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This scoping review aimed to gain an insight into the oral health status, behaviour, knowledge, and risk among cardiovascular patients, as well as to explore challenges and to make a recommendation concerning oral health and cardiovascular patients. It focused on four key areas, namely oral health status, behaviour, knowledge, and associated risk factors. Relevant studies were searched using a combination of keywords and related search terms. Four available databases were used; EBSCOhost, Scopus, Proquest, and Pubmed to identify the relevant studies. A total of 789 papers were screened and duplicated papers were removed, 28 papers were retrieved for full-text review. It was found that most cardiovascular patients have poor oral health, while their oral health behaviour and knowledge were at a fair level. There are a limited number of studies assessing oral health conditions during cardiac rehabilitation. In general, protocol and guidelines about the importance of oral health care for cardiovascular patients are still lacking. Having good oral health has potential impacts in reducing the risk of CVD. Future research is warranted with potential intervention approaches to improve oral health conditions among cardiovascular patients, thus reducing the risk of CVD. [ABSTRACT FROM AUTHOR]

Objectives: To assess the agreement between patients' and caregivers' (CGs) assessment of patients' oral health-related quality of life (OHRQoL) during the acute stage of their hospitalization. Methods: A sample of 161 consecutive patients admitted to hospital following stroke and their CGs. Patients and CGs were interviewed independently about the impact of oral health status on the life quality of the patient employing the General Oral Health Assessment Index (GOHAI). Agreement of impact was assessed by comparison (agreement at the group level) and correlation analyses (agreement of individual patient-CG pairs). Results: The response rate was 76% with 121 pairs of patients and CGs participating. At the group level, variations in patient's own and CG GOHAI scores were found ( P < 0.001). The CGs underestimated the impact of oral health on life quality, particularly with respect to aspects of psychosocial functioning compared with patients' own perceptions. However, the bias in reports was small (standardized difference = 0.43). The mean absolute difference in overall scores constituted 8% of the possible range of GOHAI scores. At the individual patient-CG pair level, the intraclass correlation coefficient for GOHAI scores was 0.73 (95% CI 0.61-0.82), indicating substantial agreement. Conclusion: At the group and individual level there was adequate agreement between patients' and CGs' assessment of patients' OHRQoL during the acute stage of their hospitalization. The findings have implications in the use of CGs as proxies in assessing oral health when patients' own assessment may be difficult to obtain. [ABSTRACT FROM AUTHOR]

AIM: To investigate prospectively the qualitative and quantitative changes in oral carriage of yeasts and coliforms in southern Chinese people suffering from stroke. MATERIALS AND METHODS: In 56 elderly people suffering from stroke in a rehabilitation unit of a general medical hospital in Hong Kong, oral microbiological sampling using a combined imprint culture, oral rinse approach and clinical assessment was made during the acute stroke phase, on hospital discharge and 6 months later. RESULTS: The oral carriage of yeasts increased significantly during acute stroke (P<0.05), whereas coliform carriage did not. A reduction in oral carriage of yeasts was found on hospital discharge and 6 months later and in coliforms at the 6-month assessment (P<0.05). Candida albicans and Klebsiella pneumoniae were the predominant yeast and coliform respectively. Stroke-related difficulty in tooth brushing and denture wearing were associated with higher oral yeast carriage (P<0.05). We also report here for the first time that the use of aspirin was associated with lower oral yeast carriage in people suffering from stroke. CONCLUSION: Oral yeast carriage was closely linked to the level of stroke-related functional disability that improved over time but had not totally resolved 6 months after hospital discharge. The oral reservoir of yeasts and coliforms in people suffering from stroke is noteworthy by care providers as K. pneumoniae may cause aspiration pneumonia. [ABSTRACT FROM AUTHOR]

