Chronic Stroke Research Articles

Computerized Adaptive Testing for the Berg Balance Scale Improves Measurement Efficiency Without Compromising Precision in People With Stroke.

Objectives of this study were to confirm the Berg Balance Scale's (BBS) measurement properties and unidimensionality with an item response theory analysis in persons with subacute and chronic stroke and examine the precision and efficiency of computerized adaptive testing (CAT). Data were obtained from 519 ambulatory persons with subacute and chronic stroke in 2 retrospective databases. A principal component analysis (PCA) of residuals was used to evaluate unidimensionality. BBS fit to a rating scale model versus a partial credit model was examined and item parameters were generated for CAT calibration. Person measures from all 14 items were defined as actual balance ability. BBS CAT simulations were used to examine changes in measurement precision with increasing number of items administered and a precision-based stopping rule (0.5 logit standard error (SE) threshold). A PCA of residuals supports the BBS's unidimensionality and Rasch analysis supports using the rating scale model for measurement. Maximum precision for BBS CAT was SE = 0.40 logits when administering all items. BBS CAT estimated balance ability was highly correlated with actual ability when 4 or more items were administered (r > 0.9). Precision was within 0.5 logits when 5 or more items were administered (SE < 0.48 logits). BBS CAT estimated balance ability was highly correlated with actual ability (r = 0.952) using a precision-based stopping rule. The average number of items administered with the precision-based stopping rule was 5.43. The BBS is sufficiently unidimensional and the rating scale model can be used for measurement. BBS CAT is efficient and replicates the full instrument's reliability when measuring balance ability in ambulatory persons with subacute and chronic stroke. Future work should aim to enhance the interpretability of measures to facilitate clinical decision making. BBS CAT provides an efficient way of measuring balance ability for individuals in stroke rehabilitation giving clinicians more time with patients.

Cost-effectiveness of neuropsychological rehabilitation for acquired brain injuries: Update of Stolwyk etal.'s (2019) review.

Acquired brain injuries (ABI), resulting from stroke or traumatic brain injury, cause a range of neuropsychological impairments and many patients continue to experience neuropsychological deficits years after onset. The increasing average age of the population highlights the importance of effective management strategies for the consequences of ABI. Despite the well-documented impact of rehabilitation interventions, the cost-effectiveness of neuropsychological rehabilitation remains largely unknown. This study conducted a scoping review to update the findings of Stolwyk etal. (Neuropsychological Rehabilitation, 2021, 31, 316), focusing on the economic evaluations of neuropsychological rehabilitation for individuals with ABI. Following the PIO framework, PRISMA ScR guidelines, and systematic review reporting checklist, the review screened 1027 articles and included eight studies published between 2019 and 2024. The studies encompassed either language rehabilitation or general neuropsychological programs, including neuropsychological interventions. The economic analyses, including two cost-effectiveness, five cost-utility, and one cost-benefit study, mostly adhered to CHEERS guidelines, enhancing the transparency and methodological rigour of their reporting. These studies demonstrated varying degrees of cost-effectiveness for interventions targeting post-stroke language disorders and neuropsychological rehabilitation for ABI, with significant cost savings and health benefits observed, particularly for home-based rehabilitation interventions. The included studies suffered from a short time horizon, limiting the ability to capture the long-term economic impacts and effectiveness of the interventions. Future research should focus on longer-term follow-up data and include broader search strategies to enhance understanding and optimise health care interventions. A comprehensive implementation of these economic analyses is crucial for informing policymakers, enabling them to introduce rehabilitative interventions based on solid evidence.

Intrarater Reliability of Catherine Bergego Scale and Albert’s Test in Chronic Stroke Patients With Unilateral Spatial Neglect

Intrarater Reliability of Catherine Bergego Scale and Albert’s Test in Chronic Stroke Patients With Unilateral Spatial Neglect

Enriched music-supported therapy for individuals with chronic stroke: a randomized controlled trial.

