Life Of Stroke Survivors Research Articles

The impact of stroke support groups on stroke patients and their caregivers

Background: Stroke survivors often face multifaceted challenges encompassing physical, psychological and social aspects of health during their recovery journey.Aim: To explore the impact of stroke support groups on stroke patients and their caregivers in Kenya.Setting: The study was conducted in eight Kenyan county referral facilities.Methods: The study applied a qualitative interpretive paradigm and collected data from semi-structured face-to-face interviews with eight stroke survivors and their caregivers. Thematic content analysis was employed to extract and analyse data.Results: The analysis of data revealed four key themes: (1) mental functioning, (2) environmental impact, (3) personal impact and (4) social participation. These themes were organised and related to the World Health Organization’s (WHO’s) International Classification of Functioning, Disability, and Health (ICF).Conclusion: Peer stroke support groups significantly enhanced the ICF component of mental functioning, environmental and personal, through emotional support, social connection, coping, learning, mobility, communication and domestic life of stroke survivors and caregivers. Participation promoted affirmation and acceptance, and reduced loneliness, which led to increased involvement in a range of activities. Moreover, stroke support groups played a vital role in empowerment, education and advocating for systemic change.Contribution: This study provides new information that improves understanding of the positive impact of stroke support groups in Kenya. It highlights the importance of integrating peer support into post-stroke rehabilitation programmes.

Mapping the Landscape of Biomechanics Research in Stroke Neurorehabilitation: A Bibliometric Perspective

Background/Objectives: The incorporation of biomechanics into stroke neurorehabilitation may serve to strengthen the effectiveness of rehabilitation strategies by increasing our understanding of human movement and recovery processes. The present bibliometric analysis of biomechanics research in stroke neurorehabilitation is conducted with the objectives of identifying influential studies, key trends, and emerging research areas that would inform future research and clinical practice. Methods: A comprehensive bibliometric analysis was performed using documents retrieved from the Scopus database on 6 August 2024. The analysis included performance metrics such as publication counts and citation analysis, as well as science mapping techniques, including co-authorship, bibliographic coupling, co-citation, and keyword co-occurrence analyses. Data visualization tools such as VOSviewer and Power BI were utilized to map the bibliometric networks and trends. Results: An overabundance of recent work has yielded substantial advancements in the application of brain–computer interfaces to electroencephalography and functional neuroimaging during stroke neurorehabilitation., which translate neural activity into control signals for external devices and provide critical insights into the biomechanics of motor recovery by enabling precise tracking and feedback of movement during rehabilitation. A sampling of the most impactful contributors and influential publications identified two leading countries of contribution: the United States and China. Three prominent research topic clusters were also noted: biomechanical evaluation and movement analysis, neurorehabilitation and robotics, and motor recovery and functional rehabilitation. Conclusions: The findings underscore the growing integration of advanced technologies such as robotics, neuroimaging, and virtual reality into neurorehabilitation practices. These innovations are poised to enhance the precision and effectiveness of therapeutic interventions. Future research should focus on the long-term impacts of these technologies and the development of accessible, cost-effective tools for clinical use. The integration of multidisciplinary approaches will be crucial in optimizing patient outcomes and improving the quality of life for stroke survivors.

Transforming Stroke Recovery: The Bobath Concept in a Case Study of Middle Cerebral Artery Infarction

Stroke remains a major cause of long-term disability, necessitating effective rehabilitation strategies. This case study examines the rehabilitation of a 57-year-old male patient recovering from a middle cerebral artery (MCA) infarction, utilising the Model of Bobath Clinical Practice (MBCP). The patient underwent interventions based on the Bobath concept, focusing on selective activation of trunk muscles, core engagement, and pelvic alignment to enhance postural control. Assessments revealed significant improvements in both sitting and standing postures, with reductions in compensatory fixation strategies. The targeted therapeutic exercises facilitated better trunk control and lower limb weight-bearing, resulting in overall enhanced stability. The findings underscore the importance of individualised approaches in stroke rehabilitation aligned with Bobath principles. While the outcomes are promising, further research is needed to confirm the effectiveness of the MBCP model across varied patient populations. This study highlights the potential of the Bobath Concept in improving functional recovery and quality of life for stroke survivors.