BACKGROUND: Throughout the stroke rehabilitation process, community care is one of the most important elements. Learning to live with and take care of a family member with a stroke is immensely complex and demanding. Without appropriate support, family caregivers are at risk of their own general health decreasing, thus becoming a patient themselves - the second patient in the family. AIM: The aim of this study was to examine aspects of social support available to family caregivers during the first 12-week transitional period following hospital discharge. DESIGN AND METHOD: This study adopted a cross-sectional descriptive design. Regression analysis was performed for examining the types of social support received and the general health of family caregivers. Open-ended questions were used to gain a better understanding of situation-specific supports including their availability, utilization and eventual satisfaction. RESULTS: Findings confirm that home care for the stroke survivor is heavy and demanding. Health-related care tasks were the most stressful. Around 40% of the family caregivers reported somatic symptoms. Fewer persons in the social network of the family caregivers had provided support compared with the number of support people that caregivers thought available. Two inadequate types of support were tangible support and information support. Professional advice and feedback in relation to home care skills were particularly lacking. CONCLUSION: Findings of this study affirmed that stroke care needs exceed the hospital boundary. Professional support to family caregivers is essential so as to sustain home care and protect the caregiver's health. This is particular important during the first 12 weeks transitional period after hospital discharge. RELEVANCE TO CLINICAL PRACTICE. This study highlighted the implications of social support to nursing practice, especially in predischarge planning and community care. Findings of this study may provide information and data for service planning and community resources co-ordination to support community stroke care. Copyright 2004 Blackwell Publishing Ltd [ABSTRACT FROM AUTHOR]

Purpose: Describe real-life practice and outcomes in the management of post-stroke upper limb spasticity with botulinum toxin A (BoNT-A) in Asian settings., Methods: Subgroup analysis of a prospective, observational study (NCT01020500) of adult patients (≥18 years) with post-stroke upper limb spasticity presenting for routine spasticity management, including treatment with BoNT-A. The primary outcome was goal attainment as assessed using goal-attainment scaling (GAS). Patients baseline clinical characteristics and BoNT-A injection parameters are also described., Results: Overall, 51 patients from Asia were enrolled. Rates of comorbid cognitive and emotional problems were relatively low. Patients tended to have more severe distal limb spasticity and to prioritize active over passive function goals. Most (94.1%) patients in the subgroup were treated with abobotulinumtoxinA. For these patients, the median total dose was 500 units, and the most frequently injected muscles were the biceps brachii (83.3%), flexor carpi radialis (72.9%), and flexor digitorum profundus (66.7%). Overall, 74.5% achieved their primary goal and the mean GAS T score after one treatment cycle was 56.0 ± 13.0, with a change from baseline of 20.9 ± 14.3 ( p  < 0.001). The majority (96.1%) of Asian patients were rated as having improved., Conclusion: In the Asian treatment setting, BoNT-A demonstrated a clinically significant effect on goal attainment for the real-life management of upper limb spasticity following stroke., Competing Interests: RR reports being a clinical trialist for Ipsen on BoNT-A applications for Cervical Dystonia and Post-Stroke Spasticity. In the past, he was engaged in an Allergan BoNT-A Cervical Dystonia Trial. He has received travel honoraria for lectures on BoNT-A for Ipsen, Allergan and Merz. NC was employed by Ipsen at the time of study. AS has received travel honoraria for lectures on BoNT-A from medical congresses. TD and PM were employed by Ipsen. The authors declare that this study received funding from Ipsen who were involved in the study design, collection, and data analysis. The funder was not involved in the interpretation of data, the writing of this article, or the decision to submit it for publication. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Rosales, Chia, Kumthornthip, Goh, Mak, Kong, Ng, Chou, Flordelis, Do, Maisonobe, Li and Suputtitada.)

