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22. European Stroke Conference 829 Rehabilitation and reorganisation after stroke Functional plasticity of the motor cortical structures demonstrated by Navigated Brain Stimu-lation in patients with stroke and brain damage. K. Shkirkova1, A. Belkin2, V. Lescovetc3 Clinical Institute of Brain, Ekaterinburg, RUSSIAN FEDERATION1, Clinical Institute of Brain, Ekaterinburg, RUSSIAN FEDERATION2, Clinical Institute of Brain, Ekaterinburg, RUSSIAN FEDERATION3 Background. Navigated Brain Stimulation (NBS) is a useful technique for topographic mapping of the cerebral cortex. NBS creates more detailed topographic maps of the cortical structures on pa-tient’s 3D reconstructed brain resolving several limitations of TMS. We used NBS to study function-al plasticity of primary motor cortex hand area following cortical damage in patients with stroke and brain traumas. Methods. 81 patients were studied: 68 patients with ischemic stroke and 13 patients with brain trau-mas, all with movement deficits of the dominant hand rated on the basis of 5-point paretic scale. NBS was performed using Nexstim (Helsinki, Finland). EMP amplitude, latency and thresholds were recorded from the “target muscles”. Further, topographic landmarks of an optimum “hotspot” were identified. Results. The cortical reorganisation included: preserved topography (Brodmann area 4) in 23 pa-tients (28.7%), reduction of cortical size in 16 cases (20%), expansion towards the premotor cortex (Brodmann area 6) in 12 cases (15%), expansion towards the somatosensory cortex (Brodmann area 2) in 5 patients (6.3%), and dual zone expansion towards both Brodmann areas 6 and 2 in 10 pa-tients (12.5%). There were ectopic zones identified in contralateral hemisphere in 3 patients (3.75%) and ipsilateral hemisphere in 5 patients (6.25%). There were 10 patients (12.5%) with unidentifiable cortical topography. The highest level of functional mobility (5, 4 points on paretic scale) were lar-gly assosiated with preserved topography of primary motor cortex and neural reorganisation to the premotor cortex (Brodmann area 6). Conclusion. Therefore, the method of NBS used in this study on patients with stroke and brain dam-age identifies cortical areas of brain plasticity with a strong neural potential for motor rehabilitation. 784 © 2013 S. Karger AG, Basel Scientific Programme 830 Rehabilitation and reorganisation after stroke Results of the HOme VIsit after Stroke (HOVIS) feasibility randomised controlled trial (RCT) N. Sprigg1, A. E. R. Drummond2, P. J. Whitehead3, K. R. Fellows4, C. J. Sampson5, C. Edwards6, N. Lincoln7 University of Nottingham, Nottingham, UNITED KINGDOM1, University of Nottingham, Not-tingham, UNITED KINGDOM2, University of Nottingham, Nottingham, UNITED KINGDOM3, Royal Derby Hospitals NHS Trust, Derby, UNITED KINGDOM4, University of Nottingham, Not-tingham, UNITED KINGDOM5, University of Nottingham, Nottingham, UNITED KINGDOM6, University of Nottingham, Nottingham, UNITED KINGDOM7 Background There is a dearth of evidence to support the clinical or cost effectiveness of pre-discharge occupa-tional therapy home visits with patients after stroke, despite their routine use1-2. Recruitment diffi-culties were encountered in a previous feasibility study where therapists were reluctant to randomise patients to a control group where they would not receive a visit3. Therefore our aim was to con-duct a feasibility trial using an alternative methodology that balanced clinical concerns with research rigor. Method RCT and a parallel cohort study. Patients for whom there was clinical uncertainty about the need to conduct a visit were eligible for randomisation and received either a pre-discharge home visit or an in-hospital interview with an occupational therapist. Those enrolled into the cohort study were those considered ‘essential’ for a home visit by clinicians, and received a visit. Patients were followed up at one week and one month post-discharge. Outcomes were recruitment and follow-up rates, mea-sures of activities of daily living performance, readmissions and follow-up service use, carer strain, mood, falls, and costs. Results 123 patients recruited. Numbers into the RCT increased as the study progressed and 93 were re-cruited. Follow-up rate was 90%. Although this study was not powered to detect significant differ-ences those who received a home visit had more hospital readmissions and this achieved statistical significance (p= 0.04). Other outcomes were similar across the hospital interview and home visit groups4. Conclusion A larger, powered study is necessary to further investigate clinical outcomes and cost effectiveness of pre-discharge home visits. This methodology was feasible, and randomisation was acceptable to clinicians, patients and carers.


Karger_ESC London_2013
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