Stroke Survivors Research Articles

Impact of quality of care on outcomes in survivors of stroke with aphasia: A linked registry and hospital data observational study

BackgroundThe impact of hospital care quality on patient outcomes in post-stroke aphasia remains unclear. We investigated the impact of nationally-endorsed acute stroke treatments on outcomes post-stroke, by aphasia status. MethodsPatient-level data from the Australian Stroke Clinical Registry (2009–2013) linked to national deaths, hospital emergency presentations and admissions data were used. Aphasia was identified for the index stroke event (ICD-10 diagnosis code R47.0). Impact of receiving an optimal stroke care bundle (stroke unit care, antihypertensive medication at discharge and discharge care plan) and an acute ischemic stroke (AIS) care bundle (stroke unit care, intravenous thrombolysis and aspirin within 48 h of admission) on outcomes were analysed using multivariable regression models with propensity score adjustment. ResultsThe study included 12,690 patients with a median age of 76, 54 % male, and 26 % with aphasia. Non-receipt of the optimal stroke care bundle was associated with worse survival, compared to optimal care, in people with aphasia (HR: 3.37; 95 % CI 2.10, 5.40; p < 0.05) and without aphasia (HR: 2.10; 95 % CI 1.19, 3.69; p < 0.05). Notably, the dose-response effect on survival was more pronounced in individuals with aphasia. In those who received the AIS care bundle, readmission within 12 months was greater in those without aphasia (vs aphasia, p-value interaction = 0.001), whereas survival was similar (p-value interaction = 0.731). ConclusionsSurvivors of stroke with aphasia who did not receive the optimal stroke care bundle, had worse survival at 12 months post-stroke. Ensuring eligible patients receive the optimal stroke care bundle is crucial for improving their 12-month survival.

Alteration in Resting-State Brain Activity in Stroke Survivors After Repetitive Finger Stimulation: Erratum.

Alteration in Resting-State Brain Activity in Stroke Survivors After Repetitive Finger Stimulation: Erratum.

Long-Term Neurologic Outcomes in Pediatric Arterial Ischemic Stroke: The Impact of Age and Lesion Location.

The impact of age-at-stroke on outcome following pediatric arterial ischemic stroke remains controversial. We studied the interaction of age-at-stroke and infarct location and extent with long-term neurological outcomes. We conducted a longitudinal prospective outcome study of children with acute pediatric arterial ischemic stroke diagnosed from 1996 to 2016 at the Hospital for Sick Children, Toronto, Canada. Pediatric Stroke Outcome Measure scores were dichotomized as normal or abnormal (ie, mild, moderate, or severe). Outcomes were analyzed by age-at-stroke (newborn: birth to 28 days; early childhood: 29 days to 5 years; middle/late childhood: >5-18 years), and infarct location, based on each of the following: model 1: circulation (anterior/posterior); model 2: cortical versus subcortical involvement; and model 3: specific arterial territory, including infarct extent (small [<50% arterial territory] or large [≥50%]). Univariable and multivariable logistic regression models were fitted. Among 285 children, the outcome at median 6.1 years was 43.5% abnormal. Controlling for infarct location, increasing age-at-stroke was associated with increasing abnormal outcome. Model 1 demonstrated that, compared with neonates, abnormal outcomes were increased in early childhood (adjusted odds ratio [aOR], 2.91 [95% CI, 1.24-7.05]) and more so in middle/late childhood (aOR, 4.46 [95% CI, 1.71-12.13]). Outcomes were worse for combined locations, including anterior+posterior (model 1: aOR, 15.4 [95% CI, 4.49-64.63]) and cortical+subcortical (model 2: aOR, 10.7 [95% CI, 3.88-32.74]). Abnormal outcomes were also increased for anterior circulation (model 1: aOR, 14.91 [95% CI, 5.29-54.21]) and subcortical locations (model 2: aOR, 4.36 [95% CI, 1.37-14.95]). Among individual arterial territories, outcomes were best for superior division middle cerebral artery (100% normal) and worst for lateral lenticulostriate artery infarcts (47.4% abnormal; model 3: aOR, 14.2 [95% CI, 3.5-67.6]). Among survivors of pediatric stroke, abnormal long-term neurological outcome is increased with increasing age-at-stroke, supporting enhanced plasticity after focal injury to the newborn brain compared with older pediatric ages.

