Balance and gait measures were obtained from a clinical assessment at discharge from inpatient stroke rehabilitation. Measures of reactive balance control were obtained: (1) during quiet standing; (2) when walking; and (3) in response to large postural perturbations. Participants reported falls and activity levels up to 6 months post-discharge. Logistic and Poisson regressions were used to identify measures of reactive balance control that were related to falls post-discharge. Decreased paretic limb contribution to standing balance control [rate ratio 0.8, 95% confidence interval (CI) 0.7 to 1.0; P=0.011], reduced between-limb synchronisation of quiet standing balance control (rate ratio 0.9, 95% CI 0.8 to 0.9; P<0.0001), increased step length variability (rate ratio 1.4, 95% CI 1.2 to 1.7; P=0.0011) and inability to step with the blocked limb (rate ratio 1.2, 95% CI 1.0 to 1.3; P=0.013) were significantly associated with increased fall rates when controlling for age, stroke severity, functional balance and daily walking activity. Impaired reactive balance control in standing and walking predicted increased risk of falls post-discharge from stroke rehabilitation. Specifically, measures that revealed the capacity of both limbs to respond to instability were related to increased risk of falls. These results suggest that post-stroke rehabilitation strategies for falls prevention should train responses to instability, and focus on remediating dyscontrol in the more-affected limb. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

[The effect of neurorehabilitation on the functional state and muscle tone of upper limb in patients after ischaemic stroke].

PubMed

Klimkiewicz, Paulina; Kubsik, Anna; Jankowska, Agnieszka; Woldańska-Okońska, Marta

2014-03-01

Rehabilitation of upper limb in patients after ischemic stroke is a major challenge for modern neurorehabilitation. Function of upper limb of patients after ischemic stroke returns on the end of the rehabilitation comparing with another parts of the body. Below presents two groups of patients after ischemic stroke who were rehabilitated with use of the following methods: kinesiotherapy combined with NDT- Bobath method and kinesiotherapy only. The aim of this study was to assess the impact of kinesiotherapy only and NDT- Bobath method combined with kinesiotherapy on the functional state and muscle tone of upper limb in patients after ischemic stroke. The study involved a group of 40 patients after ischemic stroke with motor control and muscle tone problems of upper limb. Patients were divided into two groups, each of them included 20 people. Upper limb in group I was rehabilitated with the use of kinesiotherapy exercise however group II with the use of kinesiotherapy exercise combined with NDT- Bobath method (Neurodevelopmental Treatment Bobath). To evaluate the patients before and after rehabilitation muscle tone Asworth scale was used and to assess functional status Rivermead Motor Assessment (RMAIII) scale was used. After 5 weeks of rehabilitation in group II in majority patients were observed decrease of muscle tone and improvement in upper limb functional status. In group I the muscle tone were also decreased and functional status were better but in smaller impact than in II group. Classical kinesiotherapy combined with the NDT-Bobath method gives better results in neurorehabilitation of upper limb than the use of kinesiotherapy exercises only in patients after ischemic stroke.

Flood frequency analysis for nonstationary annual peak records in an urban drainage basin

USGS Publications Warehouse

Villarini, G.; Smith, J.A.; Serinaldi, F.; Bales, J.; Bates, P.D.; Krajewski, W.F.

2009-01-01

Flood frequency analysis in urban watersheds is complicated by nonstationarities of annual peak records associated with land use change and evolving urban stormwater infrastructure. In this study, a framework for flood frequency analysis is developed based on the Generalized Additive Models for Location, Scale and Shape parameters (GAMLSS), a tool for modeling time series under nonstationary conditions. GAMLSS is applied to annual maximum peak discharge records for Little Sugar Creek, a highly urbanized watershed which drains the urban core of Charlotte, North Carolina. It is shown that GAMLSS is able to describe the variability in the mean and variance of the annual maximum peak discharge by modeling the parameters of the selected parametric distribution as a smooth function of time via cubic splines. Flood frequency analyses for Little Sugar Creek (at a drainage area of 110 km2) show that the maximum flow with a 0.01-annual probability (corresponding to 100-year flood peak under stationary conditions) over the 83-year record has ranged from a minimum unit discharge of 2.1 m3 s- 1 km- 2 to a maximum of 5.1 m3 s- 1 km- 2. An alternative characterization can be made by examining the estimated return interval of the peak discharge that would have an annual exceedance probability of 0.01 under the assumption of stationarity (3.2 m3 s- 1 km- 2). Under nonstationary conditions, alternative definitions of return period should be adapted. Under the GAMLSS model, the return interval of an annual peak discharge of 3.2 m3 s- 1 km- 2 ranges from a maximum value of more than 5000 years in 1957 to a minimum value of almost 8 years for the present time (2007). The GAMLSS framework is also used to examine the links between population trends and flood frequency, as well as trends in annual maximum rainfall. These analyses are used to examine evolving flood frequency over future decades. ?? 2009 Elsevier Ltd.

Stormwater Design Return Period Standards for U.S. Transportation Infrastructure: How Are States Approaching Resilience?

NASA Astrophysics Data System (ADS)

Samaras, C.; Lopez, T.

2016-12-01

Climate change is projected to increase the frequency and intensity of precipitation in many regions, which is relevant for stormwater engineering designs and resilience in the transportation sector. Existing and future stormwater infrastructure is generally designed for historical and stationary hydrologic conditions. For example, the design return period is based on statistical analysis of past precipitation events, often over a 50-year historical timeline. The design return period translates into how much peak precipitation volume a system is designed for in a state, and provides information about the performance of a drainage structure. The higher the design period used by an engineer for a given stormwater system, the more peak stormwater volume the system can convey. Therefore, design return periods can be associated with a design's near-term and long-term resilience. However, there is a tradeoff between the choice of design return period, the total infrastructure capital cost, and the resilience of a system to heavy precipitation events. This study analyzes current stormwater infrastructure design guidelines for state departments of transportation in the contiguous United States, in order to understand how stormwater design return periods vary across states and provide insight into the resilience of current stormwater systems design. The study found that the design return period varies considerably across the United States by roadway functional class and drainage classification, as well as within climate regions. Understanding this variation will help states identify possible vulnerabilities, highlight deficiencies across states and infrastructure types, and help in updating design return periods to increase the climate resilience of stormwater infrastructure.

VO2 Kinetics in All-out Arm Stroke, Leg Kick and Whole Stroke Front Crawl 100-m Swimming.

PubMed

Rodríguez, F A; Lätt, E; Jürimäe, J; Maestu, J; Purge, P; Rämson, R; Haljaste, K; Keskinen, K L; Jürimäe, T

2016-03-01

The VO2 response to extreme-intensity exercise and its relationship with sports performance are largely unexplored. This study investigated the pulmonary VO2 kinetics during all-out 100-m front crawl whole stroke swimming (S), arm stroke (A) and leg kick (L). 26 male and 10 female competitive swimmers performed an all-out S trial followed by A and L of equal duration in random order. Breath-by-breath VO2 was measured using a snorkel attached to a portable gas analyzer. Mean (±SD) primary component parameters and peak blood lactate (Lapeak) during S, A, and L were, respectively: time delay (s), 14.2 ± 4.7, 14.3 ± 4.5, 15.6 ± 5.1; amplitude (ml·kg(-1)·min(-1)), 46.8 ± 6.1, 37.3 ± 6.9, 41.0 ± 4.7; time constant (τ, s): 9.2 ± 3.2, 12.4 ± 4.7, 10.1 ± 3.2; Lapeak (mmol·l(-1)), 6.8 ± 3.1, 6.3 ± 2.5, 7.9 ± 2.8. During A and L respectively, 80% and 87% of amplitude in S was reached, whereas A+L were 68% greater than in S. 100-m performance was associated to shorter cardiodynamic phase and greater VO2 amplitude and Lapeak (accounting up to 61% of performance variance), but not to τ. We conclude that (i) VO2 gain was proportional to exercise intensity and muscle mass involved, (ii) kicking is metabolically less efficient, and (iii) the main limiting factor of peak VO2 appears to be O2 delivery and not muscle extraction. © Georg Thieme Verlag KG Stuttgart · New York.

The effect of changing plantarflexion resistive moment of an articulated ankle-foot orthosis on ankle and knee joint angles and moments while walking in patients post stroke

PubMed Central

Kobayashi, Toshiki; Singer, Madeline L.; Orendurff, Michael S.; Gao, Fan; Daly, Wayne K.; Foreman, K. Bo

2015-01-01

Background The adjustment of plantarflexion resistive moment of an articulated ankle-foot orthosis is considered important in patients post stroke, but the evidence is still limited. Therefore, the aim of this study was to investigate the effect of changing the plantarflexion resistive moment of an articulated ankle-foot orthosis on ankle and knee joint angles and moments in patients post stroke. Methods Gait analysis was performed on 10 subjects post stroke under four different plantarflexion resistive moment conditions using a newly designed articulated ankle-foot orthosis. Data were recorded using a Bertec split-belt instrumented treadmill in a 3-dimensional motion analysis laboratory. Findings The ankle and knee sagittal joint angles and moments were significantly affected by the amount of plantarflexion resistive moment of the ankle-foot orthosis. Increasing the plantarflexion resistive moment of the ankle-foot orthosis induced significant decreases both in the peak ankle plantarflexion angle (P<0.01) and the peak knee extension angle (P<0.05). Also, the increase induced significant increases in the internal dorsiflexion moment of the ankle joint (P<0.01) and significantly decreased the internal flexion moment of the knee joint (P<0.01). Interpretation These results suggest an important link between the kinematic/kinetic parameters of the lower-limb joints and the plantarflexion resistive moment of an articulated ankle-foot orthosis. A future study should be performed to clarify their relationship further so that the practitioners may be able to use these parameters as objective data to determine an optimal plantarflexion resistive moment of an articulated ankle-foot orthosis for improved orthotic care in individual patients. PMID:26149007

The effect of changing plantarflexion resistive moment of an articulated ankle-foot orthosis on ankle and knee joint angles and moments while walking in patients post stroke.

PubMed

Kobayashi, Toshiki; Singer, Madeline L; Orendurff, Michael S; Gao, Fan; Daly, Wayne K; Foreman, K Bo

2015-10-01

The adjustment of plantarflexion resistive moment of an articulated ankle-foot orthosis is considered important in patients post stroke, but the evidence is still limited. Therefore, the aim of this study was to investigate the effect of changing the plantarflexion resistive moment of an articulated ankle-foot orthosis on ankle and knee joint angles and moments in patients post stroke. Gait analysis was performed on 10 subjects post stroke under four different plantarflexion resistive moment conditions using a newly designed articulated ankle-foot orthosis. Data were recorded using a Bertec split-belt instrumented treadmill in a 3-dimensional motion analysis laboratory. The ankle and knee sagittal joint angles and moments were significantly affected by the amount of plantarflexion resistive moment of the ankle-foot orthosis. Increasing the plantarflexion resistive moment of the ankle-foot orthosis induced significant decreases both in the peak ankle plantarflexion angle (P<0.01) and the peak knee extension angle (P<0.05). Also, the increase induced significant increases in the internal dorsiflexion moment of the ankle joint (P<0.01) and significantly decreased the internal flexion moment of the knee joint (P<0.01). These results suggest an important link between the kinematic/kinetic parameters of the lower-limb joints and the plantarflexion resistive moment of an articulated ankle-foot orthosis. A future study should be performed to clarify their relationship further so that the practitioners may be able to use these parameters as objective data to determine an optimal plantarflexion resistive moment of an articulated ankle-foot orthosis for improved orthotic care in individual patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

ANNALS OF THE NEW YORK ACADEMY OF SCIENCES

PubMed Central

Hanna, Michael S; Mohan, Puneet; Knabb, Robert; Gupta, Elora; Frost, Charles; Lawrence, John H

2014-01-01

The factor Xa inhibitor apixaban is one of the novel anticoagulants to emerge as alternatives to long-standing standards of care that include low-molecular-weight heparin and warfarin. The development of apixaban reflects a strategy to optimize the clinical pharmacology profile, dosing posology, trial designs, and statistical analyses across multiple indications, and to seek alignment with global health authorities. The primary objective of dose selection was to maintain balance between efficacy and bleeding risk. Twice-daily dosing of apixaban, rather than once daily, was chosen to lower peak concentrations and reduce fluctuations between peak and trough levels. Our discussion here focuses on the use of apixaban for stroke prevention in nonvalvular atrial fibrillation (NVAF). Supporting this indication, a pair of registrational trials was conducted that enrolled the full spectrum of patients who, by guidelines, were eligible for anticoagulation. In the AVERROES study of patients who were unsuitable for warfarin therapy, apixaban was superior to aspirin in reducing the risk of stroke or systemic embolism (SSE), without a significant increase in major bleeding (MB). In the ARISTOTLE (Apixaban for Reduction In STroke and Other ThromboemboLic Events in Atrial Fibrillation) study, apixaban was superior to warfarin on the rates of SSE, MB, and all-cause mortality. Overall, these studies have demonstrated a substantially favorable benefit–risk profile for apixaban over warfarin and aspirin in NVAF. PMID:25377080

Effects of intermittent theta burst stimulation on spasticity after stroke.

