Middle Cerebral Artery Stroke Research Articles

HELMET: A Hybrid Machine Learning Framework for Real-Time Prediction of Edema Trajectory in Large Middle Cerebral Artery Stroke.

Malignant cerebral edema occurs when brain swelling displaces and compresses vital midline structures within the first week of a large middle cerebral artery stroke. Early interventions such as hyperosmolar therapy or surgical decompression may reverse secondary injury but must be administered judiciously. To optimize treatment and reduce secondary damage, clinicians need strategies to frequently and quantitatively assess the trajectory of edema using updated, relevant information. However, existing risk assessment tools are limited by the absence of structured records capturing the evolution of edema and typically estimate risk at a single time point early in the admission, therefore failing to account for changes in variables over the following hours or days. To address this, we developed and validated dynamic machine learning models capable of accurately predicting the severity of midline structure displacement, an established indicator of malignant edema, in real-time. Our models can provide updated estimations as frequently as every hour, using data from structured time-varying patient records, radiographic text, and human-curated neurological characteristics. Our work resulted in two novel multi-class classification models, collectively named Hybrid Ensemble Learning Models for Edema Trajectory (HELMET), predicting the progression of midline shift over 8-hour (HELMET-8) and 24-hour windows (HELMET-24), respectively. HELMET combines transformer-based large language models with supervised ensemble learning, demonstrating the value of merging human expertise and multimodal health records in developing clinical risk scores. Both models were trained on a retrospective cohort of 15,696 observations from 623 patients hospitalized with large middle cerebral artery ischemic stroke and were externally validated using 3,713 observations from 60 patients at a separate hospital system. Our HELMET models are accurate and generalize effectively to diverse populations, achieving a cross-validated mean area under the receiver operating characteristic score of 96.6% in the derivation cohort and 92.5% in the external validation cohort. Moreover, our approach provides a framework for developing hybrid risk prediction models that integrate both human-extracted and algorithm-derived multi-modal inputs. Our work enables accurate estimation of complex, dynamic, and highly specific clinical targets, such as midline shift, in real-time, even when relevant structured information is limited in electronic health record databases.

Large right middle cerebral artery stroke with hemorrhagic transformation

The authors present a case of an acute right middle cerebral artery infarct in a 65-year-old male with a history of diabetes, hypertension, and cardiovascular disease. The timeline of treatment and the evolution of the stroke is described. This case highlights the significant burden of right-sided cerebral artery stroke, even when intervention is swift.

Risk factors for urinary retention requiring catheterization after ischemic middle cerebral artery stroke

Purpose: Urinary retention is common in patients with ischemic stroke. Therefore, we aimed to identify the risk factors for urinary retention requiring indwelling urinary catheters (IUCs) in patients with acute middle cerebral artery (MCA) ischemic stroke. Materials and methods: We retrospectively reviewed the medical records of all patients with acute MCA infarction who required admission to the neurological intensive care unit between January 2009 and December 2019 at our tertiary hospital. Patients who did not need IUCs before the stroke but required them after the stroke were included. Multivariate logistic regression analysis was used to identify the risk factors associated with urinary retention requiring IUCs after 7, 14, 21, and 28 days of stroke. Results: A total of 104 patients were included in this study. Among them, 75 (72.2%), 65 (62.5%), 52 (50.0%), and 44 (42.3%) patients required IUCs 7, 14, 21, and 28 days after stroke, respectively. Multivariate logistic regression analysis showed that hypertension was associated significantly with the requirement of IUCs 7 days (odds ratio [OR] = 2.987; P = 0.026) and 14 days (OR = 3.047; P = 0.021) after acute stroke. Furthermore, a higher National Institutes of Health Stroke Scale score was associated significantly with the requirement for IUCs 14 days (OR = 1.096; P = 0.030) and 21 days (OR = 1.091; P = 0.027) after stroke. Conclusion: Hypertension and higher National Institutes of Health Stroke Scale scores are associated significantly with urinary retention requiring IUCs after acute ischemic MCA stroke and could serve as risk factors for voiding dysfunction in this population.