Effectiveness of technology-based psychosocial interventions for improving health-related outcomes of family caregivers of stroke survivors: A systematic review and meta-analysis.

To synthesize evidence regarding the effectiveness of technology-based psychosocial interventions in improving health-related outcomes among family caregivers of stroke survivors. A systematic review and meta-analysis was reported by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials that investigated the effects of psychosocial interventions delivered through information and communication technologies on self-efficacy, caregiving competence, caregiver burden, perceived social support, anxiety, depression, health-related quality of life and cost-effectiveness were included. Two researchers independently selected studies, extracted data, and appraised the quality of the included studies. Subgroup analysis, sensitivity analysis, and narrative synthesis were conducted. Ten electronic databases (PubMed, CENTRAL, Web of Science, Scopus, CINHAL, Embase, Institution of Electrical Engineers Xplore, Ovid Medline, PsycINFO, ProQuest Dissertations and Thesis) were searched up to February 2023. Nineteen studies involving 1717 participants fulfilled the eligibility criteria. Technology-based psychosocial interventions significantly improved self-efficacy (SMD = .62), caregiving competence (SMD = .55), depression (SMD = -.25) and anxiety (SMD = -.35). However, perceived social support, caregiver burden, and health-related quality of life did not show significant improvements. Subgroup analyses revealed that the interventions, lasting from 4 to 6 weeks and encompassing comprehensive contents, exhibited larger effect sizes. None of the studies measured cost-effectiveness. The technology-based psychosocial interventions are effective in enhancing self-efficacy and caregiving competence, as well as alleviating anxiety, and depression among family caregivers of stroke survivors. Future research should investigate interventions delivered through various digital platforms using well-designed RCTs with in-depth qualitative data collection and measurement of health and cost-effectiveness outcomes. Through psychosocial interventions, healthcare providers in clinical and community settings, particularly nurses, could incorporate technologies into current stroke care practices. It is not applicable as this is a systematic review. The protocol was registered on PROSPERO (CRD42023402871).

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.

Readmission and mortality during the first year after an acute stroke: A prospective cohort study from Cameroon.

Hospital readmission after discharge for stroke is associated with high morbidity and mortality. There is a paucity of data on the burden of stroke readmission in most sub-Saharan African countries. We aimed to determine the rate, reasons and predictors of hospital readmission and the mortality rate within 12 months of discharge among stroke survivors in Cameroon. This prospective cohort included patients who survived hospitalization for an acute stroke and who were discharged from two referral hospitals in the capital city of Cameroon between January 2013 and December 2013.We performed logistic regression analysis to identify demographic and clinical factors associated with readmission within 1 year of discharge and causes of readmission. Of the 254 consecutive patients admitted for acute stroke, 198 were discharged alive. There were 107 (54%) males, and their mean age (SD) was 61.7 (13.9) years (range: 10 to 95 years). A total of 30 (15.2%) patients were readmitted following discharge from the index admission over a mean follow-up time of 286.9 (127.6) days. Of these, 14 (46.7%) were discharged and 16 (53.3%) died after readmission. Thirty percent (30%) of readmissions occurred within the first month. The most frequent causes of readmissions were infections (30%) and recurrent stroke (26.7%). Factors associated with readmission in bivariate analysis were initial admission temperature > 37.5°C (risk ratio [RR]: 1.3, p = 0.021) and initial admission Glasgow Coma Score < 14 (RR: p = 1.23, p = 0.019). After stratified adjustment for age and sex, temperature > 37.5°C (adjusted RR: 1.3, 95% CI: 1-1.7, p = 0.036) and GCS <14 (adjusted RR: 1.23, 95% CI: 1-1.6, p = 0.041) were associated with readmission. Readmission after discharge for stroke was common with nearly one third occurring within the first month and more than half dying following readmission. The most common causes of readmission were infections and recurrent stroke.