Many stroke survivors still present with upper-limb paresis six months post-stroke, impacting their autonomy and quality of life (QoL). We designed an enriched Music-supported Therapy (eMST) program to reduce disability in this population. We evaluated the eMST's effectiveness in improving functional abilities and QoL in chronic stroke individuals compared to the conventional motor program Graded Repetitive Arm Supplementary Program (GRASP). We conducted a pragmatic two-arm parallel-group randomized controlled trial with a 3-month follow-up and masked assessment. The eMST involved playing instruments during individual self-administered and group music therapy sessions. The GRASP consisted of self-administered motor exercises using daily objects. Both interventions were completed at home with telemonitoring and involved four one-hour weekly sessions for 10weeks. The primary outcome was upper-limb motor function measured with the Action Research Arm Test. Secondary outcomes included motor impairment, daily life motor performance, cognitive functions, emotional well-being, QoL, self-regulation, and self-efficacy. Intention-to-treat (ITT)and per-protocol(PP) analyses were conducted including participants who discontinued the intervention and those who completed it entirely, respectively. Fifty-eight chronic stroke patients were randomized to the eMST-group (n = 26; age: 64.2 ± 12.5; 6[23.1%] females; 2.8 ± 2.9years post-stroke), and the control group (n = 32; age: 62.2 ± 12; 8[25%] females; 1.8 ± 6.2years post-stroke). The eMST-group had more participants achieving a clinically relevant improvement in motor impairment post-intervention than the control group for the ITT (55% vs 21.6%; OR = 4.5 (95% CI 1.4-14); p = .019) and PP analyses (60% vs 20%; OR = 6 (95% CI 1.5-24.7); p = .024), sustained at follow-up. The eMST-group reported greater improvements in emotion (difference = 11.1 (95% CI 0.8-21.5; p = 0.36) and participation (difference = 10.3 (95% CI 0.6-25.9); p = 0.41) subscales of QoL, and higher enjoyment during the sessions (difference = 1 (95% CI 0.3-1.5); p = 0.12). No changes were found in other outcomes. eMST demonstrated superiority over conventional motor rehabilitation program in enhancing upper-limb functions and QoL in chronic stroke individuals. ClinicalTrials.gov (ID: NCT04507542).

Decompressive Craniectomy with or Without Dural Closure: Systematic Review and Meta-analysis.

Decompressive craniectomy is used to alleviate intracranial pressure in cases of traumatic brain injury and stroke by removing part of the skull to allow brain expansion. Traditionally, this procedure is followed by a watertight dural suture, although evidence supporting this method is not strong. This meta-analysis examines the feasibility of the open-dura (OD) approach versus the traditional closed-dura (CD) technique with watertight suturing. A systematic review and comparative meta-analysis were conducted on OD and CD dural closure techniques. Medline, Embase, and Cochrane were searched for relevant trials. The primary end point was the rate of complications, with specific analyses for infection and cerebrospinal fluid (CSF) leaks. Mortality, poor neurological outcomes, and operation duration were also assessed. Odds ratios with 95% confidence intervals (CIs) were calculated using a random-effects model. Following a comprehensive search, 930 studies were screened, from which four studies and a total of 368 patients were ultimately selected. The primary outcome analysis showed a reduced likelihood of complications in the OD group when compared with the CD group (368 patients, odds ratio 0.54 [95% CI 0.32-0.90]; I2 = 17%; p < 0.05). Specific analysis of infections and CSF leaks did not show statistically significant results, as well as the evaluation of the mortality rates and poor neurological outcome differences between groups. Assessment of operation duration, however, demonstrated a significant difference between techniques, with a mean reduction of 52.50min favoring the OD approach (mean difference - 52.50 [95% CI - 92.13 to - 12.87]; I2 = 96%). This study supports the viability of decompressive craniectomy without the conventional time-spending watertight duraplasty closure, exhibiting no differences in the rate of infections or CSF leaks. Furthermore, this approach has been associated with improved rates of complications and faster surgery, which are important aspects of this technique, particularly in its potential to reduce both costs and procedure length.