Efficacy of Dry Needling in Enhancing Hand Function and Reducing Spasticity in MCA Stroke Patients: A Prospective Case Report

Stroke, particularly involving the middle cerebral artery (MCA), often leads to persistent disability, significantly impairing hand function and inducing severe spasticity in the forearm flexors due to complex motor pathway involvement. This case report evaluates the effectiveness of combining dry needling therapy (DNT) with task-oriented training (TOT) in reducing spasticity and improving hand function in a post-MCA stroke patient. A 61-year-old male with right-side hemiplegia following a left MCA stroke, compounded by a history of diabetes, hypertension, and recent kidney stone diagnosis, participated in this study. The patient experienced severe functional limitations due to spasticity (grade 3 on the Modified Ashworth Scale) and scored 31 on the CAHAI-13, indicating significant hand dysfunction. DNT was applied to key forearm muscles (flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum profundus, and pronator teres), followed by TOT targeting daily tasks. Post-intervention, the patient demonstrated significant improvements: spasticity was reduced (Modified Ashworth Scale score decreased from grade 3 to grade 2), and muscle hypertonicity, as measured by EMG, was reduced in all targeted muscles. Functional hand use improved markedly, with the CAHAI-13 score increasing from 31 to 45. These improvements led to enhanced independence in daily activities. This case report highlights the clinical relevance of integrating DNT with TOT in stroke rehabilitation. The combined intervention not only reduced spasticity and improved neuromuscular function but also led to meaningful gains in hand function, enhancing the patient’s ability to perform daily activities independently. Given the promising results, this combined approach could serve as a practical and effective strategy for improving motor recovery and functional independence in post-stroke patients. Further studies with larger sample sizes are necessary to confirm these findings and explore the broader application of this approach in clinical practice.

Association of Dynamic Trajectories of Time-Series Data and Life-Threatening Mass Effect in Large Middle Cerebral Artery Stroke.

Life-threatening, space-occupying mass effect due to cerebral edema and/or hemorrhagic transformation is an early complication of patients with middle cerebral artery stroke. Little is known about longitudinal trajectories of laboratory and vital signs leading up to radiographic and clinical deterioration related to this mass effect. We curated a retrospective data set of 635 patients with large middle cerebral artery stroke totaling 95,463 data points for 10 longitudinal covariates and 40 time-independent covariates. We assessed trajectories of the 10 longitudinal variables during the 72h preceding three outcomes representative of life-threatening mass effect: midline shift ≥ 5mm, pineal gland shift (PGS) > 4mm, and decompressive hemicraniectomy (DHC). We used a "backward-looking" trajectory approach. Patients were aligned based on outcome occurrence time and the trajectory of each variable was assessed before that outcome by accounting for cases and noncases, adjusting for confounders. We evaluated longitudinal trajectories with Cox proportional time-dependent regression. Of 635 patients, 49.0% were female, and the mean age was 69years. Thirty five percent of patients had midline shift ≥ 5mm, 24.3% of patients had PGS > 4mm, and 10.7% of patients underwent DHC. Backward-looking trajectories showed mild increases in white blood cell count (10-11K/UL within 72h), temperature (up to half a degree within 24h), and sodium levels (1-3mEq/L within 24h) before the three outcomes of interest. We also observed a decrease in heart rate (75-65 beats per minute) 24h before DHC. We found a significant association between increased white blood cell count with PGS > 4mm (hazard ratio 1.05, p value 0.007). Longitudinal profiling adjusted for confounders demonstrated that white blood cell count, temperature, and sodium levels appear to increase before radiographic and clinical indicators of space-occupying mass effect. These findings will inform the development of multivariable dynamic risk models to aid prediction of life-threatening, space-occupying mass effect.

BIOM-08. CDKN2A --AN INDEPENDENT CYCLIN-DEPENDENT KINASE INHIBITOR VARIANT ASSOCIATED WITH MALIGNANCY AND WITH SMALL VESSEL STROKE, AS A POTENTIAL MARKER FOR RISK OF LARGE-VESSEL STROKE COMPLICATING BENIGN TERATOMA

