Ovidius University Annals, Series Physical Education and Sport / SCIENCE, MOVEMENT AN !EA"T! !EA"T! Vol. XV, ISSUE 1, 2015, Romania The #ournal is inde$ed in% E&sco, SPO'Tiscus, INE( COPE'NICUS )OU'NA" MASTE' "IST, OA) I'ECTO'* O+ OPEN ACCES )OU'NA"S, )OU'NA"S, Ca&y, ale Cen-ace "earnin-, Ca&ell.s irectories
Science, Moveent and !ealth, Vol0 (V, ISSUE 1, 2314 )anuary 2314, 14 516% 74893
Original article
:O'E"ASI ANTA'A ST'O:E IS:EMI:, +I;'I"ASI AT'IUM AN NEU'O'E!A;I"ITATION NEU'O'E!A;I"ITA TION INI 1
1
OU ANCA , "UPU MI'E"A , PA'V +"O'INA
2
A&stract Objective. Atrial fibrillation is the most common cause of ischemic strokes. he ina!e"uate thera#$ of this heart arrh$thmia can lea! to brain !ama%es associate! &ith #aral$sis an! 'arious other s$m#toms !e#en!in% on the affecte! territor$. he earl$ kinetothera#$ an! the a##ro#riate treatment #la$ the ma(or role in the reco'er$ of these #atients. Methods. )et&een *anuar$ 201+ -o'ember 201 &e hos#itali/e! on emer%enc$ 1 #atients &ith acute ischemic stroke cause! b$ !eficient treatment of the atrial fibrillation. he !emo%ra#hic !ata, clinical, ima%istic cerebral34, cerebral3RI, e6tracranial ultrasoun!, minimum t&o E47s, Echocar!io%ra#h$8, #araclinic!ata, as &ell as risk factors factors h$#ertensio h$#ertension, n, !iabetes !iabetes mellitus, mellitus,'al'ul 'al'ulo#ath o#athies, ies, caroti! caroti! stenosis, stenosis, !iffuse !iffuse caroti! caroti! atheromatos atheromatosis, is, !$sli#i!emia, obesit$, obesit$, chronic renal insufficienc$, insufficienc$, #ol$%lobulie, cancer8, treatment, kinetothera#$ &ere all consi!ere!. Results. 9e stu!ie! 1 #atients, 12: females an! 5; males ,2 < 'ersus +1,:2 < 8. ost of the #atients are &ith #ermanent atrial fibrillation 1:2 cases, ;2,: <8. he bi%%est number of our cases &ere treate! &ith anti#latelet thera#$ for atrial fibrillation cases, :, +1 <8, follo&e! b$ anticoa%ulant thera#$ :: cases, 1, <8, anti#latelet = anticoa%ulant thera#$ 1 cases, :,5+ <8, !ual anti#latelet thera#$ 5 cases, 2,; <8, !ual anti#latelet = anticoa%ulant thera#$ 2 cases, 1,0: <8. Accor!in% to the a%e %rou#, the hi%hest fre"uenc$ of ischemic stroke is bet&een :03:; $ears ol! : cases, 1,; <8. ore than 50 < ha! an ina##ro#riate international normali/e! ratio. Val'es al'es insuff insuffici icienc enc$ $ &ere !ia%nose !ia%nose! ! at cases, cases, +5, <, as &ell &ell as #rosth #rostheti eticc heart heart 'al'es 'al'es an! !ilate !ilate! ! car!iom$o#ath$ 21 cases, 11,2; <8, atrial trombi 5 cases, 2, <8, h$#ertension 1: cases, ;,: <8, !iabetes mellitus cases, 2,:+ <8, caroti! stenosis cases, +,22 <8, !iffuse caroti! atheromatosis 1: cases, ;,1+ <8, !$sli#i!em !$sli#i!emia ia +; cases, 20,; <8, obesit$ 1+ cases, ,; <8, #ol$%lobulie #ol$%lobulie 21 cases, 11,2; 11,2; <8, chronic chronic renal insufficienc$ 0 cases, 21,5 <8, cancer cases, ,+ <8. 