We investigated the effects of mirror visual feedback (MVF), with reference to using a glass wall or a covered mirror, on the reduction of spatial neglect for patients with stroke. A total of 21 subacute patients with left spatial neglect after right-hemispheric stroke were randomly assigned to 3 groups: MVF, sham 1 (viewing the hemiparetic arm through the transparent glass during bilateral arm movement) and sham 2 (using a covered mirror). The 3-week treatment program for all groups consisted of 12 sessions of movement tasks for the hemiparetic arm graded according to the severity of arm impairments. Blinded assessments were administered at pre/post and a three-week follow-up. The results showed that there was no significant advantage for MVF than sham 1; however, MVF was more beneficial than sham 2, as shown by the line crossing ( p = 0.022). Improvement in discriminating the left-gap figures on the left and right side of the page in the Gap Detection Test was greater in MVF than using the covered mirror ( p = 0.013; p = 0.010), showing a slight advantage of MVF in alleviating allocentric symptoms. Our study confirms that MVF was superior to using a covered mirror as a method for reducing spatial neglect and in alleviating its allocentric symptoms, but no significant advantage over bilateral arm movement through transparent glass was found. Further research in comparing their therapeutic effects is warranted.

Studies have shown the brain's rich-club organization may underpin brain function and be associated with various brain disorders. In this study, we aimed to investigate the relation between poststroke brain functions and functional recovery versus the rich-club organization of the structural brain network of patients after first-time acute ischemic stroke. A cohort of 16 acute ischemic stroke patients (11 males) was recruited. Structural brain networks were measured using diffusion tensor imaging within 1 week and at 1, 3 and 6 months after stroke. Motor impairment was assessed using the Upper-Extremity Fugl-Meyer motor scale and activities of daily living using the Barthel Index at the same time points as MRI. The rich-club regions that were stable over the course of stroke recovery included the bilateral dorsolateral superior frontal gyri, right supplementary motor area, and left median cingulate and paracingulate gyri. The network properties that correlated with poststroke brain functions were mainly the ratio between communication cost ratio and density ratio of rich-club, feeder and local connections. The recovery of both motor functions and activities of daily living were correlated with higher normalized rich club coefficients and a shorter length of local connections within a week after stroke. The communication cost ratio of feeder connections, the length of rich-club and local connections, and normalized rich club coefficients were found to be potential prognostic indicators of stroke recovery. Our results provide additional support to the notion that different types of network connections play different roles in brain functions as well as functional recovery., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Event-related desynchronization (ERD), as a proxy for mirror neuron activity, has been used as a neurophysiological marker for motor execution after mirror visual feedback (MVF). Using EEG, this study investigated ERD upon the immediate effects of single-session MVF in unimanual arm movements compared with the ERD effects occurring without a mirror, in two groups: stroke patients with left hemiplegia and their healthy counterparts. During EEG recordings, each group performed one session of mirror therapy training in three task conditions: with a mirror, with no mirror, and with a covered mirror. An asymmetry index was calculated from the subtraction of the event-related spectrum perturbations between the C3 and C4 electrodes located over the sensorimotor cortices contralateral and ipsilateral to the moved arm. Results of the effect of task versus group in contralateral and ipsilateral motor areas showed that there was a significant effect of task condition at the contralateral motor area in the high beta band (17-35 Hz) at C3. High beta ERD showed that the suppression was greater over the contralateral hemisphere than it was over the ipsilateral hemisphere in both study groups. The magnitude of low beta (12-16 Hz) ERD in patients with stroke was more suppressed in contralesional C3 under the no mirror compared to that of the covered mirror and similarly more suppressed in ipsilesional C4 ERD under the no mirror compared to that of the mirror condition. The correlation analysis revealed that the magnitude of ERSP power correlated significantly with arm severity in the low and high beta bands in patients with stroke, and a higher asymmetry index in the low beta band was associated with higher arm functioning under the no-mirror condition. There was a shift in sensorimotor ERD toward the contralateral hemisphere as induced by MVF accompanying unimanual movement in both stroke patients and healthy controls. The use of ERD in the low beta band as a neurophysiological marker to indicate the relationships between the amount of MVF-induced ERD attenuation and motor severity, and the outcome indicator for improving stroke patients' neuroplasticity in clinical trials using MVF are warranted to be explored in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Fong, Ting, Zhang, Yau and Li.)