Relation of functional independence to balance, exercise capacity, and peripheral muscle strength in individuals with chronic stroke: A cross-sectional study

PurposeThis cross-sectional study determined the relationship between functional independence and balance, functional exercise capacity, and knee extensor strength in individuals with chronic stroke. Material and methodsThe study included fifty-four individuals with chronic stroke. A single physiotherapist evaluated clinical features. Assessments included the Functional Independence Measure (FIM), the Tinetti Performance Oriented Mobility Assessment (POMA), the Timed-Up and Go Test (TUG), the 6-min Walk Test (6MWT), and Knee Extensor Strength (KES). ResultsPatients' mean age and body mass index were 60.5 ± 7.13 years and 27.08 ± 4.65 kg/m2. FIM was significantly associated with the POMA (r = 0.644, p = 0.000), TUG (r = -0.723, p = 0.000), and 6MWT (r = 0.569, p = 0.000). FIM was not significantly associated with KES of the paretic side (r = 0.264, p = 0.054), and KES of the non-paretic side (r = 0.207, p = 0.133). However, mFIM was significantly associated with KES of the paretic side (r = 0.432, p = 0.001), and KES of the non-paretic side (r = 0.348, p = 0.010). OutcomesIt was established that there was no relationship between KES and FIM, but that a relationship existed between KES and mFIM. Functional independence is associated with balance ability and functional exercise capacity.

Comparison and combined use of NEWS2 and GCS scores in predicting mortality in stroke and traumatic brain injury: a multicenter retrospective study.

This study aims to assess the effectiveness of the National Early Warning Score 2 (NEWS2) versus Glasgow Coma Scale (GCS) in predicting hospital mortality among patients with stroke and traumatic brain injury (TBI). This multicenter study was conducted at two anonymized tertiary care hospitals in distinct climatic regions of China, with a combined annual emergency admission exceeding 10,000 patients. The study included 2,276 adult emergency admissions diagnosed with stroke (n = 1,088) or TBI (n = 1,188) from January 2021 to December 2023, excluding those with chronic pulmonary disease, severe cardiac conditions, or a history of brain surgery. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were utilized to analyze the predictive accuracy of NEWS2 and GCS for hospital mortality at 24, 48, and 72 h post-admission and at discharge. Out of 2,276 patients (mean age 61.4, 65.6% male), 1855 survived while 421 succumbed. NEWS2 demonstrated superior predictive accuracy (AUC = 0.962) over GCS (AUC = 0.854) for overall hospital mortality. Specifically, NEWS2 outperformed GCS in predicting mortality at 24 h (0.917 vs. 0.843), 48 h (0.893 vs. 0.803), and 72 h (0.902 vs. 0.763). Notably, despite a higher AUC for NEWS2 at predicting 24-h hospital mortality, the sensitivity and specificity of GCS were considerably lower (12 and 31%, respectively) compared to NEWS2 (sensitivity of 95% and specificity of 81%). Subgroup analysis showed NEWS2 outperforming GCS in predicting in-hospital mortality for TBI and stroke patients. For TBI patients (n = 260), NEWS2 had an AUC of 0.960 (95% CI: 0.948-0.973) vs. GCS's AUC of 0.811 (95% CI: 0.781-0.840). For stroke patients (n = 161), NEWS2 had an AUC of 0.930 (95% CI: 0.908-0.952) vs. GCS's AUC of 0.858 (95% CI, 0.823-0.892). NEWS2 showed greater sensitivity in both groups, highlighting its effectiveness in identifying high-risk neurological patients. NEWS2 scores are more precise and effective in predicting hospital mortality in stroke and TBI patients compared to GCS scores, although slightly less so within the first 24 h. Combining NEWS2 with GCS and clinical findings within the initial 24 h is recommended for a comprehensive prognosis evaluation.

Alpha and beta/low-gamma frequency bands may have distinct neural origin and function during post-stroke walking.

