Malec JF, Kean J, Altman IM, Swick S. Mayo-Portland Adaptability Inventory: comparing psychometrics in cerebrovascular accident to traumatic brain injury. Objectives(1) To evaluate the measurement reliability and construct validity of the Mayo-Portland Adaptability Inventory, 4th revision (MPAI-4) in a sample consisting exclusively of patients with cerebrovascular accident (CVA) using single parameter (Rasch) item-response methods; (2) to examine the differential item functioning (DIF) by sex within the CVA population; and (3) to examine DIF and differential test functioning (DTF) across traumatic brain injury (TBI) and CVA samples. DesignRetrospective psychometric analysis of rating scale data. SettingHome- and community-based brain injury rehabilitation program. ParticipantsIndividuals post-CVA (n=861) and individuals with TBI (n=603). InterventionsNot applicable. Main Outcome MeasureMPAI-4. ResultsItem data on admission to community-based rehabilitation were submitted to Rasch, DIF, and DTF analyses. The final calibration in the CVA sample revealed satisfactory reliability/separation for persons (.91/3.16) and items (1.00/23.64). DIF showed that items for pain, anger, audition, and memory were associated with higher levels of disability for CVA than TBI patients; whereas, self-care, mobility, and use of hands indicated greater overall disability for TBI patients. DTF analyses showed a high degree of association between the 2 sets of items (R=.92; R2=.85) and, at most, a 3.7 point difference in raw scores. ConclusionsThe MPAI-4 demonstrates satisfactory psychometric properties for use with individuals with CVA applying for interdisciplinary posthospital rehabilitation. DIF reveals clinically meaningful differences between CVA and TBI groups that should be considered in results at the item and subscale level.

BACKGROUND Weight gain can be a consequence of stroke, or cerebrovascular accident (CVA), because of impaired mobility, behavioral and emotional disorders, and sensory losses. Weight gain increases the patient’s risk of recurrent stroke and chronic diseases, such as diabetes, metabolic syndrome, and pulmonary and heart disease. Approaches to weight loss in this population are lacking, although necessary because of the unique physiological and cognitive needs of persons after a stroke. Evidence shows that intensive behavioral therapy interventions that address both physical activity and diet offer the greatest potential for weight loss. The Group Lifestyle Balance (GLB) intervention is a 12-month, evidence-based weight loss program that has been used extensively with the general population; this program was modified to meet the needs of people who have had a stroke (GLB-CVA). OBJECTIVE This randomized controlled trial (RCT) aims to examine the efficacy of the GLB-CVA on weight and secondary outcomes, compared with that of a waitlist control group. METHODS This RCT will enroll and randomize 64 patients over an 18-month period. RESULTS Currently, 51 people are waitlisted, with 23 out of 51 screened and 16 out of 23 eligible. CONCLUSIONS It is anticipated that the findings from this RCT will contribute to the evidence base regarding weight loss strategies for people living with stroke. CLINICALTRIAL ClinicalTrials.gov NCT03873467; https://clinicaltrials.gov/ct2/show/NCT03873467. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/14338

BackgroundWeight gain can be a consequence of stroke, or cerebrovascular accident (CVA), because of impaired mobility, behavioral and emotional disorders, and sensory losses. Weight gain increases the patient’s risk of recurrent stroke and chronic diseases, such as diabetes, metabolic syndrome, and pulmonary and heart disease. Approaches to weight loss in this population are lacking, although necessary because of the unique physiological and cognitive needs of persons after a stroke. Evidence shows that intensive behavioral therapy interventions that address both physical activity and diet offer the greatest potential for weight loss. The Group Lifestyle Balance (GLB) intervention is a 12-month, evidence-based weight loss program that has been used extensively with the general population; this program was modified to meet the needs of people who have had a stroke (GLB-CVA).ObjectiveThis randomized controlled trial (RCT) aims to examine the efficacy of the GLB-CVA on weight and secondary outcomes, compared with that of a waitlist control group.MethodsThis RCT will enroll and randomize 64 patients over an 18-month period.ResultsCurrently, 51 people are waitlisted, with 23 out of 51 screened and 16 out of 23 eligible.ConclusionsIt is anticipated that the findings from this RCT will contribute to the evidence base regarding weight loss strategies for people living with stroke.Clinical TrialClinicalTrials.gov NCT03873467; https://clinicaltrials.gov/ct2/show/NCT03873467

