Letter to the editor Can we improve stroke rehabilitation after a circadian preference study? Dear editor, Individual circadian preferences represent the rhythmic expression of biological and behavioral patterns, such as the sleep– wake cycle (1). Several physiological parameters follow this intrinsic tendency. For instance, increased body temperature near the circadian acrophase is associated with improvement in motor and cognitive performances (2). In stroke patients, the possible trend of behavioral and motor-disability oscillations during daytime has been less studied. Data indicate that morningpreferring patients with cognitive impairments performed the worst when tested in the evening (nonpreferred time) during rehabilitation (3). Motor performance also exhibits a circadian pattern. Among Correspondence: Monica Levy Andersen*, Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 925 Vila Clementino, São Paulo, SP 04024-002, Brazil. E-mail: [email protected]; [email protected] Conflict of interest: None declared. Funding: Our studies are supported by grants from Associação Fundo de Incentivo à Pesquisa (AFIP) and São Paulo Research Foundation (FAPESP) (grant #2013/14420-1 to LJK). ST and MLA received fellowships from the National Council for Scientific and Technological Development (CNPq). DOI: 10.1111/ijs.12346
© 2014 World Stroke Organization
inpatients in rehabilitation with neuromuscular disorders, longer durations of motor activity such as writing and walking were observed at 8 am, 11 am, and 11 pm (4). These findings suggest a possible influence of the circadian clock on cognitive performance and physical exercises during rehabilitation. Although the role of the circadian pattern in the onset of stroke is already well established (5), studies investigating the effectiveness of performing rehabilitation sessions during the preferred circadian time of patients after stroke are still warranted. We believe that individual circadian features could affect the motor and cognitive performances of stroke patients, influencing the time of recovery during rehabilitation. We strongly recommend that rehabilitation sessions should occur during the preferred period of stroke patients. Unfortunately, this is not always possible. Indeed, our public rehabilitation system is overloaded, and patient’s followup depends on the center’s availability. Thus, further investments and studies must be done to clarify the relationship between circadian preference and rehabilitation status in stroke patients. A rehabilitation schedule following circadian preferences may improve the stroke patient’s recovery, which could decrease treatment duration and lead to greater cost-effectiveness in the rehabilitation system.
this letter; Ms. Kim, Ms. Truksinas, Dr. Tufik, and Dr. Andersen revised it critically for important intellectual content and made substantial contributions to conception and design of the submitted article. Lenise Jihe Kim1, Eveli Truksinas2, Sergio Tufik1, Monica Levy Andersen1*, and Fernando Morgadinho Coelho1,2 1
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil 2 Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil
References 1 Adan A, Natale V. Gender differences in morningness-eveningness preference. Chronobiol Int 2002; 19:709–20. 2 Wright KP Jr, Hull JT, Czeisler CA. Relationship between alertness, performance, and body temperature in humans. Am J Physiol Regul Integr Comp Physiol 2002; 283: R1370–7. 3 Paradee CV, Rapport LJ, Hanks RA, Levy JA. Circadian preference and cognitive functioning among rehabilitation inpatients. Clin Neuropsychol 2005; 19:55–72. 4 Gueugneau N, Mauvieux B, Papaxanthis C. Circadian modulation of mentally simulated motor actions: implications for the potential use of motor imagery in rehabilitation. Neurorehabil Neural Repair 2009; 23:237–45. 5 Elliott WJ. Circadian variation in the timing of stroke onset: a meta-analysis. Stroke 1998; 29:992–6.
Author contributions Dr. Coelho drafted and made substantial contributions to conception and design of
Vol 9, October 2014, 145
145
© 2014 World Stroke Organization
inpatients in rehabilitation with neuromuscular disorders, longer durations of motor activity such as writing and walking were observed at 8 am, 11 am, and 11 pm (4). These findings suggest a possible influence of the circadian clock on cognitive performance and physical exercises during rehabilitation. Although the role of the circadian pattern in the onset of stroke is already well established (5), studies investigating the effectiveness of performing rehabilitation sessions during the preferred circadian time of patients after stroke are still warranted. We believe that individual circadian features could affect the motor and cognitive performances of stroke patients, influencing the time of recovery during rehabilitation. We strongly recommend that rehabilitation sessions should occur during the preferred period of stroke patients. Unfortunately, this is not always possible. Indeed, our public rehabilitation system is overloaded, and patient’s followup depends on the center’s availability. Thus, further investments and studies must be done to clarify the relationship between circadian preference and rehabilitation status in stroke patients. A rehabilitation schedule following circadian preferences may improve the stroke patient’s recovery, which could decrease treatment duration and lead to greater cost-effectiveness in the rehabilitation system.
this letter; Ms. Kim, Ms. Truksinas, Dr. Tufik, and Dr. Andersen revised it critically for important intellectual content and made substantial contributions to conception and design of the submitted article. Lenise Jihe Kim1, Eveli Truksinas2, Sergio Tufik1, Monica Levy Andersen1*, and Fernando Morgadinho Coelho1,2 1
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil 2 Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil
References 1 Adan A, Natale V. Gender differences in morningness-eveningness preference. Chronobiol Int 2002; 19:709–20. 2 Wright KP Jr, Hull JT, Czeisler CA. Relationship between alertness, performance, and body temperature in humans. Am J Physiol Regul Integr Comp Physiol 2002; 283: R1370–7. 3 Paradee CV, Rapport LJ, Hanks RA, Levy JA. Circadian preference and cognitive functioning among rehabilitation inpatients. Clin Neuropsychol 2005; 19:55–72. 4 Gueugneau N, Mauvieux B, Papaxanthis C. Circadian modulation of mentally simulated motor actions: implications for the potential use of motor imagery in rehabilitation. Neurorehabil Neural Repair 2009; 23:237–45. 5 Elliott WJ. Circadian variation in the timing of stroke onset: a meta-analysis. Stroke 1998; 29:992–6.
Author contributions Dr. Coelho drafted and made substantial contributions to conception and design of
Vol 9, October 2014, 145
145
