Chronic Stroke Research Articles (Page 1)

To determine the test-retest reliability and construct validity of the Instrumental- Timed Up and Go Test (i-TUG), TUG, and Berg Balance Scale (BBS) using EncephaLog in individuals with stroke. The study was conducted with 37 individuals diagnosed with chronic ischemic stroke. Participants were assessed using the i-TUG, TUG, BBS, and additional postural sway parameters collected via EncephaLog. Two test sessions were conducted to assess test-retest reliability. Pearson correlation coefficients were used to evaluate construct validity, and the Standard Error of Measurement and Minimal Detectable Change (MDC) were also calculated. High correlation was found between i-TUG and TUG (r = 0.92; r = 0.70), and moderate correlation between i-TUG and BBS (r= -0.54; r= -0.63). Postural sway parameters had negligible correlations with BBS and TUG. Test-retest reliability was excellent for i-TUG (ICC = 0.76), TUG (ICC = 0.83), BBS (ICC = 0.88), Time To Stand Up From The Chair (SUT) (ICC = 0.82), and Time To Sit Down On The Chair (SDT) (ICC = 0.79), but poor for Mediolateral Sway (MLsway) (ICC = 0.27) and Anteroposterior Sway (APsway) (ICC = 0.23). MDC values were as follows: i-TUG (12.36), TUG (9.21), BBS (7.48), MLsway (0.29), APsway (0.29), SUT (0.57), and SDT (0.51). EncephaLog-based i-TUG demonstrated high reliability and good validity, comparable to conventional clinical tests in chronic ischemic stroke. While sway parameters showed low correlation and reliability, i-TUG provides a promising, accessible, and objective tool for balance assessment.

This study examines the effects of combining transcranial direct current stimulation (tDCS) with extended reality (XR) exercises on brain connectivity and motor recovery in chronic stroke. We evaluate changes in electroencephalography (EEG) based connectivity and symmetry parameters, their correlation with clinical improvements, and their prognostic potential. Participants underwent XR rehabilitation with either active anodal tDCS or sham stimulation. EEG connectivity metrics and symmetry indices were assessed before and after the intervention alongside upper and lower limb motor function assessments. Correlation analyses were conducted to examine associations between EEG variations and motor improvements. As results, significant reductions in the brain symmetry index and the directional brain symmetry index were observed in the active tDCS group in the alpha, beta, and gamma EEG frequency bands, indicating an increase in symmetry after rehabilitation. Comparing the evolution of EEG features with clinical variations, in the active tDCS group greater correlations of changes in high frequency connectivity with upper and lower limb improvements were found. In conclusion, the addition of anodal tDCS to XR therapy seems to enhance neuroplasticity by modulating high-frequency power and connectivity, possibly also promoting more effective motor recovery. This study provides a comprehensive analysis of tDCS-enhanced XR rehabilitation, offering novel insights into brain connectivity changes and potential biomarkers for stroke recovery.

Binaural beat stimulation (BBS) has been applied to explore cognitive and sleep disorders. This pilot study aimed to examine the immediate effects of a 4-Hz frequency BBS combined with music on prefrontal cortex activity in patients with stroke. We recruited 12 patients with chronic stroke from the rehabilitation department of a medical university-affiliated hospital. Each subject received "Musical Moonlight Sonata," "4-Hz frequency BBS," and "Musical Moonlight Sonata combined with 4-Hz BBS" interventions in a random order within a 3-hour experimental period. Each intervention lasted for 20 minutes, with 30-minute rest intervals between interventions. An 8-channel wearable dry electrode electroencephalography system was used to record the prefrontal cortex activity before and after each intervention. Within-group analysis revealed an increase in alpha power following: "Musical Moonlight Sonata" intervention (R = 0.57, P = .049). Significant differences in prefrontal cortical activity were found between the 3 interventions (partial η² = 0.24, P = .04). Compared to the "4-Hz BBS" intervention, the "Musical Moonlight Sonata" intervention significantly increased alpha power in the affected prefrontal cortex. Preliminary findings indicate that a 20-min intervention with Moonlight Sonata music alone had an immediate effect on prefrontal cortex activity in patients with chronic stroke. The 4-Hz BBS or the combined music and 4-Hz BBS intervention did not seem to be as effective in changing prefrontal cortex activity after stroke.