PubMed

Kim, Dae Hyun; Shin, Ji Cheol; Jung, Seungsoo; Jung, Tae-Min; Kim, Deog Young

2015-07-08

Spasticity is a common cause of long-term disability in poststroke hemiplegic patients. We investigated whether intermittent theta burst stimulation (iTBS) could reduce upper-limb spasticity after a stroke. Fifteen hemiplegic stroke patients were recruited for a double-blind sham-controlled cross-over design study. A single session of iTBS or sham stimulation was delivered on the motor hotspot of the affected flexor carpi radialis muscle in a random and counterbalanced order with a 1-week interval. Modified Ashworth scale (MAS), modified Tardieu scale (MTS), H-wave/M-wave amplitude ratio, peak torque (PT), peak torque angle (PTA), work of affected wrist flexor, and rectified integrated electromyographic activity of the flexor carpi radialis muscle were measured before, immediately after, 30 min after, and 1 week after iTBS or sham stimulation. Repeated-measures analysis of variance showed a significant interaction between time and intervention for the MAS, MTS, PT, PTA, and rectified integrated electromyographic activity (P<0.05), indicating that these parameters were significantly improved by iTBS compared with sham stimulation. However, the H-wave/M-wave amplitude ratio and work were not affected. MAS and MTS significantly improved for at least 30 min after iTBS, but the other parameters only improved immediately after iTBS (P<0.05). In conclusion, iTBS on the affected hemisphere may help to reduce poststroke spasticity transiently.

Effects of wrist tendon vibration on arm tracking in people poststroke.

PubMed

Conrad, Megan O; Scheidt, Robert A; Schmit, Brian D

2011-09-01

The goal of this study was to evaluate the influence of wrist tendon vibration on a multijoint elbow/shoulder tracking task. We hypothesized that tendon vibration applied at the wrist musculature would improve upper arm tracking performance in chronic stroke survivors through increased, Ia-afferent feedback to the central nervous system (CNS). To test this hypothesis, 10 chronic stroke and 5 neurologically intact subjects grasped the handle of a planar robot as they tracked a target through a horizontal figure-8 pattern. A total of 36 trials were completed by each subject. During the middle trials, 70-Hz tendon vibration was applied at the wrist flexor tendons. Position, velocity, and electromyography data were evaluated to compare the quality of arm movements before, during, and after trials with concurrent vibration. Despite tracking a target that moved at a constant velocity, hand trajectories appeared to be segmented, displaying alternating intervals of acceleration and deceleration. Segments were identifiable in tangential velocity data as single-peaked, bell-shaped speed pulses. When tendon vibration was applied at the wrist musculature, stroke subjects experienced improved tracking performance in that hand path lengths and peak speed variability decreased, whereas movement smoothness increased. These performance improvements were accompanied by decreases in the muscle activity during movement. Possible mechanisms behind improved movement control in response to tendon vibration may include improved sensorimotor integration or improved cortical modulation of spinal reflex activity.

Effects of wrist tendon vibration on arm tracking in people poststroke

PubMed Central

Conrad, Megan O.; Scheidt, Robert A.

2011-01-01

The goal of this study was to evaluate the influence of wrist tendon vibration on a multijoint elbow/shoulder tracking task. We hypothesized that tendon vibration applied at the wrist musculature would improve upper arm tracking performance in chronic stroke survivors through increased, Ia-afferent feedback to the central nervous system (CNS). To test this hypothesis, 10 chronic stroke and 5 neurologically intact subjects grasped the handle of a planar robot as they tracked a target through a horizontal figure-8 pattern. A total of 36 trials were completed by each subject. During the middle trials, 70-Hz tendon vibration was applied at the wrist flexor tendons. Position, velocity, and electromyography data were evaluated to compare the quality of arm movements before, during, and after trials with concurrent vibration. Despite tracking a target that moved at a constant velocity, hand trajectories appeared to be segmented, displaying alternating intervals of acceleration and deceleration. Segments were identifiable in tangential velocity data as single-peaked, bell-shaped speed pulses. When tendon vibration was applied at the wrist musculature, stroke subjects experienced improved tracking performance in that hand path lengths and peak speed variability decreased, whereas movement smoothness increased. These performance improvements were accompanied by decreases in the muscle activity during movement. Possible mechanisms behind improved movement control in response to tendon vibration may include improved sensorimotor integration or improved cortical modulation of spinal reflex activity. PMID:21697444

A protocol for a prospective observational study using chest and thumb ECG: transient ECG assessment in stroke evaluation (TEASE) in Sweden.

PubMed

Magnusson, Peter; Koyi, Hirsh; Mattsson, Gustav

2018-04-03

Atrial fibrillation (AF) causes ischaemic stroke and based on risk factor evaluation warrants anticoagulation therapy. In stroke survivors, AF is typically detected with short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring requires substantial resources while insertable cardiac monitors are invasive and costly. Chest and thumb ECG could provide an alternative for AF detection poststroke.The primary objective of our study is to assess the incidence of newly diagnosed AF during 28 days of chest and thumb ECG monitoring in cryptogenic stroke. Secondary objectives are to assess health-related quality of life (HRQoL) using short-form health survey (SF-36) and the feasibility of the Coala Heart Monitor in patients who had a stroke. Stroke survivors in Region Gävleborg, Sweden, will be eligible for the study from October 2017. Patients with a history of ischaemic stroke without documented AF before or during ECG evaluation in the stroke unit will be evaluated by the chest and thumb ECG system Coala Heart Monitor. The monitoring system is connected to a smartphone application which allows for remote monitoring and prompt advice on clinical management. Over a period of 28 days, patients will be monitored two times a day and may activate the ECG recording at symptoms. On completion, the system is returned by mail. This system offers a possibility to evaluate the presence of AF poststroke, but the feasibility of this system in patients who recently suffered from a stroke is unknown. In addition, HRQoL using SF-36 in comparison to Swedish population norms will be assessed. The feasibility of the Coala Heart Monitor will be assessed by a self-developed questionnaire. The study was approved by The Regional Ethical Committee in Uppsala (2017/321). The database will be closed after the last follow-up, followed by statistical analyses, interpretation of results and dissemination to a scientific journal. NCT03301662; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Multidisciplinary transmural rehabilitation for older persons with a stroke: the design of a randomised controlled trial.

PubMed

Vluggen, Tom P M M; van Haastregt, Jolanda C M; Verbunt, Jeanine A; Keijsers, Elly J M; Schols, Jos M G A

2012-12-31

Stroke is one of the major causes of loss of independence, decreased quality of life and mortality among elderly people. About half of the elderly stroke patients discharged after rehabilitation in a nursing home still experience serious impairments in daily functioning one year post stroke, which can lead to difficulties in picking up and managing their social life. The aim of this study is to evaluate the effectiveness and feasibility of a new multidisciplinary transmural rehabilitation programme for older stroke patients. A two group multicentre randomised controlled trial is used to evaluate the effects of the rehabilitation programme. The programme consists of three care modules: 1) neurorehabilitation treatment for elderly stroke patients; 2) empowerment training for patient and informal caregiver; and 3) stroke education for patient and informal caregiver. The total programme has a duration of between two and six months, depending on the individual problems of the patient and informal caregiver. The control group receives usual care in the nursing home and after discharge. Patients aged 65 years and over are eligible for study participation when they are admitted to a geriatric rehabilitation unit in a nursing home due to a recent stroke and are expected to be able to return to their original home environment after discharge. Data are gathered by face-to-face interviews, self-administered questionnaires, focus groups and registration forms. Primary outcomes for patients are activity level after stroke, functional dependence, perceived quality of life and social participation. Outcomes for informal caregivers are perceived care burden, objective care burden, quality of life and perceived health. Outcome measures of the process evaluation are implementation fidelity, programme deliverance and the opinion of the stroke professionals, patients and informal caregivers about the programme. Outcome measures of the economic evaluation are the healthcare utilisation and associated costs. Data are collected at baseline, and after six and 12 months. The first results of the study will be expected in 2014. International Standard Randomised Controlled Trial Register Number ISRCTN62286281, The Dutch Trial Register NTR2412.

Prediction of outcome in neurogenic oropharyngeal dysphagia within 72 hours of acute stroke.

PubMed

Ickenstein, Guntram W; Höhlig, Carolin; Prosiegel, Mario; Koch, Horst; Dziewas, Rainer; Bodechtel, Ulf; Müller, Rainer; Reichmann, Heinz; Riecker, Axel

2012-10-01

Stroke is the most frequent cause of neurogenic oropharyngeal dysphagia (NOD). In the acute phase of stroke, the frequency of NOD is greater than 50% and, half of this patient population return to good swallowing within 14 days while the other half develop chronic dysphagia. Because dysphagia leads to aspiration pneumonia, malnutrition, and in-hospital mortality, it is important to pay attention to swallowing problems. The question arises if a prediction of severe chronic dysphagia is possible within the first 72 hours of acute stroke. On admission to the stroke unit, all stroke patients were screened for swallowing problems by the nursing staff within 2 hours. Patients showing signs of aspiration were included in the study (n = 114) and were given a clinical swallowing examination (CSE) by the swallowing/speech therapist within 24 hours and a swallowing endoscopy within 72 hours by the physician. The primary outcome of the study was the functional communication measure (FCM) of swallowing (score 1-3, tube feeding dependency) on day 90. The grading system with the FCM swallowing and the penetration-aspiration scale (PAS) in the first 72 hours was tested in a multivariate analysis for its predictive value for tube feeding-dependency on day 90. For the FCM level 1 to 3 (P < .0022) and PAS level 5 to 8 (P < .00001), the area under the curve (AUC) was 72.8% and showed an odds ratio of 11.8 (P < .00001; 95% confidence interval 0.036-0.096), achieving for the patient a 12 times less chance of being orally fed on day 90 and therefore still being tube feeding-dependent. We conclude that signs of aspiration in the first 72 hours of acute stroke can predict severe swallowing problems on day 90. Consequently, patients should be tested on admission to a stroke unit and evaluated with established dysphagia scales to prevent aspiration pneumonia and malnutrition. A dysphagia program can lead to better communication within the stroke unit team to initiate the appropriate diagnostics and swallowing therapy as soon as possible. Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Strength Asymmetry and Landing Mechanics at Return to Sport after ACL Reconstruction

PubMed Central

Schmitt, Laura C.; Paterno, Mark V.; Ford, Kevin R.; Myer, Gregory D.; Hewett, Timothy E.