9e ha'e taken into consi!eration also the !imension of the affecte! cerebral territor$, as &ell as the muscular !eficienc$ cause! b$ it 12+ cases, ,1+< &ith lar%e territor$ affecte! affecte! an! total total muscular muscular !eficienc$ !eficienc$ an! + cases, ++,:< ++,:< &ith small territor$ territor$ affecte! an! #artial #artial muscular !eficienc$ or not at all8. After 1 !a$s of kinetothera#$ an! a##ro#riate treatment, 112 cases, 0,21 < ha! a fa'orable reco'er$, 50 cases, 2, < remaine! stationar$ an! 2 cases, 12,;0 < !ie!. Conclusions Conclusions.. Incorrectl$ treate! atrial fibrillation causes lots of ischemic strokes no&a!a$s, es#eciall$ in &omen bet&een :03:; $ears ol!, associate! &ith 'arious risk factors. Strokes lea! to !e#ression an! social !isabilit$, there>s &h$ kinetothera#$ initiate! in hours after the stroke onset an! continue! till months has an im#ortant role in the rehabilitation of the muscular !eficiencies an! "ualit$ of life. Key Words: Words:?inetothera#$ ?inetothera#$,, stroke, atrial fibrillation, anti#latelet@ anticoa%ulant thera#$. Introduction Atrial fibrillation is a 'er$ commonl$ heart arrh$t arrh$thmi hmiaa &hich &hich can be #aro6$ #aro6$sma smal, l, #ersis #ersisten tentt or #ermanent. 4an be !ia%nose! at normal #atients es#eciall$ after stress, sur%ical inter'entions, effort or alcoholic alcoholic into6icat into6ication. ion. Also h$#o6ia, h$#o6ia, h$#erca#nia h$#erca#nia or metabolic metabolic an! hemo!$nami hemo!$namicc !isturbanc !isturbances es can lea! to this arrh$thmia. arrh$thmia. ermanent ermanent atrial fibrillat fibrillation ion can be #ro!uces b$ 'arious car!io#athies reumatismal, nonreu nonreumat matism ismal' al'al' al'ula ulars, rs, h$#ert h$#ertensi ensi'e, 'e, )4B8, )4B8, t$reoto6icit$ A'ram A'ram at al, 2008. It is &ell &ell kno&n kno&n that that #acien #acients ts &ith &ith atrial atrial fibrillation ha'e of a hi%her risk of thromboembolism causin% es#eciall$ strokes &ith a hi%h im#act in the "ual "ualit it$ $ of life. life. ati atien ents ts &ith &ith #aro #aro6$ 6$sm smal al atri atrial al fib fibril rillation e6#e 6#erience nce a similar risk of thromboembolism com#are! to #atients &ith #ersistent atrial fibrillation. herefore, consensus %ui!elines
recommen! recommen! anticoa%ulant anticoa%ulant thera#$ in those at risk for thromboemb thromboembolism olism irres#ecti' irres#ecti'ee of atrial atrial fibrillat fibrillation ion classification Csu et al, 2018. -ot all #atients &ith atrial fibrillation can recei'e anticoa%ulant thera#$ because of the associate! #atholo%ies or hi%h risk of blee!in%. here is &h$ the$ are treate! onl$ &ith anti#latelet thera#$. he #ur#ose of our stu!$ &as to com#are the #re'alence of acute strokes cause! b$ atrial fibrillation !e#en!in% on the anti#latelet@anticoa%ulant thera#$. Acute Acute strokes strokes re#resent re#resentss one of the main causes of mortalit$ an! morbi!it$ in the &orl!. he most common substrate for cerebral embolism in ol!er #atients is atrial fibrillation. here are also a lot of r isk facto factors rs such such as h$#e h$#ert rten ensi sion on,, !iab !iabet etes es mell mellit itus, us, 'al'ul 'al'ulo#a o#athi thies, es, caroti caroti! ! stenos stenosis, is, !iffus !iffusee caroti caroti! ! atheromatosi atheromatosis, s, !$sli#i!emi !$sli#i!emia, a, obesit$ obesit$,, chronic chronic renal insufficienc$, insufficienc$, #ol$%lobulie, cancer&hich, associate!