ABSTRACT Objectives Ischemic stroke often causes severe neurological impairments. Our previous studies showed that Col003, a heat shock protein (HSP47) inhibitor, has neuroprotective effects in acute ischemic stroke, but its role in chronic ischemic stroke remains unclear. Methods This study investigated gene changes in ischemic brain tissue of rats treated with Col003 after chronic ischemic stroke. Rats with middle cerebral artery occlusion (MCAO) received Col003 injections via tail vein daily for 14 days. Neurological function and cerebral infarct volume were measured post-ischemia. Rat brain tissues from Sham, Vehicle, and Col003 groups were analyzed by western blot (WB), real-time quantitative polymerase chain reaction (RT-qPCR), and RNA-Seq. Results Fourteen days post-MCAO, Col003 treatment significantly decreased cerebral infarct volume and enhanced neurological function scores in rats. There were 1956 genes up-regulated (Vehicle vs. Sham) and 251 genes down-regulated (Col003 vs. Vehicle) by RNA-Seq analysis, and 136 differentially expressed genes (DEGs) were identified by Venn diagram analysis. We screened genes closely associated with ischemic stroke, including lipocalin-2 (LCN2), from the top 20 significantly DEGs. Pathway enrichment analysis of DEGs showed that JAK-STAT pathway was strongly associated with chronic ischemic stroke. RT-qPCR and WB showed that LCN2 was upregulated in peri-infarct brain tissue at 14 days after ischemic stroke, and LCN2 was significantly reduced after Col003 treatment. Col003 decreased JAK2/STAT3 phosphorylation in ischemic brain tissue. Conclusion In rats with chronic ischemic stroke, Col03 may lessen the size of the cerebral infarction and neurological impairments by blocking LCN2 through the JAK2/STAT3 signaling pathway.

BackgroundCurrent practice guidelines recommend 70-85% age-predicted heart rate (HR) max attainment and high walking dosages for ambulatory persons with chronic stroke. The evidence to support target heart rate attainment and walking dosage on gait speed for persons post stroke with severe balance impairments has been limited during inpatient rehabilitation.ObjectivesTo examine the relationship between 70% HR max attainment, walking distance (≥304.8 meters), and minimum detectable changes (MDC) in gait speed for persons post stroke who have severe balance impairment on admission to inpatient rehabilitation.MethodsRetrospective observational cohort study examining 70% HR max heart rate attainment during locomotor training for 244 persons post stroke with severe balance impairment (BERG Balance Scale ≤ 6/56) during inpatient rehabilitation and its association with the minimum detectable change (MDC) for the 10-meter walk test (10 MWT).Results164/244 persons post stroke achieved 70% HR max and this was significantly associated with MDC in gait speed (odds ratio 2.64, CI: 1.41-5.08). Preserved sitting balance (BERG Balance Scale 4-6/56) on admission was positively associated with meaningful gait speed changes (odds ratio 1.36, CI: 1.15-1.64). Walking distance was not positively associated with gait speed.ConclusionTwo-thirds of persons post stroke with severe balance impairment on admission to inpatient rehabilitation were able to achieve target heart rate. When this heart rate is achieved, meaningful changes in gait speed are likely to occur. Additionally, persons post stroke with preserved sitting balance are more likely to achieve meaningful improvements in gait speed.