Prognostic influence of the neurological complications in patients supported with venoarterial extracorporeal membrane oxygenation

Abstract Background Neurologic injuries including ischemic or hemorrhagic stroke and hypoxic-ischemic encephalopathy are common in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Purpose Our objective was to analyze the prognostic influence of neurological injuries on in-hospital survival. Methods Retrospective analysis of consecutive VA-ECMO cases in a referal center. We studied the neurological diagnoses and the results of complementary tests (brain computed tomography –CT- and electroencephalogram –EEG-) and their influence on in-hospital evolution. Results 238 VA-ECMO were implanted between oct 2013-jan 2024. Baseline, admission and evolution characteristics are collected in the table. 58.4% of patients had suffered cardiac arrest (prior to VA-ECMO implantation, and extracorporeal cardiopulmonary resuscitation was performed in 28.6% of cases. 6 (2.5%) suffered intracranial hemorrhage, 13 (5.5%) ischemic stroke and 40 (16.8%) some degree of hypoxic-ischemic encephalopathy. In-hospital survival was 32.4% (n=77). In 17.2% of the cases neurological damage influenced death (adequacy of therapeutic effort or non-escalation of therapies) and in 14.7% of cases death was directly due to neurological cause (table). Survival was lower in patients with ischemic (stroke survival 23.1% vs no stroke 33.2%, p=0.555) or hemorrhagic stroke (16.7% vs 33%, p=0.667), although without statistically significant differences. The presence of hypoxic brain damage was related to lower hospital survival (survival in patients with encephalopathy 15% vs. without 36.8%, p=0.009). Best EEG pattern registered was related to survival: I survival 33.3% and II 12.5% (good prognosis), III 25% (uncertain prognosis), IV 16.7% and V 0% (poor prognosis), p=0.048. The presence of status epilepticus showed a non-statistically significant trend towards lower survival (survival status 0% vs no estatus 25%, p=0.082). VA-ECMO preimplantation cardiac arrest was associated with the occurrence of encephalopathy (encephalopathy 84% vs. not 40%, p=0.049). The duration of cardiac arrest and lactate before VA-ECMO implantation were significantly higher as the EEG pattern was worse (figure). Conclusions Neurological damage is relevant in patients under VA-ECMO support, being a determining factor in death in up to 17.2% of patients. Hypoxic-ischemic encephalopathy was associated with lower survival, with the EEG pattern associated with previous cardiac arrest, its duration and lactate.Table.Baseline, admission and follow-upFigure.Cardiac arrest, lactate and EEG

Effect of integrated manual and verbal cueing on functional transfers in chronic stroke survivors: a randomized controlled study

Purpose The profession of physical therapy has historically relied on manual facilitation to improve motor control strategies and performance in persons rehabilitating from a stroke, yet there is insufficient evidence to support its use during functional task training. The purpose of this study was to determine the effects of integrated cueing (verbal and manual) and verbal cueing approaches during sit-to-stand training on midline alignment & muscle activation in chronic stroke survivors. Methods Twenty-one chronic right-brained stroke survivors with hemiplegia were randomly assigned to the Integrated Cueing or Verbal Only group and outcome measures were recorded using an 18-Camera Motion Capture System, force plates, and surface electromyography (EMG). Results Both groups demonstrated a significant improvement in symmetry toward the midline after thirty training repetitions. Significant improvements in muscle activation were found in two muscle groups on the affected side of the body in the Integrated Cueing group, gastrocnemius and rectus femoris. Conclusion Both the Verbal Only and Integrated Cueing groups made significant progress toward more symmetrical movement, yet more significant changes in the activation of hemiparetic extensor muscles were seen in the Integrated Cueing group. These findings support the use of manual cueing in movement activation and performance during the training of functional tasks. IMPLICATIONS FOR REHAB Physical therapists commonly use manual tactile cues to facilitate movement performance but there is currently insufficient evidence to support this use with stroke survivors. In a relatively small sample size, both verbal cues and integrated cues (verbal plus manual) improved symmetry during sit to stand in chronic right brain stroke survivors. Integrated cueing enhanced motor activation and performance during sit to stand better than verbal cues alone. Manual tactile cueing should be considered during functional task retraining.

The Relationship Between Dyadic Coping and Mental Health in Stroke Survivors and Their Spouse Caregivers: An Actor-Partner Interdependence Model.