2014-01-01

Purpose Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport following anterior cruciate ligament (ACL) reconstruction are lacking. This study investigated the impact of QF strength asymmetry on knee landing biomechanics at the time of return to sport following ACL reconstruction. Methods Seventy-seven individuals (17.4 years) at the time of return to sport following primary ACL reconstruction (ACLR group) and 47 uninjured control individuals (17.0 years) (CTRL group) participated. QF strength was assessed and Quadriceps Index calculated (QI = [involved strength/uninvolved strength]*100%). The ACLR group was sub-divided based on QI: High Quadriceps (HQ, QI≥90%) and Low-Quadriceps (LQ, QI<85%). Knee kinematic and kinetic variables were collected during a drop vertical jump maneuver. Limb symmetry during landing, and discrete variables were compared among the groups with multivariate analysis of variance and linear regression analyses. Results The LQ group demonstrated worse asymmetry in all kinetic and ground reaction force variables compared to the HQ and CTRL groups, including reduced involved limb peak knee external flexion moments (p<.001), reduced involved limb (p=.003) and increased uninvolved limb (p=.005) peak vertical ground reaction forces, and higher uninvolved limb peak loading rates (p<.004). There were no differences in the landing patterns between the HQ and CTRL groups on any variable (p>.05). In the ACLR group, QF strength estimated limb symmetry during landing after controlling for graft type, meniscus injury, knee pain and symptoms. Conclusion At the time of return to sport, individuals post-ACL reconstruction with weaker QF demonstrate altered landing patterns. Conversely, those with nearly symmetrical QF strength demonstrate landing patterns similar to uninjured individuals. Consideration of an objective QF strength measure may aid clinical decision-making to optimize sports participation following ACL reconstruction. PMID:25373481

Tide-surge historical assessment of extreme water levels for the St. Johns River: 1928-2017

NASA Astrophysics Data System (ADS)

Bacopoulos, Peter

2017-10-01

An historical storm population is developed for the St. Johns River, located in northeast Florida-US east coast, via extreme value assessment of an 89-year-long record of hourly water-level data. Storm surge extrema and the corresponding (independent) storm systems are extracted from the historical record as well as the linear and nonlinear trends of mean sea level. Peaks-over-threshold analysis reveals the top 16 most-impactful (storm surge) systems in the general return-period range of 1-100 years. Hurricane Matthew (2016) broke the record with a new absolute maximum water level of 1.56 m, although the peak surge occurred during slack tide level (0.00 m). Hurricanes and tropical systems contribute to return periods of 10-100 years with water levels in the approximate range of 1.3-1.55 m. Extratropical systems and nor'easters contribute to the historical storm population (in the general return-period range of 1-10 years) and are capable of producing extreme storm surges (in the approximate range of 1.15-1.3 m) on par with those generated by hurricanes and tropical systems. The highest astronomical tide is 1.02 m, which by evaluation of the historical record can contribute as much as 94% to the total storm-tide water level. Statically, a hypothetical scenario of Hurricane Matthew's peak surge coinciding with the highest astronomical tide would yield an overall storm-tide water level of 2.58 m, corresponding to an approximate 1000-year return period by historical comparison. Sea-level trends (linear and nonlinear) impact water-level return periods and constitute additional risk hazard for coastal engineering designs.

A single trial of transcutaneous electrical nerve stimulation (TENS) improves spasticity and balance in patients with chronic stroke.

PubMed

Cho, Hwi-young; In, Tae Sung; Cho, Ki Hun; Song, Chang Ho

2013-03-01

Spasticity management is pivotal for achieving functional recovery of stroke patients. The purpose of this study was to investigate the effects of a single trial of transcutaneous electrical nerve stimulation (TENS) on spasticity and balance in chronic stroke patients. Forty-two chronic stroke patients were randomly allocated into the TENS (n = 22) or the placebo-TENS (n = 20) group. TENS stimulation was applied to the gastrocnemius for 60 min at 100 Hz, 200 µs with 2 to 3 times the sensory threshold (the minimal threshold in detecting electrical stimulation for subjects) after received physical therapy for 30 min. In the placebo-TENS group, electrodes were placed but no electrical stimulation was administered. For measuring spasticity, the resistance encountered during passive muscle stretching of ankle joint was assessed using the Modified Ashworth Scale, and the Hand held dynamometer was used to assess the resistive force caused by spasticity. Balance ability was measured using a force platform that measures postural sway generated by postural imbalance. The TENS group showed a significantly greater reduction in spasticity of the gastrocnemius, compared to the placebo-TENS group (p < 0.05). TENS resulted in greater balance ability improvements, especially during the eyes closed condition (p < 0.05). However, these effects returned to baseline values within one day. This study shows that TENS provides an immediately effective means of reducing spasticity and of improving balance in chronic stroke patients. The present data may be useful to establish the standard parameters for TENS application in the clinical setting of stroke.

Effect of a care plan based on Roy adaptation model biological dimension on stroke patients' physiologic adaptation level.

PubMed

Alimohammadi, Nasrollah; Maleki, Bibi; Shahriari, Mohsen; Chitsaz, Ahmad

2015-01-01

Stroke is a stressful event with several functional, physical, psychological, social, and economic problems that affect individuals' different living balances. With coping strategies, patients try to control these problems and return to their natural life. The aim of this study is to investigate the effect of a care plan based on Roy adaptation model biological dimension on stroke patients' physiologic adaptation level. This study is a clinical trial in which 50 patients, affected by brain stroke and being admitted in the neurology ward of Kashani and Alzahra hospitals, were randomly assigned to control and study groups in Isfahan in 2013. Roy adaptation model care plan was administered in biological dimension in the form of four sessions and phone call follow-ups for 1 month. The forms related to Roy adaptation model were completed before and after intervention in the two groups. Chi-square test and t-test were used to analyze the data through SPSS 18. There was a significant difference in mean score of adaptation in physiological dimension in the study group after intervention (P < 0.001) compared to before intervention. Comparison of the mean scores of changes of adaptation in the patients affected by brain stroke in the study and control groups showed a significant increase in physiological dimension in the study group by 47.30 after intervention (P < 0.001). The results of study showed that Roy adaptation model biological dimension care plan can result in an increase in adaptation in patients with stroke in physiological dimension. Nurses can use this model for increasing patients' adaptation.

Analysis and Assessment of Peak Lightning Current Probabilities at the NASA Kennedy Space Center

NASA Technical Reports Server (NTRS)

Johnson, D. L.; Vaughan, W. W.

1999-01-01

This technical memorandum presents a summary by the Electromagnetics and Aerospace Environments Branch at the Marshall Space Flight Center of lightning characteristics and lightning criteria for the protection of aerospace vehicles. Probability estimates are included for certain lightning strikes (peak currents of 200, 100, and 50 kA) applicable to the National Aeronautics and Space Administration Space Shuttle at the Kennedy Space Center, Florida, during rollout, on-pad, and boost/launch phases. Results of an extensive literature search to compile information on this subject are presented in order to answer key questions posed by the Space Shuttle Program Office at the Johnson Space Center concerning peak lightning current probabilities if a vehicle is hit by a lightning cloud-to-ground stroke. Vehicle-triggered lightning probability estimates for the aforementioned peak currents are still being worked. Section 4.5, however, does provide some insight on estimating these same peaks.

Launch pad lightning protection effectiveness

NASA Technical Reports Server (NTRS)

Stahmann, James R.

1991-01-01

Using the striking distance theory that lightning leaders will strike the nearest grounded point on their last jump to earth corresponding to the striking distance, the probability of striking a point on a structure in the presence of other points can be estimated. The lightning strokes are divided into deciles having an average peak current and striking distance. The striking distances are used as radii from the points to generate windows of approach through which the leader must pass to reach a designated point. The projections of the windows on a horizontal plane as they are rotated through all possible angles of approach define an area that can be multiplied by the decile stroke density to arrive at the probability of strokes with the window average striking distance. The sum of all decile probabilities gives the cumulative probability for all strokes. The techniques can be applied to NASA-Kennedy launch pad structures to estimate the lightning protection effectiveness for the crane, gaseous oxygen vent arm, and other points. Streamers from sharp points on the structure provide protection for surfaces having large radii of curvature. The effects of nearby structures can also be estimated.

A survey to explore what information, advice and support community-dwelling people with stroke currently receive to manage instability and falls.

PubMed

Shovlin, Eleanor; Kunkel, Dorit

2017-09-13

To describe and determine the benefits of the information and support services currently offered to people with stroke experiencing instability and falls. A cross-sectional survey study. Two hundred and fifty-six surveys were sent out to community stroke groups in Hampshire and the Isle of Wight, as well as to people with stroke on a patient register. One hundred and twenty-five surveys were returned. A total of 107 participants (86%) reported instability and 62 (50%) had experienced a fall in the preceding year; 29 (28%) had reportedly received information on falls prevention. Forty-four participants (43%) sought help from health professionals following instability and falls; just over half reported that the information they received was useful. One quarter (n = 11) of those seeking help were referred on to falls clinics; all attended and 86% felt attending had been beneficial. However, only one participant was followed up by these clinics. Findings suggest that the majority of people with stroke who have experienced instability and falls did not receive any information and support, with very few referred on to falls clinics. Health professionals play a key role in information provision and facilitating access to falls prevention programs. Further research is required to determine the most effective ways to implement current guidelines to manage instability and falls in this high-risk group. Implications for rehabilitation: Many community-dwelling people with stroke did not receive any information, help or support after experiencing instability and falls. Clinicians must stress that falls are a complication, not an expectation, post-stroke. Information on falls prevention and available support services should be offered to individuals prior to discharge from hospital, in GP practices and in rehabilitation settings. All individuals with stroke seeking health professional help following instability and falls should be referred on to falls clinics for individualized multifactorial assessment and intervention to comply with current guidelines.

Poststroke Aphasia Frequency, Recovery, and Outcomes: A Systematic Review and Meta-Analysis.

PubMed

Flowers, Heather L; Skoretz, Stacey A; Silver, Frank L; Rochon, Elizabeth; Fang, Jiming; Flamand-Roze, Constance; Martino, Rosemary

2016-12-01

To conduct a systematic review to elucidate the frequency, recovery, and associated outcomes for poststroke aphasia over the long-term. Using the Cochrane Stroke Strategy, we searched 10 databases, 13 journals, 3 conferences, and the gray literature. Our a priori protocol criteria included unselected samples of adult stroke patients from randomized controlled trials or consecutive cohorts. Two independent reviewers rated abstracts and articles for exclusion or inclusion, resolving discrepancies by consensus. We documented aphasia frequencies by stroke type and setting, and computed odds ratios (ORs) with their 95% confidence intervals (CIs) for outcomes. We retrieved 2168 citations, reviewed 248 articles, and accepted 50. Median frequencies for mixed stroke (ischemic and hemorrhagic) were 30% and 34% for acute and rehabilitation settings, respectively. Frequencies by stroke type were lowest for acute subarachnoid hemorrhage (9%) and highest for acute ischemic stroke (62%) when arrival to the hospital was ≤3 hours from stroke onset. Articles monitoring aphasia for 1 year demonstrated aphasia frequencies 2% to 12% lower than baseline. Negative outcomes associated with aphasia included greater odds of in-hospital death (OR=2.7; 95% CI, 2.4-3.1) and longer mean length of stay in days (mean=1.6; 95% CI, 1.0-2.3) in acute settings. Patients with aphasia had greater disability from 28 days (OR=1.5; 95% CI, 1.3-1.7) to 2 years (OR=1.7; 95% CI, 1.6-2.0) than those without aphasia. By 2 years, they used more rehabilitation services (OR=1.5; 95% CI, 1.3-1.6) and returned home less frequently (OR=1.4; 95% CI, 1.2-1.7). Reported frequencies of poststroke aphasia range widely, depending on stroke type and setting. Because aphasia is associated with mortality, disability, and use of health services, we recommend long-term interdisciplinary vigilance in the management of aphasia. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The use of virtual reality-based therapy to augment poststroke upper limb recovery.

PubMed

Samuel, Geoffrey S; Choo, Min; Chan, Wai Yin; Kok, Stanley; Ng, Yee Sien

2015-07-01

Stroke remains one of the major causes of disability worldwide. This case report illustrates the complementary use of biomechanical and kinematic in-game markers, in addition to standard clinical outcomes, to comprehensively assess and track a patient's disabilities. A 65-year-old patient was admitted for right-sided weakness and clinically diagnosed with acute ischaemic stroke. She participated in a short trial of standard stroke occupational therapy and physiotherapy with additional daily virtual reality (VR)-based therapy. Outcomes were tracked using kinematic data and conventional clinical assessments. Her Functional Independence Measure score improved from 87 to 113 and Fugl-Meyer motor score improved from 56 to 62, denoting clinically significant improvement. Corresponding kinematic analysis revealed improved hand path ratios and a decrease in velocity peaks. Further research is being undertaken to elucidate the optimal type, timing, setting and duration of VR-based therapy, as well as the use of neuropharmacological adjuncts.