Benchmarking Stroke Outcome Prediction through Comprehensive Data Analysis - NeuralCup 2023.

Stroke is a significant cause of mortality and long-term disability worldwide, with variable recovery trajectories posing substantial challenges in anticipating post-event care and rehabilitation planning. The NeuralCup 2023 consortium was established to address these challenges by comparing the predictability of stroke outcome models through a collaborative, data-driven approach. This study presents the consortium's findings, which involved 15 participating teams worldwide. Using a comprehensive dataset, which included clinical and imaging data, we conducted an open competition to identify and compare predictors of motor, cognitive, and neuropsychological (emotional) outcomes one-year post-stroke. Analyses incorporated both traditional and novel methods, including machine learning algorithms. These efforts culminated in the search for 'optimal recipes' for predicting each domain through an exhaustive exploration of the features of all the approaches. Key predictors included lesion characteristics, T1-weighted MRI sequences, and demographic factors. Notably, integrating FLAIR imaging and white matter tract analysis emerged as crucial to improving the accuracy of cognitive and motor outcome predictions, respectively. These findings advocate for a tailored, multifaceted approach to stroke outcome prediction, underscoring the potential of collaborative data science in addressing complex neurological prognostication challenges. This study also sets a new benchmark methodology in stroke research, offering a foundational step toward personalized care strategies that could significantly impact recovery planning and quality of life for stroke survivors.

Estimation of Interferences in Magnetoencephalography (MEG) Brain Data Using Intelligent Methods for BCI-based Neurorehabilitation Applications

<p>Brain-Computer Interface (BCI) neurorehabilitation offers the potential to improve recovery and quality of life for stroke survivors. It aims to restore lost physical and mental abilities through motor and cognitive therapies. Magnetoencephalography (MEG) signals are a major advancement in BCI technology as they provide accurate and consistent assessments of brain activity for control and interaction applications. MEG is indispensable for recording the magnetic fields produced in the brain during motor imagery tasks due to its capability to evaluate cerebral activity with remarkable temporal resolution. However, one of the major challenges associated with MEG recording is the loss of signal quality due to physiological artifacts and ambient noise. Additionally, the head movement of the individual during the recording process can result in the introduction of artifacts into the recorded data, which can distort the spatial mapping of brain activity. This, in turn, can jeopardize the reliability and accuracy of the results obtained. This study aims to identify the most effective technique for removing artifacts from MEG signals by conducting a comparative performance analysis of prominent denoising algorithms, such as Infomax, FastICA, SOBI, and SWT. The findings conclude that Infomax is the most effective algorithm for removing physiological artifacts from a signal while maintaining the integrity and essential features of the original data. FastICA was found to be the second most effective algorithm. Infomax outperformed FastICA in Power Spectral Density (PSD) and Percentage Root mean square error Difference (PRD) measurements.</p>

Effects of end-effector robotic arm reach training with functional electrical stimulation for chronic stroke survivors

ABSTRACT Background Upper-extremity dysfunction significantly affects dependence in the daily lives of stroke survivors, limiting their participation in the social environment and reducing their quality of life. Objectives This study aimed to investigate the effect of end-effector robotic arm reach training (RAT) with functional electrical stimulation (FES) on upper-limb motor recovery in chronic stroke survivors. Methods In this single-blinded randomized controlled trial, 28 chronic stroke survivors were randomized to receive RAT-with-FES and RAT-without-FES for 40 min/day, three times per week over a 4-week period, and the data of 26 participants were used in the final analysis. Upper-limb motor recovery was measured using the Fugl-Meyer assessment (FMA), and kinematics (movement time, speed, and distance) during reaching movements toward targets placed in three directions (ipsilateral, median, and contralateral sides) were measured using a robotic arm. Results The upper-limb motor recovery (FMA and kinematics) improvement for the within-group comparisons tended to be greater in the RAT-with-FES group than in the RAT-without-FES group. However, in the between-group comparison, no significant differences were found in FMA, and significant differences were observed only for 2 distance parameters of kinematic factors: total (23.0% vs. 1.7%) and straight total (25.5% vs. 2.6%) distance on the ipsilateral side (p < 0.05). Conclusions This study was unable to clearly reveal the positive effects of electrical stimulation combined with robotic arm training. However, we believe that it provides basic data that furthers our understanding of the role of hybrid neuroprostheses in stroke rehabilitation and the factors determining successful treatment.

