Poster Abstracts Thursday, November 10, 2005 $387

1124 Effects of cognitive of behaviomal rehabilitation in Stroke patient

Bala, R a, BurInan, G 1. 2Sha]cti Neuro Science Centre Barwala Road, Hisar, India

We report patients of cerebral stroke showing ideational apraxia who were applied into cognitive therapeutic exercises as a cognitive rehabilitation procedure. 11 patients with cerebral infracts (16-9 month old) of 30-50 yrs who showed ideation apraxia caused by left cortical or sub cortical infracts in the distribution of middle cerebral (80'%) and anterior cerebral artery tertiary were chosen for the study. Major symptoms documented were a significant decreased spontaneity and sensory aphasia with minimal or no paralysis and they could not accept the verbal instructions of the therapist or able to imitate their activities. MRI/CT Scan revealed infracts in the parietal or parieto occipito lobe. Intracerebral hemorrhagic patients were not included in the study. Rehabilitation was introduced within 2 days after hos- pitalization for convert ion of sensory information visual left / right interspaced matching was first performed but at the beginning the approach did not work well but gradually patients learn to do it well. The training advance to object identification by means of touch and the shape of palpating the object. 4 months had passed since the irfitiation of the treating patient had improve to the level where they could understand instruction of the physiotherapist and imitate their simple activities. Since the left sided cerebral infract cases were having limb kinetic aprxia ideomotor apxia and ideation apxria as a part of parietal lobe dysfunction the symptoms of the patients were judged as the category of ideational apraxia. Generally the rehabilitation for apraxia is entirely focused only on identification of goods or repetition of operational activity. Symptoms rarely improved. We have con- sider aprmxia as a disordered of information of convertion among heterogeneous sense and hence advocated to cognitive rehabilitation. The perforated challenges might promote in improvement in conver- tion in sensory information in our case. In the process of training disorders of control functions were considered to be improved by encouraging cognitive process and kinetic process and the favorable activities were obtained up to 60% cases of patients with aprmxia related to cerebral stroke.

1125 Functional outcome after audiovisual sthilulation in Post-Stroke patient rehabilitation

Bykov y 1 Nikolaichuk S a, Avetisjan M 1, Chernick M 2, Chernick M, Leontjeva, Y. 1State ivlediea[ University, Ir~tsk, Russia; 2Clinic of Ophtha#nie Diseases, State Medical University, Ir]eutsk, Russia

Background: Stroke rehabilitation is one of the main problems in neurology. There are various methods, reducing neurological defects, however, not all of them are effective. Audiovisual stimulation (AVS) is one of the perspective methods in rehabilitation. Method: clinical (Lindmark Scale, Barthel Index), functional analysis of sensory-motor processes (based at electromyogram). Results: Patients with cerebral infarction in the middle cerebral artery area in 1 2 months after stroke were treated by AVS and by medicine (drug). AVS was used in process of daily physiotherapy for 2 or 3 weeks. In the first group the index of Lindmark Scale before stimulation was 326,3 ± 1,8, after stimulation - 371,1 ± 1,1 (p < 0,001). Barthel Index changed from 66,6 ± 0,8 to 78,2 ± 1,8 (p < 0,001). In the second group the index of Lindmark Scale before treatment was 323,3 ± 1,7, after treatment 341,5 ± 2,9 (p < 0,01). Barthel Index was 68,4 ± 0,9 and 73,3 ± 1,7 accordingly (iJ < 0,01). Conclusion: Positive results were obtained in both groups, however, degrees of the efficacy were different. The better results in the first group may be explained by the finding of the individual pattern of movement. Tiffs conception implies that any person has individual characteristics o f voluntary movement. Human activity is integral in norm. There are disintegrations of nerves system in pathology. If to

define an individual frequency of movement pattern it will become a basis for new matrix o f movements. New pattern might be constructed with the help of audiovisual stimulation - flash-light or sound click. These results are preliminary, further investigations are needed.

1126 Operative and 5-year outcomes of carotid endarterectomy in a Korean educational hospital

Chang, DI ~, Ctmng, SH ~, Yoon, SS a, Ahn, TB a, Park, KJ a, Clmng, KC 1, Park, JC 2. 1Department of Neurology', College of Medicine, Kyunghee University, Seoul, Korea," 2Thoracic surgery, College of Medicine, Kyunghee University, Seoul, Korea

Background: Carotid endarterectomy (CEA) reduces risk of stroke in patients with symptomatic, or asymptomatic internal carotid stenosis. We investigated operative and 5-year outcomes of CEA. Method: A retrospective review was performed of records for patients who underwent CEA between 1996 and 2004. Data on demographic, operative indications, and operative outcome were obtained by each patient. Survival follow-up was conducted in January 2005 and the incidence of late stroke and other complication was investigated in all surviving patients by phone interview. Results: Seventy-five patients (mean age; 63, 10[11'%] female patients) underwent CEA during the study period. Operative death occurred in 1 of 75 patients (1.3%). Only one perioperative stroke was documented (contralateral side of minor stroke). In all, 63 of 75 patients (84¢/0) were alive at the time of the study and completed surveys were col- lected from 58 of 63 patients (192'%). Of these 58 patients, 4 reported a late ipsilateral stroke (7°,5; 1 ICH, 3 undetermined). Median survival follow-up was 43 months (range 3 to 107), and the corresponding 5-year Kaplan-Meier survival was 90.4%. Contusion: Our results suggest that CEA can be accomplished with acceptable morbidity and mortality in this hospital.

1127 Magnetically guided targeted Stroke therapy: a theoretical feasibility evaluation

Chert, H L4, Kaminski, M D 2~, XAe, yL4, Ebner, A D ~, PAtter J A 3, Guy, SG ~, Rosengart, A J~*. 1Departments of Neurology and Surgery (Neurosurgery), The University of Chicago and Pritzker School of Medicine, Chicago, USA; 2Chemical Engineering Division, Argonne National Laboratory, Argonne, USA; 3Department of Chemical Engineering, University of South Carolina, Columbia, USA; 4Department of Biomedical Engineering, Illinois Ns titute of Technology, Chicago, USA; 1-4Collaborative Investigators for Applied Nanotechnology in Medicine * Co- Principal Investigators

Our overall research goal is to advance the safety and effectiveness of acute ischemic stroke therapy by improving the benefit/risk ratio of tissue plasminogen activator (t-PA) mediated thrombolysis and hence the long-term outcome of acute ischemic stroke victims. Using a common occlusion site for stroke we positioned in this simulation a ferromagnetic wire close to the internal artery origin. An external magnetic field was used to magnetize the wire in order to create high local magnetic field gradients needed for selective concentration of the freely circulating t-PA loaded nano- and microspheres from the blood stream and at the occlusion site. Using FEMLAB software we studied the capture collection efficiency (CE) of blood borne magnetic nano- and microspheres by such a system. Simulations included variations of the following system variables: 1) permanent magnet and wire, 2) homogeneous magnetic field and wire, and 3) permanent magnet only. Furthermore, the effects of blood flow velodty, t-PA carrier size (15-50/~m) and magnetic, content (120-100 wt% magnetite) on targeted drug carrier CE were studied. The result identify that a permanent magnet with a wire close to the occlusion had kigher CE than the other two systems do and that CE of 7°,5 and 26"/o per cardiac cycle at mean velocities o f 79 and 2 cm/s, respectively, were aclfieved (5/~m particles;