The use of virtual reality-based therapy to augment poststroke upper limb recovery

PubMed Central

Samuel, Geoffrey S; Choo, Min; Chan, Wai Yin; Kok, Stanley; Ng, Yee Sien

2015-01-01

Stroke remains one of the major causes of disability worldwide. This case report illustrates the complementary use of biomechanical and kinematic in-game markers, in addition to standard clinical outcomes, to comprehensively assess and track a patient’s disabilities. A 65-year-old patient was admitted for right-sided weakness and clinically diagnosed with acute ischaemic stroke. She participated in a short trial of standard stroke occupational therapy and physiotherapy with additional daily virtual reality (VR)-based therapy. Outcomes were tracked using kinematic data and conventional clinical assessments. Her Functional Independence Measure score improved from 87 to 113 and Fugl-Meyer motor score improved from 56 to 62, denoting clinically significant improvement. Corresponding kinematic analysis revealed improved hand path ratios and a decrease in velocity peaks. Further research is being undertaken to elucidate the optimal type, timing, setting and duration of VR-based therapy, as well as the use of neuropharmacological adjuncts. PMID:26243983

Apparatus for the conversion of power strokes of a random sequence and of random lengths of strokes into potential energy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Elkuch, E.

1984-01-17

The apparatus comprises at least one positive displacement pump, which is driven by the sea waves. The quantity of delivery of this pump is adjustable in accordance with the lengths of strokes made by the ocean waves. This is made possible in that the positive displacement pump comprises pistons having different volume displacements. The height of the incoming waves is measured by a membrane box connected to a transducer which generates signals such that only that piston of the plurality of pistons is made to operate, which has by design a volume displacement which gives the optimal recovery of themore » energy of the ocean waves. The or these pistons pump a working fluid into a storage vessel, which allows the generation of peak load as well as base load electrical energy.« less

Characteristics of M-component in rocket-triggered lightning and a discussion on its mechanism

NASA Astrophysics Data System (ADS)

Jiang, Rubin; Qie, Xiushu; Yang, Jing; Wang, Caixia; Zhao, Yang

2013-09-01

The current and electric field pulses associated with M-component following dart leader-return stroke sequences in negative rocket-triggered lightning flashes were analyzed in detail by using the data from Shandong Artificially Triggering Lightning Experiment, conducted from 2005 to 2010. For 63 M-components with current waveforms superimposed on the relatively steady continuing current, the geometric mean values of the peak current, duration, and charge transfer were 276 A, 1.21 ms, and 101 mC, respectively. The behaviors of the channel base current versus close electric field changes and the observation facts by different authors were carefully examined for investigation on mechanism of the M-component. A modified model based on Rakov's "two-wave" theory is proposed and confirms that the evolution of M-component through the lightning channel involves a downward wave transferring negative charge from the upper to the lower channel and an upward wave draining the charge transported by the downward wave. The upward wave serves to deplete the negative charge by the downward wave at its interface and makes the charge density of the channel beneath the interface layer to be roughly zero. Such modified concept is recognized to be reasonable by the simulated results showing a good agreement between the calculated and the measured E-field waveforms.

Population age structure and asset returns: an empirical investigation.

PubMed

Poterba, J M

1998-10-01

"This paper investigates the association between population age structure, particularly the share of the population in the 'prime saving years' 45-60, and the returns on stocks and bonds. The paper is motivated by the claim that the aging of the 'Baby Boom' cohort in the United States is a key factor in explaining the recent rise in asset values. It also addresses the associated claim that asset prices will decline when this large cohort reaches retirement age and begins to reduce its asset holdings. This paper begins by considering household age-asset accumulation profiles. Data from the Survey of Consumer Finances suggest that while cross-sectional age-wealth profiles peak for households in their early 60s, cohort data on the asset ownership of the same households show a much less pronounced peak.... The paper then considers the historical relationship between demographic structure and real returns on Treasury bills, long-term government bonds, and corporate stock. The results do not suggest any robust relationship between demographic structure and asset returns.... The paper concludes by discussing factors such as international capital flows and forward-looking behavior on the part of market participants that could weaken the relationship between age structure and asset returns in a single nation." excerpt

Presence of intracranial artery calcification is associated with mortality and vascular events in patients with ischemic stroke after hospital discharge: a cohort study.

PubMed

Bugnicourt, Jean-Marc; Leclercq, Claire; Chillon, Jean-Marc; Diouf, Momar; Deramond, Hervé; Canaple, Sandrine; Lamy, Chantal; Massy, Ziad A; Godefroy, Olivier

2011-12-01

Although intracranial artery calcification (IAC) has been reported to be a risk factor for ischemic stroke, the prognostic implications of IAC in stroke outcome are unknown. The purpose of this study was to determine the association between IAC and risk of vascular events and death in patients with stroke after hospital discharge. All patients with ischemic stroke over a 1-year period were included (n=302). IAC, assessed by multidetector CT, was defined as hyperdense foci (peak density>130 Hounsfield units) and assessed in the 7 major cerebral arteries. The IAC scores ranged from 0 (no calcification) to 7. Follow-up information on major clinical events (including fatal or nonfatal ischemic stroke, cardiac and peripheral artery events, and all-cause death) was obtained by means of a structured phone interview. IAC was present in 260 patients (83%). With a mean follow-up of 773±223 days, 88 major clinical events occurred in 67 patients (22%): 45 new ischemic vascular events (ischemic stroke: n=22; cardiac event: n=15; peripheral artery event: n=8) and 43 deaths from any cause. Patients with the highest IAC scores had significantly higher rates of death and vascular events than those with the lowest IAC scores (log rank test, P=0.029). In the Cox proportional hazards regression model, the IAC score was significantly associated with major clinical events (hazard ratio, 1.34; 95% CI, 1.11-1.61; P=0.002). In patients with ischemic stroke, IAC detection may constitute a simple marker of a high risk of future major clinical events.

Demand charge reduction with digester gas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1985-02-01

This paper examines a rather sophisticated treatment system in the city of Whitewater, Wisconsin. The power generated is used to trim utility peak power loads and demand charges. Power is derived from four Waukesha VHP 3600G engine generator sets with provisions for a fifth as growth requires. The engine is a Waukesha F3521GU spark ignited, six-cylinder gas engine with 9.375 in. x 8.50 bore and stroke driving a Kato 350 kW generator rated at 480/277 volts and 1200 rpm. Normal operation is to reduce the peak demand.

The Effect of Pitching Phase on the Vortex Circulation for a Flapping Wing During Stroke Reversal

NASA Astrophysics Data System (ADS)

Burge, Matthew; Ringuette, Matthew

2017-11-01

We study the effect of pitching-phase on the circulation behavior for the 3D flow structures produced during stroke reversal for a 2-degree-of-freedom flapping wing executing hovering kinematics. Previous research has related the choice in pitching-phase with respect to the wing rotation during stroke reversal (advanced vs. symmetric pitch-timing) to a lift peak preceding stroke reversal. However, results from experiments on the time-varying circulation contributions from the 3D vortex structures across the span produced by both rotation and pitching are lacking. The objective of this research is to quantitatively examine how the spanwise circulation of these structures is affected by the pitching-phase for several reduced pitching frequencies. We employ a scaled wing model in a glycerin-water mixture and measure the time-varying velocity using multiple planes of stereo digital particle image velocimetry. Data-plane positions along the wing span are informed by the unsteady behavior of the 3D vortex structures found in our prior flow visualization movies. Individual vortices are identified to calculate their circulation. This work is aimed at understanding how the behavior of the vortex structures created during stroke reversal vary with key motion parameters. This work is supported by the National Science Foundation, Award Number 1336548, supervised by Dr. Ronald Joslin.

Study of Pharmacodynamic and Pharmacokinetic Interaction of Bojungikki-Tang with Aspirin in Healthy Subjects and Ischemic Stroke Patients

PubMed Central

Yoo, Jung-Hwa; Yim, Sung-Vin

2018-01-01

Background Bojungikki-tang (BJIKT) is a widely used traditional herbal formula in China, Japan, and Korea. There have been reports that several herbs among BJIKT have interactions with antiplatelet drugs, such as aspirin. This study aimed to assess whether BJIKT interacts with aspirin in terms of pharmacokinetics (PK) and pharmacodynamics (PD) in healthy subjects and ischemic stroke patients. Methods The phase I interaction trial was a randomized, open-label, crossover study of 10 healthy male subjects, and the phase III interaction trial was a randomized, placebo-controlled, parallel study of 43 ischemic stroke patients. Each participant randomly received aspirin + BJIKT or aspirin + placebo. For PK analysis, plasma acetyl salicylic acid (ASA) and salicylic acid (SA) were evaluated, and, for PD analysis, platelet aggregation and plasma thromboxane B2 (TxB2) were measured. Results In the PK parameters, mean area under curve, maximum concertation, and peak concentration time of ASA and SA were not different between two groups in healthy subjects and ischemic stroke patients. In the PD profiles, TxB2 concentrations and platelet aggregation were not affected by coadministration of BJIKT in healthy subjects and ischemic stroke patients. Conclusions These results suggest that coadministration of BJIKT with aspirin may not result in herb-drug interaction. PMID:29599812

Vestibular plasticity following orbital spaceflight: recovery from postflight postural instability

NASA Technical Reports Server (NTRS)

Black, F. O.; Paloski, W. H.; Doxey-Gasway, D. D.; Reschke, M. F.

1995-01-01

Results of previous studies suggested that the vestibular mediated postural instability observed in astronauts upon return to earth from orbital spaceflight may be exacerbated by an increased weighting of visual inputs for spatial orientation and control of movement. This study was performed to better understand the roles of visual and somatosensory contributions to recovery of normal sensori-motor postural control in returning astronauts. Preflight and postflight, 23 astronaut volunteers were presented randomly with three trials of six sensory organization test (SOT) conditions in the EquiTest system test battery. Sagittal plane center-of-gravity (COG) excursions computed from ground reaction forces were significantly higher on landing day than preflight for those test conditions presenting sway-referenced visual and/or somatosensory orientation cues. The ratio of summed peak-to-peak COG sway amplitudes on the two sway-referenced vision tests (SOTs 3 + 6) compared to the two eyes closed tests (SOTs 2 + 5) was increased on landing day, indicating an increased reliance on visual orientation cues for postural control. The ratio of peak-to-peak COG excursions on sway-referenced surfaces (SOTs 4, 5 & 6) to an earth fixed support surfaces (SOTs 1, 2 & 3) increased even more after landing suggesting primary reliance on somatosensory orientation cues for recovery of postflight postural stability. Readaptation to sway-referenced support surfaces took longer than readaptation to sway-referenced vision. The increased reliance on visual and somatosensory inputs disappeared in all astronauts 4-8 days following return to earth.

Effect of muscle length on strength and dexterity after stroke.

PubMed

Ada, L; Canning, C; Dwyer, T

2000-02-01

The effect of muscle length on strength and dexterity after stroke was investigated. The aim was to determine if poor function at a particular muscle length could be attributed solely to differential weakness at this joint angle or whether an additional problem of differential dexterity exists. This descriptive research study measured elbow flexor and extensor strength as well as dexterity at three elbow joint angles: 30 degrees , 60 degrees and 90 degrees flexion. Dexterity was measured independently of strength. Fifteen (seven female, eight male) chronic stroke patients (mean age 67 years) who could actively flex and extend their affected elbow participated. Ten neurologically normal control subjects (mean age 67 years) acted as controls. Strength was measured as peak elbow flexor and extensor torque at three angles; and dexterity was measured as coherence for slow and fast tracking also at three angles. Dexterity was not affected by muscle length but strength was and this finding was the same for both stroke and controls. While the magnitude of the torque-angle curves was not significantly different between stroke and controls, the shape of torque-angle curves was altered after stroke so that both the elbow flexors (p < 0.05) and extensors (p < 0.05) tested weaker in the testing position where they were shortest. Since there was no differential loss of dexterity, it appears that differential loss of strength, especially in the shortened range, may explain the clinical observation of poorer function at one muscle length than another after stroke. Specific training to strengthen the muscles in these ranges is therefore of clinical importance for rehabilitation.