Plantarflexors provide propulsion during walking and receive input from both corticospinal and corticoreticulospinal tracts, which exhibit some frequency-specificity that allows potential differentiation of each tract's descending drive. Given that stroke may differentially affect each tract and impair the function of plantarflexors during walking; here, we examined this frequency-specificity and its relation to walking-specific measures during post-stroke walking. Fourteen individuals with chronic stroke walked on an instrumented treadmill at self-selected and fast walking speed (SSWS and FWS, respectively) while surface electromyography (sEMG) from soleus (SOL), lateral gastrocnemius (LG), and medial gastrocnemius (MG) and ground reaction forces (GRF) were collected. We calculated the intermuscular coherences (IMC; alpha, beta, and low-gamma bands between SOL-LG, SOL-MG, LG-MG) and propulsive impulse using sEMG and GRF, respectively. We examined the interlimb and intralimb IMC comparisons and their relationships with propulsive impulse and walking speed. Interlimb IMC comparisons revealed that beta LG-MG (SSWS) and low-gamma SOL-LG (FWS) IMCs were degraded on the paretic side. Intralimb IMC comparisons revealed that only alpha IMCs (both speeds) exhibited a statistically significant difference to random coherence. Further, alpha LG-MG IMC was positively correlated with propulsive impulse in the paretic limb (SSWS). Alpha and beta/low-gamma bands may have a differential functional role, which may be related to the frequency-specificity of the underlying descending drives. The persistence of alpha band in plantarflexors and its strong positive relationship with propulsive impulse suggests relative alteration of corticoreticulospinal tract after stroke. These findings imply the presence of frequency-specific descending drives to walking-specific muscles in chronic stroke.

Comparative insight into the regenerative mechanisms of the adult brain in zebrafish and mouse: highlighting the importance of the immune system and inflammation in successful regeneration.

Regeneration, the complex process of restoring damaged or absent cells, tissues, and organs, varies considerably between species. The zebrafish is a remarkable model organism for its impressive regenerative abilities, particularly in organs such as the heart, fin, retina, spinal cord, and brain. Unlike mammals, zebrafish can regenerate with limited or absent scarring, a phenomenon closely linked to the activation of stem cells and immune cells. This review examines the unique roles played by the immune response and inflammation in zebrafish and mouse during regeneration, highlighting the cellular and molecular mechanisms behind their divergent regenerative capacities. By focusing on zebrafish telencephalic regeneration and comparing it to that of the rodents, this review highlights the importance of a well-controlled, acute, and non-persistent immune response in zebrafish, which promotes an environment conducive to regeneration. The knowledge gained from understanding the mechanisms of zebrafish regeneration holds great promises for the treatment of human neurodegenerative diseases and brain damage (stroke and traumatic brain injuries), as well as for the advancement of regenerative medicine approaches.

Evaluation of Posthospital Brain Injury Rehabilitation Outcomes With Quasi-Experimental Controls.

To further evaluate, using quasi-experimental methodologies, posthospital brain injury rehabilitation outcomes described in an accompanying report of a large observational study (n =2120). Data from Intensive Rehabilitation (IR: Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community Neurorehabilitation, Day Treatment, Outpatient Neurorehabilitation) and Supported Living (SL) programs serving individuals with acquired brain injury (ABI). Two hundred twenty-eight individuals with traumatic brain injury, stroke, or other ABI in propensity score analysis; 1344 in analysis by extent of recommended treatment completed (TC) rating. Sex, age, time since injury, Mayo-Portland Adaptability Inventory-4th edition (MPAI-4) Rasch-derived T-scores, and TC rating. Analyses of covariance (1) of discharge MPAI-4 Total, index, and subscale T-scores on propensity score-matched samples of IR and SL participants controlling for admission scores and (2) of MPAI-4 T-scores by TC rating and diagnostic category. Propensity score-matched groups showed superior outcomes for IR participants compared to SL participants on MPAI-4 Total T-score (F =77.21, P <.001; partial η2=0.257) and all MPAI-4 index and subscale T-scores controlling for sex, age, and baseline scores. Participants with traumatic brain injury and stroke who completed the recommended course of rehabilitation had superior outcomes on all MPAI-4 T-scores compared to those who completed less than or much less than the recommended treatment. No additional benefit was apparent for those who completed more than the recommended course. The association between TC rating and outcome was not significant for the other ABI group. These analyses using quasi-experimental controls provide more scientifically rigorous evidence of the benefit of IR provided through posthospital brain injury rehabilitation programs after acute inpatient care, consistent with the results of numerous observational studies. However, improved internal validity limits external validity and generalization. The absence of a significant association between TC rating and outcomes for the other ABI group most likely reflects the difficulty prescribing rehabilitation for this highly heterogeneous group.