Abstract BACKGROUND Cyclin-dependent kinase inhibitor variants, particularly those of CDKN2A are known to be associated with autosomal dominant Familial Atypical Multiple Mole/Melanoma Syndrome and pancreatic cancer predisposition. These variants are associated with risk of small vessel stroke in African/ African-American populations, and are risk factors for stroke in Nordic populations with hypertension, independent of cardiovascular risk factors. METHODS We performed a case review of a female presenting in late infancy with a central nervous system teratoma, that later was complicated by a right hemispheric middle cerebral artery (MCA)stroke, associated with a CDKN2A germline mutation. RESULTS This 14month old female presented with transient alterations of consciousness and apparent abdominal migraine events with pernicious vomiting. Neuroimaging revealed a right heterogeneous para- suprasellar mass and bilateral complex arachnoid adjacent cysts. She was observed closely for any progression, as the lesion was immediately adjacent to the optic chiasm. One year after presentation, she developed an acute ischemic right middle cerebral artery (MCA) stroke and had radiographic evidence of severe stenosis and decreased flow primarily within the right supra-clinoid internal carotid artery, the M1 segment and portion of the right A1 segment of cerebral vessels, with decreased enhancement and number of vessels in the distal right MCA territory. The vessels did not appear to be compressed by any mass effect. The radiologic appearance was consistent with vasospasm. The patient upon stoke recovery, underwent near- complete resection of the mass with no evidence of disruption of the capsule surrounding it and no vascular infiltration. Pathology revealed the expected teratoma with prominence of pancreatic acinar structures, and molecular evidence of a variant of CDKN2A, which was present in the patient and mother in the germline. CONCLUSION We propose that the imaging evidence of a vasculopathy was related to the genotype at the cyclin- dependent kinase site.

Influence of the implementation of automatic artificial intelligence-based CT image analysis systems in diagnosis of middle cerebral artery stroke in human

The purpose of the study was to investigate the possibility of applying first-reader and second-reader modes in the implementation of an automatic detection program for MCA ischemic stroke in the diagnostic process of radiologists with less than 3 years of experience and varying expertise in emergency neuroradiology.Material and methods. The study included a software product based on artificial intelligence technologies, as well as seven doctors with less than 3 years of experience and varying expertise in the diagnosis of ischemic stroke. Complementary evaluation was performed based on a cohort of 100 patients admitted to the regional vascular center in Saint Petersburg with clinical presentation of ischemic stroke in the territory of the middle cerebral artery, who underwent native CT brain studies. Ischemic stroke was confirmed in half of the patients based on clinical data, as well as CT angiography of the cerebral vessels and CT perfusion. The diagnosis was ruled out in the other half. Two variants of implementing the artificial intelligence algorithm as a decision support system in the diagnostic process of a radiologist were simulated: the first (parallel) and second reader modes.Results. The results of the study showed that the application of the complementary evaluation parallel- reader mode leads to an increase in diagnostic efficiency indicators and interobserver agreement in assessing ASPECTS scale among young specialists, regardless of their experience with urgent pathology.

Virtual reality gameplay classification illustrates the multidimensionality of visuospatial neglect.

Brain injuries can significantly impact mental processes and lead to hidden disabilities not easily detectable. Traditional methods for assessing these impacts are imprecise, leading to unreliable prevalence estimates and treatments with uncertain effectiveness. Immersive virtual reality has shown promise for assessment, but its use as a standalone tool is rare. Our research focused on developing and validating a standalone immersive virtual reality classification system for unilateral spatial neglect, a condition common following brain injury characterized by inattention to one side of space. Our study involved 51 brain injury inpatients and 30 controls, all engaging with 'The Attention Atlas', an immersive virtual reality game for testing visual search skills. Our classification system aimed to identify patients with neglect, 'minor atypicality' (indicative of inattention not consistent enough to be labelled as neglect) or non-neglect. This categorization was based on a simple mathematical definition, utilizing gameplay to describe spatial orientation (to the left or right side) and attentional challenge (indicative of search inefficiency). These metrics were benchmarked against a normative model to detect atypical visual search, which refers to gameplay beyond the usual bounds. The combination of neglected side, orientation and challenge factors was used to categorize neglect. We discovered a strong correlation between atypical visual search patterns and neglect risk factors, such as middle cerebral artery stroke, parietal injuries and existing neglect diagnoses (Poisson regression incidence rate ratio = 7.18, 95% confidence interval = 4.41-11.90). In our study, immersive virtual reality-identified neglect in one-fourth of the patients (n = 13, 25.5%), minor atypicality in 17.6% (n = 9) and non-neglect in the majority, 56.9% (n = 29). This contrasts with standard assessments, which detected neglect in 17.6% (n = 9) of cases and had no intermediate category. Our analysis determined six categories of neglect, the most common being left hemispace neglect with above-median orientation and challenge scores. Traditional assessments were not significantly more accurate (accuracy = 84.3%, P = 0.06) than a blanket assumption of non-neglect. Traditional assessments were also relatively insensitive in detecting immersive virtual reality-identified neglect (53.8%), particularly in less severe cases and those involving right-side inattention. Our findings underline the effectiveness of immersive virtual reality in revealing various dimensions of neglect, surpassing traditional methods in sensitivity and detail and operating independently from them. To integrate immersive virtual reality into real-world clinical settings, collaboration with healthcare professionals, patients and other stakeholders is crucial to ensure practical applicability and accessibility.