Abstract Background: Stroke or Cerebrovascular Accident (CVA) is a primary neurologic problem in the United States and in the World. There are approximately 2 million people surviving from strokes that have a disability of 40% need help in daily activities (Brunener & Suddarth, 2002). The restoration of the functioning of the limbs and the ability to move within a community is a top priority for individual adoption after experiencing CVA. Ankle Foot Orthosis (AFO) can be used by someone with a CVA hemiparetic to help restrain ambulation abilities. AFO can prevent drop foot, controls the ankle in the coronal and sagittal areas during standing and walking and improves the stability of the knee during ambulation. Method: This research use cross sectional study method to find out what happened now by using correlative design design research. The researcher discusses the strength of the relationship between variables that is dynamic balance in drop foot because CVA, when using AFO Flexible. This data is obtained from direct measurement of dynamic balance of Flexible AFO users using Time up and go Test. Results :Differences in the effect of AFO on the dynamic balance of Hemiaretic Cerebrovascular Accident (CVA) patients in the intervention and control group. The results showed the average dynamic balance of hemiaretic cerebrovascular accident patients in the intervention group (28.20) while the mean equilibrium was maintained in the control group (12.80). The result of statistical test with man whitney showed p value 0,000 <0,05 so there was difference of influence of AFO use to dynamic balance of Hemiaretic Cerebrovascular Accident (CVA) patient in intervention group and control group. This means that the more frequently the patient uses AFO in daily activities it can improve the optimal dynamic balance and can perform activities independently. Conclusion: There is a difference in the effect of AFO on the dynamic balance of Hemiaretic Cerebrovascular Accident (CVA) patients in the intervention and control group with p value 0,000 <0.05.

Background: Stroke or cerebrovascular accident (CVA) is noted as the second cause of mortality, especially in the elderly population. Recent studies indicated that higher concentrations of uric acid are involved in various vascular diseases. The findings of previous investigations suggest that, elevated serum alkaline phosphatase (ALP) levels may have a pathophysiological character in the occurrence of atherosclerotic vascular disease (AVD) of the heart and brain. This study evaluated the association between serum uric acid (SUA) levels, serum lipid levels, serum alkaline phosphatase (ALP) levels, and changes in ischemic cerebrovascular accident patients.Methods: All patients with Ischemic cerebrovascular accident age >50 years were included based on their clinical, laboratory, and radiological findings (including computed tomography (CT)/magnetic resonance imaging (MRI)) those admitted in our hospital. As control group 200 healthy individuals matched for sex and age were recruited from the same demographic area.Result: Multiple logistic regression analysis findings proposed four components as significant predictors in ischemic cerebrovascular accident (serum uric acid, serum ALP, LDL and HDL. In this study, it was found, that patients with ischemic cerebrovascular accident had significant difference (p<0.001) in serum uric acid and serum ALP than normal patients (non-ischemic cerebrovascular accident patients).Conclusions: Patients with ischemic cerebrovascular accident had significant difference (p<0.001) in SUA and serum ALP than normal patients (non-ischemic cerebrovascular accident patients). High SUA levels were observed to be associated significantly with ischemic stroke. On the basis of our study design, we cannot clarify that the elevated levels are the risk of ischemic stroke and it requires further studies.

Background: Cerebrovascular accident (CVA) or stroke is a leading cause of morbidity and mortality worldwide. The aim of the study is to document the retinal abnormalities in patients with CVA seen in a tertiary hospital. Materials and Methods: The retina of patients aged ≥18 years with CVA occurring within 1 year managed in a tertiary hospital were examined from October to December 2013 and the findings recorded. Patients with prior history of ocular trauma and unconscious stroke patients were excluded. Data were analyzed with Statistical Package for the Social Sciences (SPSS) version 20 and P < 0.05 was taken as significant. Results: A total of 85 patients comprising 61 (71.8%) males and 24 (28.2%) females were seen. The mean age was 66.1 ± 11.0 years (range: 43-88 years), out of which 57 (67.1%) were ≥60 years. There were 67 (78.8%) and 18 (21.2%) cases of ischemic and hemorrhagic stroke, respectively. Hypertension was the most common predisposing factor of stroke in 95.3% of the patients. Abnormalities in the retina background included hemorrhages in 18 (10.6%) eyes, hard exudates and cotton wool spots in 13 (7.8%) and 4 (2.4%) eyes respectively. Retinal vascular abnormalities were documented in 55 (32.4%) eyes. There were more abnormalities in the retina vasculature of patients with hypertension, diabetes mellitus (DM), and hyperlipidemia than in patients without these conditions (P < 0.50). There were also more abnormalities in the background retina of the diabetics when compared to the nondiabetics (P = 0.02). Conclusion: Regular ophthalmic evaluation of patients with predisposing risk factors for CVA with early detection of ocular manifestations/complications of the disease could help modify treatment to prevent or limit more untoward and debilitating effects such as stroke.