To investigate the relationship among dyadic coping, mental health and the individual and mutual influences on stroke survivors and their spouse caregivers. A cross-sectional descriptive study was conducted in China from November 2019 to August 2020. The STROBE checklist was used to report the present study. The analysis included 224 dyads of stroke survivors and their spouse caregivers in China. Data on stroke survivors and their spouse caregivers were collected using the Dyadic Coping Inventory (DCI), the Patient Health Questionnaire nine-item scale (PHQ-9) and the Generalised Anxiety Disorder seven-item scale (GAD-7). The dyadic analysis was conducted based on the Actor-Partner Interdependence Model (APIM). Regarding actor effects, spouse caregivers' dyadic coping and perceived dyadic coping had a negative predictive effect on their own anxiety and depression. Stroke survivors' perceived dyadic coping had a negative effect on their own depression. Regarding partner effects, spouse caregivers' perceived dyadic coping also had a negative predictive effect on the depression of the patients. In contrast, stroke survivors' perceived dyadic coping was positively associated with spouse caregivers' anxiety and depression. These findings suggested that mental health of stroke survivors and their spouse caregivers was affected by various dyadic coping dimensions. Our research has the potential to contribute to the understanding dyadic coping and mental health of stroke survivor-spouse caregiver dyads. The findings reveal that the coping strategies employed by stroke couples are closely related to the mental health of both partners. This study provides evidence for the significant impact of dyadic coping on the psychological well-being of stroke survivors and their spouse caregivers. Therefore, dyadic interventions aiming at strengthening dyadic coping may have positive effects on their mental health. This study directly involved the patients and family caregivers in hospital settings.

Effects of Manual Acupuncture Versus Sham Acupuncture in patients with Post-Stroke Depression: A Randomized Clinical Trial.

Post-stroke depression (PSD) is a prevalent psychiatric complication in stroke patients, severely reducing quality of life and delaying social recovery in stroke survivors. Clinical studies have shown that acupuncture can be used as an alternative approach for PSD. The aim of this study was to examine the safety, efficacy, and electroencephalogram (EEG) mechanism of acupuncture in treating PSD patients. From October 28, 2022 to May 16, 2023, this single-center, single-blind, randomized clinical trial was conducted at the Second Affiliated Hospital of Nanchang University. A total of 56 eligible subjects were assigned in a random manner, with an equal distribution between two groups: the manual acupuncture (MA) group and the sham acupuncture (SA) group. The primary outcome was the Hamilton Depression Scale-24 (HAMD-24); the secondary outcomes included the Pittsburgh Sleep Quality Index (PSQI), the National Institutes of Health Stroke Scale (NIHSS), the Barthel index, EEG power spectrum, and EEG imaginary coherent (iCOH). Compared to the SA group, the MA group exhibited significant improvements in HAMD-24, NIHSS, PSIQ, and Barthel index at week 6. The total improvement rate was 85.71% in the MA group and 28.57% in the SA group. After 6weeks of treatment, the alpha and beta bands power spectrum increased significantly, while the delta and theta bands power spectrum decreased significantly in the MA group compared to the SA group. The iCOH analysis showed that the MA group had significantly higher functional connectivity in the four bands than the SA group. Acupuncture might be regarded as an adjunctive treatment for PSD patients with improvements in their neurological deficits, sleep quality, and depression. Meanwhile, the mechanism of acupuncture in treating PSD patients may be through decreasing the slow wave power spectrum and increasing the fast wave power spectrum, and enhancing brain functional connectivity. Chinese Clinical Trial Registry (ChiCTR2200065112/2022-10-28).

Enhancing Activity Recognition After Stroke: Generative Adversarial Networks for Kinematic Data Augmentation

The generalizability of machine learning (ML) models for wearable monitoring in stroke rehabilitation is often constrained by the limited scale and heterogeneity of available data. Data augmentation addresses this challenge by adding computationally derived data to real data to enrich the variability represented in the training set. Traditional augmentation methods, such as rotation, permutation, and time-warping, have shown some benefits in improving classifier performance, but often fail to produce realistic training examples. This study employs Conditional Generative Adversarial Networks (cGANs) to create synthetic kinematic data from a publicly available dataset, closely mimicking the experimentally measured reaching movements of stroke survivors. This approach not only captures the complex temporal dynamics and common movement patterns after stroke, but also significantly enhances the training dataset. By training deep learning models on both synthetic and experimental data, we enhanced task classification accuracy: models incorporating synthetic data attained an overall accuracy of 80.0%, significantly higher than the 66.1% seen in models trained solely with real data. These improvements allow for more precise task classification, offering clinicians the potential to monitor patient progress more accurately and tailor rehabilitation interventions more effectively.

