First Year Of Stroke Research Articles

Cognitive decline before and after a first-ever stroke in Africans.

There is a knowledge gap on the impact of pre-existing cognitive decline on poststroke decline in indigenous Africans. We describe the trajectories of domain-specific cognitive and activities of daily life (ADL) functioning across the first year of stroke in Nigerians with pre-existing cognitive decline. Prospective observational study. Prestroke cognitive decline was ascertained retrospectively using the 16-item Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Assessments for global cognition, learning, memory, executive and ADL functioning were conducted at 3 time points using the Mini-Mental state examination (MMSE), 10-words list learning and delayed recall test (10 WDRT), Animal naming test and Barthel index, respectively. Among 150 stroke survivors, prestroke cognitive decline was found in 25 (16.7%, 95% C.I=11.5%-23.6%). In linear regression analyses adjusting for the effect of age, education, stroke severity and comorbid diabetes mellitus, prestroke cognitive decline predicted poor memory scores at one year [Adjusted standardized mean difference (SMD)=-0.6, 95% C.I=-1.1, -0.1, p=0.016)]. The association of prestroke cognitive decline with poststroke poor memory was substantially mediated by age (SMD=-0.9, 95% C.I=-1.4, -0.4, p<0.001). Pre-existing cognitive decline in this sample was associated with an age-mediated poor memory function at one-year poststroke. Early institution of targeted cognitive rehabilitation in stroke survivors with pre-existing cognitive decline may reduce the neurocognitive burden of stroke in Black Africans.

A Prospective Economic Evaluation of Rapid Endovascular Therapy for Acute Ischemic Stroke.

During the Randomized Assessment of Rapid Endovascular Treatment (EVT) of Ischemic Stroke (ESCAPE) trial, patient-level micro-costing data were collected. We report a cost-effectiveness analysis of EVT, using ESCAPE trial data and Markov simulation, from a universal, single-payer system using a societal perspective over a patient's lifetime. Primary data collection alongside the ESCAPE trial provided a 3-month trial-specific, non-model, based cost per quality-adjusted life year (QALY). A Markov model utilizing ongoing lifetime costs and life expectancy from the literature was built to simulate the cost per QALY adopting a lifetime horizon. Health states were defined using the modified Rankin Scale (mRS) scores. Uncertainty was explored using scenario analysis and probabilistic sensitivity analysis. The 3-month trial-based analysis resulted in a cost per QALY of $201,243 of EVT compared to the best standard of care. In the model-based analysis, using a societal perspective and a lifetime horizon, EVT dominated the standard of care; EVT was both more effective and less costly than the standard of care (-$91). When the time horizon was shortened to 1 year, EVT remains cost savings compared to standard of care (∼$15,376 per QALY gained with EVT). However, if the estimate of clinical effectiveness is 4% less than that demonstrated in ESCAPE, EVT is no longer cost savings compared to standard of care. Results support the adoption of EVT as a treatment option for acute ischemic stroke, as the increase in costs associated with caring for EVT patients was recouped within the first year of stroke, and continued to provide cost savings over a patient's lifetime.Clinical Trial Registration: NCT01778335.

Dexteria app. therapy versus conventional hand therapy in stroke

Purpose Hand impairment post-stroke is a very common and important rehabilitation goal for functional independence. Advanced therapy options such as an app. therapy provides repetitive training, which may be beneficial for improving fine motor function. This study aims to evaluate the effect of app-based therapy compared to conventional hand therapy in improving dexterity in individuals with stroke. Methodology In total, 39 individuals within the first year of stroke with Brunnstrom stage of hand recovery IV to VI were randomly divided into three groups. All three groups received 60 min of therapy for 21 sessions over a period of 30 days. Group A received conventional hand therapy; Group B received app. therapy, while Group C received conventional therapy along with the app. therapy. All participants were assessed on the Nine-Hole Peg Test and Jebsen–Taylor Hand Function Test at the beginning and after completion of 21 sessions of intervention. Kruskal–Wallis (H) test and Wilcoxon test were used for statistical analysis. Results All three groups improved on hand function post-treatment. However, Group C demonstrated significant improvement with 16%–58% increase in hand function performance on outcome measures (p &lt; 0.05). Findings Findings of the present study demonstrate improvement in dexterity with the app. therapy and combination therapy, in comparison to conventional therapy alone in individuals with stroke. Originality This experimental study focuses the first time on a structured protocol using an enabling technology adjunct to conventional physical therapy to improve hand function in individuals with stroke, which opens up the further scope in Neurorehabilitation. Peer review The peer review history for this article is available at: https://publons.com/publon/10.1108/ILT-04-2020-0144/

Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans

BackgroundThere is relatively limited information on the risk factors and outcome of new onset Poststroke Anxiety (PSA) in Low- and Middle-Income Countries. We estimated incidence, cumulative incidence, risk factors and outcome of new onset anxiety in the first year of stroke among African stroke survivors. MethodsWe analyzed the dataset of a completed clinical trial comprising patients enrolled to test an intervention designed to improve one-year blood pressure control among recent (≤ one month) stroke survivors in Nigeria. Anxiety was measured using the Hospital Anxiety and Depression Scale. Outcomes were assessed using the modified Rankin Scale (mRS), Community screening instrument for dementia (CSID) and Health Related Quality of Life in Stroke Patients (HRQOLISP-26). ResultsAmong 322 stroke survivors who were free of anxiety at baseline, we found a one-year cumulative incidence of 34% (95% CI = 28.6–39.3). Rates were 36.2% (95% CI =29.6–42.7) for men and 29.2% (95% CI =19.9–38.3) for women. In multivariate Cox regression analyses, haemorrhagic stroke type was associated with higher risk of new onset PSA (Hazard Ratio=1.52, 95% CI =1.01–2.29). New onset PSA was independently associated with cognitive [(mean difference (MD) in CSID scores=1.1, 95% C.I=0.2, 1.9)] and motor decline (MD in mRS scores= −0.2, 95% C.I= −0.4, −0.02), as well as poorer quality of life overtime (MD in total HRQOLISP-26 scores=3.6, 95% C.I=1.0, 6.2). ConclusionOne in 3 stroke survivors in Nigeria had PSA at one year. Clinicians in SSA should pay special attention to survivors of haemorrhagic stroke as they are at higher risk of incident anxiety and therefore its consequences.

Does functional mobility vary among individuals with up to one year after stroke? An analysis using the TUG-ABS

The Timed “Up and Go” Assessment of Biomechanical Strategies (TUG-ABS) analyses functional mobility activities of Timed “Up and Go” (TUG) test, showing to be valid and reliable for individuals with stroke. The aim of this study was to evaluate if the performance of functional mobility activities varies between subjects within the first year poststroke. Thirty-eight stroke subjects (mean age 56.5 years) of both genders and with up to one year of first stroke that caused gait deficits (gait speed < 0.8 m/s) participated in the study. Participants were instructed to perform the following activities: standing up from a chair without armrests, walking and circling (180° turns) a cone placed at the 1.35-m mark, walking back and sitting down. The performances of these activities were registered by the Qualisys Motion Capture System. By analyzing the images, TUG-ABS was applied to evaluate: sit-to-stand (STSt), walking (W), turn (T) and stand-to-sit (STSi). For statistical analysis, participants were divided into: one group with up to 3 months poststroke ( n = 21), and another group with 4 to 12 months poststroke ( n = 17). Study groups were compared with Mann Whitney test for TUG-ABS activities and total TUG-ABS score (TS). The groups were homogeneous with regard to middle age, cognitive level (Mini-Mental State Examination), neurological status (National Institute of Health Stroke Scale) and walking ability (Functional Ambulatory Category). For TUG-ABS, there was also no difference between groups for the activities: STSt: P = 0.161; W: P = 0.383; T: P = 0.052; STSi: P = 0.542, and for TS: P = 0.144. Although motor recovery can be influenced by lesion time, the performance of functional mobility activities did not appear to be different among subjects in the first year poststroke. This suggests that biomechanical strategies for performing these activities are developed within the first three months following stroke, indicating the importance of early intervention for rehabilitation.