Association of large core middle cerebral artery stroke and hemorrhagic transformation with hospitalization outcomes.

Historically, investigators have not differentiated between patients with and without hemorrhagic transformation (HT) in large core ischemic stroke at risk for life-threatening mass effect (LTME) from cerebral edema. Our objective was to determine whether LTME occurs faster in those with HT compared to those without. We conducted a two-center retrospective study of patients with ≥ 1/2 MCA territory infarct between 2006 and 2021. We tested the association of time-to-LTME and HT subtype (parenchymal, petechial) using Cox regression, controlling for age, mean arterial pressure, glucose, tissue plasminogen activator, mechanical thrombectomy, National Institute of Health Stroke Scale, antiplatelets, anticoagulation, temperature, and stroke side. Secondary and exploratory outcomes included mass effect-related death, all-cause death, disposition, and decompressive hemicraniectomy. Of 840 patients, 358 (42.6%) had no HT, 403 (48.0%) patients had petechial HT, and 79 (9.4%) patients had parenchymal HT. LTME occurred in 317 (37.7%) and 100 (11.9%) had mass effect-related deaths. Parenchymal (HR 8.24, 95% CI 5.46-12.42, p < 0.01) and petechial HT (HR 2.47, 95% CI 1.92-3.17, p < 0.01) were significantly associated with time-to-LTME and mass effect-related death. Understanding different risk factors and sequelae of mass effect with and without HT is critical for informed clinical decisions.

Iatrogenic Air Embolism with Middle Cerebral Artery Stroke Following Lung Biopsy (P8-5.018)

Iatrogenic Air Embolism with Middle Cerebral Artery Stroke Following Lung Biopsy (P8-5.018)

Transient deficit in acute stroke: a case of musical hallucinations

We reported a case of a 62-year-old female patient affected by musical hallucinations (MHs) as a transient symptom after an ischemic stroke in the right middle cerebral artery. CT scan showed widespread cortical and subcortical hypodensity associated with moderate hemorrhage involving the lentiform nucleus, insular cortex, and caudate nucleus. The patient had no history of psychiatric disorders, hearing defects, or epilepsy. MHs appeared one week after the stroke and spontaneously vanished 10 days after their onset. From our perspective, the early activation of MHs after unilateral brain injury, and their timing of resolution, can be explained according to the “interhemispheric imbalance theory”. According to this theory, in the minutes or weeks following the onset of a focal cerebrovascular event, a series of changes in global brain connectivity occur leading to a temporary imbalance in interhemispheric excitation.

Transcranial Doppler ultrasonography can predict inpatient rehabilitation functional outcome in patients with stroke.

Despite advances in imaging techniques and treatment modalities, tools to predict recovery after stroke remain limited. To determine if transcranial Doppler (TCD) mean flow velocities were predictive of functional recovery following ischemic stroke. Data were collected from patients with stroke admitted to an academic tertiary care facility in the southeastern region of the United States between 2012 and 2019 who had a middle cerebral artery distribution ischemic stroke, TCD, and were discharged to our inpatient rehabilitation facility. Mean flow velocities were categorized as low (<40 cm/s), normal (40-80 cm/s), or high (>80 cm/s). Functional Independence Measure (FIM) scores were collected on admission to and discharge from inpatient rehabilitation. Multiple linear regression models were used to assess the differences in mean FIM score changes by categories of mean flow velocities. We enrolled 57 patients, mean age 60 years, 73.7% male. Compared to the normal velocity group, those with abnormally low velocities had a significantly smaller change in their FIM score (adjusted β = -8.42; p = .01). Compared to the normal velocity group, those with abnormally high velocities experienced a greater change in FIM score, but this association was not statistically significant (beta = 1.12; p = .77). In this limited population, we found that low mean flow velocity as measured by TCD ultrasonography after a middle cerebral artery stroke is associated with poorer functional recovery following inpatient rehabilitation. Our results suggest that the value of TCD ultrasonography as a tool to predict motor recovery after stroke warrants further investigation.