Background: With 97% of congenital heart disease (CHD) patients now reaching adulthood, the risk of cardiovascular disease, including atrial fibrillation (AF), is higher compared to the general population. Hypothesis: We hypothesize that AF patients with CHD have worse cardiovascular outcomes compared to those without. Methods: This is a retrospective cohort using the REACHnet database from 2010 to 2019. Kaplan-Meier curves and log-rank test were used to study time-to-death, cardiovascular event and hospitalization. Cox regression was used to adjust for age, sex, BMI, hypertension, and diabetes, CHD as confounders. Chi-square and t-test were used to compare categorical and continuous variables, respectively. Results: In total, 5947 AF subjects were included in our analysis, among which 60 (1.0%) were diagnosed with CHD. Most of our CHD cohort had a left-to-right shunt lesion (n=31, 51.7%). AF patients with CHD were significantly more likely to have hypertension (81.7% vs 42.8%, p <0.0001), diabetes mellitus (40.0% vs 23.3%, p =0.002), chronic kidney disease (23.3% vs 11.9%, p =0.007) and strokes (36.7% vs 8.7%, p <0.0001), and had lower BMI (28.25 + 8.2 vs 31.0 + 8.0 , p =0.007) compared to those without. They were also more frequently on antiarrhythmic drugs (16.7% vs 6.0%, p =0.004) and anticoagulants (68.3% vs 35.4%, p <0.0001). There was no difference between the two groups in terms of age ( p =0.318), sex ( p =0.285) and race ( p =0.450). Kaplan-Meier curves showed a significantly shorter time to stroke ( p <0.0001) (Figure 1E), myocardial infarction ( p <0.0001) (Figure 1D) and congestive heart failure ( p =0.001) (Figure 1C) in the CHD group. Patients with CHD had higher risk of stroke (HR = 2.78, 95% CI 1.75–4.43, p <0.0001), and MI (HR = 2.56, 95% CI 1.43–4.61, p =0.004). There was no significant mortality ( p =0.1) (Figure 1A) or hospitalization difference ( p =0.44) (Figure 1B) between the groups. Conclusion: Our preliminary analysis showed that AF patients with CHD have higher stroke and MI risk compared to those without. There was no difference in mortality, CHF and hospitalization between the two groups. Our results suggest that both CHD and AF may contribute to adverse cardiovascular outcomes.

Background: Out-of-hospital cardiac arrest (OHCA) survivors who regain spontaneous circulation may progress to brain death, but early prediction remains challenging. Accurate prognostication can inform treatment decisions and facilitate organ donation, yet robust models are lacking. Objectives: To identify predictors of brain death progression in OHCA patients treated with targeted temperature management (TTM) and to develop and validate an early prediction model, also assessing subsequent organ donation rates. Methods: We retrospectively analyzed data from the Korean Hypothermia Network registry, including OHCA patients treated with TTM between October 2015 and September 2024. Patients with acute brain hemorrhage or stroke, poor pre-arrest cerebral status (CPC 3 or 4), terminal illness, severe hypothermia (<30°C), or those not receiving post-arrest care were excluded. The development cohort (2015–2020) included 1,966 patients; the validation cohort (2020–2024) included 927 patients. Results: Of 23,160 registered patients, 3,067 underwent TTM with consent; 2,893 with complete data were analyzed. In the development cohort, 273 patients (13.9%) were suspected of brain death. Multivariate analysis identified age, witnessed arrest, respiratory cause, heart rate and GCS motor score after ROSC, NSE at 72 hours, and post-rewarming fever as significant predictors. The model achieved an AUC of 0.860 (95% CI: 0.825–0.892), sensitivity 89.6%, and specificity 72.1% in the development cohort; in the validation cohort, AUC was 0.893 (95% CI: 0.836–0.918), sensitivity 89.4%, specificity 83.4%. Among 273 suspected brain death patients, only 113 (41.4%) proceeded to organ donation, indicating that about half of potential donors did not become actual donors. Six-month survival and good neurological outcome rates were 41.7% and 31.7% in the development cohort. Conclusions: We developed and validated a robust model for early prediction of brain death in OHCA survivors treated with TTM. Despite accurate identification, only about half of brain death cases led to organ donation, highlighting a gap between potential and actual donors. This model can support clinical decision-making and may help increase organ donation rates through timely identification.

