The European Stroke Organisation (ESO) Simulation Committee was established in 2017 with the intent to promote simulation education and training in the stroke field. The application of simulation methodology in education and training improves healthcare professional performances in real clinical practice and patient outcomes. We evaluated the implementation of simulation training in stroke medicine, how it can significantly affect stroke pathways and quality of care. We herewith describe simulation techniques in the acute stroke setting. Simulation programs place the trainees in a safe environment, allowing both role-playings for decision making training and procedural simulation for technical skills improvement. This paper includes the position of the Committee on the key points, principles, and steps in order to set up and promote simulation programs in European stroke centers. Stroke is an emergency, and hyperacute phase management requires knowledge, expertise, optimal multidisciplinary team working, and timely actions in a very narrow time window. The ESO Simulation Committee promotes the implementation of simulation training in stroke care according to a specific and validated methodology.
- Publication type
- Journal Article MeSH
1 disketa ; 18 cm + 1 uživatelský manuál (13 s.)
- MeSH
- Myocardial Infarction MeSH
- Publication type
- Examination Questions MeSH
- Conspectus
- Patologie. Klinická medicína
- NML Fields
- kardiologie
- angiologie
- NML Publication type
- software
PURPOSE: There is a clinical need for shortened door-to-needle time (DNT) for intravenous thrombolysis, but effective training methods are missing. Simulation training improves teamwork and logistics in numerous fields. Still, it is not clear if simulation improves logistics in stroke. METHODS: To evaluate the efficiency of a simulation training programme, the DNT of participating centres was compared with the rest of stroke centres in the Czech Republic. Patients' data were prospectively collected from the nationally used Safe Implementation of Treatments in Stroke Registry. The outcome was an improvement in DNT in 2018 as compared with 2015 (after and before the simulation training). Scenarios were based on real clinical cases, and simulation courses were conducted in a standardly equipped simulation centre. FINDINGS: Between 2016 and 2017, 10 courses were conducted for stroke teams from 9 of all 45 stroke centres. DNT data were available both in 2015 and 2018 from 41 (91%) stroke centres. The simulation training improved the DNT in 2018 as compared with 2015 by 30 min (95% CI 25.7 to 34.7) and as compared with 20 min (95% CI 15.8 to 24.3) in stroke centres without the simulation training (p=0.01). Any parenchymal haemorrhage occurred in 5.4% and 3.5% of patients treated in centres without and with simulation training (p=0.054), respectively. CONCLUSIONS: DNT was considerably shortened nationally. It was feasible to implement simulation as a nationwide training programme. The simulation was associated with improved DNT; however, other studies should confirm that such an association is causal.
- MeSH
- Time-to-Treatment MeSH
- Stroke * therapy MeSH
- Administration, Intravenous MeSH
- Humans MeSH
- Simulation Training * MeSH
- Thrombolytic Therapy methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Flies achieve supreme flight maneuverability through a small set of miniscule steering muscles attached to the wing base. The fast flight maneuvers arise from precisely timed activation of the steering muscles and the resulting subtle modulation of the wing stroke. In addition, slower modulation of wing kinematics arises from changes in the activity of indirect flight muscles in the thorax. We investigated if these modulations can be described as a superposition of a limited number of elementary deformations of the wing stroke that are under independent physiological control. Using a high-speed computer vision system, we recorded the wing motion of tethered flying fruit flies for up to 12,000 consecutive wing strokes at a sampling rate of 6250 Hz. We then decomposed the joint motion pattern of both wings into components that had the minimal mutual information (a measure of statistical dependence). In 100 flight segments measured from 10 individual flies, we identified 7 distinct types of frequently occurring least-dependent components, each defining a kinematic pattern (a specific deformation of the wing stroke and the sequence of its activation from cycle to cycle). Two of these stroke deformations can be associated with the control of yaw torque and total flight force, respectively. A third deformation involves a change in the downstroke-to-upstroke duration ratio, which is expected to alter the pitch torque. A fourth kinematic pattern consists in the alteration of stroke amplitude with a period of 2 wingbeat cycles, extending for dozens of cycles. Our analysis indicates that these four elementary kinematic patterns can be activated mutually independently, and occur both in isolation and in linear superposition. The results strengthen the available evidence for independent control of yaw torque, pitch torque, and total flight force. Our computational method facilitates systematic identification of novel patterns in large kinematic datasets.