The rapid development of medical rehabilitation services in China over the last 30 years has progressed from minimal to the present various models of rehabilitation services in general hospitals, specialized rehabilitation hospitals, and community-based and home-based rehabilitation. Contributing factors such as rapid economic growth, rehabilitation needs after natural disasters, changes in insurance policies, an aging population, and new government policies have accelerated the growth in rehabilitation services. Persons with disability in China include 85 million permanently disabled persons, more than 200 million with disabilities from chronic diseases, and more than 240 million elderly individuals., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: This study was to assess the effectiveness of a conventional oral hygiene care programme (COHCP) and an advanced oral hygiene care programme (AOHCP) on prevalence and viable counts of oral opportunistic pathogens among patients undergoing stroke rehabilitation., Methods: A total of 94 patients were randomized to two groups. Subjects were block randomized to either (a) COHCP: manual toothbrushing with oral hygiene instruction (OHI); or (b) AOHCP: powered toothbrushing, mouthrinsing with chlorhexidine and OHI. Prevalence and viable counts of oral opportunistic pathogens including yeasts, aerobic and facultative anaerobic gram-negative bacilli, Staphylococcus aureus, were assessed at baseline, the end of 3 and 6 months., Results: No significant difference was observed in the prevalence of oral opportunistic pathogens within each group over the clinical trial period. A significant decrease in the viable counts of S. aureus was found over the clinical trial period within AOHCP group (p < 0.05), while the viable counts of yeasts and anaerobic gram-negative bacillus (AGNB) remained stable within each group. Regression analysis failed to detect an association between intervention and the prevalence/viable counts of oral opportunistic pathogens., Conclusions: Neither oral healthcare programme significantly affects AGNB, yeast or S. aureus over the study period in terms of prevalence and viable counts., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

Objective: To evaluate the presence of oral opportunistic pathogens among stroke survivors, both before and after oral health care interventions., Methods: A multicenter randomized clinical trial was conducted on hospitalized stroke survivors. Those in the control group were given standard care of oral hygiene (a manual toothbrush and toothpaste), whereas those in the test group were given intense care of oral hygiene (a powered toothbrush and 1% chlorhexidine oral gel). Oral clinical assessments were carried out, and microbiological samples were collected, using concentrated oral rinse samples at 3 time points: baseline, 3 months, and 6 months., Results: The prevalence of oral yeast was significantly reduced in the test group at 6 months (P < .05), but no significant difference was observed over time. A significant reduction was observed in the prevalence of Staphylococcus aureus (P < .01) and aerobic and facultative gram-negative bacilli over time (P < .05), but there were no significant differences noted between groups at 6 months. Candida albicans and Klebsiella pneumoniae were the prominent pathogens determined throughout the trial. Kluyvera strains have also been isolated from this cohort., Conclusion: Oral hygiene intervention using a powered tooth brush and 1% chlorhexidine oral gel was effective in reducing the prevalence of oral opportunistic pathogens., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Maintaining good oral hygiene is important following stroke. This study aimed to evaluate the effectiveness of two oral health promotion (OHP) programmes to reduce dental plaque levels following stroke. A multi-centre randomised clinical control trial was conducted among patients hospitalised following stroke in Malaysia. Patients were randomly allocated to two OHP groups: (i) control group who received the conventional method for plaque control-daily manual tooth brushing with a standardised commercial toothpaste, (ii) test group-who received an intense method for plaque control-daily powered tooth brushing with 1% Chlorhexidine gel. Oral health assessments were performed at baseline, at 3 months and 6 months post-intervention. Within- and between-group changes in dental plaque were assessed over time. Regression analyses were conducted on dental plaque levels at 6 months controlling for OHP group, medical, dental and socio-demographic status. The retention rate was 62.7% (54 of 86 subjects). Significant within-group changes of dental plaque levels were evident among the test group (P < .001) and the control group (P < .001). No significant between-group changes of dental plaque levels were apparent (P > .05). Regression analyses identified that baseline plaque levels (adjusted ß = 0.79, P < .001) and baseline functional dependency level (adjusted ß = -0.34, P < .05) were associated with dental plaques levels at the end of the trial (6 months). Both, "Conventional" and "Intense" oral health promotion programmes may successfully reduce dental plaque during stroke rehabilitation and are of comparable effectiveness. Baseline dental plaque levels and functional dependency level were key factors associated with dental plaque levels at follow-up at 6 months., (© 2017 John Wiley & Sons Ltd.)