Decreased Respiratory Muscle Function Is Associated with Impaired Trunk Balance among Chronic Stroke Patients: A Cross-sectional Study.

PubMed

Lee, Kyeongbong; Cho, Ji-Eun; Hwang, Dal-Yeon; Lee, WanHee

2018-06-01

The abdominal muscles play a role in trunk balance. Abdominal muscle thickness is asymmetrical in stroke survivors, who also have decreased respiratory muscle function. We compared the thickness of the abdominal muscles between the affected and less affected sides in stroke survivors. In addition, the relationship between respiratory muscle function and trunk balance was evaluated. Chronic stroke patients (18 men, 15 women; mean age, 58.94 ± 12.30 years; Mini-Mental Status Examination score ≥ 24) who could sit without assist were enrolled. Abdominal muscle thickness during rest and contraction was measured with ultrasonography, and the thickening ratio was calculated. Respiratory muscle function assessment included maximum respiratory pressure, peak flow, and air volume. Trunk function was evaluated using the Trunk Impairment Scale, and trunk balance was estimated based on the center of pressure velocity and path length within the limit of stability in sitting posture. Abdominal muscles were significantly thinner on the affected side, and the thickening ratio was lower in the affected side (P < 0.05). In addition, the higher thickening ratio of the affected side showed significant relationship with higher trunk function. Moreover, higher respiratory muscle function was significantly correlated with higher level of trunk function and balance in stroke patients (P < 0.05). Thus, chronic stroke survivors have decreased abdominal muscle thickness on the affected side, and respiratory muscle function has positive correlation with trunk function and balance. We propose that respiratory muscle training should be included as part of trunk balance training in chronic stroke patients.

Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial

PubMed Central

2012-01-01

Background In New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities. However, on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of resources and geographical location. Currently most people receive no treatment beyond three months post stroke. The study aims to determine if the Augmented Community Telerehabilitation Intervention (ACTIV) results in better physical function for people with stroke than usual care, as measured by the Stroke Impact Scale, physical subcomponent. Methods/design This study will use a multi-site, two-arm, assessor blinded, parallel randomised controlled trial design. People will be eligible if they have had their first ever stroke, are over 20 and have some physical impairment in either arm or leg, or both. Following discharge from formal physiotherapy services (inpatient, outpatient or community), participants will be randomised into ACTIV or usual care. ACTIV uses readily available technology, telephone and mobile phones, combined with face-to-face visits from a physiotherapist over a six-month period, to help people with stroke resume activities they enjoyed before the stroke. The impact of stroke on physical function and quality of life will be assessed, measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options. These outcomes will be collected at baseline, six months and 12 months. In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study. Discussion The lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation. Best practice guidelines recommend a prolonged period of rehabilitation, however this is expensive and therefore not undertaken in most publicly funded centres. An effective, cost-effective, and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home. Trial registration ACTRN12612000464864 PMID:23216861

Risk of Ischemic Stroke and Transient Ischemic Attack Is Increased up to 90 Days after Non-Carotid and Non-Cardiac Surgery.

PubMed

Grau, Armin J; Eicke, Martin; Burmeister, Christoph; Hardt, Roland; Schmitt, Eberhard; Dienlin, Sieghard

2017-01-01

The risk of stroke after cardiac and carotid surgery is well established. In contrast, stroke risk in association with non-cardiac and non-carotid surgery and its time course are insufficiently known. We investigated the prevalence of recent and planned surgery among patients with stroke and transient ischemic attack (TIA), time dependency of stroke risk, stroke etiology, and interruption of antithrombotic medication in association with surgery. Data on type and date of surgery and similar interventions within the last year or planned for the next 2 weeks were anonymously collected together with demographic data, vascular risk factors, stroke severity, handicap before stroke and stroke etiology within a state-wide, mandatory, hospital-based acute stroke care quality monitoring project (Rhineland-Palatinate, Germany) for 1 year (2010). Non-carotid and non-cardiothoracic surgery was reported as performed within 1 year before the index event or as planned for the next 2 weeks thereafter in 532 out of 12,120 patients with ischemic stroke/TIA (4.4%). Compared to 91-365 days before stroke/TIA as reference period, risk of cerebral ischemia (per day analysis) was increased for surgery within 61-90 days before ischemia (rate ratio 2.0, 95% CI 1.5-2.8) and continuously increased along shorter intervals between stroke and surgery (31-60 days: rate ratio 3.6, 95% CI 2.9-4.5; 15-30 days: rate ratio 8.2, 95% CI 6.7-10.1; 8-14 days: rate ratio 13.2, 95% CI 10.3-16.8; 4-7 days: rate ratio 16.5, 95% CI 12.2-22.1) peaking at an interval of 1-3 days before ischemia (rate ratio 34.0, 95% CI 26.9-42.8). On the day of surgery, rate ratio was 14.8 (95% CI 7.8-27.9) and for planned surgery it was 2.7 (95% CI 1.8-4.0). Results were similar for first-ever and for recurrent ischemic stroke. Perioperative stroke/TIA was positively associated with atrial fibrillation and cardioembolic stroke etiology, higher mortality, more severe neurological deficits at discharge, and longer hospital stay; and it was inversely associated with microangiopathic etiology and discharge at home. In 34.5% of patients with recent/planned surgery, prior antithrombotic or anticoagulant medication had been interrupted. Recent or planned surgery imposes a considerable short-term stroke risk particularly by cardioembolism with cessation of medication as an important contributor. Stroke after surgery is associated with poor outcome and high mortality. Better strategies to reduce the burden of perioperative stroke are urgently required. © 2017 S. Karger AG, Basel.

Simulated Reentry Heating by Torching

NASA Technical Reports Server (NTRS)

Harvey, Gale A.

2008-01-01

The two first order reentry heating parameters are peak heating flux (W/cm2) and peak heat load (kJ/cm2). Peak heating flux (and deceleration, gs) is higher for a ballistic reentry and peak heat load is higher for a lifting reentry. Manned vehicle reentries are generally lifting reentries at nominal 1-5 gs so that personnel will not be crushed by high deceleration force. A few off-nominal manned reentries have experienced 8 or more gs with corresponding high heating flux (but below nominal heat load). The Shuttle Orbiter reentries provide about an order of magnitude difference in peak heating flux at mid-bottom (TPS tiles, approximately 6 W/cm2 or 5 BTU/ft2- sec) and leading edge (RCC, approximately 60 W/cm2 or 50 BTU/ft2- sec). Orion lunar return and Mars sample lander are of the same order of magnitude as orbiter leading edge peak heat loads. Flight temperature measurements are available for some orbiter TPS tile and RCC locations. Return-to-Flight on-orbit tile-repair-candidate-material-heating performance was evaluated by matching propane torch heating of candidate-materials temperatures at several depths to orbiter TPS tile flight-temperatures. Char and ash characteristics, heat expansion, and temperature histories at several depths of the cure-in-place ablator were some of the TPS repair material performance characteristics measured. The final char surface was above the initial surface for the primary candidate (silicone based) material, in contrast to a receded surface for the Apollo-type ablative heat shield material. Candidate TPS materials for Orion CEV (LEO and lunar return), and for Mars sample lander are now being evaluated. Torching of a candidate ablator material, PICA, was performed to match the ablation experienced by the STARDUST PICA heat shield. Torching showed that the carbon fiberform skeleton in a sample of PICA was inhomogeneous in that sample, and allowed measurements (of the clumps and voids) of the inhomogeneity. Additional reentry heating-performance characterizations of high temperature insulation materials were performed.

Monocyte-Derived Macrophages Contribute to Spontaneous Long-Term Functional Recovery after Stroke in Mice.

PubMed

Wattananit, Somsak; Tornero, Daniel; Graubardt, Nadine; Memanishvili, Tamar; Monni, Emanuela; Tatarishvili, Jemal; Miskinyte, Giedre; Ge, Ruimin; Ahlenius, Henrik; Lindvall, Olle; Schwartz, Michal; Kokaia, Zaal

2016-04-13

Stroke is a leading cause of disability and currently lacks effective therapy enabling long-term functional recovery. Ischemic brain injury causes local inflammation, which involves both activated resident microglia and infiltrating immune cells, including monocytes. Monocyte-derived macrophages (MDMs) exhibit a high degree of functional plasticity. Here, we determined the role of MDMs in long-term spontaneous functional recovery after middle cerebral artery occlusion in mice. Analyses by flow cytometry and immunocytochemistry revealed that monocytes home to the stroke-injured hemisphere., and that infiltration peaks 3 d after stroke. At day 7, half of the infiltrating MDMs exhibited a bias toward a proinflammatory phenotype and the other half toward an anti-inflammatory phenotype, but during the subsequent 2 weeks, MDMs with an anti-inflammatory phenotype dominated. Blocking monocyte recruitment using the anti-CCR2 antibody MC-21 during the first week after stroke abolished long-term behavioral recovery, as determined in corridor and staircase tests, and drastically decreased tissue expression of anti-inflammatory genes, including TGFβ, CD163, and Ym1. Our results show that spontaneously recruited monocytes to the injured brain early after the insult contribute to long-term functional recovery after stroke. For decades, any involvement of circulating immune cells in CNS repair was completely denied. Only over the past few years has involvement of monocyte-derived macrophages (MDMs) in CNS repair received appreciation. We show here, for the first time, that MDMs recruited to the injured brain early after ischemic stroke contribute to long-term spontaneous functional recovery through inflammation-resolving activity. Our data raise the possibility that inadequate recruitment of MDMs to the brain after stroke underlies the incomplete functional recovery seen in patients and that boosting homing of MDMs with an anti-inflammatory bias to the injured brain tissue may be a new therapeutic approach to promote long-term improvement after stroke. Copyright © 2016 the authors 0270-6474/16/364182-14$15.00/0.

Is blood pressure control for stroke prevention the correct goal? The lost opportunity of preventing hypertension.

PubMed

Howard, George; Banach, Maciej; Cushman, Mary; Goff, David C; Howard, Virginia J; Lackland, Daniel T; McVay, Jim; Meschia, James F; Muntner, Paul; Oparil, Suzanne; Rightmyer, Melanie; Taylor, Herman A

2015-06-01

Although pharmacological treatment of hypertension has important health benefits, it does not capture the benefit of maintenance of ideal health through the prevention or delay of hypertension. A total of 26 875 black and white participants aged 45+ years were assessed and followed for incident stroke events. The association was assessed between incident stroke and: (1) systolic blood pressure (SBP)categorized as normal (<120 mm Hg), prehypertension (120-139 mm Hg), stage 1 hypertension (140-159 mm Hg), and stage 2 hypertension (160 mm Hg+), and (2) number of classes of antihypertensive medications, classified as none, 1, 2, or 3 or more. During 6.3 years of follow-up, 823 stroke events occurred. Nearly half (46%) of the population were successfully treated (SBP<140 mm Hg) hypertensives. Within blood pressure strata, the risk of stroke increased with each additional class of required antihypertensive medication, with hazard ratio [HR], 1.33; 95% confidence interval, 1.16 to 1.52 for normotensive, HR, 1.15; 95% confidence interval, 1.05 to 1.26 for prehypertension, and HR, 1.22; 95% confidence interval, 1.06 to 1.39 for stage 1 hypertension. A successfully treated (SBP<120 mm Hg) hypertensive person on 3+ antihypertensive medication classes was at marginally higher stroke risk than a person with untreated stage 1 hypertension (HR, 2.48 versus HR=2.19; relative to those with SBP <120 on no antihypertensive medications). Maintaining the normotensive status solely through pharmacological treatment has a profound impact, as nearly half of this general population cohort were treated to guideline (SBP<140 mm Hg) but failed to return to risk levels similar to normotensive individuals. Even with successful treatment, there is a substantial potential gain by prevention or delay of hypertension. © 2015 American Heart Association, Inc.

