Chronic Stroke Research Articles

Evaluating the reliability and validity of a Chinese version of the performance-oriented mobility assessment among patients with chronic stroke

BackgroundThe Performance-Oriented Mobility Assessment (POMA) is a reliable instrument for evaluating the mobility (balance and gait) of patients with chronic stroke to manage their risk of falling; however, it has not been validated among Chinese patients with stroke. This study aimed to evaluate the reliability and validity of the Chinese POMA in patients with stroke.MethodsThe POMA was applied to volunteer patients with stroke from the Shanghai MCC Hospital. The patients underwent the Chinese POMA, Berg balance scale (BBS), and timed up and go (TUG) tests on the first day of inpatient treatment. The same physician repeated the tests the next day to assess test–retest reliability, and upon the patient’s discharge from the inpatient department, two different physicians measured inter-rater reliability.ResultsThe study involved 76 patients with stroke (age: 62.04 ± 9.76 years; 34.2% female). The results showed that the Chinese POMA had good overall internal consistency (σ=. 875), with a moderate consistency between its two subscales (balance σ = 0.875; gait σ = 0.668). The individual items showed high test–retest (ICC = 0.997) and inter-rater reliability (ICC = 0.988). The content validity test showed high correlations between the Chinese POMA, the BBS (rs = 0.70), and the TUG (rs = −0.75). However, the confirmatory factor analysis suggested that the two-factor model (balance and gait) was mediocre.ConclusionThe Chinese POMA showed acceptable reliability and validity for evaluating mobility (balance and gait) in Chinese patients with stroke in terms of their risk of falling. However, further evaluation of the two-factor model (balance and gait) is required.

Transplantation of human neural stem cells repairs neural circuits and restores neurological function in the stroke-injured brain

Exogenous neural stem cell (NSC) transplantation has become one of the most promising treatment methods for chronic stroke. Recent studies have shown that most ischemia-reperfusion model rats recover spontaneously after injury, which limits the ability to observe long-term behavioral recovery. Here, we used a severe stroke rat model with 150 minutes of ischemia, which produced severe behavioral deficiencies that persisted at 12 weeks, to study the therapeutic effect of neural stem cells on neural restoration in chronic stroke. Our study showed that stroke model rats treated with human neural stem cells had long-term sustained recovery of motor function, reduced infarction volume, long-term human neural stem cell survival, and improved local inflammatory environment and angiogenesis. We also demonstrated that transplanted human neural stem cells differentiated into mature neurons in vivo, formed stable functional synaptic connections with host neurons, and exhibited the electrophysiological properties of functional mature neurons, indicating that they replaced the damaged host neurons. The findings showed that human fetal-derived neural stem cells had long-term effects for neurological recovery in a model of severe stroke, which suggests that human neural stem cells-based therapy may be effective for repairing damaged neural circuits in stroke patients.

Mesenchymal Stem Cell Therapy to Reduce the Neurological Deficit of Chronic Ischemic Stroke Patients: A Systematic Review

Current ischemic and hemorrhagic stroke treatments are limited by a narrow golden period and lack of regenerative benefits, so stem cell therapy emerges as an ideal candidate for functional recovery in stroke patients. Stem cell therapy, still being studied, is expected to repair ischemic areas damaged by stroke to restore their physiological functions and reduce neurological deficits in chronic stroke patients. This study aimed to determine the therapeutic efficacy of MSCs in reducing neurological deficits in chronic ischemic stroke patients. We conducted a systematic review. We searched PubMed, Cochrane Library, Science Direct, and Springer Link from inception until December 2022 for cohort studies dealing with mesenchymal stem cell therapy for patients with ischemic stroke. The citation-searching method in this study collected 1,038 articles using the advanced searching method and 8 articles using the citation-searching method, bringing the total number of articles to 1,046. The exclusion criteria used were articles with systematic reviews and meta-analyses and articles that were not accessible in full text. Based on the results of a systematic review study conducted, the conclusion that can be drawn is that MSCs therapy has proven effective in reducing neurological deficits in chronic ischemic stroke patients in terms of the decreased NIHSS score.