Kinematic assessments provide a quantitative evaluation of movement outcomes in chronic stroke survivors. However, it is unclear whether these assessments provide an added benefit to standardized clinical assessments when evaluating functional independence. We hypothesized that kinematic assessments of ipsilesional arm motor and cognitive performance would be better at predicting functional independence compared to their standardized clinical assessment counterparts. We recruited 21 chronic stroke survivors with severe hemiparesis to complete 2 clinical assessments (Jebsen-Taylor Hand Function Test, Grooved Pegboard Test) and 2 kinematic assessments on the Kinereach motion tracking system (a simple reaching task and a cognitively challenging reaching task). We found moderate-to-weak correlations between the Functional Independence Measure (FIM) and each of the kinematic outcomes. The clinical assessments had weak correlations with the FIM. Thus, kinematic assessments provided no significant advantage over clinical assessments in predicting functional independence.

Stroke-related long-term disability is primarily due to impaired motor function. Rehabilitation efforts have traditionally focused on central strategies while ignoring the affected muscles. Regenerative medicine approaches have emerged as a promising option for treating various conditions, including muscular disorders. The present study aims to compare the effects of intramuscular injections of mesenchymal stromal cells (MSCs) and Platelet-rich plasma (PRP) on motor recovery in poststroke survivors. A single-blind, randomized, controlled trial will be followed. Fifteen stroke patients who meet the eligibility criteria will be randomly assigned to the cell therapy, PRP, or waiting-list control groups. Patients in each group will receive a single injection of MSCs or PRP into their affected biceps brachii muscle. Patients in the waiting list control group will receive no intervention. The outcome measures include the Modified Modified Ashworth Scale (MMAS), Brunnstrom recovery stages for the upper limb, elbow range of motion, and sonographic evaluations. All outcome measures will be assessed at baseline, 1, 2, and 3 months after injection. The findings of this study will provide initial supportive evidence regarding the efficacy of MSCs and PRP therapy in improving biceps brachii muscle spasticity and function in patients with chronic stroke. IRCT20230208057351N1.

ABSTRACT Introduction Cerebral air embolism accompanied by right‐to‐left shunt through the venous system during Robot‐assisted partial nephrectomy (RAPN) is regarded as a rare occurrence, with a high mortality rate. Case Presentation A case of a 77‐year‐old man with renal cell carcinoma who developed cerebral air embolism during right retroperitoneal RAPN using AirSeal. Intraoperatively, a sudden drop in end‐tidal CO 2 was observed during tumor resection. Postoperatively, the patient developed seizures, and imaging revealed cerebral air embolization. Despite hyperbaric oxygen therapy and intensive care, he progressed to fatal cerebral infarction. Conclusion This case highlights the risk of serious brain stroke during RAPN. The pathways of air entry into the cerebral circulation occasionally remain unclear and are difficult to fully exclude preoperatively. Renal vein clamping and adequate insufflation pressure are recommended when the tumor is entirely endophytic or close to the renal vein, especially when performing a right retroperitoneal approach.

ExF-SVM: Exhaustive feature selection with support vector machine algorithm for brain stroke prediction.

Hinge craniotomy versus decompressive craniectomy for the neurosurgical management of traumatic brain injury and stroke: A systematic review and meta-analysis.

Ambient PM2.5: Health policy implications and management in Khuzestan, Iran.

Vascular magnifier for ultrahigh-resolution visualization of cerebral vessels in vivo.