Background: Cerebrovascular accident (CVA) is also called Stroke. These is a well-recognized epidemiological link between elevated serum uric acid and increased cerebrovascular risk. Several studies have identified as elevated serum uric acid concentration as a predictor of cerebrovascular events. The aim of this study was to correlate serum uric acid in cerebrovascular accident (CVA) patients with Hypertension.Methods: A prospective study was conducted on 100 patients aged &gt;18 years of admitted with new onset focal/global neurological deficit/event with cerebrovascular accident (CVA). Brain imaging (CT/MRI) was performed on the patients within 24-48 hrs of admission. Data was collected with regards to patient’s demography, medical history, risk factors for stroke or vascular disease. Serum uric acid was measured as part of fasting biochemical profile taken within 24-48 hrs of admission by standard analytical methods in Biochemistry department.Results: Out of 100 patients included in this study 74 of them were male and 26 were female. Among 100 patients 61 patients had hemorrhage, out of which 45 (73.77%) were male and 16 (26.23%) were female, followed by 39 patients had infract, out of which 29 (74.35%) were male and 10 (25.65%) were female. Mean value of serum uric acid levels in hypertensive patients was significantly high in comparison to normotensive patients.Conclusions: Concluded that correlation of serum uric acid in cerebrovascular accident (CVA) patients with Hypertension was found statistically significant.

Background: Cerebrovascular accident (CVA) is a problem that refers to a group of conditions that affect the circulation of blood to the brain. The objective of this study was to identify factors related to cerebrovascular accident patients in the Ayder Comprehensive Specialized Hospital. Method: A retrospective cohort study design was conducted in the Ayder Comprehensive Hospital from January 2015 to August 2016 and followed for a total of 20 days during the admission period. Data was collected from a database of electronic medical records and medical charts using a structured data extraction tool. Kaplan-Meier, log rank test and Cox-proportional hazard regression were used. STATA V.13 program was used for data entry, cleaning and analysis. Result: From 292 CVA case patients, 42(14.4%) died and (80.95%) were died with in the 7 days of hospital stay and their median survival time was also 7 days. Factors associated with CVA mortality were: positive history of hypertension (HR=4.8, 95%, CI= 1.486 – 16.018), positive history of diabetes mellitus (HR=2.0, 95%, CI= 1.086 – 3.789), Stroke sub type as haemorrhagic (HR= 2.1, 95%, CI= 1.070 – 4.160), admitted in intensive care unit (HR= 2.48, 95%, CI= 1.166 -5.306) and increased age (HR= 5.1, 95%, CI= 1.725 – 15.487) Conclusion: The risk rate of patients at an earlier time was high, and there was more death in the intensive care unit than any other medical wards. Hypertension was the most common risk factor for both types of cardiovascular accidents. Ischemic stroke subtype, diabetes mellitus and rising age were also associated survival factors.

Cerebrovascular Accident (CVA), the third most common cause of death in developing countries, is the term used to describe episodes of focal brain dysfunction due to focal ischemia or hemorrhage. Acute stroke is characterized most commonly by hemiplegia with or without signs of focal higher cerebral dysfunction that has posed a great problem as far as its management is concerned. Ayurveda can help in such conditions. A 54 years old male patient diagnosed with non-hemorrhagic infarct presented with right side hemiplegia and difficulty in speech was admitted in IPD. This manifestation was compared with Kaphavrita dakshina pakshaghata. Panchakarma procedures including Rookshana, Snehana and Virechana were adopted along with other internal medicines. Assessments were made using National Institute of Health Stroke Scale (NIH-SS), Barthel Index (BI) and Modified Rankin Scale (MRS). At the end of the treatment, there was considerable improvement in the subjective and objective clinical features. The observations reveal that, Panchakarma procedures can play a key role in the management of conditions like CVA. The treatment strategies followed in this study can be safely adopted under the supervision of a trained Ayurveda specialist.

Abstract Cerebrovascular Accident (CVA) is the second leading cause of death in the world while also being the plurality cause of disability in adults. A definitive factor for survivability and successful recovery of a patient is the time passage from the onset of symptoms to the administration of medical treatment. This paper introduces Stroke Help, a mobile application utilizing various mobile technologies together with Artificial Intelligence algorithms in order to quickly detect CVA in either the user or someone the user is concerned about. The application implements the well known F.A.S.T. test making use of real-time face detection, speech recognition, and other artificial intelligence techniques applied over common sensors found in modern mobile phones. In addition of detecting whether there is a high probability a patient is suffering from a stroke, the application will calculate an approximated Japan Urgent Stroke Triage (JUST) score utilized in identifying the specific type of stroke, very important information for medical staff to potentially reduce the time required to evaluate the patient before beginning the appropriate treatment. We will also present additional crucial functionalities such as notifying contacts, identifying the closest clinics capable of treating CVA, making our solution a complete approach.