Effects of gait training with unilateral leg load on weight bearing asymmetry of individuals with stroke: A randomized clinical trial

Stroke patients have shown expressive asymmetry between the paretic and non-paretic lower limb (NPLL). The aim of this study was to examine the effects of unilateral leg load used as a restraint for the NPLL during gait training on weight bearing asymmetry after stroke. Thirty-eight stroke patients of both genders and with up to one year of first stroke that caused gait deficits (gait speed < 0.8 m/s) participated in the study. Participants were randomized into: treadmill training with load (equivalent to 5% of body weight) on the NPLL (experimental group) and treadmill training without load (control group). Interventions lasted 30 min per day, for 2 weeks (9 sessions). Kinetic data were collected with a force plate, during standing position (static) and during gait (dynamic). Limb loading was evaluated by the mean of vertical component of ground reaction force (GRF), for paretic and non-paretic limbs. Static and dynamic symmetry ratio (paretic GRF/non-paretic GRF) was calculated for both groups at baseline, post-training and after 40-day follow-up. At baseline, groups were homogeneous with regard to age, time since stroke, neurological status (according to National Institute of Health Stroke Scale) and walking ability (according to Functional Ambulatory Category). Repeated-measures analysis of variance showed no effects over time in static and dynamic symmetry ratio (static: F = 0.985; P = 0.364; dynamic: F = 2.005; P = 0.153). In addition, ANOVA showed no changes between experimental and control groups in static and dynamic symmetry ratio (static: F = 0.031; P = 0.862; dynamic: F = 0.063; P = 0.803). Although load addition might favor the use of paretic limb by restraining NPLL, weight bearing asymmetry has not been changed over time in any group. Once this protocol is innovative, future studies should investigate other parameters such as training duration and amount of load, to improve weight bearing asymmetry after stroke.

Upper Limb Kinematics in Stroke and Healthy Controls Using Target-to-Target Task in Virtual Reality.

Kinematic analysis using virtual reality (VR) environment provides quantitative assessment of upper limb movements. This technique has rarely been used in evaluating motor function in stroke despite its availability in stroke rehabilitation. To determine the discriminative validity of VR-based kinematics during target-to-target pointing task in individuals with mild or moderate arm impairment following stroke and in healthy controls. Sixty-seven participants with moderate (32-57 points) or mild (58-65 points) stroke impairment as assessed with Fugl-Meyer Assessment for Upper Extremity were included from the Stroke Arm Longitudinal study at the University of Gothenburg-SALGOT cohort of non-selected individuals within the first year of stroke. The stroke groups and 43 healthy controls performed the target-to-target pointing task, where 32 circular targets appear one after the other and disappear when pointed at by the haptic handheld stylus in a three-dimensional VR environment. The kinematic parameters captured by the stylus included movement time, velocities, and smoothness of movement. The movement time, mean velocity, and peak velocity were discriminative between groups with moderate and mild stroke impairment and healthy controls. The movement time was longer and mean and peak velocity were lower for individuals with stroke. The number of velocity peaks, representing smoothness, was also discriminative and significantly higher in both stroke groups (mild, moderate) compared to controls. Movement trajectories in stroke more frequently showed clustering (spider's web) close to the target indicating deficits in movement precision. The target-to-target pointing task can provide valuable and specific information about sensorimotor impairment of the upper limb following stroke that might not be captured using traditional clinical scale. The trial was registered with register number NCT01115348 at clinicaltrials.gov, on May 4, 2010. URL: https://clinicaltrials.gov/ct2/show/NCT01115348.

A Simple Geometric Assessment of Perfusion Lesion Volume at Hyperacute Stage of Ischemic Stroke in Patients with Symptomatic Steno-Occlusion of Major Cerebral Arteries and Risk of Subsequent Cerebral Ischemic Events

Our objective is to elucidate the association of baseline perfusion lesion volume on perfusion-weighted magnetic resonance imaging (PWI) obtained at hyperacute stage of ischemic stroke with subsequent cerebral ischemic events (SIEs) in patients with symptomatic steno-occlusion of major cerebral arteries. Using a prospective stroke registry database, patients arriving within 24 hours of onset with symptomatic steno-occlusion of major supratentorial cerebral arteries were identified. On baseline PWI, time-to-peak lesion volume (TTP-LV) was determined by a simple geometric method and dichotomized into the highest tertile (large) and the other tertiles (small to medium) according to the vascular territory of occluded arteries. Primary outcome was a time to SIE up to 1 year after stroke onset. A total of 385 patients (a median time delay from onset to arrival, 2.2 hours) were enrolled. During the first year of stroke, the SIE rate of the large TTP-LV group was twice that of the small-to-medium TTP-LV group (35.7% versus 17.4%; P < .001). Large TTP-LV independently raised the hazard of SIE (hazard ratio, 2.24; 95% confidence interval, 1.45-3.44). This study demonstrates that TTP-LV on PWI measured through a simple geometric method at an emergency setting can be used to predict progression or recurrence of ischemic stroke in patients with symptomatic steno-occlusion of major cerebral arteries.