Představa chůze neboli mentální simulace chůze bez jejího skutečného provedení se jeví jako vhodný doplněk komplexní rehabilitace pacientů po cévní mozkové příhodě (CMP), protože zlepšuje následnou realizaci chůze a její obnovu. Cílem studie bylo určit, jak se změní svalová aktivita vybraných svalů paretické i neparetické dolní končetiny u pacientů v subakutní fázi po CMP při představě běžné chůze a její náročnější varianty, chůze po čáře. Povrchová elektromyografie (polyEMG) m. rectus femoris, m. biceps femoris, m. tibiais anterior a m. gastrocnemius medialis byla snímána při třech úlohách (klidová úloha, představa chůze před a po jejím reálném vykonání) pro běžnou chůzi a chůzi po čáře u 40 pacientů po CMP. Svalová aktivita se významně snížila u většiny vybraných svalů obou dolních končetin při jednotlivých úlohách představy běžné chůze a chůze po čáře. U paretického m. gastrocnemius medialis a neparetického m. rectus femoris a m. biceps femoris jsme nalezli nižší polyEMG aktivitu při úlohách představy náročnější situace. Svalová aktivita paretické a neparetické dolní končetiny se nelišila při představě před a po realizaci obou typů chůze. Z výsledků studie vyplývá, že představa běžné chůze a chůze po čáře mění svalovou aktivitu paretické i neparetické dolní končetiny. Zjištěné poznatky mohou usnadnit aplikaci představy těchto pohybů v rámci komplexního rehabilitačního přístupu u subakutních pacientů po CMP s omezením chůze.
The gait imagery, or mental simulation of walking without actually performing it, appears to be the suitable adjunct to comprehensive rehabilitation for stroke survivors because it improves their subsequent gait performance and recovery. The aim of this study was to determine how muscle activity of selected paretic and non-paretic lower limb muscles changes in patients in the subacute phase after stroke when imagining normal gait and its more challenging variant, gait on the line. Surface electromyography (sEMG) of rectus femoris, biceps femoris, tibiais anterior and gastrocnemius medial head was recorded during three tasks (resting task, gait imagery before and after its actual execution) for normal gait and gait on the line in 40 stroke survivors. Muscle activity decreased significantly in most of the selected muscles of both lower limbs during each of the tasks of normal gait imagery and gait on the line imagery. We found lower sEMG activity in paretic gastrocnemius medial head and non-paretic rectus femoris and biceps femoris during the tasks of imagining more challenging situation. Muscle activity of paretic and non-paretic lower limbs did not differ during imagination before and after execution of both types of gait. The results of the study show that normal gait imagery and gait on a line imagery alters muscle activity in both paretic and non-paretic lower limbs. The findings may facilitate the application of imagining these movements as part of a comprehensive rehabilitation approach in subacute stroke survivors with gait limitations.
- MeSH
- Gait Analysis * methods instrumentation statistics & numerical data MeSH
- Stroke pathology MeSH
- Gait MeSH
- Lower Extremity physiology physiopathology MeSH
- Electromyography MeSH
- Muscle, Skeletal physiology physiopathology MeSH
- Humans MeSH
- Paresis etiology pathology MeSH
- Stroke Rehabilitation * methods MeSH
- Data Collection methods MeSH
- Motion Perception MeSH
- Check Tag
- Humans MeSH
- Publication type
- Clinical Study MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND AND PURPOSE: Botulinum toxin (BTX) treatment can relieve focal arm spasticity after stroke, presumably through dynamic changes at multiple levels of the motor system, including the cerebral cortex. However, the neuroanatomical correlate of BTX spasticity relief is not known and should be reflected in changes of cortical activation during motor tasks assessed using repeated functional magnetic resonance imaging (fMRI). METHODS: Four patients (2 males, 2 females, mean age 25.5 years) with hemiplegia and distal arm spasticity after chronic ischemic stroke sparing the motor cortex were studied. fMRI during mental movement simulation of the impaired hand was performed in 2 sessions before and 4 weeks after BTX treatment. The change in arm spasticity was assessed using the modified Ashworth scale (MAS). RESULTS: BTX treatment significantly decreased arm spasticity across the group (mean MAS change 2.1). Whereas fMRI during imagined movement pre-BTX treatment showed extensive bilateral network of active areas, post-BTX activation was confined to the midline and contralateral sensorimotor cortices. The pre- > post-BTX contrast revealed a significant decrease in activation of the posterior cingulate/precuneus region after BTX treatment. CONCLUSION: This small study suggests that structures outside the classical motor system, such as the posterior cingulate/precuneus region, may be associated with the relief of poststroke arm spasticity.