Home and workforce reintegration one year after thrombectomy in acute stroke patients.

Endovascular thrombectomy (EVT) combined with intravenous thrombolysis is the current standard treatment for acute large-vessel occlusion stroke. Beyond clear clinical benefits in the acute and post-acute phases, comprehensive evaluations of long-term outcomes, including home and workforce reintegration, remain limited. This study aimed to assess home and workforce reintegration 1 year post-EVT in a cohort of acute stroke patients and explore their association with health-related quality of life (HRQoL). We conducted a prospective observational study of 404 patients undergoing EVT at a tertiary university medical center between October 2019 and December 2021. Patients' functional outcomes were evaluated using the modified Rankin Scale (mRS), and HRQoL was assessed via the European Quality of Life Five Dimension Scale (EQ-5D). Data on occupational and living status were collected through standardized telephone interviews at 3- and 12-months post-treatment. Of 357 patients with 12-month follow-up data, 33.6% had a favorable outcome (mRS 0-2). Among stroke survivors, the rate of home reintegration without nursing care was 42.1%, and workforce reintegration among previously employed patients was 43.3% at 12 months. Both outcomes were significantly associated with improved HRQoL. Lower neurological deficits and younger age were predictive of successful home and workforce reintegration. One year post-EVT, approximately 40%-50% of acute stroke patients successfully reintegrate into home and work settings. These findings underscore the need for ongoing support tailored to improving long-term reintegration and quality of life for stroke survivors. The data supporting the findings of the study are available from the corresponding author upon reasonable request and in accordance to European data privacy obligations.

EHealth Interventions of Health Literacy for Stroke Survivors: Systematic Review and Meta-Analysis.

eHealth literacy interventions have emerged as a new approach in management of stroke survivors. Its effect on knowledge and clinical outcomes presents an inconsistent result in literature. We aim to evaluate the impact of eHealth interventions on health literacy, clinical metrics, adherence to healthy behaviors, stroke recurrence, mortality, and health-related quality of life in stroke survivors. We systematically searched six databases (PubMed, Cochrane Library, CINAHL, EMBASE, Web of Science, ProQuest) up to February 21, 2024, selecting articles that meet these criteria: (i) patients with stroke; (ii) intervention with education content; (iii) eHealth interventions included telehealth, mobile phone, internet or computer; (iv) randomized controlled trials. The mean differences (MD) and standardized mean differences (SMD) between groups were measured. Risk of bias was evaluated using the Cochrane tool. From 16 studies involving 9646 participants, we observed that eHealth interventions significantly improved systolic blood pressure (MD = -2.78mmHg, 95% confidence interval (CI) [-4.67 to -0.88], p = 0.004), medication adherence (SMD = 0.28, 95% CI [0.04 to 0.52], p = 0.023), and health-related quality of life (SMD = 0.21, 95% CI [0.04 to 0.37], p = 0.013). Meta-regression found that age modified the effect size of systolic blood pressure (p = 0.027). There was insufficient evidence to conclude effects on other outcomes. The quality of evidence was moderate. Outcome variation may be due to the diversity in eHealth intervention approaches. The limited number of studies precluded the subgroup analysis. More interactive interventions with longer follow-ups were more effective. eHealth interventions may benefit stroke survivors in terms of blood pressure, medication adherence, and health-related quality of life. eHealth literacy interventions could be implemented to improve the management of stroke survivors, especially in the context of resource limitations. PROSPERO registration number: CRD42024502470.

Effectiveness of Two Models of Telerehabilitation in Improving Recovery from Subacute Upper Limb Disability after Stroke: Robotic vs. Non-Robotic.