Effects of ischemic stroke on dynamics of cerebral autoregulation

NASA Astrophysics Data System (ADS)

Chen, Zhi; Ivanov, Plamen Ch; Hu, Kun; Stanley, Eugene; Novak, Vera

2004-03-01

Cerebral vasoregulation involves several complex mechanisms adapting blood flow to fluctuations of systemic blood pressure (BP). Autonomic BP and metabolic vasoregulation are impaired after stroke and cerebral blood flow depends on systemic BP. To probe the mechanisms of cerebral autoregulation we study levels of nonlinear synchronization between cerebral blood flow velocity (BFV) and peripheral BP. We quantify the instantaneous phase of each signal employing analytic signal approach and Hilbert transform. As a marker of synchronization, we introduce a measure of cross-correlation between the instantaneous phase increments of the BFV and BP signals at different time lags. We have studied 12 subjects with minor chronic ischemic stroke and 11 matched normotensive controls (age<65years). BFV and BP of these subjects are continuously recorded during supine baseline, head-up tilt, hyperventilation and CO2 rebreathing. For control subjects we find significant synchronization between cerebral BFV and peripheral BP only for short time lags of up to 5-6 seconds, suggesting a rapid return to a steady cerebral blood flow after initial blood pressure perturbations. In contrast, for stroke subjects BFV/BP we find enhanced synchronization over longer time lags of up to 20 seconds, suggesting entrainment of cerebral blood flow velocity by slow vasomotor rhythms. These findings suggest that cerebral vasoregulation is impaired and cerebral blood flow follows the fluctuations of systemic BP in a synchronous manner. Our analysis shows that cerebral autoregulation is impaired in 10 out of the 12 stroke subjects, which is typically difficult to diagnose with conventional methods. Thus, our novel synchronization approach offers a new tool sensitive for evaluation of changes in the dynamics of cerebral autoregulation under stroke.

Early supported discharge following mild stroke: a qualitative study of patients' and their partners' experiences of rehabilitation at home.

PubMed

Lou, Stina; Carstensen, Kathrine; Møldrup, Marie; Shahla, Seham; Zakharia, Elias; Nielsen, Camilla Palmhøj

2017-06-01

Early supported discharge (ESD) allows mild-to-moderate stroke patients to return home as soon as possible and continue rehabilitation at their own pace in familiar surroundings. Thus, the main responsibility for continued rehabilitation is in the hands of patients and their partners, who must collaborate to adjust to poststroke everyday life. However, couples' joint experiences of stroke, early discharge and rehabilitation at home remain minimally investigated. To investigate how mild stroke patients' and their partners' experience and manage everyday life in a context of ESD. We conducted qualitative interviews with a purposive sample of 22 ESD patients and 18 partners. Interviews were conducted 3-6 weeks after stroke, and we used thematic analysis to analyse the data. The analysis identified three themes. First, 'Home as a healing place' involved the couples' experiences of a well-informed discharge from hospital. They trusted the health professionals' assessment that the patient was ready to go home. They described home as a comforting and calm place, where recovery could meaningfully take place. The second theme, 'Flow of everyday life', comprised the experiences of adapting to and continuing everyday life. Most of the interviewees had relatively minor physical and cognitive impairments, and the patients and their partners were hopeful for a full recovery in the foreseeable future. Finally, 'Professional safety net' involved the much appreciated stroke team. Although most of the participants only had one visit from the team, knowing that they were an accessible resource was very important to the couples. ESD was experienced as a meaningful and adequate rehabilitation service that allowed patients and partners to collaboratively reinvent and rebuild their flow of everyday life by jointly adjusting routines, activities and their relationship. © 2016 Nordic College of Caring Science.

Aerothermodynamic Environment Definition for the Genesis Sample Return Capsule

NASA Technical Reports Server (NTRS)

Cheatwood, F. McNeil; Merski, N. Ronald, Jr.; Riley, Christopher J.; Mitcheltree, Robert A.

2001-01-01

NASA's Genesis sample return mission will be the first to return material from beyond the Earth-Moon system. NASA Langley Research Center supported this mission with aerothermodynamic analyses of the sample return capsule. This paper provides an overview of that effort. The capsule is attached through its forebody to the spacecraft bus. When the attachment is severed prior to Earth entry, forebody cavities remain. The presence of these cavities could dramatically increase the heating environment in their vicinity and downstream. A combination of computational fluid dynamics calculations and wind tunnel phosphor thermography tests were employed to address this issue. These results quantify the heating environment in and around the cavities, and were a factor in the decision to switch forebody heat shield materials. A transition map is developed which predicts that the flow aft of the penetrations will still be laminar at the peak heating point of the trajectory. As the vehicle continues along the trajectory to the peak dynamic pressure point, fully turbulent flow aft of the penetrations could occur. The integrated heat load calculations show that a heat shield sized to the stagnation point levels will be adequate for the predicted environment aft of the penetrations.

Agent-based spin model for financial markets on complex networks: Emergence of two-phase phenomena

NASA Astrophysics Data System (ADS)

Kim, Yup; Kim, Hong-Joo; Yook, Soon-Hyung

2008-09-01

We study a microscopic model for financial markets on complex networks, motivated by the dynamics of agents and their structure of interaction. The model consists of interacting agents (spins) with local ferromagnetic coupling and global antiferromagnetic coupling. In order to incorporate more realistic situations, we also introduce an external field which changes in time. From numerical simulations, we find that the model shows two-phase phenomena. When the local ferromagnetic interaction is balanced with the global antiferromagnetic interaction, the resulting return distribution satisfies a power law having a single peak at zero values of return, which corresponds to the market equilibrium phase. On the other hand, if local ferromagnetic interaction is dominant, then the return distribution becomes double peaked at nonzero values of return, which characterizes the out-of-equilibrium phase. On random networks, the crossover between two phases comes from the competition between two different interactions. However, on scale-free networks, not only the competition between the different interactions but also the heterogeneity of underlying topology causes the two-phase phenomena. Possible relationships between the critical phenomena of spin system and the two-phase phenomena are discussed.

Kinematic measures for upper limb robot-assisted therapy following stroke and correlations with clinical outcome measures: A review.

PubMed

Tran, Vi Do; Dario, Paolo; Mazzoleni, Stefano

2018-03-01

This review classifies the kinematic measures used to evaluate post-stroke motor impairment following upper limb robot-assisted rehabilitation and investigates their correlations with clinical outcome measures. An online literature search was carried out in PubMed, MEDLINE, Scopus and IEEE-Xplore databases. Kinematic parameters mentioned in the studies included were categorized into the International Classification of Functioning, Disability and Health (ICF) domains. The correlations between these parameters and the clinical scales were summarized. Forty-nine kinematic parameters were identified from 67 articles involving 1750 patients. The most frequently used parameters were: movement speed, movement accuracy, peak speed, number of speed peaks, and movement distance and duration. According to the ICF domains, 44 kinematic parameters were categorized into Body Functions and Structure, 5 into Activities and no parameters were categorized into Participation and Personal and Environmental Factors. Thirteen articles investigated the correlations between kinematic parameters and clinical outcome measures. Some kinematic measures showed a significant correlation coefficient with clinical scores, but most were weak or moderate. The proposed classification of kinematic measures into ICF domains and their correlations with clinical scales could contribute to identifying the most relevant ones for an integrated assessment of upper limb robot-assisted rehabilitation treatments following stroke. Increasing the assessment frequency by means of kinematic parameters could optimize clinical assessment procedures and enhance the effectiveness of rehabilitation treatments. Copyright © 2018 IPEM. Published by Elsevier Ltd. All rights reserved.

Lack of Hypertonia in Thumb Muscles After Stroke

PubMed Central

Kamper, Derek G.; Rymer, William Z.

2010-01-01

Despite the importance of the thumb to hand function, little is known about the origins of thumb impairment poststroke. Accordingly, the primary purpose of this study was to assess whether thumb flexors have heightened stretch reflexes (SRs) following stroke-induced hand impairment. The secondary purpose was to compare SR characteristics of thumb flexors in relation to those of finger flexors since it is unclear whether SR properties of both muscle groups are similarly affected poststroke. Stretch reflexes in thumb and finger flexors were assessed at rest on the paretic side in each of 12 individuals with chronic, severe, stroke-induced hand impairment and in the dominant thumb in each of eight control subjects also at rest. Muscle activity and passive joint flexion torques were measured during imposed slow (SS) and fast stretches (FS) of the flexors that span the metacarpophalangeal joints. Putative spasticity was then quantified in terms of the peak difference between FS and SS joint torques and electromyographic changes. For both the hemiparetic and control groups, the mean normalized peak torque differences (PTDs) measured in thumb flexors were statistically indistinguishable (P = 0.57). In both groups, flexor muscles were primarily unresponsive to rapid stretching. For 10 of 12 hemiparetic subjects, PTDs in thumb flexors were less than those in finger flexors (P = 0.03). Paretic finger flexor muscle reflex activity was consistently elicited during rapid stretching. These results may reflect an important difference between thumb and finger flexors relating to properties of the involved muscle afferents and spinal motoneurons. PMID:20668270

Stroke and transient ischemic attack incidence rate in Spain: the IBERICTUS study.

PubMed

Díaz-Guzmán, Jaime; Egido, Jose-A; Gabriel-Sánchez, Rafael; Barberá-Comes, Gloria; Fuentes-Gimeno, Blanca; Fernández-Pérez, Cristina

2012-01-01

In Spain, stroke is a major public health concern, but large population-based studies are scarce and date from the 1990s. We estimated the incidence and in-hospital mortality of stroke through a multicentered population-based stroke register in 5 geographical areas of Spain, i.e. Lugo, Almería, Segovia, Talavera de la Reina and Mallorca, representing north, south, central (×2) and Mediterranean areas of Spain, respectively, the aim and novelty being that all methodologies were standardized, and diagnoses were verified by a neurologist using neuroimaging techniques. The register identified subjects >17 years of age who suffered a first-ever stroke or transient ischemic attack (TIA) between 1 January and 31 December 2006. Stroke and TIA were defined according to the WHO criteria. The Lausanne Stroke Registry definitions were used to classify ischemic stroke subtypes, as follows: (1) large-artery atherosclerosis (LAA); (2) cardioembolism (CE); (3) lacunar stroke or small-artery occlusion (SAO); (4) stroke of other infrequent cause (SIC), and (5) stroke of undetermined cause (UND). We used several complementary data sources such as hospital discharge registers, emergency room registers and primary care surveillance systems. In the 1-year study period, we identified 2,700 first-ever cerebrovascular episodes (53% men; 2,257 strokes + 443 TIA episodes). Brain CT in the acute stage was performed in 99% of cases. Of a total of 2,257 stroke patients, 1,817 (81%) had cerebral infarction, 350 (16%) had intracerebral hemorrhage, 59 (3%) had subarachnoid hemorrhage (SAH) and 31 (1%) had unclassifiable stroke. The overall unadjusted annual incidence for all cerebrovascular events was 187 per 100,000 [95% confidence interval (CI) 180-194; incidence for men: 202, 95% CI 189-210; incidence for women: 187, 95% CI 180-194]. The subtype of ischemic stroke could be determined in 1,779 patients and was classified as LAA in 624 (35%), CE in 352 (20%), SAO in 316 (18%), SIC in 56 (3%) and UND in 431 (24%). The incidence rates per 100,000 (95% CI) standardized to the 2006 European population were as follows: all cerebrovascular events, 176 (169-182); all stroke (non-TIA), 147 (140-153); TIA, 29 (26-32); ischemic stroke, 118 (112-123); intracerebral hemorrhage, 23 (21-26), and SAH, 4.2 (3.1-5.2). Incidence rates clearly increased with age in both genders, with a peak at or above 85 years of age. The in-hospital mortality was 14%. Our results show that the incidence of stroke and TIA in Spain is moderate compared to other Western and European countries. However, it is expected that these figures will change due to progressively aging populations. Copyright © 2012 S. Karger AG, Basel.