1
De#artment of -eurolo%$, Uni'ersit$ of e!icine an! harmac$ Victor )abesF, imisoara, RBA-IA
2
De#artment of 4ar!iolo%$, Uni'ersit$ of e!icine an! harmac$ Victor )abesF, imisoara, RBA-IA Email a!!ressG a%o%uH$ahoo.com a%o%uH$ahoo.com Recei'e! 25.10.201 @ Acce#te! 21.11.201
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Ovidius University Annals, Series Physical Education and Sport / SCIENCE, MOVEMENT AN !EA"T! !EA"T! Vol. XV, ISSUE 1, 2015, Romania The #ournal is i nde$ed in% E&sco, SPO'Tiscus, INE( COPE'NICUS )OU'NA" MASTE' "IST, OA) I'ECTO'* O+ OPEN ACCES )OU'NA"S, )OU'NA"S, Ca&y, ale Cen-ace "earnin-, Ca&ell.s irectories
&ith atrial fibrillation, raise the chan%es to !e'elo# an acute stroke. he conce#t time means brainF refers to the fact fact that that the the trea treatm tment ent of the the acut acutee strok strokee is an emer%enc$ )a(enaru 20128. he secon! im#ortant role in the reco'er$ of the #at #atients ents &ith #aral aral$s $sis is #la #la$s the earl arl$ kinetothera#$.It shoul! be initiate! in hours after the stroke onsetan! continue! till si6 months because the most ra#i! reco'er$ takes #lace in the first fe& &eek &eekss an! an! then then the the lar% lar%es estt amou amount nt of reco' reco'er er$ $ occurre! &ithin the first three to si6 months.
In'esti%ationsG Electrocar!io%ram E478G for each #atient &e ha'e ma!e a first E47 in the Emer%enc$ Unit an! another one later. All of them ha! atrial fibrillation at a!mission. -ati'e 4om#uter omo%ra#h$ omo%ra#h$ 48 ma!e in the emer%enc$ sho&e! us either the e6actl$ lesions or onl$ in!irect si%ns, but &e coul! e6clu!e hemorrha%es. 4aroti 4aroti! ! ultra ultrasou soun! n! &as use! use! to !ia%no !ia%nose se caro carotti! sten stenos osiis an! !if !iffuse fuse caro carotti! atheromatosis Echoca!io%ra#h$ &as util to !ia%nose 'arious 'al' 'al'ul ulo#a o#ath thie ies, s, #rost #rosthe heti ticc hear heartt 'al' 'al'es es,, car!iom$o#ath$, car!iom$o#ath$, atrial trombi 4erebral RI &as useful for us to !isco'er the e6act lesions or to monitore! the lesions alrea!$ sho&e! in the cerebral 4 )loo! #ressure measurement )loo! oo! test estsG 4)4, )4, %l$c %l$cae aem mia, total otal cholesterol, creatinine
Material and ethods atientsG )et&een *anuar$ 201+ -o'ember 201 &e hos#itali/ hos#itali/e! e! on emer%enc$ emer%enc$ 1 #atients #atients &ith acute ischemic stroke cause! b$ !eficient treatment of the atrial atrial fibril fibrillat lation ion.. he !emo%r !emo%ra#h a#hic ic !ata, !ata, clinic clinical, al, ima%istic ima%istic cerebral34 cerebral34,, cerebral3RI, cerebral3RI, e6tracrania e6tracraniall ultrasoun!, minimum t&o E47s, Echocar!io%ra#h$8, #araclinic!ata, as &ell as risk factors h$#ertension, !iabetes !iabetes mellitus, mellitus, 'al'ulo#athi 'al'ulo#athies, es, caroti! caroti! stenosis, stenosis, !iffuse !iffuse caroti! caroti! atheromato atheromatosis, sis, !$sli#i!em !$sli#i!emia, ia, obesit$ obesit$,, chroni chronicc renal renal insuff insuffici icienc enc$ $, #ol$%l #ol$%lobu obulie lie,, cancer8 cancer8,, treatment, kinetothera#$ &ere all consi!ere!.