Finding innovative digital solutions is fundamental to ensure prompt and continuous care for patients with chronic neurological disorders, whose demand for rehabilitation also in home-based settings is steadily increasing. The aim is to verify the safety and the effectiveness of two telerehabilitation (TR) models in improving recovery from subacute upper limb (UL) disability after stroke, with and without a robotic device. One hundred nineteen subjects with subacute post-stroke UL disability were assessed for eligibility. Of them, 30 patients were enrolled in the study and randomly assigned to either the Robotic Group (RG), undergoing a 20-session TR program, using a robotic device, or the Non-Robotic Group (NRG), undergoing a 20-session TR program without robotics. Clinical evaluations were measured at baseline (T0) and post-intervention (T1, 5 weeks after baseline), and included assessments of quality of life, motor skills, and clinical/functional status. The primary outcome measure was the World Health Organization Disability Assessment Schedule 2.0, evaluating the change in perceived disability. Statistical analysis shows that patients of both groups improved significantly over time in all domains analyzed (mean decrease from baseline in the WHODAS 2.0 of 6.09 ± 2.62% for the NRG, and of 0.76 ± 2.21% for the RG), with a greater improvement of patients in the NRG in motor (Fugl-Meyer Assessment Upper Extremity-motor function, Box and Block Test) and cognitive skills (Trail Making Test-A). This study highlights the potential of TR programs to transform stroke rehabilitation by enhancing accessibility and patient-centered care, promoting autonomy, improving adherence, and leading to better outcomes and quality of life for stroke survivors.

Assessment of Health-Related Quality of Life of Stroke Survivors in Southeast Communities in Nigeria.

The prevalence of stroke in Nigeria has continued to be a major public health challenge. Recovery from a stroke episode can be a long-impacting process with reduced quality of life outcomes. Past studies have explored the quality of life (QoL) of stroke survivors. However, none have explored the QoL of stroke survivors in Southeastern Nigeria. This study therefore describes the QoL of Nigerian stroke survivors in Southeastern Nigeria. One hundred and one participants (44 male and 58 female) were recruited into the study. QoL domains were assessed using the stroke-specific Health-Related Quality of Life in Stroke Patients (HRQOLISP). The physical domain was significantly lower than other domains measured (mean = 2.52, SD = 0.76), contributing to poor quality of life. On the other hand, the spiritual domain had the greatest positive influence on QoL (mean = 3.70, SD = 0.50). We found the physical domain was the poorest part of stroke survivors' stroke experience. The spiritual domain had a positive impact on improving QoL. There is a need for research on interventions relating to the physical rehabilitation of stroke survivors and a review of how the spiritual domain can be enhanced to improve QoL.

The efficacy of virtual reality-based rehabilitation in improving motor function in patients with stroke: a systematic review and meta-analysis.

Stroke is a major cause of adult disability, prompting the exploration of innovative rehabilitation methods. Virtual rehabilitation (VR), leveraging technological advances, has gained popularity as a treatment for stroke recovery. The authors conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published in English within the last decade, adhering to the PRISMA guidelines. The authors searched databases such as Medline/PubMed, and the Cochrane Library using specific search keywords and Medical Subject Headings (MeSH). The methodological quality was assessed using the PEDro scale, focusing on RCTs involving adult stroke patients undergoing VR rehabilitation, with outcomes related to motor function and quality of life. The authors included 15 studies in our meta-analysis. VR rehabilitation offers several advantages over traditional therapy, such as enhanced feedback and increased patient motivation. Engaging VR environments helps improve focus during treatment, potentially boosting recovery from post-stroke impairments. VR therapies significantly benefit motor function, which can improve activities of daily living and overall quality of life. VR has demonstrated efficacy in improving motor function and quality of life for stroke survivors. Future research should explore patient variability and refine intervention methods. Incorporating VR into rehabilitation programs could optimize stroke recovery outcomes.

Peripheral, but not central, IGF-1 treatment attenuates stroke-induced cognitive impairment in middle-aged female Sprague Dawley rats: The gut as a therapeutic target