The effect of unaffected side resistance training on upper limb function reconstruction and prevention of sarcopenia in stroke patients: a randomized controlled trial

Aging has made stroke a top killer and disabler, with post-stroke sarcopenia worsening disability and quality of life. While resistance training benefits the elderly, its impact on stroke patients is understudied. This study evaluates the potential of a 4-week unilateral resistance training (URT) program to prevent sarcopenia in stroke patients. It assesses the impact of URT on hand grip strength (HG), muscle thickness (MT), upper limb functionality, and the psychological status of the patients. The study aims to quantitatively analyze these indicators to inform evidence-based post-stroke rehabilitation practices. This study employed a randomized controlled trial (RCT) involving 77 eligible stroke survivors, equally allocated into a control group (n = 39) and an intervention group (n = 38). The control group received standard rehabilitation, while the intervention group additionally underwent a 4-week URT program. The primary outcomes were unaffected side HG and MT, measuring muscle mass and function. Secondary outcomes included the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) for upper limb functionality and the Hamilton Depression Rating Scale (HAMD) for psychological well-being changes. Statistical analysis showed significant differences (p < 0. 05) in all measured parameters between the intervention and control groups after the 4-week period. Intra-group comparisons also indicated substantial improvements (p < 0. 05). Unilateral resistance training significantly mitigates muscle atrophy in stroke patients, preventing sarcopenia and enhancing upper limb function. It also ameliorates depressive symptoms, improving rehabilitation outcomes and overall quality of life.

Multiple imputation integrated to machine learning: predicting post-stroke recovery of ambulation after intensive inpatient rehabilitation

Good data quality is vital for personalising plans in rehabilitation. Machine learning (ML) improves prognostics but integrating it with Multiple Imputation (MImp) for dealing missingness is an unexplored field. This work aims to provide post-stroke ambulation prognosis, integrating MImp with ML, and identify the prognostic influential factors. Stroke survivors in intensive rehabilitation were enrolled. Data on demographics, events, clinical, physiotherapy, and psycho-social assessment were collected. An independent ambulation at discharge, using the Functional Ambulation Category scale, was the outcome. After handling missingness using MImp, ML models were optimised, cross-validated, and tested. Interpretability techniques analysed predictor contributions. Pre-MImp, the dataset included 54.1% women, 79.2% ischaemic patients, median age 80.0 (interquartile range: 15.0). Post-MImp, 368 non-ambulatory patients on 10 imputed datasets were used for training, 80 for testing. The random forest (the validation best-performing algorithm) obtained 75.5% aggregated balanced accuracy on the test set. The main predictors included modified Barthel index, Fugl-Meyer assessment/motricity index, short physical performance battery, age, Charlson comorbidity index/cumulative illness rating scale, and trunk control test. This is among the first studies applying ML, together with MImp, to predict ambulation recovery in post-stroke rehabilitation. This pipeline reliably exploits the potential of incomplete datasets for healthcare prognosis, identifying relevant predictors.

Video Game-Based Trunk Exercises for Rehabilitation in Chronic Stroke Survivors: A Mixed-Methods Feasibility Study

Video Game-Based Trunk Exercises for Rehabilitation in Chronic Stroke Survivors: A Mixed-Methods Feasibility Study

Relationship between locus of control and health-related quality of life in chronic stroke patients: a cross-sectional study

IntroductionStroke is a major cause of disability in adults and the elderly worldwide. Post-stroke rehabilitation success largely depends on consistent participation in treatment sessions and adherence to prescribed physical exercises; however, factors such as individual belief about their health status often affect motivation, slowing recovery. Addressing these influences is essential for improving health-related quality of life and optimizing recovery outcomes.MethodsThis study employed a cross-sectional and correlational design with convenience sampling. The aim was to explore the relationship between recovery locus of control (RLOC) and health-related quality of life (HRQoL) among chronic stroke survivors. The Recovery Locus of Control scale and the EuroQol 5D-5L scale were utilized for assessment.ResultsA total of 69 participants were included in this survey. The mean RLOC score was 34.91, with internal RLOC at 21.16 and external RLOC at 13.77 and the total EQ5D index was 0.659. Age was a significant grouping factor, with the 30–39 age group showing a significant positive relationship (r = 1.000, p = 0.002), pain and anxiety/depression (p = .045), mobility and anxiety/depression (p = .009), anxiety/depression and self-care (p = .047), IRLOC and ERLOC (p = .013).ConclusionThe study found that while respondents exhibited high RLOC scores, there was no significant relationship between RLOC scores and the EQ5D-5L index score, suggesting that other factors may play a more critical role in influencing HRQoL among chronic stroke survivors.