Assessing Relative Linguistic Impairment With Model-Based Item Selection.

A picture naming test is presented that reveals impairment to specific mechanisms involved in the naming process, using accuracy scores on curated item sets. A series of psychometric validation experiments are reported. Using a computational model that enables estimation of item difficulty at the lexical and sublexical stages of word retrieval, two complimentary sets of items were constructed that challenge the respective psycholinguistic levels of representation. The difference in accuracy between these item sets yields the relative linguistic impairment (RLI) score. In a cohort of 91 people with chronic left-hemisphere stroke who enrolled in a clinical trial for anomia, we assessed psychometric properties of the RLI score and then used the new scale to make predictions about other language behaviors, lesion distributions, and functional activation during naming. RLI scores had adequate psychometric properties for clinical significance. RLI scores contained predictive information about spontaneous speech fluency, over and above accuracy. A dissociation was observed between performance on the RLI item sets and performance on the subtests of an independent language battery. Sublexical RLI was significantly associated with apraxia of speech and with lesions encompassing perisylvian regions, while lexical RLI was associated with lesions to deep white matter. The RLI construct was reflected in functional brain activity during naming, independent of overall accuracy, with a respective shift of activation between dorsal and ventral networks responsible for different aspects of word retrieval. The RLI assessment satisfies the psychometric requirements to serve as a useful clinical measure.

Development a novel nano-platform for Thrombolysis acceleration by Thrombin sensitive polymer-peptide hybrid nancapsules

According to the importance of time in treatment of thrombosis disorders, faster than current treatments are required. For the first time, this research discloses a novel strategy for rapid dissolution of blood clots by encapsulation of a fibrinolytic (Reteplase) into a Thrombin sensitive shell formed by polymerization of acrylamide monomers and bisacryloylated peptide as crosslinker. Degradability of the peptide units in exposure to Thrombin, creates the Thrombin-sensitive Reteplase nanocapsules (TSRNPs) as a triggered release system. Accelerated thrombolysis was achieved by combining three approaches including: deep penetration of TSRNPs into the blood clots, changing the clot dissolution mechanism by altering the distribution pattern of TSRNPs to 3D intra-clot distribution (based on the distributed intra-clot thrombolysis (DIT) model) instead of peripheral and unidirectional distribution of unencapsulated fibrinolytics and, enzyme-stimulated release of the fibrinolytic. Ex-vivo study was carried out by an occluded tube model that mimics in-vivo brain stroke as an emergency situation where faster treatment in short time is a golden key. In in vivo, efficacy of the developed formulation was confirmed by PET scan and laser Doppler flowmetry (LDF). As the most important achievements, 40.0 ± 0.7 (n = 3) % and 37.0 ± 0.4 (n = 3) % reduction in the thrombolysis time (faster reperfusion) were observed by ex-vivo and in-vivo experiments, respectively. Higher blood flow and larger digestion mass of clot at similar times in comparison to non-encapsulated Reteplase were observed that means more effective thrombolysis by the developed strategy.

MHealth devices demonstrate validity and reliability in detecting steps in chronic stroke survivors who rely on assistive devices

PurposeTo assess the concurrent validity and reliability of five mHealth devices (STEPZ, Health, Pacer, Google Fit, and Fitbit Inc.®) in counting steps among individuals with chronic stroke using assistive devices (AD). Our primary objective was to identify significant variations in step counts between AD users and non-users. MethodsIn a cross-sectional study, individuals performed a 2-min walking test while carrying two smartphones (Android OS and iOS) equipped with four different applications (STEPZ, Health, Pacer, and Google Fit), alongside a Fitbit Inc.® device. A visual video recording served as criterion-standard measure for step counting. Each participant completed four walking trials. Two proficient researchers conducted data collection in a controlled environment at a single day. ResultsTwenty-four individuals were included. The devices were valid for individuals in individuals with chronic stroke who used AD (0.52 ≤ r ≥ 0.89), except for Health (iOS). There is no agreement between the criterion-standard and Health (iOS), and all other devices showed adequate reliability (0.107 ≤ CCI [2, 1] ≥ 0.701). There was no difference in stepping counting when the individuals used or not the AD. ConclusionsHealth for iOS is neither valid nor reliable for individuals with chronic stroke who are AD users. There is no difference in step counting were when the individuals with chronic stroke are users or non-users of AD.