Stroke results in immediate sensory or motor disability and increases the risk for long term cognitive-affective impairments. Thus, therapies are urgently needed to improve quality of life for stroke survivors, especially women who are at a greater risk for severe stroke after menopause. Most current research on stroke therapies target the central nervous system; however, stroke also impacts peripheral organ systems. Our studies using acyclic (estrogen-deficient) middle aged female Sprague Dawley rats show that this group not only displays worse outcomes after stroke as compared to adult females, but also has lower levels of the neuroprotective peptide Insulin-like Growth Factor (IGF1) in circulation. Intracerebroventricular (ICV) administration of IGF1 to this group decreases infarct volume and improves sensory motor performance in the acute phase. In this study, we show that, despite this neuroprotection, ICV-IGF1 did not reduce peripheral inflammation or improve post stroke cognitive impairment in the chronic phase. In view of the evidence that stroke induces rapid gut dysfunction, we tested whether systemic delivery of IGF1 (intraperitoneal, IP) would promote gut health and consequently improve long-term behavioral outcomes. Surprisingly, while IP-IGF1, delivered 4 h and 24 h after ischemic stroke, did not reduce infarct volume or acute sensory motor impairment, it significantly attenuated circulating levels of pro-inflammatory cytokines, and attenuated stroke-induced cognitive impairment. In addition, IP-IGF1 treatment reduced gut dysmorphology and gut dysbiosis. Our data support the conclusion that therapeutics targeting peripheral targets are critical for long-term stroke recovery, and that gut repair is a novel therapeutic target to improve brain health in aging females.

Quality of Life of Post-Stroke Patients in Aceh, Indonesia

Introduction: The quality of life of stroke survivors is a major concern for healthcare providers due to the physical, psychological, and social issues caused by stroke. This study aims to identify the quality of life of post-stroke patients undergoing outpatient treatment at the neurology clinic of the General Hospital of South Aceh Regency, Indonesia. Methods: This research uses a cross-sectional study design with a sample of 120 respondents. All post-stroke patients undergoing treatment at the clinic were included in the study. Data were collected through face-to-face interviews at the specialized stroke clinic from January to March 2024. The research instrument used was the Indonesian version of the Stroke-Specific Quality of Life (SS-QoL) questionnaire, which has been validated. The reliability test of the SS-QoL resulted in a Cronbach’s Alpha value of 0.920. Data analysis was conducted using a descriptive approach, including frequency distribution, percentage, standard deviation, and SS-QoL scale score distribution. Results: The study found that the majority of stroke patients' quality of life was in the good category, amounting to 77.5%. The quality of life domain indicated that personality was the worst dimension (mean=3.13, SD=0.762), while family role, social role, mood, and energy were the best domains (mean=4.13, SD=0.766). Conclusion: The quality of life of stroke patients undergoing outpatient treatment at the Neurology Clinic of South Aceh General Hospital is predominantly in the good category. Interventions focusing on personality aspects need to be enhanced to further improve patients' quality of life.

Prevalence and determinants of post-stroke psychosis in Aswan: a prospective study

BackgroundPost-stroke psychosis (PSP) is a rare but serious neuropsychiatric condition characterized by delusions and/or hallucinations following a stroke. Despite its impact on prognosis and quality of life, PSP remains underdiagnosed and undertreated, with limited data on its prevalence and risk factors. The purpose of this study is to assess the prevalence and determinants of post-stroke psychosis (PSP), as well as to compare PSP and non-PSP patients in terms of improvement and daily living outcomes. This nested case–control study included 2,624 acute stroke patients from a university hospital between May 2017 and April 2022. Patients who developed PSP within 6 months post-stroke were identified as cases (n = 108), and 119 patients without PSP were randomly selected as controls. Comprehensive assessments included clinical, laboratory, and imaging evaluations at baseline. After 6 months, follow-up evaluations were conducted, including neurological examinations, psychiatric assessments, and stroke severity assessments using the Barthel index (BI). The psychiatric assessments included the Hamilton Depression Rating Scale for depression and the Mini-Mental State Examination for cognitive status.ResultsThe prevalence of PSP was 5.4%. risk factors significantly associated with PSP included older age, male patients, lower education level (≤ 5 years), hemiplegia, sphincter affection, cortical lesion, brain atrophy, small vessel disease, ischemic stroke, post-stroke dementia, and seizures. Non-specified psychosis and delusional disorder were the most common psychosis subtypes. There was a significantly higher percentage of excellent patients in the non-PSP group compared to those who had PSP regarding the observed improvement in the patient's condition. Also, there is a higher percentage of deteriorated patients in the PSP group (46.6%) compared to another group (18.9%) regarding BI.ConclusionPSP is a prevalent post-stroke complication associated with distinct risk factors and poor functional outcomes. Early screening and identification of high-risk patients, along with multidisciplinary management strategies, are crucial for optimizing recovery and quality of life in stroke survivors.