Target 3-D reconstruction of streak tube imaging lidar based on Gaussian fitting

NASA Astrophysics Data System (ADS)

Yuan, Qingyu; Niu, Lihong; Hu, Cuichun; Wu, Lei; Yang, Hongru; Yu, Bing

2018-02-01

Streak images obtained by the streak tube imaging lidar (STIL) contain the distance-azimuth-intensity information of a scanned target, and a 3-D reconstruction of the target can be carried out through extracting the characteristic data of multiple streak images. Significant errors will be caused in the reconstruction result by the peak detection method due to noise and other factors. So as to get a more precise 3-D reconstruction, a peak detection method based on Gaussian fitting of trust region is proposed in this work. Gaussian modeling is performed on the returned wave of single time channel of each frame, then the modeling result which can effectively reduce the noise interference and possesses a unique peak could be taken as the new returned waveform, lastly extracting its feature data through peak detection. The experimental data of aerial target is for verifying this method. This work shows that the peak detection method based on Gaussian fitting reduces the extraction error of the feature data to less than 10%; utilizing this method to extract the feature data and reconstruct the target make it possible to realize the spatial resolution with a minimum 30 cm in the depth direction, and improve the 3-D imaging accuracy of the STIL concurrently.

Static Electric Fields and Lightning Over Land and Ocean in Florida Thunderstorms

NASA Technical Reports Server (NTRS)

Wilson, J. G.; Cummins, K. L.; Simpson, A. A.; Hinckley, A.

2017-01-01

Natural cloud-to-ground (CG) lightning and the charge structure of the associated clouds behave differently over land and ocean. Existing literature has raised questions over the years on the behavior of thunderstorms and lightning over oceans, and there are still open scientific questions. We expand on the observational datasets by obtaining identical electric field observations over coastal land, near-shore, and deep ocean regions during both clear air and thunderstorm periods. Oceanic observations were obtained using two 3-meter NOAA buoys that were instrumented with Campbell Scientific electric field mills to measure the static electric fields. These data were compared to selected electric field records from the existing on-shore electric field mill suite of 31 sensors at Kennedy Space Center (KSC). CG lightning occurrence times, locations and peak current values for both on-shore and ocean were provided by the U.S. National Lightning Detection Network. The buoy instruments were first evaluated on-shore at the Florida coast, to calibrate field enhancements and to confirm proper behavior of the system in elevated-field environments. The buoys were then moored 20NM and 120NM off the coast of KSC in February (20NM) and August (120NM) 2014. Statistically larger CG peak currents were reported over the deep ocean for first strokes and for subsequent strokes with new contacts points. Storm-related static fields were significantly larger at both oceanic sites, likely due to decreased screening by nearby space charge. Time-evolution of the static field during storm development and propagation indicated weak or missing lower positive charge regions in most storms that initiated over the deep ocean, supporting one mechanism for the observed high peak currents in negative first strokes over the deep ocean. This project also demonstrated the practicality of off-shore electric field measurements for safety-related decision making at KSC.

Strength, power, and muscular endurance exercise and elite rowing ergometer performance.

PubMed

Lawton, Trent W; Cronin, John B; McGuigan, Michael R

2013-07-01

Knowledge of the relationship between weight room exercises and various rowing performance measures is limited; this information would prove useful for sport-specific assessment of individual needs and exercise prescription. The purpose of this study was to establish strength, power, and muscular endurance exercises for weight room training, which are strong determinants of success in specific performance measures used to assess elite rowers. Nineteen heavyweight elite males determined their repetition maximum (RM) loads for exercises using a Concept 2 DYNO [5, 30, 60 and 120RM leg pressing and seated arm pulling (in Joules)] and free weights [1RM power clean (in kilograms) and 6RM bench pull (in kilograms and watts)]. Rowing performance measures included a 7-stage blood lactate response ergometer test (aerobic condition), time trials (500, 2000, and 5000 m), a peak stroke power test, and a 60-minute distance trial. Pearson correlation moments (r ≥ 0.7) and stepwise multiple linear regression calculations (R ≥ 50%) were used to establish strong common variances between weight room exercises and rowing ergometer performance (p ≤ 0.05). Weight room exercises were strong predictors of 2000-m, 500-m time (in seconds), and peak stroke power performance measures only. Bench pull power (in watts) and 1RM power clean (in kilograms) were the best 2-factor predictors of peak stroke power (R = 73%; standard error of the estimates [SEE] = 59.6 W) and 500 m (R = 70%; SEE = 1.75 seconds); while 5RM leg pressing (in Joules) and either 6RM bench pull (kg) or 60RM seated arm pulling (in Joules) the best predictors of 2000 m (R = 59%; SEE = 6.3 seconds and R = 57%; SEE = 6.4 seconds, respectively). Recommended exercises for weight room training include a 1RM power clean, 6RM bench pull, 5RM leg press, and 60RM seated arm pulling.

The influence of emotional stress on Doppler-derived aortic peak velocity in boxer dogs.

PubMed

Pradelli, D; Quintavalla, C; Crosta, M C; Mazzoni, L; Oliveira, P; Scotti, L; Brambilla, P; Bussadori, C

2014-01-01

Subaortic stenosis (SAS) is a common congenital heart disease in Boxers. Doppler-derived aortic peak velocity (AoPV) is a diagnostic criterion for the disease. To investigate the influence of emotional stress during echocardiographic examination on AoPV in normal and SAS-affected Boxers. To evaluate the effects of aortic root diameters on AoPV in normal Boxers. DOGS: Two hundred and fifteen normal and 19 SAS-affected Boxers. The AoPV was recorded at the beginning of echocardiographic examination (T0), and when the emotional stress of the dog was assumed to decrease based on behavioral parameters and heart rate (T1). AoPV0-AoPV1 was calculated. In normal dogs, stroke volume index was calculated at T0 and T1. Aortic root diameters were measured and their relationship with AoPV and AoPV0-AoPV1 was evaluated. In normal dogs, AoPV was higher at T0 (median, 1.95 m/s; range, 1.60-2.50 m/s) than at T1 (median, 1.76 m/s; range, 1.40-2.20 m/s; P < .0001; reduction 9.2%). The stroke volume index at T0 also was greater than at T1 (P < .0001). Weak negative correlations were detected between aortic root size and aortic velocities. In SAS-affected dogs, AoPV0 was higher than AoPV1 (P < .0001; reduction 7.3%). Aortic peak velocity was affected by emotional stress during echocardiographic examination both in SAS-affected and normal Boxers. In normal Boxers, aortic root size weakly affected AoPVs, but did not affect AoPV0-AoPV1. Stroke volume seems to play a major role in stress-related AoPV increases in normal Boxers. Emotional stress should be taken into account when screening for SAS in the Boxer breed. Copyright © 2014 by the American College of Veterinary Internal Medicine.

Simulation of extreme reservoir level distribution with the SCHADEX method (EXTRAFLO project)

NASA Astrophysics Data System (ADS)

Paquet, Emmanuel; Penot, David; Garavaglia, Federico

2013-04-01

The standard practice for the design of dam spillways structures and gates is to consider the maximum reservoir level reached for a given hydrologic scenario. This scenario has several components: peak discharge, flood volumes on different durations, discharge gradients etc. Within a probabilistic analysis framework, several scenarios can be associated with different return times, although a reference return level (e.g. 1000 years) is often prescribed by the local regulation rules or usual practice. Using continuous simulation method for extreme flood estimation is a convenient solution to provide a great variety of hydrological scenarios to feed a hydraulic model of dam operation: flood hydrographs are explicitly simulated by a rainfall-runoff model fed by a stochastic rainfall generator. The maximum reservoir level reached will be conditioned by the scale and the dynamics of the generated hydrograph, by the filling of the reservoir prior to the flood, and by the dam gates and spillway operation during the event. The simulation of a great number of floods will allow building a probabilistic distribution of maximum reservoir levels. A design value can be chosen at a definite return level. An alternative approach is proposed here, based on the SCHADEX method for extreme flood estimation, proposed by Paquet et al. (2006, 2013). SCHADEX is a so-called "semi-continuous" stochastic simulation method in that flood events are simulated on an event basis and are superimposed on a continuous simulation of the catchment saturation hazard using rainfall-runoff modelling. The SCHADEX process works at the study time-step (e.g. daily), and the peak flow distribution is deduced from the simulated daily flow distribution by a peak-to-volume ratio. A reference hydrograph relevant for extreme floods is proposed. In the standard version of the method, both the peak-to-volume and the reference hydrograph are constant. An enhancement of this method is presented, with variable peak-to-volume ratios and hydrographs applied to each simulated event. This allows accounting for different flood dynamics, depending on the season, the generating precipitation event, the soil saturation state, etc. In both cases, a hydraulic simulation of dam operation is performed, in order to compute the distribution of maximum reservoir levels. Results are detailed for an extreme return level, showing that a 1000 years return level reservoir level can be reached during flood events whose components (peaks, volumes) are not necessarily associated with such return level. The presentation will be illustrated by the example of a fictive dam on the Tech River at Reynes (South of France, 477 km²). This study has been carried out within the EXTRAFLO project, Task 8 (https://extraflo.cemagref.fr/). References: Paquet, E., Gailhard, J. and Garçon, R. (2006), Evolution of the GRADEX method: improvement by atmospheric circulation classification and hydrological modeling, La Houille Blanche, 5, 80-90. doi:10.1051/lhb:2006091. Paquet, E., Garavaglia, F., Garçon, R. and Gailhard, J. (2012), The SCHADEX method: a semi-continuous rainfall-runoff simulation for extreme food estimation, Journal of Hydrology, under revision

Screening methods for post-stroke visual impairment: a systematic review.

PubMed

Hanna, Kerry Louise; Hepworth, Lauren Rachel; Rowe, Fiona

2017-12-01

To provide a systematic overview of the various tools available to screen for post-stroke visual impairment. A review of the literature was conducted including randomised controlled trials, controlled trials, cohort studies, observational studies, systematic reviews and retrospective medical note reviews. All languages were included and translation was obtained. Participants included adults ≥18 years old diagnosed with a visual impairment as a direct cause of a stroke. We searched a broad range of scholarly online resources and hand-searched articles registers of published, unpublished and on-going trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Study selection was performed by two authors independently. The quality of the evidence and risk of bias were assessed using the STROBE, GRACE and PRISMA statements. A total of 25 articles (n = 2924) were included in this review. Articles appraised reported on tools screening solely for visual impairments or for general post-stroke disabilities inclusive of vision. The majority of identified tools screen for visual perception including visual neglect (VN), with few screening for visual acuity (VA), visual field (VF) loss or ocular motility (OM) defects. Six articles reported on nine screening tools which combined visual screening assessment alongside screening for general stroke disabilities. Of these, three included screening for VA; three screened for VF loss; three screened for OM defects and all screened for VN. Two tools screened for all visual impairments. A further 19 articles were found which reported on individual vision screening tests in stroke populations; two for VF loss; 11 for VN and six for other visual perceptual defects. Most tools cannot accurately account for those with aphasia or communicative deficits, which are common problems following a stroke. There is currently no standardised visual screening tool which can accurately assess all potential post-stroke visual impairments. The current tools screen for only a number of potential stroke-related impairments, which means many visual defects may be missed. The sensitivity of those which screen for all impairments is significantly lowered when patients are unable to report their visual symptoms. Future research is required to develop a tool capable of assessing stroke patients which encompasses all potential visual deficits and can also be easily performed by both the patients and administered by health care professionals in order to ensure all stroke survivors with visual impairment are accurately identified and managed. Implications for Rehabilitation Over 65% of stroke survivors will suffer from a visual impairment, whereas 45% of stroke units do not assess vision. Visual impairment significantly reduces the quality of life, such as being unable to return to work, driving and depression. This review outlines the available screening methods to accurately identify stroke survivors with visual impairments. Identifying visual impairment after stroke can aid general rehabilitation and thus, improve the quality of life for these patients.

Differences between poststroke drivers and nondrivers: demographic characteristics, medical status, and transportation use.