Microglial heterogeneity in the ischemic stroke mouse brain of both sexes

BackgroundIschemic stroke elicits a complex and sustained immune response in the brain. Immunomodulatory treatments have long held promise for improving stroke outcomes, yet none have succeeded in the clinical setting. This lack of success is largely due to our incomplete understanding of how immune cells respond to stroke. The objective of the current study was to dissect the effect of permanent stroke on microglia, the resident immune cells within the brain parenchyma.MethodsA permanent middle cerebral artery occlusion (pMCAO) model was used to induce ischemic stroke in young male and female mice. Microglia were sorted from fluorescence reporter mice after pMCAO or sham surgery and then subjected to single-cell RNA sequencing analysis. Various methods, including flow cytometry, RNA in situ hybridization, immunohistochemistry, whole-brain imaging, and bone marrow transplantation, were also employed to dissect the microglial response to stroke. Stroke outcomes were evaluated by infarct size and behavioral tests.ResultsFirst, we showed the morphologic and spatial changes in microglia after stroke. We then performed single-cell RNA sequencing analysis on microglia isolated from sham and stroke mice of both sexes. The data indicate no major sexual dimorphism in the microglial response to permanent stroke. Notably, we identified seven potential stroke-associated microglial clusters, including four major clusters characterized by a disease-associated microglia-like signature, a highly proliferative state, a macrophage-like profile, and an interferon (IFN) response signature, respectively. Importantly, we provided evidence that the macrophage-like cluster may represent the long-sought stroke-induced microglia subpopulation with increased CD45 expression. Lastly, given that the IFN-responsive subset constitutes the most prominent microglial population in the stroke brain, we used fludarabine to pharmacologically target STAT1 signaling and found that fludarabine treatment improved long-term stroke outcome.ConclusionsOur findings shed new light on microglia heterogeneity in stroke pathology and underscore the potential of targeting specific microglial populations for effective stroke therapies.

Identifying alterations in hand movement coordination from chronic stroke survivors using a wearable high-density EMG sleeve

Objective.Non-invasive, high-density electromyography (HD-EMG) has emerged as a useful tool to collect a range of neurophysiological motor information. Recent studies have demonstrated changes in EMG features that occur after stroke, which correlate with functional ability, highlighting their potential use as biomarkers. However, previous studies have largely explored these EMG features in isolation with individual electrodes to assess gross movements, limiting their potential clinical utility. This study aims to predict hand function of stroke survivors by combining interpretable features extracted from a wearable HD-EMG forearm sleeve.Approach.Here, able-bodied (N= 7) and chronic stroke subjects (N= 7) performed 12 functional hand and wrist movements while HD-EMG was recorded using a wearable sleeve. A variety of HD-EMG features, or views, were decomposed to assess alterations in motor coordination.Main Results.Stroke subjects, on average, had higher co-contraction and reduced muscle coupling when attempting to open their hand and actuate their thumb. Additionally, muscle synergies decomposed in the stroke population were relatively preserved, with a large spatial overlap in composition of matched synergies. Alterations in synergy composition demonstrated reduced coupling between digit extensors and muscles that actuate the thumb, as well as an increase in flexor activity in the stroke group. Average synergy activations during movements revealed differences in coordination, highlighting overactivation of antagonist muscles and compensatory strategies. When combining co-contraction and muscle synergy features, the first principal component was strongly correlated with upper-extremity Fugl Meyer hand sub-score of stroke participants (R2= 0.86). Principal component embeddings of individual features revealed interpretable measures of motor coordination and muscle coupling alterations.Significance.These results demonstrate the feasibility of predicting motor function through features decomposed from a wearable HD-EMG sleeve, which could be leveraged to improve stroke research and clinical care.