Sequence variants associated with BMI affect disease risk through BMI itself

AbstractMendelian Randomization studies indicate that BMI contributes to various diseases, but it’s unclear if this is entirely mediated by BMI itself. This study examines whether disease risk from BMI-associated sequence variants is mediated through BMI or other mechanisms, using data from Iceland and the UK Biobank. The associations of BMI genetic risk score with diseases like fatty liver disease, knee replacement, and glucose intolerance were fully attenuated when conditioned on BMI, and largely for type 2 diabetes, heart failure, myocardial infarction, atrial fibrillation, and hip replacement. Similar attenuation was observed for chronic kidney disease and stroke, though results varied. Findings were consistent across sexes, except for myocardial infarction. Residual effects may result from temporal BMI changes, pleiotropy, measurement error, non-linear relationships, non-collapsibility, or confounding. The attenuation extent of BMI genetic risk score on disease associations suggests the potential impact of reducing BMI on disease risk.

Abstract 4119428: Monosialoganglioside-containing nanoliposomes protect against acute and chronic ischemic stroke injury

Background: Stroke remains a leading cause of mortality and disability. The narrow temporal window and limited availability of, and eligibility for thrombolytic therapy or endovascular thrombectomy are major therapeutic limitations in treating stroke. Neuroprotective therapies that could be given early to replace or augment these existing therapies are needed to improve stroke outcomes. We showed that monosialoganglioside (GM1) containing nanoliposomes composed of phosphatidylcholine, cholesterol and GM1 (70/25/5% molar ratios, NLGM1) protect against hypoxic injury likely through Nrf2-dependent upregulation of antoxidant enzymes. Aims: To test if post-occlusion NLGM1 treatment could reduce 1) acute stroke injury following middle cerebral artery occlusion (MCAO) and 2) chronic injury following photothrombotic (PT) stroke injury. Methods: 20 week old C57BL/6 mice underwent MCAO for 60 minutes and then injected with saline or NLGM1 (1 or 2 mg IV) prior to reperfusion. Neurologic deficit score and brain infarct % area were measured the next day. Separately, mice underwent PT injury followed by injection of saline or NLGM1 (1 or 2 mg immediately and 2 hours post-injury) and cognitive/behavior tests done 1-90 days post injury. Results: Following MCAO, there was reduced neurologic impairment, infarct volume and brain edema with NLGM1 versus saline control (Fig. 1). Following PT injury, there was reduced neurologic, cognitive and motor impairment from Day 2-90 post-injury with NLGM1 versus saline control (Fig. 2). In both stroke models, there was no difference in efficacy between 1 and 2 mg NLGM1 doses. Conclusions: Treatment of mice with NLGM1 following MCAO or PT stroke injury resulted in improved structural (infarct size, edema) and functional (cognitive, behavior, motor) outcomes in the acute (MCAO) and chronic (PT) timeframes. NLGM1 is a potential novel therapeutic agent for stroke.

ATIVIDADE E PARTICIPAÇÃO SOCIAL: ANÁLISE DE CORRELAÇÃO EM PACIENTES HEMIPARÉTICOS CRÔNICOS

The International Classification of Functioning, Disability and Health (ICF) defines activities as actions performed by an individual, while social participation refers to involvement in life situations. The use of participation assessment questionnaires allows investigating the impact of these chronic conditions on functionality. In this cross-sectional study, ten individuals with chronic stroke sequelae were recruited. Activity and social participation were assessed using the Brazilian version of the Assessment of Life Habits 3.1. The results showed that nutrition-related activities had a significant positive correlation with community living (rs=0.7, p=0.02) and recreation (rs=0.7, p=0.01), while personal care and housing correlated significantly with responsibility (rs=0.6, p=0.02). Housing had a positive correlation with employment (rs=0.6, p=0.02) and recreation (rs=0.7, p=0.02). The positive correlations observed in this study suggest that better performance in activities is associated with better levels of social participation.