'esults 9e stu!ie! 1 #atients, 12: females an! 5; males ,2 < 'ersus +1,:2 < 8. i%.1.8
i%.1. Distribution of cases accor!in% to se6
ost ost of of the the #ati #atient entss are are &it &ith h #erma #ermanen nentt atri atrial al fibri fibrill llat atio ion n 1:2 1:2 cas cases es,, ;2, ;2,: : <8, <8, 12+ 12+ fema female les, s, :1, :1,51 51 < an! ; males, 2,; < an! onl$ 1 cases, :,5+ < are
&ith &ith #aro6 #aro6$sm $smal al atrial atrial fibril fibrillat lation ion,, female females, s, 2, 2, < an! an! mal males es,, 5:,1 5:,1 <. i% i%.2 .2.8 .8
i%.2. Distribution of the cases accor!in% to atrial fibrillation t$#e
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Ovidius University Annals, Series Physical Education and Sport / SCIENCE, MOVEMENT AN !EA"T! !EA"T! Vol. XV, ISSUE 1, 2015, Romania The #ournal is i nde$ed in% E&sco, SPO'Tiscus, INE( COPE'NICUS )OU'NA" MASTE' "IST, OA) I'ECTO'* O+ OPEN ACCES )OU'NA"S, )OU'NA"S, Ca&y, ale Cen-ace "earnin-, Ca&ell.s irectories
he bi%%est number of our cases &ere treate! &ith anti#latelet thera#$ for atrial fibrillation cases, :, +1 <8, follo&e! b$ anticoa%ulant thera#$ :: cases, 1, <8, anti#latelet = anticoa%ulant thera#$ 1 cases,
:,5+ <8, !ual anti#latelet thera#$ 5 cases, 2,; <8, !ual anti#latelet = anticoa%ulant thera#$ 2 cases, 1,0: <8. i%.+.8
i%.+. Distribution of the cases accor!in% to anti#latelet@anticoa%ulant anti#latelet@anticoa%ulant thera#$
Acco Accor!i r!in% n% to the a%e a%e %rou %rou#, #, the hi%h hi%hes estt fre"uenc$ of ischemic stroke is bet&een :03:; $ears ol! ol! : : cas cases es,, 1, 1,; ; <8, <8, fol follo lo&e &e! ! b$ 03 03; ; $ear $earss ol! ol!
52 52 case cases, s, 2:,; 2:,; <8, <8, 03; 03; $ear $earss ol! ol! +: cases cases,, 1;, 1;,; ; <8, 5035; $ears ol! 1+ cases, ,;; <8 an! ;03;; $ears ol! ol! case cases, s, +,22 +,22 <8. <8. i i%. %.. .88
i%.. Distribution of the cases accor!in% to a%e %rou#s
90
78
80 70 60
52
50
Number
37
40
of cases
30 20 10
13
6
0 50-59 years 60-69 years 70-79 years 80-89 years 90-98 years
ore ore than than 50 < ha! an ina##ro#riate international normali/e! ratio. ratio. ore ore e6actl e6actl$ $ #atients from + &ith !icuma !icumarin rinic ic treatm treatment ent 5:,+< 5:,+<8, 8, 2 female femaless 'ersus 5,++ < an! 20 males 'ersus 1, <. Valves &ere insu<
an! 1 male 'ersus 20 <8, caroti! stenosis cases, +,22
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Ovidius University Annals, Series Physical Education and Sport / SCIENCE, MOVEMENT AN !EA"T! !EA"T! Vol. XV, ISSUE 1, 2015, Romania The #ournal is i nde$ed in% E&sco, SPO'Tiscus, INE( COPE'NICUS )OU'NA" MASTE' "IST, OA) I'ECTO'* O+ OPEN ACCES )OU'NA"S, )OU'NA"S, Ca&y, ale Cen-ace "earnin-, Ca&ell.s irectories
)ut 1: cases, ;,: < ha! also hypertension 11: females 'ersus :0,0 < an! 50 males 'ersus 2;,; <8 an! cases, 2,:+
chronic chronic renal insu<
i%.5. Distribution of the cases accor!in% to risk factors 180 160 140 120 100 80 60 40 20
0
167
66 46
40
39
Number of Cases
9e ha'e ha'e taken taken into into consi! consi!era eratio tion n also also the !imension of the affecte! cerebral territor$, as &ell as the muscul muscular ar !eficie !eficienc$ nc$ cause! cause! b$ it G12+ G12+ cases, cases, ,1+< ;0 females 'ersus :+,1: < an! ++ males 'ersus 2,+ <8 &ith lar%e territor$ affecte! an! total
muscular !eficienc$ an! + cases, ++,:< +: females 'ersus 5,:+ < an! 2 males 'ersus 1,2: <8 &ith small territor$ affecte! an! #artial muscular !eficienc$ or not at all8. i%..8
i%.. Distribution of the cases accor!in% to !imension of the territor$ affecte!