Development and External Validation of a Motor Intention–Integrated Prediction Model for Upper Extremity Motor Recovery After Intention-Driven Robotic Hand Training for Chronic Stroke

ObjectiveTo derive and validate a prediction model for minimal clinically important differences (MCIDs) in upper extremity (UE) motor function after intention-driven robotic hand training using residual voluntary electromyography (EMG) signals from affected UE. DesignA prospective longitudinal multicenter cohort study. We collected preintervention candidate predictors: demographics, clinical characteristics, Fugl-Meyer assessment of UE (FMAUE), Action Research Arm Test scores, and motor intention of flexor digitorum and extensor digitorum (ED) measured by EMG during maximal voluntary contraction (MVC). For EMG measures, recognizing challenges for stroke survivors to move paralyzed hand, peak signals were extracted from 8 time windows during MVC-EMG (0.1-5s) to identify subjects’ motor intention. Classification and regression tree algorithm was employed to predict survivors with MCID of FMAUE. Relationship between predictors and motor improvements was further investigated. SettingNine rehabilitation centers. ParticipantsChronic stroke survivors (N=131), including 87 for derivation sample, and 44 for validation sample. InterventionsAll participants underwent 20-session robotic hand training (40min/session, 3-5sessions/wk). Main Outcome MeasuresPrediction efficacies of models were assessed by area under the receiver operating characteristic curve (AUC). The best effective model was final model and validated using AUC and overall accuracy. ResultsThe best model comprised FMAUE (cutoff score, 46) and peak activity of ED from 1-second MVC-EMG (MVC-EMG 4.604 times higher than resting EMG), which demonstrated significantly higher prediction accuracy (AUC, 0.807) than other time windows or solely using clinical scores (AUC, 0.595). In external validation, this model displayed robust prediction (AUC, 0.916). Significant quadratic relationship was observed between ED-EMG and FMAUE increases. ConclusionsThis study presents a prediction model for intention-driven robotic hand training in chronic stroke survivors. It highlights significance of capturing motor intention through 1-second EMG window as a predictor for MCID improvement in UE motor function after 20-session robotic training. Survivors in 2 conditions showed high percentage of clinical motor improvement: moderate-to-high motor intention and low-to-moderate function; as well as high intention and high function.

Virtual Reality for Improving Cognitive Outcomes After Brain Injury &amp; Stroke: A Systematic Review

Abstract Date Presented 03/22/24 Virtual reality (VR) provides an immersive environment that can be used to simulate real-world tasks. This systematic review summarized the evidence for using VR in OT to target cognition in adults with brain injury and stroke. Primary Author and Speaker: Paige M. Eck Additional Authors and Speakers: Mary Hildebrand

Cardiac stasis imaging, stroke, and silent brain infarcts in patients with nonischemic dilated cardiomyopathy.

Cardioembolic stroke is one of the most devastating complications of nonischemic dilated cardiomyopathy (NIDCM). However, in clinical trials of primary prevention, the benefits of anticoagulation are hampered by the risk of bleeding. Indices of cardiac blood stasis may account for the risk of stroke and be useful to individualize primary prevention treatments. We performed a cross-sectional study in patients with NIDCM and no history of atrial fibrillation (AF) from two sources: 1) a prospective enrollment of unselected patients with left ventricular (LV) ejection fraction <45% and 2) a retrospective identification of patients with a history of previous cardioembolic neurological event. The primary end point integrated a history of ischemic stroke or the presence intraventricular thrombus, or a silent brain infarction (SBI) by imaging. From echocardiography, we calculated blood flow inside the LV, its residence time (TR) maps, and its derived stasis indices. Of the 89 recruited patients, 18 showed a positive end point, 9 had a history of stroke or transient ischemic attack (TIA) and 9 were diagnosed with SBIs in the brain imaging. Averaged TR, [Formula: see text] performed well to identify the primary end point [AUC (95% CI) = 0.75 (0.61-0.89), P = 0.001]. When accounting only for identifying a history of stroke or TIA, AUC for [Formula: see text] was 0.92 (0.85-1.00) with odds ratio = 7.2 (2.3-22.3) per cycle, P < 0.001. These results suggest that in patients with NIDCM in sinus rhythm, stasis imaging derived from echocardiography may account for the burden of stroke.NEW & NOTEWORTHY Patients with nonischemic dilated cardiomyopathy (NIDCM) are at higher risk of stroke than their age-matched population. However, the risk of bleeding neutralizes the benefit of preventive oral anticoagulation. In this work, we show that in patients in sinus rhythm, the burden of stroke is related to intraventricular stasis metrics derived from echocardiography. Therefore, stasis metrics may be useful to personalize primary prevention anticoagulation in these patients.

