Influence of Physical Therapy and Cholinergic Medication on the Life Quality Parameters in Post-Stroke with the arm Motor Dysfunction
Motor dysfunction makes the greatest contribution to the patient’s functional independence and has a significant impact on the quality of life (QOL) of post-stroke patients.
The objective of the research was to evaluate the impact of different physical therapy approaches and choline alphoscerate on the functional independence and quality of life in patients in 1 year after ischemic stroke.
Materials and methods. There were 104 patients examined in 1-year period after first anterior circulation ischemic stroke. Neurological status, functional independence and QOL were assessed according to the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Functional Independence Measurement (FIM) and Stroke Specific Quality of Life Scale (SS-QOL). Patients in Group 1 received secondary stroke prevention therapy and performed the exercises complex for general muscle function improvement for 2 months; patients in Group 2 also performed the exercise complex for hand motility improvement for 2 months; patients in Group 3 received choline alphoscerate 400 mg twice a day for 2 months in addition to the abovementioned physical therapy.
Results. 2 months of physical therapy in Group 1 resulted in increase of “Transfer” and subtotal motor scores. A significant increase in the “Self-care”, “Transfer” and therefore subtotal motor and total scores was observed in the patients in Group 2 and Group 3; the motor subtotal and total scores in Group 3 were 11.4% and 11.6 % higher than the same indices in Group 1, respectively.
The most significant improvement of QOL parameters was observed in patients in Group 3, whose total score increased by 36.8% from the baseline (p<0.05), and exceeded the same index of Group 1 by 17.1% (p<0.05).
Conclusions. Adding of hand exercise into the physical therapy complex for post-stroke patients contributes to better upper extremity motor performance and therefore functional independence. Stimulation of cholinergic neurotransmission with the choline alphoscerate may also increase the efficacy of physical therapy and contribute to patients’ general mobility, upper extremity function and QOL.
Abualait TS, Alzahrani MA, Ibrahim AI et al. Determinants of life satisfaction among stroke survivors 1 year post stroke. Medicine (Baltimore). 2021; 100 (16): e25550. Available from:
Blanchet S, Richards CL, Leblond J et al. Cardiorespiratory fitness and cognitive functioning following short-term interventions in chronic stroke survivors with cognitive impairment: a pilot study. International Journal of Rehabilitation Research. 2016; 39 (2): 153-159. Available from:
Boudokhane S, Migaou H, Kalai A et al. Predictors of Quality of Life in Stroke Survivors: A 1-year Follow-Up Study of a Tunisian Sample. J Stroke Cerebrovasc Dis. 2021; 30 (4): 105600. Available from: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105600
Brott T, Adams HP, Olinger CPbet al. Measurements of acute cerebral infarction; a clinical examination scale. Stroke. 1989; 20: 864 - 870. Available from: https://doi.org/10.1161/01.STR.20.7.864
Catanesi M, d'Angelo M, Antonosante A et al. Neuroprotective potential of choline alfoscerate against β-amyloid injury: Involvement of neurotrophic signals. Cell Biol Int. 2020;44 (8): 1734-1744. Available from: https://doi.org/10.1002/cbin.11369
Debreceni-Nagy A, Horváth J, Bajuszné Kovács N. et al. The effect of low-intensity aerobic training on cognitive functions of severely deconditioned subacute and chronic stroke patients: a randomized, controlled pilot study. International Journal of Rehabilitation Research. 2019; 42 (3); 275-279. Available from: https://doi.org/10.1097/MRR.0000000000000346
Gerasymchuk VR. Indicators of energy metabolism in patients during the early recovery period of ischemic stroke under the influence of complex therapy using neuroprotectors and vasoactive drugs. Archive of Clinical Medicine. 2016; Vol. 22, №1: 61 - 65.