33.87%
Large territory
66.13%
After 1 !a$s of kinetothera#$ an! a##ro#riate trea treatm tmen entt 112 case cases, s, 0,2 0,21 1 < ha! ha! a fa' fa'or orab able le reco reco'e 'er$ r$,,
50 cases, 2, < remaine! stationar$ an! 2. cases, 12,; 12,;0 0 < !ie! !ie!..
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Ovidius University Annals, Series Physical Education and Sport / SCIENCE, MOVEMENT AN !EA"T! !EA"T! Vol. XV, ISSUE 1, 2015, Romania The #ournal is i nde$ed in% E&sco, SPO'Tiscus, INE( COPE'NICUS )OU'NA" MASTE' "IST, OA) I'ECTO'* O+ OPEN ACCES )OU'NA"S, )OU'NA"S, Ca&y, ale Cen-ace "earnin-, Ca&ell.s irectories
i%.:. Distribution of the cases accor!in% to #r o%nostic
60.21%
e!o!ere"
#ta$oary
&eat's
0.00%
26.88%
12.90%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
:inetotherapy -eurorehabilitation is a com#le6 me!ical #rocess &hose #ur#ose is to minimi/e or to com#ensate alterations resultin% from a brain in(ur$. in(ur$. In the the neur neurore oreha habi bili lita tati tion on #roce #rocess ss is not not onl$ onl$ the the kineto kinetothe thera# ra#ist ist im#li im#lie!, e!, but also also the famil famil$ $ of the #atient. A #articular focus is %i'en to im#ro'in% mobilit$ an! stren%th, as this is the ke$ to a #ersonKs in!e#en!ence. Rehabilitation of stroke #atients, is a com#le6 chain of consistent consistentl$ l$ con!ucte! con!ucte! me!ical an! social measures measures aime! at rehabilita rehabilitation, tion, health or #ossible #ossible a!a#tation to self3ser'ice in the #resence of a #ersistent neurolo%ica neurolo%icall !efect. !efect. Alrea!$ in acute stroke #atient #atient nee!s not onl$ to !ru% thera#$ an! care, but also in the emotional an! #s$cholo%ical su##ort for the t$#e of Lcauti Lcautious ous o#timi o#timism. sm.LL It shoul! shoul! be e6#lai e6#laine! ne! to the #atient a tem#orar$, tem#orar$, re'ersible nature of its e6istin% motor. 9ith relati'es #atient shoul! !iscuss the real situation, situation, #ro%nosis, #ro%nosis, rehabilita rehabilitation tion o##ortunit o##ortunities, ies, the nee! for hos#itali hos#itali/ation /ation or a##ro#riate a##ro#riate treatment treatment at home, #ut them in front of clear ob(ecti'es for the near future urashko, 20128. Im#air Im#aire! e! motor motor functi function on after after stroke stroke is a ma(or cause of !isabilit$ in $oun% stroke sur'i'ors. he #lasti #lasticit cit$ $ of the a!ult a!ult human human brain brain #ro'i! #ro'i!es es o##ort o##ortuni uniti ties es to enhanc enhancee tra!it tra!ition ional al rehabil rehabilita itatio tion n #ro%rams for these in!i'i!uals. Moun%er stroke #atients a##ear to ha'e a %reater abilit$ to reco'er from stroke an! are likel$ to benefit substantiall$ from treatments that facilitate #lasticit$3me!iate! reco'er$ Stein, 2008. A##ro6i A##ro6imat matel$ el$ one3th one3thir! ir! of #atien #atients ts &ith &ith stroke stroke e6hibi e6hibitt #ersis #ersisten tentt !isabi !isabili lit$ t$ after after the initia initiall cerebro cerebro'as 'ascul cular ar e#iso! e#iso!e, e, &ith &ith motor motor im#ai im#airme rments nts accountin% for most #oststroke !isabilit$. E6ercise an! trainin% ha'e lon% been use! to restore motor function after stroke. )etter trainin% strate%ies an! thera#ies to enhance the effects of these rehabilitati'e #rotocols are