Segmentation of stroke lesions using transformers-augmented MRI analysis.

Accurate segmentation of chronic stroke lesions from mono-spectral magnetic resonance imaging scans (e.g., T1-weighted images) is a difficult task due to the arbitrary shape, complex texture, variable size and intensities, and varied locations of the lesions. Due to this inherent spatial heterogeneity, existing machine learning methods have shown moderate performance for chronic lesion delineation. In this study, we introduced: (1) a method that integrates transformers' deformable feature attention mechanism with convolutional deep learning architecture to improve the accuracy and generalizability of stroke lesion segmentation, and (2) an ecological data augmentation technique based on inserting real lesions into intact brain regions. Our combination of these two approaches resulted in a significant increase in segmentation performance, with a Dice index of 0.82 (±0.39), outperforming the existing methods trained and tested on the same Anatomical Tracings of Lesions After Stroke (ATLAS) 2022 dataset. Our method performed relatively well even for cases with small stroke lesions. We validated the robustness of our method through an ablation study and by testing it on new unseen brain scans from the Ischemic Stroke Lesion Segmentation (ISLES) 2015 dataset. Overall, our proposed approach of transformers with ecological data augmentation offers a robust way to delineate chronic stroke lesions with clinically relevant accuracy. Our method can be extended to other challenging tasks that require automated detection and segmentation of diverse brain abnormalities from clinical scans.

A home-based hand rehabilitation platform for hemiplegic patients after stroke: A feasibility study

BackgroundPatients with stroke often experience weakened upper limbs, making daily tasks difficult to perform. Although rehabilitation devices are available, patients often relapse post-discharge due to insufficient practice. We present a home-based hand telerehabilitation intervention using the iManus™ platform comprising a sensorized glove, a mobile app for the patients, and a therapist portal for monitoring patient progress. ObjectivesThis research aimed to examine the feasibility, safety, and effectiveness of a home-based telerehabilitation intervention in improving hand function for individuals with mild stroke. A qualitative approach was also used to explore users' experiences, perceived benefits, and challenges associated with using the platform in a home setting. MethodsIn this single-case study, we delivered a hand telerehabilitation intervention to a chronic stroke patient with impaired hand function using the iManus™ platform. The intervention consisted of 40 home sessions over eight weeks. We assessed feasibility through user adherence and feedback obtained using a System Usability Scale (SUS) and a semi-structured interview with the participant and their informal caregiver. Safety was evaluated by monitoring pain levels using the Visual Analog Scale (VAS), and efficacy was determined by observing the changes in the fingers’ range of motion using the iManus™ platform and clinical outcomes measures, namely the Fugl-Meyer Assessment (FMA) and Jebsen Taylor Hand Function Test (JTHFT). ResultsOur participant completed all the assigned sessions, with each averaging 20 min. Usability scored 77.5 out of 100 on the SUS. User feedback from the interviews revealed improved mobility and control over therapy as benefits, indicating room for improvement in the intervention's adaptability and functionality. During the intervention, the participant noted no pain increase, and the telerehabilitation platform recorded range of motion improvements for all finger and wrist joints, excluding wrist extension. The FMA scores were 43 at T0, 53 at T1, and 56 at T2, while the JTHFT scores were 223 at T0, 188 at T1, and 240 at T2. ConclusionsThis single case study demonstrated the preliminary feasibility, safety, and efficacy of a novel home-based hand intervention for stroke survivors. The participant showed improved hand functions, good adherence to the program, and reported satisfaction with the intervention. However, these results are based on a single-case study, and further large-scale studies are needed before any generalization is recommended.