BackgroundAlcohol use disorder (AUD), epilepsy, hemorrhagic stroke (HS), and traumatic brain injury (TBI) are all linked to neuroinflammation and associated with an increased risk of Alzheimer's disease (AD). Drug responses in cognitive health remain largely unknown in patients with neuroinflammation-related conditions.ObjectiveTo investigate the associations between drug exposure and AD incidence in patients with neuroinflammation-related conditions.MethodsWe derived covariate matched cohorts for individuals with and without neuroinflammation-related conditions (e.g., AUD, epilepsy, HS and TBI) from a US nationwide insurance claim data. We used covariate-adjusted Cox models to estimate the hazard ratios (HRs) of drug exposure on AD. We identified neuroinflammation-specific drug responses by comparing HRs between individuals with and without neuroinflammation-related conditions.ResultsWe identified 0.4 million matched pairs of individuals with and without neuroinflammation-related conditions. We identified three drugs (levothyroxine [HR = 0.89], mirabegron [HR = 0.69], and ropinirole [HR = 0.81]) had a lower HR and two drugs (levetiracetam [HR = 1.19], and quetiapine [HR = 1.83]) had a higher HR in individuals with neuroinflammation-related conditions compared to without (false discovery rate <0.05).ConclusionsIn patients with neuroinflammation-related conditions, we identified drugs associated with lower risks (levothyroxine, mirabegron and ropinirole) and higher risks (levetiracetam and quetiapine) of AD incidence.

A novel feature extraction and deep spiking MobileNet for brain stroke detection using MRI image

(1) Background: Hand and Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) is a high-dose evidence-based neurorehabilitation. This study aims to develop and validate a protocol using three inertial measurement units (IMUs) to objectively document upper and lower extremities’ (UE; LE) motor activity during a HABIT-ILE intervention in chronic stroke adults. (2) Method: Thirteen adults (57.1 y ± 11.3) who completed 65 h of HABIT-ILE (2 weeks, 6.5 h/d) were included. Daily motor activity was recorded with IMUs placed on both wrists and one thigh with nine IMU-derived variables extracted to evaluate motor activity and posture. Each variable was correlated with baseline abilities and day-to-day patterns were observed with subgroup analyses based on baseline dexterity and walking endurance. Day-to-day patterns were highlighted based on mean values and effect size analyses. (3) Results: Only the Magnitude and Use ratios showed high correlations with baseline abilities, with a day-to-day specific pattern highlighted for participants with moderate to good dexterity at baseline. (4) Conclusions: All participants reported a high level of engagement during HABIT-ILE independently of their baseline abilities. Although we could not detect a global trend to document the content of a HABIT-ILE intervention, these exploratory results suggest IMU monitoring to be relevant to characterize therapeutic content.

Exercise is a key component in the management of type 2 diabetes mellitus (T2DM), but its benefits in older adults with comorbidities remain unclear. To evaluate the metabolic effects of therapeutic exercise on older patients with T2DM and comorbidities and identify clinical characteristics associated with glycaemic improvement. We retrospectively analysed patients with T2DM and at least one comorbidity (e.g. chronic kidney disease, cardiovascular disease, osteoporosis, cancer, stroke and dementia) who received therapeutic exercise guidance from physical therapists between November 2022 and October 2023. Biochemical data were collected at baseline and 3 and 6 months. Patients were considered to be glycated haemoglobin (HbA1c) responders if their HbA1c levels decreased after the intervention. Among 43 patients (mean age: 74.1 ± 12.5 years; 44% men), 21 were HbA1c responders at 3 months. Responders had higher baseline HbA1c levels (7.88% vs 6.87%, P < 0.05), and a greater proportion had HbA1c ≥ 7% (71.4% vs 40.9%, P < 0.05). At 6 months, triglyceride levels significantly decreased in responders (123.3 to 108.7 mg/dL, P < 0.005) and significantly increased in non-responders (113.6 to 149.7 mg/dL, P < 0.01). HbA1c declined significantly in patients with baseline HbA1c ≥ 7% compared to those with HbA1c < 7% (-0.62% vs +0.34%, P < 0.05). Therapeutic exercise improves glycaemic control and triglyceride levels in older patients with T2DM and comorbidities, particularly among those with poorly controlled baseline HbA1c. Baseline HbA1c can be a useful indicator for identifying patients who are likely to benefit from exercise.

Influence of Joint-Specific Action Observation Training on Ambulatory Function in Chronic Stroke Survivors

A Clamshell Exercise on the Affected Side in Chronic Stroke Patients Gluteus Medius Activity and Its Effects on Balance and Gait