How Can Graph Theory Inform the Dual-stream Model of Speech Processing? A Resting-state Functional Magnetic Resonance Imaging Study of Stroke and Aphasia Symptomology

Abstract The dual-stream model of speech processing describes a cortical network involved in speech processing. However, it is not yet known if the dual-stream model represents actual intrinsic functional brain networks. Furthermore, it is unclear how disruptions after a stroke to the functional connectivity of the dual-stream model's regions are related to speech production and comprehension impairments seen in aphasia. To address these questions, in the present study, we examined two independent resting-state fMRI data sets: (1) 28 neurotypical matched controls and (2) 28 chronic left-hemisphere stroke survivors collected at another site. We successfully identified an intrinsic functional network among the dual-stream model's regions in the control group using functional connectivity. We then used both standard functional connectivity analyses and graph theory approaches to determine how this connectivity may predict performance on clinical aphasia assessments. Our findings provide evidence that the dual-stream model of speech processing is an intrinsic network as measured via resting-state MRI and that functional connectivity of the hub nodes of the dual-stream network defined by graph theory methods, but not overall average network connectivity, is weaker in the stroke group than in the control participants. In addition, the functional connectivity of the hub nodes predicted linguistic impairments on clinical assessments. In particular, the relative strength of connectivity of the right hemisphere's homologues of the left dorsal stream hubs to the left dorsal hubs, versus to the right ventral stream hubs, is a particularly strong predictor of poststroke aphasia severity and symptomology.

Explainable and Interpretable Model for the Early Detection of Brain Stroke Using Optimized Boosting Algorithms

Stroke stands as a prominent global health issue, causing considerable mortality and debilitation. It arises when cerebral blood flow is compromised, leading to irreversible brain cell damage or death. Leveraging the power of machine learning, this paper presents a systematic approach to predict stroke-patient survival based on a comprehensive set of factors. These factors include demographic attributes, medical history, lifestyle elements, and physiological metrics. An effective random sampling method is proposed to handle the highly biased data on strokes. Stroke prediction using optimized boosting machine-learning algorithms is supported with explainable AI using LIME and SHAP. This enables the models to discern intricate data patterns and establish correlations between selected features and patient survival. Through this approach, the study seeks to uncover actionable insights to guide healthcare practitioners in devising personalized treatment strategies for stroke patients.

Does sleep moderate the effects of exercise training or complex mental and social activities on cognitive function in adults with chronic stroke? Secondary analysis of a randomized trial.

Exercise (EX) or cognitive and social enrichment (ENRICH) are two strategies for promoting cognition post-stroke. Whether sleep moderates the effects of EX or ENRICH on cognition in adults with chronic stroke is unknown. A three-arm parallel randomized clinical trial among community-dwelling adults aged 55+ years with chronic stroke (i.e., ≥12 months since stroke). Participants were randomized to 2x/week EX, ENRICH, or balance and tone control (BAT). At baseline, device-measured sleep duration and efficiency were measured using wrist-worn actigraphy; self-reported quality was measured by Pittsburgh Sleep Quality Index (PSQI). Participants were categorized at baseline as having good or poor device-measured duration, device-measured efficiency, or self-reported quality based on PSQI. The primary cognitive outcome was Alzheimer's Disease Assessment Scale Plus (ADAS-Cog-Plus) measured at baseline, 6 months (end of intervention), and 12 months (6-month follow-up). We examined if baseline sleep categorizations (i.e., good/poor) moderated effects of EX or ENRICH on ADAS-Cog-Plus. We enrolled 120 participants in the trial (EX=34; ENRICH=34; BAT=52). Sleep quality (i.e., device-measured sleep efficiency or self-reported sleep quality) categorization moderated effects of EX (but not ENRICH) on ADAS-Cog-Plus. Compared with BAT participants with poor sleep quality, EX participants with poor sleep quality had better ADAS-Cog-Plus performance at 6 months (estimated mean difference for those with poor device-measured sleep efficiency: -0.48; 95% CI:[-0.85, -0.10]; p=0.010); estimated mean difference for those with poor self-reported sleep quality: -0.38; 95% CI:[-0.70, -0.07]; p=0.014). There was no effect of EX on ADAS-Cog-Plus for participants with good sleep quality. Device-measured sleep duration did not moderate intervention effects. Exercise is particularly beneficial in improving cognitive function in adults with chronic stroke and poor sleep quality.