Feasibility of a 10-week community-based mobile health rehabilitation program using the WalkWithMe application in late sub-acute and chronic stroke survivors in a low resource setting: A pilot study

ABSTRACT Physical functioning can be increased in people with stroke by using a mobile health application. This study aimed to investigate the feasibility of a 10-week community-based program using the WalkWithMe (WWM) application in people with late sub-acute and chronic stroke in Benin. An interventional pilot study with mixed methods research design was used examining the application of an unsupervised individualized mobile Health (mHealth) instructed training program. Main outcome included the application usage, safety, adherence, perceived enjoyment, mHealth quality, patient experiences and pre-post efficacy measures. Nine adults, five males, median age of 60 years and time since stroke of 12 months participated in this study. For most participants adherence with the application was over 70%. However, some usability problems were observed due to incorrect understanding and use by participants and technical problems. The application was very fun, stimulating and enjoyable. Significant improvements were found with median (pre/post measures) of locomotors skill (1.4/3.4); impairments (38/40), Barthel Index (85/95), activity limitation (2.1/3.1), and quality of life (194/218). A trend towards significant improvement was found with 6 minutes walking test (181/220, p = 0.06). The WWM application is perceived as a potential approach to increase physical activity and functioning among people with stroke in Benin.

Examining Factors That Contribute to Poststroke Depression Within the Family Caregiver and Care Recipient Dyadic Experience

Purpose: Stroke survivors often experience biochemical changes in the brain. This decreases the ability to experience positive emotions. Stroke survivors contend with the loss of their former self and are often left with residual physical, cognitive, communicative, and psychological changes leading to a depressive state. With an increasing number of stroke survivors returning to the community, informal care provided by family members will continue to rise. Many of the challenges faced by stroke survivors with poststroke depression (PSD) and by family caregivers (FCGs) have a significant impact on the relationship itself. With the goal to obtain insight into potential contributing factors to poststroke depressive features in stroke survivors, this qualitative research study aimed to investigate the experiences, behaviors, and perceptions of participants with PSD living in the dyadic relationship between FCG and stroke survivors. Method: Six FCG–stroke survivor care recipient dyads served as the participants. All stroke survivor care recipients were diagnosed with or had signs and symptoms of depression poststroke. Semistructured interviews were conducted with stroke survivors within each dyadic relationship. All participants were within this dyadic relationship for at least 3 months. Results: Six themes emerged from the stroke survivors. The findings indicated that grieving of the former self, lack of self-efficacy, isolation, difficulty with communication, perceived stress of the FCG, and lack of depressive coping skills are factors that contribute to PSD. Conclusions: There were multiple factors experienced by stroke survivors within the dyad affecting their emotional state and leading to or exacerbating depressive symptoms. Additionally, stroke survivors have limited coping strategies for depressive symptoms. Stroke survivor informational counseling, training, and education may improve coping strategies and decrease symptoms of depression and therefore lead to strengthened rehabilitative outcomes. Supplemental Material: https://doi.org/10.23641/asha.27156381

Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial

People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of accessing secondary prevention programs, it is important to consider alternative ways that this information can be made available to survivors of stroke worldwide. Using the “design thinking” framework and drawing on principles of the integrated knowledge translation approach, we adapted 2 co-designed telehealth programs called i-REBOUND – Let’s get moving (physical activity intervention) and i-REBOUND – Eat for health (diet Intervention) to create the i-REBOUND after stroke website. The aim of this paper is to describe the systematic process undertaken to adapt resources from the telehealth delivered i-REBOUND – Let’s get moving and i-REBOUND – Eat for health programs to a website prototype with a focus on navigation requirements and accessibility for survivors of stroke. We engaged a variety of key stakeholders with diverse skills and expertise in areas of stroke recovery, research, and digital health. We established a governance structure, formed a consumer advisory group, appointed a diverse project team, and agreed on scope of the project. Our process of adaptation had the following 3 phases: (1) understand, (2) explore, (3) materialize. Our approach considered the survivor of stroke at the center of all decisions, which helped establish guiding principles related to our prototype design. Careful and iterative engagement with survivors of stroke together with the application of design thinking principles allowed us to establish the functional requirements for our website prototype. Through user testing, we were able to confirm the technical requirements needed to build an accessible and easy-to-navigate website catering to the unique needs of survivors of stroke. We describe the process of adapting existing content and co-creating new digital content in partnership with, and featuring, people who have lived experience of stroke. In this paper, we provide a road map for the steps taken to adapt resources from 2 telehealth-delivered programs to a website format that meets specific navigation and accessibility needs of survivors of stroke.