- MeSH
- Botulinum Toxins, Type A pharmacology therapeutic use MeSH
- Stroke complications physiopathology MeSH
- Chronic Disease MeSH
- Adult MeSH
- Hemiplegia etiology physiopathology MeSH
- Brain Ischemia complications physiopathology MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Brain Mapping MeSH
- Brain drug effects physiopathology MeSH
- Neuromuscular Agents pharmacology therapeutic use MeSH
- Neural Pathways drug effects physiopathology MeSH
- Arm physiopathology MeSH
- Severity of Illness Index MeSH
- Muscle Spasticity drug therapy etiology physiopathology MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Nahrávací stroje se používají v tréninku v různých sportovních hrách. Nedávné studie odhalily rozdíly v načasování úderu, když hráč čelí nahrávacímu stroji. My jsme sledovali čas zahájení pohybu hráče a načasování jeho švihu během příjmu tenisového podání (když hráč čelil podávajícímu hráči a nahrávacímu stroji). Cílem bylo zjistit, zdali různé vizuální informace při odehrávání míče proti nahrávacímu stroji a podávajícímu tenistovi ovlivní načasování úderu hráče. Při měření na dvorci jsme použili rychlosti podání 100 a 125 km.h–1. Jedna skupina hráčů (n = 7) čelila nahrávacímu stroji, druhá skupina hráčů (n =7) odehrávala míče od tenisty. Probandi měli kratší čas zahájení pohybu, když odehrávali míče od nahrávacího stroje. Analýza rozptylu pro opakovaná měření ukázala významné rozdíly v době trvání celého švihu hráče při příjmu podání mezi podávajícím tenistou a nahrávajícím strojem. Tato doba byla delší ve skupině čelící nahrávacímu stroji. Výsledky doby zahájení pohybu a doby trvání švihu ukazují rozdíly v načasování úderu. Používání nahrávacích strojů v tréninku by mělo být omezeno na minimum.
Ball machines are often used in practice in various sport games. Recent studies have shown some differences in the swing timing and movement coordination, when the player is facing a ball machine. We watched the movement initiation time and stroke timing during returning tennis serves (simulated by a ball machine or server). The aim of this study was to examine whether different constraints of returning against a ball machine compared to a server in tennis affect timing of the return stroke. The measures proceeded on a tennis court. We used the ball speeds of the serves 100 kph and 125 kph. One of the groups (n = 7) faced a ball machine. The other group (n = 7) faced a server. Players had shorter initial movement time when they were facing the ball machine. duration between the ball machine and the server. The swing duration was longer in the ball machine group. The results showed significant differences in the swing duration between the ball machine and server. However, different movement initiation time and swing duration are demonstrating differences in the movement timing of the return stroke. The use of ball machines should be limited in practice sessions.
Acute ischemic stroke and intracranial hemorrhages (ICH) represent critical situations for the patient. Rapid accurate diagnosis and therapy are required to prevent serious lifelong consequences or death. In the case of suspected head circulatory pathology, computed tomography (CT) is often the first choice among imaging techniques because of its availability, speed and reliability. In order to refine and speed up the diagnostic process, advanced algorithms implemented in computer aided diagnosis systems are currently being developed. This paper presents approaches to an automatic ICH localization as a part of a research project aimed at the development of machine learning methods for the analysis of circulatory disorders in head CT scans. Three designed deep learning-based algorithms are described and compared for prediction of the exact position of ICH within a 3D CT scan, and in two cases also for classification into the sub-types. An objective evaluation of the methods is presented along with a discussion of the results. Further possibilities for circulatory diseases analysis in head CT scans using modern algorithms are also discussed.
- MeSH
- Biomedical Technology * MeSH
- Biomedical Research MeSH
- Intracranial Hemorrhages * diagnostic imaging prevention & control MeSH
- Ischemic Stroke diagnostic imaging prevention & control MeSH
- Cardiovascular System diagnostic imaging physiopathology MeSH
- Humans MeSH
- Neural Networks, Computer MeSH
- Tomography, X-Ray Computed methods instrumentation MeSH
- Computer Simulation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