The Two Faces of HDAC3: Neuroinflammation in Disease and Neuroprotection in Recovery.

Histone deacetylase 3 (HDAC3) is a critical regulator of gene expression, influencing a variety of cellular processes in the central nervous system. As such, dysfunction of this enzyme may serve as a key driver in the pathophysiology of various neuropsychiatric disorders and neurodegenerative diseases. HDAC3 plays a crucial role in regulating neuroinflammation, and is now widely recognized as a major contributor to neurological conditions, as well as in promoting neuroprotective recovery following brain injury, hemorrhage and stroke. Emerging evidence suggests that pharmacological inhibition of HDAC3 can mitigate behavioral and neuroimmune deficits in various brain diseases and disorders, offering a promising therapeutic strategy. Understanding HDAC3 in the healthy brain lays the necessary foundation to define and resolve its dysfunction in a disease state. This review explores the mechanisms of HDAC3 in various cell types and its involvement in disease pathology, emphasizing the potential of HDAC3 inhibition to address neuroimmune, gene expression and behavioral deficits in a range of neurodegenerative and neuropsychiatric conditions.

Corticospinal and corticoreticulospinal projections have discrete but complementary roles in chronic motor behaviors after stroke.

After corticospinal tract (CST) stroke, several motor deficits can emerge in the upper extremity (UE), including diminished muscle strength, motor control, and muscle individuation. Both the ipsilesional CST and contralesional corticoreticulospinal tract (CReST) innervate the paretic UE, but their relationship to motor behaviors after stroke remains uncertain. In this cross-sectional study of 15 chronic stroke and 28 healthy subjects, we examined two questions: whether the ipsilesional CST and contralesional CReST differentially relate to chronic motor behaviors in the paretic arm and hand, and whether the severity of motor deficits differ by proximal versus distal location. In the paretic biceps and first dorsal interosseous muscles, we therefore used transcranial magnetic stimulation to measure the projection strengths of the ipsilesional CST and contralesional CReST. We also used quantitative testing to measure strength, motor control, and muscle individuation in each muscle. Stroke subjects had comparable muscle strength to healthy subjects but poorer motor control and muscle individuation. In both muscles, stronger ipsilesional CST projections related to better motor control, whereas stronger contralesional CReST projections related to better muscle strength. Stronger CST projections related to better individuation in the biceps alone. The severity of motor control and individuation deficits was comparable in the arm and hand. These findings suggest that the ipsilesional CST and contralesional CReST have specialized but complementary roles in motor behaviors of the paretic arm and hand. They also suggest that deficits in motor control or muscle individuation are not segmentally biased, underscoring the functional reach and efficacy of the pathways.

Characterizing practice-dependent motor learning after a stroke.

After stroke, patients must learn to use residual motor function correctly. Consistently, motor learning is crucial in stroke motor recovery. We assessed motor performance, practice-dependent on-line motor learning, and factors potentially affecting them in stroke patients. This is a cross-sectional observational study. Twenty-six patients with first brain stroke leading to upper limb motor deficit in the subacute or chronic timeframe were enrolled. They performed a Finger Tapping Task (FTT) with both the affected and unaffected limbs. We assessed how patients learn to perform motor tasks despite the motor deficit and the differences in performance between the unaffected and affected limbs. Furthermore, by randomizing the order, we evaluated the possible inter-limb transfer of motor learning (i.e. transfer of a motor skill learned in one limb to the opposite one). Moreover, sleep, attention, anxiety, and depression were assessed through specific tests and questionnaires. Improved FTT accuracy and completed sequences for the affected limb were observed, even if lower than for the unaffected one. Furthermore, when patients initially performed the FTT with the unaffected limb, they showed higher accuracy in subsequent task completion with the affected limb than subjects who started with the affected limb. Only anxiety and attentional abilities showed significant correlations with motor performance. This work provides relevant insights into motor learning in stroke. Practice-dependent on-line motor learning is preserved in stroke survivors, and an inter-limb transfer effect can be observed. Attentional abilities and anxiety can affect learning after stroke, even if the effect of other factors cannot be excluded.