Exploring Stroke Patients' Needs: A Cultural Adaptation and Validation of the Modified Needs Assessment Questionnaire in a Greek Context.

Stroke survivors often face diverse unmet needs highlighting the significance of identifying and addressing these needs to enhance rehabilitation outcomes and overall quality of life. This study aimed to validate the modified Needs Assessment Questionnaire (mNAQ) as a reliable and valid tool for assessing the needs of stroke patients in the Greek context. Additionally the research sought to identify potential differences in the assessment of stroke patients' needs based on their stroke phase and National Institutes of Health Stroke Scale (NIHSS) scores. A sample of 71 adult stroke survivors adhering to World Health Organization guidelines and providing autonomous consent participated in the study. The mNAQ comprising 141 items across 12 domains was utilized to evaluate stroke patients' needs. The NIHSS and Barthel Index (BI) were employed for functional independence and mobility assessment. Data analysis incorporated confirmatory factor analysis, exploratory factor analysis and Cronbach's reliability analysis to establish construct validity and internal consistency. Concurrent and known-groups validity analyses were conducted; and Spearman's rho correlation explored the relationship between mNAQ and BI scores. Non-parametric analyses were applied to identify differences based on stroke phase and NIHSS scores. The study revealed that the mNAQ initially lacked satisfactory psychometric properties in the Greek context. Subsequent modifications guided by confirmatory and exploratory factor analyses resulted in a refined three-factor scale encompassing 31 items in the domains of communication, mobility, and social functioning needs. This adapted measure effectively differentiated between acute and chronic stroke patients and those with minor and moderate strokes. In conclusion, the validated 31-item Greek mNAQ emerges as a crucial tool for comprehensively assessing the needs of stroke patients. Its application holds promise for optimizing post-stroke care improving functional outcomes and ultimately enhancing the overall well-being and quality of life for stroke survivors.

The Effects of mirror therapy in postural and kinesthetic rehabilitation on stance phase of gait in subacute stroke

Background: This study explored the effectiveness of mirror therapy in improving postural and kinesthetic rehabilitation during the stance phase of gait in subacute stroke patients. Given the crucial role of balance and functional recovery in enhancing mobility and overall quality of life in stroke survivors, the primary focus was on these aspects. Objective: The primary objective was to evaluate the impacts of mirror therapy on postural and kinesthetic rehabilitation during the stance phase of gait in subacute stroke patients. Methods: A randomized controlled trial was conducted over nine months in Rahim Yar Khan, involving both private and government hospitals. Sixty-four participants were randomly assigned to two groups: the Conventional+KTR group and the Mirror Therapy group, with 32 participants in each. Inclusion criteria required participants to have a single episode of hemiplegic subacute stroke diagnosed by a neurologist, inclusion of both ischemic and hemorrhagic stroke, and sufficient cognitive ability to follow instructions as indicated by a Mini-Mental State Examination (MMSE) score of 24 or higher. Mild spasticity in all joints of the affected limb was defined by a Modified Ashworth Scale score of less than 3. The intervention for the experimental group involved mirror therapy conducted four days a week for six weeks, supplemented by a home plan for the remaining three days. The control group received conventional therapy, including proprioceptive neuromuscular facilitation (PNF) and electrical interventions, also for four days a week, with a home plan for the remaining days. Key outcome measures were the Berg Balance Scale (BBS) for balance and the Fugl-Meyer Assessment for functional recovery. Data were analyzed using SPSS Version 25, with significance set at p&lt;0.05. Results: The Mirror Therapy group showed significantly greater improvements in balance scores, with a mean BBS of 40.31 at week 6 compared to 36.78 in the Conventional+KTR group (p&lt;0.001). Functional recovery was more pronounced in the Conventional+KTR group, which had a mean Fugl-Meyer Assessment score of 35.63 at week 6 compared to 30.50 in the Mirror Therapy group (p&lt;0.001). Gender distribution was similar across both groups, with the Conventional+KTR group consisting of 21.9% males and 78.1% females, and the Mirror Therapy group having 18.8% males and 81.3% females. Conclusion: Mirror therapy significantly enhances postural and kinesthetic rehabilitation in subacute stroke patients, particularly in improving balance more effectively than Conventional+KTR therapy. Conversely, Conventional+KTR therapy showed better results in functional recovery. These findings suggest that mirror therapy can be a valuable addition to stroke rehabilitation programs, offering a potential avenue for improved patient outcomes. Keywords: Mirror Therapy, Subacute Stroke Rehabilitation, Gait Improvement, Postural Awareness, Kinesthetic Awareness, Berg Balance Scale, Fugl-Meyer Assessment, Randomized Controlled Trial, Stroke Recovery, Balance Rehabilitation.

