Stroke is one of the leading causes of disability worldwide. Hemiplegia is the name of
the clinical condition that occurs after a stroke. It is the loss of strength in the arm,
leg and sometimes the face on one side of the body. Rehabilitation is vital to minimize
the sequelae after a stroke, and patients who undergo continuous professional and
systematic rehabilitation after the acute phase tend to recover rapidly. An important
therapeutic goal of motor recovery is to maximize neuronal plasticity and facilitate
motor tasks through motor learning during therapeutic exercise in the neurorehabilitation
of patients with motor dysfunction. In particular, intact motor-related regions of the
brain are expected to compensate for the impaired neuronal systems. Therefore,
therapeutic exercise is expected to compensate for the impaired neuronal system by
altering the (cortical) neuronal network as well as the expression of postsynaptic
receptors, presynaptic neurotransmitters, regeneration, modulation and synaptic formation
at cortical synapses. Epigenetic mechanisms regulate gene transcription based on
modifications of DNA promoter regions and histones in chromatin. Epigenetic mechanisms
include various DNA and histone modifications (i.e., methylation and acetylation of DNA
and histones). In particular, the acetylation level of specific lysine residues in
histones is one of the most powerful epigenetic modifications and is essential for
transcriptional regulation. Studies show that exercise reduces the expression and
activity of HDACs and increases histone acetylation, upregulating the expression of genes
important for neuroplasticity.
Some genes associated with neuroplasticity are:Brain-Derived Neurotrophic Factor (BDNF) ,
Cyclic adenosine monophasphate Response Element-Binding Protein (CREB1), Growth
Associated Protein 43 (GAP43), Neurotrophic Receptor Tyrosine Kinase 2 (NTRK2), Synapsin
I (SYN1).
Histone H3 Lysine 27 Acetylation (H3K27ac) plays a critical role in the epigenetic
regulation of gene expression and is associated with processes such as neuroplasticity,
memory, and learning. Various studies have shown that environmental factors such as
exercise can increase H3K27ac levels and thus support neuroplasticity.
In this study, participants with acute hemiplegia will be given the same routine
rehabilitation program. Neuroplasticity-related gene expression and histone acetylation
levels will be compared in venous blood taken from the patient before and after exercise.
In addition, the patient will be examined before and after exercise, and routine
Mini-Mental Test, Brunnstrom, Fulg-Meyer upper and lower extremity evaluation, Spasticity
evaluation with modified ashworth scale, Functional Independence Scale, ABILHAND Stroke
Hand Function Questionnaire, Stroke Impact Questionnaire, 10-meter walking test will be
performed to evaluate quality of life and motor function.