Impact of intracranial hypertension and cerebral perfusion pressure on spreading depolarization.

Spreading depolarization (SD) develops after stroke and traumatic brain injury and may contribute to secondary brain damage. These diseases are often accompanied by intracranial hypertension, but little is known about the effects of intracranial pressure (ICP) on SD. Here, we study the effect of increased ICP on hemodynamic and metabolic response to SD in rats. SDs were triggered at different ICPs and cerebral perfusion pressures (CPP). The regional cerebral blood flow (rCBF), partial pressure of brain tissue oxygen (PbtO2), cerebral extracellular glucose and lactate concentrations were recorded. Fluoro-Jade staining was used to quantify neuronal injury in cortex. At high ICP (50 mmHg) with low CPP (30 mmHg), rCBF and PbtO2 were monophasically decreased in contrast to a monophasically increased pattern under normal conditions. Neuronal death increased in both hemispheres but much more on the side where SDs were triggered. At high ICP (50 mmHg) with normal CPP (70 mmHg), CBF and metabolism during SD did not differ from baseline, and neuronal death did not increase even on the side of SD induction. These data suggest that maintaining CPP at 70 mmHg, even when the ICP is as high as 50 mmHg, preserves normal blood flow and metabolism during SD events and prevents neuronal degeneration.

Heart rate variability in chronic ischemic stroke: analysis during the sleep-wake cycle.

Alterations of the autonomic nervous system (ANS) in the chronic stage of ischemic stroke (IS) are not well understood. Heart rate variability (HRV) provides a noninvasive approach to assess autonomic function. To compare the HRV parameters during the sleep-wake cycle between patients with IS in the chronic stage and healthy subjects. We conducted a retrospective transversal study based on clinical records and 24-hour electrocardiogram (EKG) monitoring registries of 179 patients with a confirmed IS diagnosis and 184 age- and sex-matched healthy subjects. Circadian variation was calculated according to the variation of the total autonomic activity (VTAI) and the parasympathetic activity (VPAI) indexes. Comparisons were performed using nonparametric tests. Multivariable analyses were performed with canonical discriminant analysis (CDA) and a three-way analysis of variance (ANOVA). Statistical significance was established with a confidence level of 95%. During waking hours, the healthy group exhibited higher variability in the time domain and frequency domain parameters: standard deviation of NN intervals (SDNN, p < 0.001) and of the average NN intervals (SDANN, p < 0.001), as well as low-frequency (LF) band (p < 0.001). During sleep, the difference was higher in the high-frequency (HF) band (p < 0.001), and lower in the low-/high-frequency ratio (LF/HF, p < 0.001). Both VPAI and VTAI showed less significant difference in IS patients (p < 0.001). There was diminished heart vagal activity among IS patients, as measured through HRV. During sleep, this is likely caused by an imbalance in the sympathetic and parasympathetic systems shifting through the sleep phases. These imbalances could persist over time in patients with IS, lasting months after the initial injury.

Blood-brain barrier disruption following brain injury: Implications for clinical practice.

The blood-brain barrier (BBB) plays a critical role in regulating the exchange of substances between peripheral blood and the central nervous system and in maintaining the stability of the neurovascular unit in neurological diseases. To guide clinical treatment and basic research on BBB protection following brain injury, this manuscript reviews how BBB disruption develops and influences neural recovery after stroke and traumatic brain injury (TBI). By summarizing the pathological mechanisms of BBB damage, we underscore the critical role of promoting BBB repair in managing brain injury. We also emphasize the potential for personalized and precise therapeutic strategies and the need for continued research and innovation. From this, broadening insights into the mechanisms of BBB disruption and repair could pave the way for breakthroughs in the treatment of brain injury-related diseases.