Post-Stroke Mania- A Case Series

Background: Post-stroke mania is a complex neuropsychiatric phenomenon that poses challenges in both diagnosis and management. This paper presents a detailed analysis of three distinct cases, comprising two females and one male, each exhibiting post-stroke mania following cerebrovascular events. Our study aims to provide insights into the varied clinical presentations, contributing factors, and therapeutic interventions in this unique subset of stroke survivors. Case 1: A 71-year-old female experienced a left hemispheric stroke, subsequently displaying manic symptoms characterized by elevated mood, impulsivity, and increased energy. Neuroimaging revealed damage to the parieto-occipital lobe, prompting further exploration into the neural correlates of post-stroke mania. Case 2: A 51-year-old female presented with right hemiparesis. Shortly after the stroke, he manifested manic features, including decreased need for sleep and heightened irritability. Psychosocial factors and pharmacological interventions were investigated to better understand the interplay of biological and environmental influences. Case 3: A 55-year-old male suffered a left hemispheric stroke. Poststroke, she exhibited manic symptoms such as distractibility and excessive goal-directed activity. The impact of lesion location on the manifestation of post-stroke mania was explored in this case. Conclusion: Through a comprehensive analysis of these cases, we aim to contribute to the growing body of literature on post-stroke mania, shedding light on its clinical heterogeneity and paving the way for tailored treatment approaches. Recognizing the nuanced nature of post-stroke mania is crucial for healthcare providers to optimize care strategies and improve the quality of life for stroke survivors grappling with this challenging neuropsychiatric condition

Community rehabilitation by the trained village health volunteers on activities of daily living and quality of life in stroke survivors

Background: The number of people with disabilities resulting from strokes is increasing in Thailand. The major sequela of the disease was weakness in one side of the body that causes difficulty in activities of daily living (ADL) and poor quality of life (QOL) for stroke survivors. Community-based rehabilitation could be one of the strategies that enhances functional performance and improves QOL in these individuals. There were many disabled people in Mae Ka subdistrict, San Pa Tong District, Chiang Mai Province, where health care providers and local people were enthusiastic to take care of each other’s health in the community. Objective: The present study aimed to investigate rehabilitation outcomes in ADL and QOL of stroke participants who received rehabilitation services from trained village health volunteers (VHVs). Materials and methods: This study was a quasi-experimental research design. Subjects were recruited using purposive sampling, including 10 stroke survivors. Instruments used were 1) ADL Assessment for Occupational Therapy Clients; and 2) World Health Organization Quality of Life Assessment, Short Form-Thai version. The statistics used were descriptive, as well as the Wilcoxon Signed Ranks Test. Results: Results demonstrated that scores of basic activities of daily living (BADL) in the participants increased significantly (p&lt;0.05) except for sexual expression. The score in the instrumental activities of daily living (IADL) was also significantly higher at post-rehabilitation than pre-intervention (p&lt;0.05), as was the total ADL score. Stroke patients had significantly higher QOL scores after intervention than the pretest (p&lt;0.05). Conclusion: These indicated that the community rehabilitation center at Mae Ka Subdistrict Administrative Organization, San Pa Tong District, Chiang Mai Province, run by the trained VHVs could promote ability in daily activities and improve QOL in stroke participants who come for their services.

Effects of a nurse-led eHealth programme on functional outcomes and quality of life of patients with stroke: a pooled analysis of randomized controlled trials.

