Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
Impact Factor (IF) – 1.514
Index Copernicus (ICV 2018) – 157.72
MNiSW – 40
Average rejection rate – 84.38%
ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download PDF

Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 5, August, p. 767–776

doi: 10.17219/acem/63138

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Location of the ischemic focus in rehabilitated stroke patients with impairment of executive functions

Agnieszka M. Jankowska1,A,B,C,D, Robert Klimkiewicz1,B,C, Anna Kubsik1,B,C, Paulina Klimkiewicz1,B,C, Janusz Śmigielski2,C, Marta Woldańska-Okońska1,E,F

1 Department of Rehabilitation and Physical Medicine, WAM University Hospital, Łódź, Poland

2 Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Poland


Background. Executive dysfunctions are part of the clinical symptoms of a stroke and can inhibit the process of rehabilitation. Patients with impaired executive functions may manifest aggression, impulsiveness, impaired thinking and planning.
Objectives. The aim of this study was to assess the effect of the ischemic focus location on the effectiveness of physiotherapy in improving the executive functions in patients after stroke.
Material and Methods. Ninety patients after unilateral ischemic cerebral stroke were studied. We studied 45 patients treated at the Department of Rehabilitation and Physical Medicine of the WAM University Hospital of Lodz for 5 weeks. The rehabilitation program included: kinesitherapy, physiotherapy, speech therapy, psychological consultations and psychotherapy. The control group consisted of patients who were waiting for admission to the Department of Rehabilitation. The patients in both groups were divided into three subgroups with different locations of stroke: front, back and subcortical. Executive functions were measured by the Wisconsin Card Sorting Test (WCST), the trail making test (TMT - A, TMT - B), the verbal fluency test (VFT).
Results. Patients rehabilitated in the hospital with the front and subcortical lesion location reported improvement in executive functions in terms of a greater number of the analyzed indicators of the Wisconsin Card Sorting Test (WCST) than those with the back lesion location. Patients rehabilitated at home with the subcortical lesion location did not experience a significant improvement in executive functions in any of the analyzed indicators of the Wisconsin Card Sorting Test (WCST). Most of the indicators, with the exception of the total errors of Wisconsin Card Sorting Test (WCST) and TMT B, have not been modified by the location of stroke.
Conclusion. Executive dysfunction occurs not only in patients with an anterior location of the stroke, but also in the posterior and subcortical locations. Patients with a subcortical location of the stroke require more treatment to mitigate the dysfunction.

Key words

rehabilitation, executive functions, stroke

References (15)

  1. Brola W, Fudala M, Przybylski W, et al. Profilaktyka późnych powikłań udaru mózgu. Studia Medyczne. 2008;9:21–26.
  2. Barker-Collo S, Feigin V. The impact of neuropsychological deficits on functional stroke outcomes. Neuropsychol Rev. 2006;16:53–54.
  3. Jodzio K. Neuropsychologia intencjonalnego działania. Warszawa 2008. Wydawnictwo Naukowe SCHOLAR.
  4. Pąchalska M. Rehabilitacja neuropsychologiczna. Lublin 2007. Wydawnictwo Uniwersytetu Marii Curie-Skłodowskiej.
  5. Stuss DT, Alexander MP. Executive functions and the frontal lobes: A conceptual view. Psych Res. 2000;63:289–298.
  6. Fuster JM. Executive frontal functions. Exp Brain Res. 2000;133:66–70.
  7. Jaworowska A. Test Sortowania Kart z Wisconsin WCST. Warszawa 2002. Pracownia Testów Psychologicznych Polskiego Towarzystwa Psychologicznego.
  8. Kimberg DY, D’Esposito M, Farah MJ. Cognitive functions in the prefrontal cortex – working memory and executive control. Cur Dir Psych Science. 1998;6:185–192.
  9. Kramer JH, Quitania L, Dean D, et al. Magnetic resonance imaging corelates of set shifting. JINS. 2007;13:386–392.
  10. Duncan J, Owen AM. Common regions of the human frontal lobe recruited by diverse cognitive demands. Trends in Neuroscience. 2000;23:475–483.
  11. Royall DR, Lauterbach EC, Cummings JL, et al. Executive control function: A review of its promise and challenges for clinical research. J Neuropsych Clinl Neuroscience. 2002;14:377–405.
  12. Saint-Cyr JA. Frontal-striatal circuit function: Context, sequence, and cosequence. JINS. 2003;9:103–127.
  13. Stuss DT. Frontal lobes and attention: Processes and networks, fractionation and integration. JINS. 2006;12:261–262.
  14. Jodzio K, Szurowska E, Biechowska D, et al. Funkcje wykonawcze po udarze mózgu w świetle danych testowych i neuroobrazowych. Psychologia – Etiologia – Genetyka. 2010;21:7–25.
  15. Kowalska J, Szczepańska- Gieracha J, Rymaszewska J. Zaburzenia poznawcze i objawy depresyjne a stan funkcjonalny osób starszych po udarze mózgu. Postępy Rehabilitacji. 2010;4:17–22.