The Functional Capacity of the Upper Airway in Older Adults with Chronic Stroke

(1) Background: Older adults with chronic stroke may experience compromised upper airway functions due to stroke-related changes and aging. This study aimed to evaluate the functional capacity of the upper airway in older adults with chronic stroke. (2) Methods: A total of 44 patients (22 in each group) were included in the study. The respiratory assessment involved measuring forced vital capacity, forced expiratory volume in one second, maximum voluntary ventilation, and peak cough flow. The voice assessment recorded intensity, frequency, shimmer, and the harmonics-to-noise ratio during a monologue task. Additionally, the maximum phonation time of /a/ and /s/ was recorded. The swallowing assessment included the Eating Assessment Tool—10 and the Swallowing Quality of Life questionnaire. (3) Results: Significant differences were found in the experimental group compared to the control group in maximum voluntary ventilation (44.59 ± 15.61 vs. 58.50 ± 28.08, p = 0.049) and peak cough flow (173.64 ± 101.09 vs. 291.59 ± 176.58, p = 0.009). Additionally, the experimental group showed poorer results than the control group in monologue intensity (66.60 ± 3.72 vs. 114.72 ± 63.09, p = 0.001), the harmonics-to-noise ratio (9.08 ± 2.06 vs. 10.26 ± 1.59, p = 0.042), and the maximum phonation time of /s/ (4.36 ± 1.67 vs. 8.09 ± 4.07, p &lt; 0.001). Patients with stroke also had significantly lower values for swallowing efficiency and safety compared to the control group (7.05 ± 8.44 vs. 2.23 ± 4.14, p = 0.021) and reported poorer quality of life related to swallowing difficulties (185.50 ± 23.66 vs. 200.32 ± 19.60, p = 0.029). (4) Conclusions: Older adults with chronic stroke exhibited significantly reduced cough strength, voice intensity, maximum phonation time, and swallowing function compared to controls.

Effect of cognitive training on selected gait parameters in patients with stroke

Background. Not only may early cognitive rehabilitation help stroke patients with their cognitive impairment, but it can also help patients restore their capabilities to do everyday activities. There isn’t much data on how cognitive training affects spatiotemporal gait variables in stroke survivors. Objective. To examine the impact of cognitive training on selected gait parameters in stroke patients. Subjects and Methods. Forty male and female patients with mild ischemic chronic stroke, ranging in age from 45 to 60 years, were recruited and distributed into two equal groups at random (G1 and G2). The Montreal Cognitive Assessment Scale (MOCA) and the Rehacom system were utilized to evaluate the patient’s cognitive function. The Biodex gait trainer device was utilized to measure several gait variables for all patients. Rehacom cognitive training and a selected physiotherapy program were administered to the study group (G1). The similar selected physiotherapy program utilized for the G1 was applied to the control group (G2). For eight weeks, the treatment was administrated three sessions each week, day after day. All variables were evaluated before- and after-intervention. Results. The step length and walking speed, as well as the MOCA scale score of G1, were significantly higher after treatment than those of G2 (p = 0.001). The correlation between step length and median reaction time (MRT) was moderate negative significant correlation (r = – 0.698, p = 0.001). Conclusion. Cognitive training has a beneficial impact on improving the selected spatiotemporal gait parameters in stroke patients.

The role of beta blockers in the treatment of cardiovascular diseases

Beta-blockers are used to treat various cardiovascular diseases, including hypertension and chronic heart failure. They act by suppressing the effects of catecholamines through various pathways and affect heart rate, strength, and renin release, providing antihypertensive and anti-ischemic effects. The individual effects of various drugs on clinical outcomes in this group were determined according to characteristics of the patient, underlying disease, and type of beta-blocker used. In recent years, beta-blockers have faced a serious obstacle when new guidelines on hypertension suggest their use as second-line therapy after angiotensin converting enzyme inhibitors, angiotensin receptor blockers and slow calcium channel blockers in the absence of clear indications. In fact, these recommendations were based on meta-analyses that showed that beta-blockers have fewer beneficial effects on overall mortality, cardiovascular events, and brain stroke. In addition, according to currently available data, the appointment of beta-blockers for diseases such as heart failure with preserved ejection fraction and stable coronary heart disease can cause more harm than good outcomes. Bisoprolol is a beta-blocker with the highest selectivity for beta1-adrenergic receptors, which determines the rare frequency of side effects that develop because of its use. This review presents current data on the use of beta-blockers for treating cardiovascular diseases, with an emphasis on the use of bisoprolol.