Three-year survival and recurrence after first-ever stroke: the Joinville stroke registry.

BackgroundData estimating the recurrence and risk of death are lacking in low and middle income countries, where two thirds of the stroke burden occurs. Previously we had shown that the incidence and mortality have been decreasing over the last 18 years in Joinville, Southern Brazil. In this study, we aim to determine the recurrence rates, survival rates and the cause of death in 3 years after their first-ever incident in a urban population-based setting.MethodsFrom the Joinville Stroke Registry, we identified all the cases of first-ever stroke that occurred from October 2009 to September 2010. Multiple overlapping sources of information were used to ensure the completeness of case identification. Patients were followed up prospectively at regular intervals from 30-days to 3 years after the index event. Kaplan-Meir and Cox proportional hazards were used to assess the cumulative risk of death and recurrence.ResultsWe registered 407 first-ever stroke patients. After 3 years, 136 (33%) had died. In the first year of stroke the risk of death was 28% (95% CI, 25 to 32). Beyond the first year, approximately 3 to 5% of survivors died each year. The cumulative risk of death in ischemic stroke (IS) subtypes was 3.6 higher for cardioembolic (CE) IS (hazard ratio 3.6, 95% CI, 2.1 to 6.4; p = 0.001) and 3.3 times higher for undetermined IS (HR 3.3, 95% CI 1.9 to 5.8; p = 0.001) compared to small artery occlusion IS. Over 3 years, the overall stroke recurrence risk was 9% (35/407). We found no difference in stroke recurrence risk between IS subtypes. Cardiovascular disease was the main cause of death all follow up time.ConclusionsCompared to other cohort studies conducted between 10 and 20 years ago in high-income countries, our recurrence rates and 3-year risk of death were similar. Among IS subtypes, we confirmed that CE has highest risk of death. The most common cause of death after a first-ever stroke is cardiovascular disease. This has implications for the uptake of current secondary preventive strategies and the development of new strategies.

Trajectory of Motor Performance Over Twelve Months in Nigerian Stroke Survivors

Objective: Submissions on recovery of post-stroke motor performance vary, especially in relation to increasing time after stroke. This study examined the trajectory of motor performance over the first 12 months after stroke.Methods: Consecutive first-incidence stroke survivors (N= 83) were recruited within 1 month of onset from a tertiary health institution in Nigeria. Simplified Fugl Meyer scale (S-FM) was used to assess motor performance at monthly intervals. Changes in overall motor performance, and differences between the affected upper and lower extremities, were examined using Friedman's ANOVA and pairedt-tests, respectively.Results: Significant improvement in motor performance was observed across 12 months (p&lt; .001), with the proportion of stroke survivors with severe impairment at onset (53.3%) decreasing to 20% by 12 months. Lower extremity motor performance scores were significantly higher than for the upper extremity from 1 to 12 months (p&lt;.01 at 3, 4, 5, 6 and 12 months; andp&lt; .05 at the remaining months).Conclusions: The potential for long-term improvement in motor performance after stroke was observed, suggesting that this can be harnessed by long-term rehabilitation efforts. The comparatively poorer outcome in the upper extremity indicates the need for extra rehabilitation strategies to enhance upper-extremity motor recovery in the first year of stroke.

Temporal recovery and predictors of upper limb dexterity in the first year of stroke: A prospective study of patients admitted to a rehabilitation centre

To document temporal recovery of upper extremity dexterity and establish predictors of limb dexterity in a cohort of stroke patients in the first year after stroke. Prospective cohort study. One hundred patients with a first-ever ischemic stroke admitted to a rehabilitation centre. Assessment of upper extremity dexterity, motor power and selfcare function using the Motor Assessment Scale (MAS), Upper Extremity Motor Index (UEMI) and Modified Barthel Index (MBI) respectively. Eighteen percent, 25.5% and 31.6% of patients recovered limb dexterity at 3, 6 and 12 months after stroke respectively. Patients who recovered dexterity late (≥6 months after stroke) were significantly younger with lower rehabilitation admission UEMI scores than those who recovered dexterity early. The UEMI score was the most significant correlate of limb dexterity at all follow up periods. Recovery of limb dexterity at 12 months was predicted by UEMI (OR1.54, 95% CI 1.13-2.10) and MBI (OR 1.03, 95% CI 1.00-1.07) scores on admission to rehabilitation. In this study, 31.6% of patients recovered upper extremity dexterity at 12 months after stroke. Although late recovery of dexterity occurs only in a small proportion of patients, this finding is still pertinent given the significant impact of dexterity on upper limb and selfcare function.