This study was to evaluate the effectiveness of oral hygiene care in improving oral health- and health-related quality of life (OHRQoL and HRQoL) among patients receiving outpatient stroke rehabilitation. Subjects were randomized to: (1) a conventional oral hygiene care programme (COHCP) comprising a manual toothbrush, and oral hygiene instruction, or (2) an advanced oral hygiene care programme (AOHCP) comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, and oral hygiene instruction. The interventional period lasted for 3 months, followed by a 3-month observational period. HRQoL was assessed by SF-12, and OHRQoL was assessed by Oral Health Impact Profile-14 (OHIP-14), General Oral Health Assessment Index (GOHAI), and Oral Health Transitional Scale (OHTS). Participants in AOHCP group had significantly better OHRQoL at the end of clinical trial as assessed by OHTS (p < 0.01), and at the end of observational study as assessed by GOHAI (p < 0.05) than those in the COHCP. Participants in the AOHCP group had significantly better HRQoL as assessed by physical component summary score (PCS) the end of both 3 and 6 months (both p < 0.05). This study provided the evidence that the AOHCP was more effective than the COHCP within stroke rehabilitation in improving subjective health.

Objective: There are potential benefits of repetitive transcranial magnetic stimulation (rTMS) in improving swallowing functions after stroke; however, few studies have been performed in the chronic stroke population. This study aims to distil the key effects of rTMS on swallowing functions and swallowing-related quality of life., Methods: Twenty-two participants with chronic post-stroke dysphagia were randomly assigned into active or sham rTMS groups. Seven participants withdrew from the study, thus data from 15 participants (mean age 64.6 years) were analysed. Participants received 3,000 pulses of 5 Hz rTMS (active: n = 11; sham: n = 4) on the tongue area of the motor cortex for 10 days over a period of 2 weeks. All participants were assessed 1 week before, and 2 months, 6 months and 12 months after stimulation. Outcomes were measured by a videofluoroscopic swallowing study, swallowing-related quality-of-life questionnaire and Iowa Oral Performance Instrument., Results: No statistically significant effects were identified for any outcome measures., Conclusion: This study indicates that 5 Hz rTMS applied over the tongue area of the motor cortex is not effective for improving swallowing function in individuals with chronic post-stroke dysphagia. Possible explanations for these non-significant results are dis cussed. Future studies should explore the potential of the current protocol in conjunction with conventional dysphagia therapy.

Objectives: The objectives of this study were to evaluate and compare the effectiveness of an advanced oral hygiene care programme (AOHCP) and a conventional oral hygiene care programme (COHCP) in improving oral hygiene, and reducing gingival bleeding among patients with stroke during outpatient rehabilitation., Methods: Subjects were randomized to receive (i) the COHCP comprising a manual toothbrush, toothpaste, and oral hygiene instruction, or (ii) the AOHCP comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, toothpaste, and oral hygiene instruction. Dental plaque, gingival bleeding, and other clinical oral health outcomes were assessed at baseline, the end of the clinical trial, and the end of observation period. Development of infectious complications was also monitored., Results: Participants of both programmes had a significant reduction in the percentages of sites with moderate to abundant dental plaque (p<0.001) and with gingival bleeding (p<0.05). Those in the AOHCP had significantly less plaque and gingival bleeding than those in the COHCP controlling for other factors at the end of the clinical trial period (both p<0.001) and the observational period (plaque: p<0.05, gingival bleeding: p<0.01)., Conclusions: Although both oral hygiene care programmes were effective in terms of plaque and gingival bleeding control, the AOHCP was more effective than the COHCP in reducing dental plaque and gingival bleeding., Clinical Significance: This study highlighted the value of oral hygiene programmes within stroke outpatient rehabilitation and provides evidence to advocate for the inclusion of oral hygiene care programmes within stroke outpatient rehabilitation for patients with normal cognitive abilities., (Copyright © 2017 Elsevier Ltd. All rights reserved.)