An ensemble convolutional neural network model for brain stroke prediction using brain computed tomography images

A stroke is a potentially fatal brain attack that causes an interruption in the blood supply to the brain. As a result, brain cells start to die due to a lack of oxygen and nutrients. After a stroke, every minute is critical. A million or more brain cells perish every minute during a stroke. The prompt identification of a stroke can prevent lasting brain damage or even save the patient’s life. Doctors advise computed tomography (CT) images of the brain for earlier stroke detection. If doctors delay CT diagnosis or may make erroneous diagnoses, this can be life-threatening. For that reason, an automatic diagnosis of stroke from a brain CT scan image will be beneficial for stroke patients. This study moderates three pre-trained convolutional neural network (CNN) models named Inceptionv3, MobileNetv2, and Xception by updating the top layer of those models using the transfer-learning technique based on CT images of the brain. A new ensemble convolutional neural network (ENSNET) model is proposed for automatic brain stroke prediction from brain CT scan images. ENSNET is the average of two improved CNN models named InceptionV3 and Xception. We have relied on the following metrics: accuracy, precision, recall, f1-score, confusion matrix, accuracy versus epoch, loss versus epoch, and the receiver operating characteristic (ROC) curve to assess performance matrices. The accuracy of the moderated Inceptionv3 is 97.48%, the moderated MobileNetv2 is 83.29%, and the moderated Xception is 96.11%. Nonetheless, the suggested ensemble model ENSNET performs better than the other models when it comes to the diagnosis of stroke from brain CT scans, providing 98.86% accuracy, 97.71% precision, 98.46% recall, 98.08% f1-score, and 98.74% area under the ROC curve(AUC). Therefore, the proposed model ENSNET can detect strokes from computed tomography images of the brain more successfully than other models.

Evaluating Biomarkers of Bone Health After an 8-Week Walking Program in Non-Ambulatory Stroke Survivors: A Pilot Study

Background/Objectives: Stroke survivors have a significantly increased likelihood of developing osteoporosis, a condition characterized by weak and brittle bones as well as an elevated risk of bone fractures. However, previous studies on exercise intervention have mostly been on stroke survivors who are able to walk. The objective of this study was to examine the effect of walking exercise on bone health in non-ambulatory stroke survivors. Methods: This pre- and post-test study enrolled a group of chronic non-ambulatory stroke survivors. They were instructed to complete an 8-week aerobic walking exercise program, three sessions per week. Serum concentrations of osteocalcin (OC) and carboxy-terminal telopeptides of type I collagen (ICTP) were evaluated at baseline and after completing the walking exercise program. In addition, we assessed the ambulation capacity and balance control using the functional ambulation category (FAC) and Berg Balance Scale (BBS), respectively. Results: A total of 9 out of 10 non-ambulatory stroke survivors who were recruited completed the intervention. The serum concentration of OC significantly increased from 8.51 ± 2.28 ng/mL to 9.39 ± 2.97 ng/mL (p &lt; 0.10). The serum concentration of ICTP significantly increased from 4.45 ± 2.58 ng/mL to 5.31 ± 2.92 ng/mL (p &lt; 0.10). Both FAC and BBS scores significantly improved from 1.0 ± 0 to 1.33 ± 0.5 (p &lt; 0.1) and from 7.22 ± 10.02 to 15.78 ± 14.81 (p &lt; 0.01), respectively. Conclusions: The findings of this pilot study suggest that walking exercise may improve bone health by initiating a bone remodeling process in chronic non-ambulatory stroke survivors.