PubMed

Finestone, Hillel M; Marshall, Shawn C; Rozenberg, Dmitry; Moussa, Raffy C; Hunt, Lynn; Greene-Finestone, Linda S

2009-11-01

To determine the demographic, medical, and transportation use characteristics of stroke survivors wanting to drive who resumed or did not resume driving and compare the driving habits of those who drove with those of a nonstroke control group. One hundred and six stroke survivors who underwent a driving evaluation at a rehabilitation center in Ottawa, Canada, between 1995 and 2003, participated in a structured telephone interview 4-5 yrs after the evaluation. Information on driving history and transportation use before the driving assessment was obtained from the driving assessment client database. The nonstroke control group was derived from the literature. After stroke, 66% of subjects had resumed driving. Prestroke driving history was similar for drivers and nondrivers. Drivers were younger than nondrivers (mean age +/- SD, 62.7 +/- 12.7 yrs vs. 69.2 +/- 13.4 yrs; P = 0.02), had less medical comorbidity (mean modified Cumulative Illness Rating Scale score, 3.7 +/- 1.97 vs. 5.0 +/- 2.89; P = 0.01), and were less likely to rely on a walker (1.4% vs. 19.4%, P < 0.001). Self-imposed restrictions were reported by 35.7% of drivers. More nondrivers than drivers relied on family/friends (94.4% vs. 41.4%), public transportation (60.7% vs. 35.3%), or taxis (27.8% vs. 2.9%) (all P < 0.05). Drivers reported fewer driving difficulties (e.g., skill, weather, or traffic related;

A survey exploring self-reported indoor and outdoor footwear habits, foot problems and fall status in people with stroke and Parkinson's.

PubMed

Bowen, Catherine; Ashburn, Ann; Cole, Mark; Donovan-Hall, Margaret; Burnett, Malcolm; Robison, Judy; Mamode, Louis; Pickering, Ruth; Bader, Dan; Kunkel, Dorit

Ill-fitting shoes have been implicated as a risk factor for falls but research to date has focused on people with arthritis, diabetes and the general older population; little is known about people with neurological conditions. This survey for people with stroke and Parkinson's explored people's choice of indoor and outdoor footwear, foot problems and fall history. Following ethical approval, 1000 anonymous postal questionnaires were distributed to health professionals, leads of Parkinson's UK groups and stroke clubs in the wider Southampton area, UK. These collaborators handed out survey packs to people with a confirmed diagnosis of stroke or Parkinson's. Three hundred and sixty three completed surveys were returned (218 from people with Parkinson's and 145 from people with stroke). Most respondents wore slippers indoors and walking shoes outdoors and considered comfort and fit the most important factors when buying footwear. Foot problems were reported by 43 % (95 % confidence intervals 36 to 52 %; stroke) and 53 % (95 % confidence interval 46 to 59 %; Parkinson's) of respondents; over 50 % had never accessed foot care support. Fifty percent of all respondents reported falls. In comparison to non-fallers, a greater proportion of fallers reported foot problems (57 %), with greater proportions reporting problems impacting on balance and influencing choice of footwear ( p  < 0.01) in comparison to non-fallers in each case. Forty-seven percent of fallers with foot problems had not accessed foot care support. Many people with stroke and Parkinson's wear slippers indoors. A high percentage of these individuals reported both foot problems and falls impacting on footwear habits and choice of footwear; however many did not receive foot care support. These findings highlight that further exploration of footwear and foot problems in these populations is warranted to provide evidence based advice on safe and appropriate footwear to support rehabilitation and fall prevention.

Dominance of the Unaffected Hemisphere Motor Network and Its Role in the Behavior of Chronic Stroke Survivors

PubMed Central

Bajaj, Sahil; Housley, Stephen N.; Wu, David; Dhamala, Mukesh; James, G. A.; Butler, Andrew J.

2016-01-01

Balance of motor network activity between the two brain hemispheres after stroke is crucial for functional recovery. Several studies have extensively studied the role of the affected brain hemisphere to better understand changes in motor network activity following stroke. Very few studies have examined the role of the unaffected brain hemisphere and confirmed the test–retest reliability of connectivity measures on unaffected hemisphere. We recorded blood oxygenation level dependent functional magnetic resonance imaging (fMRI) signals from nine stroke survivors with hemiparesis of the left or right hand. Participants performed a motor execution task with affected hand, unaffected hand, and both hands simultaneously. Participants returned for a repeat fMRI scan 1 week later. Using dynamic causal modeling (DCM), we evaluated effective connectivity among three motor areas: the primary motor area (M1), the premotor cortex (PMC) and the supplementary motor area for the affected and unaffected hemispheres separately. Five participants’ manual motor ability was assessed by Fugl-Meyer Motor Assessment scores and root-mean square error of participants’ tracking ability during a robot-assisted game. We found (i) that the task performance with the affected hand resulted in strengthening of the connectivity pattern for unaffected hemisphere, (ii) an identical network of the unaffected hemisphere when participants performed the task with their unaffected hand, and (iii) the pattern of directional connectivity observed in the affected hemisphere was identical for tasks using the affected hand only or both hands. Furthermore, paired t-test comparison found no significant differences in connectivity strength for any path when compared with one-week follow-up. Brain-behavior linear correlation analysis showed that the connectivity patterns in the unaffected hemisphere more accurately reflected the behavioral conditions than the connectivity patterns in the affected hemisphere. Above findings enrich our knowledge of unaffected brain hemisphere following stroke, which further strengthens our neurobiological understanding of stroke-affected brain and can help to effectively identify and apply stroke-treatments. PMID:28082882

Secondary prevention lifestyle interventions initiated within 90 days after TIA or 'minor' stroke: a systematic review and meta-analysis of rehabilitation programmes.

PubMed

Heron, Neil; Kee, Frank; Cardwell, Christopher; Tully, Mark A; Donnelly, Michael; Cupples, Margaret E

2017-01-01

Strokes are often preceded by a transient ischaemic attack (TIA) or 'minor' stroke. The immediate period after a TIA/minor stroke is a crucial time to initiate secondary prevention. However, the optimal approach to prevention, including non-pharmacological measures, after TIA is not clear. To systematically review evidence about the effectiveness of delivering secondary prevention, with lifestyle interventions, in comprehensive rehabilitation programmes, initiated within 90 days of a TIA/minor stroke. Also, to categorise the specific behaviour change techniques used. The review identified randomised controlled trials by searching the Cochrane Library, Ovid MEDLINE, Ovid EMBASE, Web of Science, EBSCO CINAHL and Ovid PsycINFO. Two review authors independently screened titles and abstracts for eligibility (programmes initiated within 90 days of event; outcomes reported for TIA/minor stroke) and extracted relevant data from appraised studies; a meta-analysis was used to synthesise the results. A total of 31 potentially eligible papers were identified and four studies, comprising 774 patients post-TIA or minor stroke, met the inclusion criteria; two had poor methodological quality. Individual studies reported increased aerobic capacity but meta-analysis found no significant change in resting and peak systolic blood pressure, resting heart rate, aerobic capacity, falls, or mortality. The main behaviour change techniques were goal setting and instructions about how to perform given behaviours. There is limited evidence of the effectiveness of early post-TIA rehabilitation programmes with preventive lifestyle interventions. Further robust randomised controlled trials of comprehensive rehabilitation programmes that promote secondary prevention and lifestyle modification immediately after a TIA are needed. © British Journal of General Practice 2017.

Unit Hydrograph Peaking Analysis for Goose Creek Watershed in Virginia: A Case Study

DTIC Science & Technology

2017-05-01

ER D C/ CH L TR -1 7- 6 Unit Hydrograph Peaking Analysis for Goose Creek Watershed in Virginia: A Case Study Co as ta l a nd H yd ra...default. ERDC/CHL TR-17-6 May 2017 Unit Hydrograph Peaking Analysis for Goose Creek Watershed in Virginia: A Case Study Nawa Raj Pradhan and...confidence interval precipitation depths to the watershed in addition to the 50% value. This study concluded that a design event with a return period greater

Short-duration hypothermia after ischemic stroke prevents delayed intracranial pressure rise.

PubMed

Murtha, L A; McLeod, D D; McCann, S K; Pepperall, D; Chung, S; Levi, C R; Calford, M B; Spratt, N J

2014-07-01

Intracranial pressure elevation, peaking three to seven post-stroke is well recognized following large strokes. Data following small-moderate stroke are limited. Therapeutic hypothermia improves outcome after cardiac arrest, is strongly neuroprotective in experimental stroke, and is under clinical trial in stroke. Hypothermia lowers elevated intracranial pressure; however, rebound intracranial pressure elevation and neurological deterioration may occur during rewarming. (1) Intracranial pressure increases 24 h after moderate and small strokes. (2) Short-duration hypothermia-rewarming, instituted before intracranial pressure elevation, prevents this 24 h intracranial pressure elevation. Long-Evans rats with two hour middle cerebral artery occlusion or outbred Wistar rats with three hour middle cerebral artery occlusion had intracranial pressure measured at baseline and 24 h. Wistars were randomized to 2·5 h hypothermia (32·5°C) or normothermia, commencing 1 h after stroke. In Long-Evans rats (n = 5), intracranial pressure increased from 10·9 ± 4·6 mmHg at baseline to 32·4 ± 11·4 mmHg at 24 h, infarct volume was 84·3 ± 15·9 mm(3) . In normothermic Wistars (n = 10), intracranial pressure increased from 6·7 ± 2·3 mmHg to 31·6 ± 9·3 mmHg, infarct volume was 31·3 ± 18·4 mm(3) . In hypothermia-treated Wistars (n = 10), 24 h intracranial pressure did not increase (7·0 ± 2·8 mmHg, P < 0·001 vs. normothermia), and infarct volume was smaller (15·4 ± 11·8 mm(3) , P < 0·05). We saw major intracranial pressure elevation 24 h after stroke in two rat strains, even after small strokes. Short-duration hypothermia prevented the intracranial pressure rise, an effect sustained for at least 18 h after rewarming. The findings have potentially important implications for design of future clinical trials. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

A comparison of electromyography and stroke kinematics during ergometer and on-water rowing.

PubMed

Fleming, Neil; Donne, Bernard; Mahony, Nicholas

2014-01-01

This study assessed muscle recruitment patterns and stroke kinematics during ergometer and on-water rowing to validate the accuracy of rowing ergometry. Male rowers (n = 10; age 21 ± 2 years, height 1.90 ± 0.05 m and body mass 83.3 ± 4.8 kg) performed 3 × 3 min exercise bouts, at heart and stroke rates equivalent to 75, 85 and 95% VO2peak, on both dynamic and stationary rowing ergometers, and on water. During exercise, synchronised data for surface electromyography (EMG) and 2D kinematics were recorded. Overall muscle activity was quantified by the integration of rmsEMG and averaged for each 10% interval of the stroke cycle. Muscle activity significantly increased in rectus femoris (RF) and vastus medialis (VM) (P <0.01), as exercise intensity increased. Comparing EMG data across conditions revealed significantly (P <0.05) greater RF and VM activity during on-water rowing at discrete 10% intervals of stroke cycle. In addition, the drive/recovery ratio was significantly lower during dynamic ergometry compared to on-water (40 ± 1 vs. 44 ± 1% at 95%, P <0.01). Results suggest that significant differences exist while comparing recruitment and kinematic patterns between on-water and ergometer rowing. These differences may be due to altered acceleration and deceleration of moving masses on-ergometer not perfectly simulating the on-water scenario.

Changes of pelvis control with subacute stroke: A comparison of body-weight- support treadmill training coupled virtual reality system and over-ground training.

PubMed

Mao, Yurong; Chen, Peiming; Li, Lifang; Li, Le; Huang, Dongfeng

2015-01-01

Gait recovery is very important to stroke survivors to regain their independence in activity of daily life. This study aimed to investigate the effects of virtual reality (VR) coupled body weight support treadmill training (BWSTT) on pelvic control at the early stage of stroke. Kinematic and kinetic changes of pelvic motion were evaluated by a 3D gait analysis system and were compared to the results from over-ground walking training. Twenty-four patients having unilateral hemiplegia with subacute stroke were recruited to a VR coupled BWSTT group (n= 12) and a conventional therapy (CT) group (n= 12). Both of the groups received training of 20-40 min/day, 5 days/week, for 3 weeks. The results showed the tilt of pelvis in sagittal plane improved significantly (P= 0.038) after treatment in the BWSTT+VR group, in terms of decreased amplitude of anterior peak (mean, from 10.99° to 6.25°), while there were no significant differences in the control group. The findings suggested that VR coupled BWSTT gait training could decrease anterior tilt of pelvis in early hemiparetic persons following a modest intervention dose, and the training may have advantages over conventional over-ground gait training and can assist the therapists in correcting abnormal gait pattern of stroke survivors.