currentl$ currentl$ bein% !e'elo#e! for #oststroke #oststroke !isabilit !isabilit$ $ Dim$an, 4ohen, 20118 iscussions Atri Atrial al fibr fibril illa lati tion on is a !e'as !e'asta tati tin% n% heart heart arrh$thmia, arrh$thmia, &hich incorrectl incorrectl$ $ treate!, treate!, an! associate! associate! &ith &ith other other risk risk factor factorss can #ro!uc #ro!ucee seriou seriouss brain brain !ama%e !ama%es. s. he conse" conse"uenc uences es of these these !ama%e !ama%ess are !ecreasin% si%nificant the "ualit$ of life of the affecte! #atients because the$ can lea! to serious !isabilities an! loss of in!e#en!ence. o a'oi! these catastro#hes,the scientists are tr$i tr$in% n% to !isc !isco' o'er er the the best best trea treatm tmen entt for for this this arrh$th arrh$thmi mia. a. Althou Althou%h %h a substa substanti ntial al #ro#ort #ro#ortion ion of #atients &ith atrial fibrillation &ho ha'e an ischemic stroke are alrea!$ recei'in% oral anticoa%ulation. Sub3 o#tima o#timall le'els le'els of antico anticoa%u a%ulat lation ion an! a!!iti a!!itiona onall etiolo%ies e6#lain, onl$ in #art, this failure. urther research is nee!e! to hel# fin! a!e"uate thera#eutic strate%ies in atrial fibrillation #atients &ho sustain an ischemic stroke &hile recei'in% oral anticoa%ulation. he reco'er$ of the stroke #atients !e#en!s on a number of factors. irstl$ the a!e"uate me!ical treatment, treatment, secon!l$ the kinetothera kinetothera#$ #$ an! finall$ finall$ the o#timism of the #atients. Also a lot of risk factors shoul! be taken into consi!eration. ?inetothera# ra#$ shoul! ul! be !one b$ a kinetotera#ist !urin% the hos#itali/ation an! then b$ the famil$. Ce shoul! teach the #atient>s famil$ all the techni"ues nee!e! to &ork &ith each se%ment of the bo!$ an! then &ith the &hole &hole bo!$. bo!$. Definitel$ !etectin% this heart arrh$thmia is crucial for each #atient an! the correct treatment is essential essential to a'oi! a ischemic ischemic stroke. Bther&ise, Bther&ise, the cons conse"u e"uen ence cess are are !e'as !e'asta tati tin% n% an! an! a bi% bi% team team of me!i me!ica call #ers #erson onal al must must &ork &ork to%e to%eth ther er for for the the neurorehabilitation of these #atients.
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Ovidius University Annals, Series Physical Education and Sport / SCIENCE, MOVEMENT AN !EA"T! !EA"T! Vol. XV, ISSUE 1, 2015, Romania The #ournal is i nde$ed in% E&sco, SPO'Tiscus, INE( COPE'NICUS )OU'NA" MASTE' "IST, OA) I'ECTO'* O+ OPEN ACCES )OU'NA"S, )OU'NA"S, Ca&y, ale Cen-ace "earnin-, Ca&ell.s irectories
Conclusions Incorrectl$ Incorrectl$ treate! treate! atrial atrial fibrillat fibrillation ion causes lots lots of ischem ischemic ic stroke strokess no&a!a no&a!a$s, $s, es#ecia es#eciall ll$ $ in &omen &omen bet&ee bet&een n :03:; :03:; $ears $ears ol!, ol!, associ associate ate! ! &ith &ith 'arious risk factors. he ischem ischemic ic stroke strokess lea! lea! to !e#ress !e#ression ion an! social social !isabi !isabilit lit$ $, there> there>ss &h$ the correct correct treatm treatment ent an! kineto kinetothe thera# ra#$ $ initi initiate ate! ! in hours hours after after the stroke stroke onset an! continue! till months has an im#ortant role in the rehabilitation of these #atients an! in the "ualit$ of life. 'e
Csu *4, 4han S, an% , et all, 201, Differences in Anti Anticoa coa%u %ula lant nt hera hera#$ #$ res rescr cri# i#ti tion on in atients atients &ith aro6$smal aro6$smal Versus ersistent ersistent Atrial ibrillation, Abstract3)ack%roun!. )a(enaru B, 2012, 7hi!uri !e Dia%nostic si ratament in -eurolo%ie, #.12. urash urashko ko -?, 2012, 2012, Sta%es Sta%es of kineto kinetothe thera# ra#$ $ an! thera#eutic massa%e for lon% time be!ri!!en #atients, Abstract Stein *, 200, otor reco'er$ strate%ies after stroke, Abstract. Dim$an A, 4ohen N7, 2011, -euro#lasticit$ in the conte6t of motor rehabilitation after stroke, Abstract.
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