Han P, Zhang W, Kang L et al. Clinical Evidence of Exercise Benefits for Stroke. Advances in Experimental Medicine and Biology. 2017; 1000: 131-151. Available from: https://doi.org/10.1007/978-981-10-4304-8_9
Hara Y. Brain plasticity and rehabilitation in stroke patients. Journal of Nippon Medical School. 2015; 82 (1): 4 - 12. Available from: https://doi.org/10.1272/jnms.82.4
Hsieh HC, Liao RD, Yang TH et al. The clinical effect of Kinesio taping and modified constraint-induced movement therapy on upper extremity function and spasticity in patients with stroke: a randomized controlled pilot study [published online ahead of print, 2021 Jan 15]. Eur J Phys Rehabil Med. 2021;10.23736/S1973-9087.21.06542-4. Available from: https://doi.org/10.23736/S1973-9087.21.06542-4
Johnston TE, Keller S, Denzer-Weiler C, Brown L. A Clinical Practice Guideline for the Use of Ankle-Foot Orthoses and Functional Electrical Stimulation Post-Stroke. J Neurol Phys Ther. 2021; 45(2): 112-196. Available from: https://doi.org/10.1097/NPT.0000000000000347
Kanai M, Izawa KP, Kubo H, et al. Association of Health Utility Score with Physical Activity Outcomes in Stroke Survivors. Int J Environ Res Public Health. 2020; 18 (1): 251. Available from: https://doi.org/10.3390/ijerph18010251
Krishnamurthi RV, Moran AE, Feigin VL et al. Stroke prevalence, mortality and disability-adjusted life years in adults aged 20-64 years in 1990-2013: data from the global burden of disease 2013 study. Neuroepidemiology. 2015; 45: 190-202. Available from: https://doi.org/10.1159/000441098
Leisman G, Moustafa AA, Shafir T. Thinking, Walking, Talking: Integratory Motor and Cognitive Brain Function. Frontiers in Public Health. 2016; 4: 94. Available from: https://doi.org/10.3389/fpubh.2016.00094
Lin C, Lee J, Hurt CP et al. Gait Measures at Admission to Inpatient Rehabilitation after Ischemic Stroke Predict 3-Month Quality of Life and Function. PM R. 2021; 13 (3): 258-264. Available from: https://doi.org/10.1002/pmrj.12402
McDowell I, Newell,C. Measuring health: a guide to rating scales and questionnaires (2nd Ed.). New York, Oxford University Press. 1996: 63-67
PayenokAV, ZadorozhnaBV, KukhlenkoOYaetal. Influence of Gliatilin on the Dynamics of Neuropsychological Functions and Systemic Inflammatory Response Parameters in Patients in the Recovery Period of Ischemic Stroke. International Neurological Journal. 2013; 8 (62): 51-57 [In Ukrainian].
Pedersen SG, Friborg O, Heiberg GA et al. Stroke-Specific Quality of Life one-year post-stroke in two Scandinavian country-regions with different organisation of rehabilitation services: a prospective study. Disabil Rehabil. 2020; 1-11. Available from: https://doi.org/10.1080/09638288.2020.1753830
Rancic NK, Mandic MN, et al. Health-Related Quality of Life in Stroke Survivors in Relation to the Type of Inpatient Rehabilitation in Serbia: A Prospective Cohort Study. Medicina (Kaunas). 2020; 56 (12): 666. Available from: https://doi.org/10.3390/medicina56120666
Rankin J. Cerebral vascular accidents in patients over the age of 60. Scottish Medical Journal. 1957; 2: 200-215. Available from: https://doi.org/10.1177/003693305700200504
Sadlonova M, Wasser K, Nagel J et al. Health-related quality of life, anxiety and depression up to 12 months post-stroke: Influence of sex, age, stroke severity and atrial fibrillation - A longitudinal subanalysis of the Find-AFRANDOMISED trial. J Psychosom Res. 2021; 142: 110353. Available from: https://doi.org/10.1016/j.jpsychores.2020.110353
Tollár J, Nagy F, Csutorás B et al. High Frequency and Intensity Rehabilitation in 641 Subacute Ischemic Stroke Patients. Arch Phys Med Rehabil. 2021; 102 (1): 9-18. Available from: https://doi.org/10.1016/j.apmr.2020.07.012
Traini E, Carotenuto A, Fasanaro AM et al. Volume Analysis of Brain Cognitive Areas in Alzheimer's Disease: Interim 3-Year Results from the ASCOMALVA Trial. J Alzheimers Dis. 2020; 76(1): 317-329. Available from: https://doi.org/10.3233/JAD-190623
van Mierlo ML, van Heugten CM, Post MW et al. Quality of Life during the First Two Years Post Stroke: The Restore4Stroke Cohort Study. Cerebrovasc Dis. 2016; 41(1-2): 19-26. Available from: https://doi.org/10.1159/000441197
Vinogradov OI, Daminov VD, Rybalko NV. Use of choline alphoscerate (Gliatiline) in patients with ischemic stroke. Journal of Neurology and Psychiatry n. a. S. S. Korsakov. 2013; №1: 43 - 45 [in Russian].
Williams LS, Weinberger M, Harris LE et al. Development of a stroke-specific quality of life scale. Stroke. 1999; 30 (7): 1362-1369. Available from: https://doi.org/10.1161/01.STR.30.7.1362
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica. 1983; 67 (6): 61-370. Available from: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Copyright (c) 2021 Iriah Festus Uwa-Agbonikhena
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).