Selective Serotonin Reuptake Inhibitors for Stroke Recovery

Each year, about 16 million people in the world experience a first-ever stroke. Of these, about 5.7 million die and another 5 million remain disabled.1 Although there are effective treatments that restore brain perfusion and minimize complications and recurrent stroke, there is no treatment proven to facilitate neurological recovery after stroke. A recent small trial demonstrated that the selective serotonin reuptake inhibitor (SSRI) fluoxetine, commonly used to treat depression, improved motor recovery and reduced dependency after stroke when given to people without depression.2 Experimental studies reporting neurogenic and neuroprotective effects of SSRIs3,4 provide a plausible mechanism of action. Our objective was to systematically review and perform a meta-analysis of all (published and unpublished) randomized controlled trials of SSRI compared with control, given within the first year of stroke, to determine the effect on dependency, disability, and other important clinical outcomes. ### Searches and Study Selection Extensive literature searches were performed between August 2011 and March 2012 (see Data in online-only Data Supplement); this included searching the gray literature. Two review authors scrutinized the searches of Cochrane Stroke Group, CENTRAL, CCDAN and the trials registers, and applied inclusion criteria. One review author scrutinized the other searches and applied inclusion criteria. We included all randomized controlled trials in patients with a clinical diagnosis of stroke, in which SSRIs were given within the first year of stroke, for any clinical indication. The control arm included usual care or a placebo. Any drug classified as an SSRI (for example fluvoxamine, fluoxetine, sertraline, citalopram, escitalopram, and paroxetine) given at any dose, by any mode of delivery, was included. Drugs with mixed effects were not included. Two review authors independently extracted data, except for papers in Chinese, for which 1 review author extracted data. ### Outcomes The primary outcomes were dependence and disability. The secondary outcomes were neurological …

The rate and extent of improvement with therapy from the different types of aphasia in the first year after stroke

Objective: To examine the rate and extent of improvement from the different types of aphasia in the first year after stroke. Design: A prospective longitudinal study. Setting: A specialist stroke unit. Participants: Seventy-five aphasic patients with first-ever stroke. Intervention: The type of aphasia was classified according to the criteria of the Western Aphasia Battery. The Western Aphasia Battery aphasia quotient was used to measure the initial severity and the rate and extent of improvement from aphasia. Assessments were made at baseline and 4, 8, 12 and 24 weeks later. Results: The median percentage increase in the Western Aphasia Battery aphasia quotient was statistically higher in patients with Broca's aphasia than in the other groups at all weeks. Patients with Wernicke's aphasia had a significantly greater median percentage increase in their aphasia quotient than those with conduction and anomic aphasia at weeks 12 and 24, but less than patients with global aphasia at week 24. Conclusions: Patients with Broca's aphasia appear to have the best prognosis for improvement of language function in the first year of stroke. The extent of improvement in patients with global aphasia is better than that of patients with Wernicke's aphasia.

A Pilot Study to Investigate the Combined Use of Botulinum Neurotoxin Type A and Functional Electrical Stimulation, with Physiotherapy, in the Treatment of Spastic Dropped Foot in Subacute Stroke

The objective was to inform sample size calculations for a full randomized controlled trial (RCT). The design included an RCT pilot trial with a 16 week study period, including a 4 week baseline phase. The subjects were adults within 1 year of first stroke, ambulant with a spastic dropped foot. Twenty-one participants were recruited from the stroke services of 4 centers. For intervention all participants received physiotherapy; the treatment group also received botulinum neurotoxin Type A (BoNTA) intramuscular injections to triceps surae (800 U Dysport) and functional electrical stimulation (FES) of the common peroneal nerve to assist walking. The main outcome measure was walking speed. The result was a significant upward trend in median walking speed for both the control (p = 0.02) and treatment groups (nonstimulated p = 0.004, stimulated p = 0.042). Trend lines were different in location (p = 0.04 and p = 0.009, respectively). In conclusion, there is evidence of an additional, beneficial effect of BoNTA and FES. Sufficient information has been gained on the variability of the primary outcome measure to inform sample size calculations for a full RCT to quantify the treatment effect with precision.