Development of a behaviour change intervention for improving physical activity amongst stroke survivors with physical disabilities: a co-design approach

BackgroundStroke survivors face many barriers to physical activity (PA). Solving physical inactivity after stroke requires a “systems-based” approach. We aimed to develop a complex intervention targeted at improving PA after stroke in Singapore using behaviour change theory and a co-design approach involving multiple stakeholders.MethodsWe carried out the intervention development in three phases: i. preparation phase, ii. co-design phase, and iii. intervention refinement phase. During the preparation phase, we conducted surveys (n = 38 stroke survivors, 71 physiotherapists and 35 exercise professionals) and interviews (n = 19 stroke survivors) to understand the factors influencing PA after stroke. The co-design phase consisted of two-co-design workshops held in August 2022 and were attended by 13 stroke survivors and 4 caregivers. Relevant domains of the Theoretical Domains Framework (TDF) and items in the Template for Intervention Description and Replication (TIDieR) checklist guided the discussion topics in the first co-design workshop. Solution prototypes such as exercise videos, arm and leg straps and information resources were shown in the second co-design workshop to gather feedback. In the intervention refinement phase, eight healthcare professionals from various sectors participated in two virtual Zoom meetings in August 2023, and used the Acceptability, Practicability, Effectiveness, Affordability, Spillover effects and Equity (APEASE) grid to rate the active ingredients in the complex intervention by considering the current healthcare landscape in terms of resources and manpower.ResultsStroke survivors and caregivers want a personalised PA program, stroke-specific PA opportunities and information resources, medical clearance, advice and help from healthcare professionals skilled in stroke care, face-to-face sessions at preferred exercise spaces, and access to adaptive equipment. A complex intervention consisting of 21 behaviour change techniques, 6 intervention functions and 8 options was developed.ConclusionsUsing behaviour change theory and a co-design approach involving multiple stakeholders, a complex intervention was developed to target physical inactivity after stroke. The intervention titled MOTIVATE is currently being tested in a type 1 hybrid effectiveness-implementation trial.

Home-based guidance training system with interactive visual feedback using kinect on stroke survivors with moderate to severe motor impairment

The home-based training approach benefits stroke survivors by providing them with an increased amount of training time and greater feasibility in terms of their training schedule, particularly for those with severe motor impairment. Computer-guided training systems provide visual feedback with correct movement patterns during home-based training. This study aimed to investigate the improvement in motor performance among stroke survivors with moderate to severe motor impairment after 800 min of training using a home-based guidance training system with interactive visual feedback. Twelve patients with moderate to severe stroke underwent home-based training, totaling 800 min (20–40 min per session, with a frequency of 3 sessions per week). The home-based guidance training system uses Kinect to reconstruct the 3D human body skeletal model and provides real-time motor feedback during training. The training exercises consisted of six core exercises and eleven optional exercises, including joint exercises, balance control, and coordination. Pre-training and post-training assessments were conducted using the Fugl-Meyer Assessment-Upper Limb (FMA-UE), Fugl-Meyer Assessment-Lower Limb (FMA-LE), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), Barthel Index (BI), Modified Ashworth Scale (MAS), as well as kinematic data of joint angles and center of mass (COM). The results indicated that motor training led to the attainment of the upper limit of functional range of motion (FROM) in hip abduction, shoulder flexion, and shoulder abduction. However, there was no improvement in the active range of motion (AROM) in the upper extremity (U/E) and lower extremity (L/E) joints, reaching the level of the older healthy population. Significant improvements were observed in both left/right and superior/inferior displacements, as well as body sway in the mediolateral axis of the COM, after 800 min of training. In conclusion, the home-based guidance system using Kinect aids in improving joint kinematics performance at the level of FROM and balance control, accompanied by increased mediolateral body sway of the COM for stroke survivors with moderate to severe stroke. Additionally, spasticity was reduced in both the upper and lower extremities after 800 min of home-based training.