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Influence of laterality of hemispheric injury in post-Stoke on the effects of multimodal training on hemodynamics and electrical brain activity: a longitudinal study

Grant number: 23/04797-2
Support Opportunities:Scholarships in Brazil - Doctorate (Direct)
Effective date (Start): March 01, 2024
Effective date (End): September 30, 2027
Field of knowledge:Health Sciences - Physiotherapy and Occupational Therapy
Principal Investigator:Thiago Luiz de Russo
Grantee:Paloma Nepomuceno Araujo
Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil


Stroke is considered the second cause of death in the world and, among neurological diseases, is the main cause of disability-adjusted life years. It is important that stroke be analyzed in the field of neurocardiology, and a complicating factor for understanding the influence of stroke on cardiac responses is related to the different functions performed by the cerebral hemispheres. However, there is still much divergence in the literature about the influence of the hemispheric laterality of the lesion. For this population, multimodal training is effective in improving mobility, but the mechanisms related to the regulation of cerebral blood flow and cortical activity are less known. Furthermore, it is not clear whether the side of the hemispheric lesion could influence these variables, as well as whether the time of injury will influence. Aim: To investigate the influence of the laterality of the cerebral hemisphere affected by the stroke on the benefits of physical training on cerebrovascular health and cerebral electrical activity, improvement of functional capacity and sensorimotor impairment. Methods: This is a longitudinal characterization study pre- and post-intervention. Individuals of both sexes who have had a single stroke, ischemic, with unilateral involvement, within a period of 2 months to 2 years will be included. Individuals will be divided into four groups: individuals with subacute stroke on the right hemisphere; subacute stroke on the left hemisphere; cronic stroke on the right hemisphere; cronic stroke on the left hemisphere. All groups will perform a circuit training protocol of moderate to high intensity (Target Heart Rate - HRtarget - 50-80% of HRreserve) for 12 weeks. The exercise test will be used to determine the HRmax. Pre- and post-intervention assessments will be carried out. The main outcome of the study is the blood flow velocity of the great cerebral arteries measured by transcranial doppler. Secondary outcomes are: brain electrical activity assessed by electroencephalogram; velocity of blood flow and morphology of carotid arteries assessed by carotid doppler; functional capacity measured by the 6-minute walk test; and sensorimotor impairment assessed using the Fugl-Meyer rating scale. Statistical analysis will be performed using the Statistical Package for Social Sciences software (SPSS Inc. Chicago, IL) version 22.0. Descriptive analysis will be used for population profile data and description of variables. If the data have a normal and homogeneous distribution (parametric), the Anova Two-Way analysis will be performed with repeated measures followed by Bonferroni post-hoc to verify the effect of the intervention, with a significance level of 5%. If data do not have normal distribution, Friedman analysis (p<0.05) will be used followed by Wilcoxon (Bonferroni manual adjustment). Linear regression analysis will be performed to estimate associations between the laterality of the hemisphere affected by the stroke and the magnitude of the blood flow velocity response of the anterior cerebral circulation arteries. Multivariate regression analysis will be used to adjust for potential confounders. (AU)

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