Stroke remains a leading cause of disability worldwide. Nurse-led eHealth programs have emerged as a potentially effective strategy to improve functional outcomes and quality of life in stroke survivors. However, the variability of study designs and outcomes measured across trials necessitates a pooled analysis to comprehensively assess the efficacy of these interventions. This protocol outlines the methodology for a pooled analysis that aims to synthesize evidence from randomized controlled trials (RCTs) evaluating nurse-led eHealth interventions for stroke patients. This pooled analysis will be conducted according to the PRISMA guidelines. We will include RCTs that evaluate nurse-led eHealth programs and report on functional outcomes or quality of life in stroke patients. Comprehensive searches of electronic databases including Pubmed, EMBASE, the Cochrane Library, CINAHL, and PsycINFO will be conducted with a predefined search strategy. Study selection will involve screening titles and abstracts, followed by full-text review using explicit inclusion and exclusion criteria. Data extraction will be undertaken independently by two reviewers. The risk of bias will be assessed through the Cochrane Risk of Bias tool. Additionally, the quality of evidence for each outcome will be evaluated using the GRADE approach. Meta-analyses will be performed using random-effects models, and heterogeneity will be quantified using the I2 statistic. Subgroup and sensitivity analyses will explore potential sources of heterogeneity. This pooled analysis is poised to provide a nuanced understanding of the effectiveness of nurse-led eHealth programs in stroke rehabilitation, leveraging a thorough methodological framework and GRADE tool to ensure robustness and reliability of evidence. The investigation anticipates diverse improvements in patient outcomes, underscoring the potential of personalized, accessible eHealth interventions to enhance patient engagement and treatment adherence. Despite the challenges posed by the heterogeneity of interventions and rapid technological advancements, the findings stand to influence clinical pathways by integrating eHealth into standard care, if substantiated by the evidence. Our study's depth and methodological rigor possess the potential to initiate changes in healthcare policy, advocating for the adoption of eHealth and subsequent investigations into its cost-efficiency. Ultimately, we aim to contribute rich, evidence-based insights into the burgeoning field of digital health, offering a foundational assessment of its applications in stroke care. Our data is expected to have a lasting impact, not only guiding immediate clinical decisions but also shaping the trajectory of future healthcare strategies in stroke recovery. Identifier (CRD42024520100: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=520100).

Wallenberg syndrome associated with hysteria: A case report

Rationale: Wallenberg syndrome, also referred to as posterior inferior cerebellar artery syndrome, represents the most prevalent form of bulbar syndrome and typically arises from occlusion of the posterior inferior cerebellar artery or its perforator artery. This vascular impairment can result in profound dysphagia, significantly compromising both survival time and quality of life for stroke survivors. Managing swallowing disorders associated with Wallenberg syndrome alone poses considerable challenges, while diagnosing and treating complex swallowing disorders stemming from other etiologies present formidable obstacles for clinicians and rehabilitation therapists alike. Naturally, such intricate swallowing disorders are infrequently encountered in clinical practice. Patient concerns: The dysphagia experienced by a 60-year-old Asian male with right medulla infarction was severe, rendering him unable to swallow any food or saliva. However, unlike typical bulbar palsy patients, these individuals exhibit functional dysphagia disorders in addition to neurodysphagia. Notably, there is no damage observed in the brain’s cognitive areas; however, evident cognitive impairment related to swallowing is present. Diagnosis: Swallowing disorders associated with Wallenberg syndrome, in conjunction with swallowing hysteria syndrome, were examined. Interventions: Cognitive training incorporating mirror swallowing techniques, high‐intensity electrical stimulation, and balloon expansion therapy. Outcomes: Following treatment, the patient swiftly regained normal swallowing function within a span of 21 days, and this functionality was sustained during the six-month follow-up period. Lessons: Wallenberg syndrome frequently presents with severe dysphagia, characterized by complex and debilitating symptoms, resulting in a poor prognosis. Due to the prolonged requirement of nasogastric feeding even after treatment, alternative etiologies for dysphagia are often overlooked. Isolated hysterical swallowing syndrome is relatively uncommon in clinical practice, particularly when coexisting with Wallenberg syndrome; however, fortunately, it exhibits a more favorable recovery outcome. The objective of this case report is to prompt clinicians and rehabilitation therapists to consider other potential causes of swallowing disorders in patients with Wallenberg syndrome when conventional treatments prove ineffective, thereby enhancing the rehabilitative outcomes for these individuals.