Consistent spatial lesion-symptom patterns: A comprehensive analysis using triangulation in lesion-symptom mapping in a cohort of stroke patients

IntroductionThe relationship between brain lesions and stroke outcomes is crucial for advancing patient prognosis and developing effective therapies. Stroke is a leading cause of disability worldwide, and it is important to understand the neurological basis of its varied symptomatology. Lesion-symptom mapping (LSM) methods provide a means to identify brain areas that are strongly associated with specific symptoms. However, inner variations in LSM methods can yield different results. To address this, our study aimed to characterize the lesion-symptom mapping variability using three different LSM methods. Specifically, we sought to determine a lesion symptom core across LSM approaches enhancing the robustness of the analysis and removing potential spatial bias. Material & methodsA cohort consisting of 35 patients with either right- or left-sided middle cerebral artery strokes were enrolled and evaluated using the NIHSS at 24 h post-stroke. Anatomical T1w MRI scans were also obtained 24 h post-stroke. Lesion masks were segmented manually and three distinctive LSM methods were implemented: ROI correlation-based, univariate, and multivariate approaches. ResultsThe results of the LSM analyses showed substantial spatial differences in the extension of each of the three lesion maps. However, upon overlaying all three lesion-symptom maps, a consistent lesion core emerged, corresponding to the territory associated with elevated NIHSS scores. This finding not only enhances the spatial accuracy of the lesion map but also underscores its clinical relevance. ConclusionThis study underscores the significance of exploring complementary LSM approaches to investigate the association between brain lesions and stroke outcomes. By utilizing multiple methods, we can increase the robustness of our results, effectively addressing and neutralizing potential spatial bias introduced by each individual method. Such an approach holds promise for enhancing our understanding of stroke pathophysiology and optimizing patient care strategies.

Effect of continuous 2MHz transcranial ultrasound as an adjunct to tenecteplase thrombolysis in acute anterior circulation ischemic stroke patients: an open labeled non-randomized clinical trial.

The treatment of acute ischemic stroke has improved in last few decades. While meta-analyses of several trials have established the safety and efficacy of Intravenous (IV) Tenecteplase thrombolysis, concomitant continuous transcranial doppler (TCD) ultrasound administration has not been assessed in any clinical trial. The aim of this study was to determine the effects of continuous 2MHz TCD ultrasound during IV Tenecteplase thrombolysis for Middle cerebral artery (MCA) stroke. A total of 19 patients were included, 13 received TCD ultrasound and 6 sham TCD with IV Tenecteplase. TCD spectrum and difference in Pre and post TCD parameters were measured. Asymptomatic hemorrhagic transformation of infarct wasseen in two patients. There was no mortality or clinical worsening in thesonothrombolysis group as against sham sonothrombolysis group. Median of peak systolic velocity wasincreased in both thesonothrombolysis (P = 0.0002) and sham sonothrombolysis group (P-value = 0.001). The difference in change in mean flow velocity between two groups, sonothrombolysis (11cm/sec)and sham sonothrombolysis (3.5cm/sec) were also significantly different (P = 0.014). This pilot work has established safety of continuous 30min TCD application along with IV Tenecteplase thrombolysis and it concludes thatconcomitant 2MHz TCD ultrasound administration significantly increased the MCA blood flow compared to chemothrombolysis alone.CTRI Registered Number: CTRI/2021/02/031418.

Impact of the pandemic and concomitant COVID-19 on the management and outcomes of middle cerebral artery strokes: a nationwide registry-based study

ObjectivesTo investigate the impact of the COVID-19 pandemic as well as concomitant COVID-19 itself on stroke care, focusing on middle cerebral artery (MCA) territory infarctions.DesignRegistry-based study.SettingWe used the National Inpatient...

Thrombectomy in Stroke Patients With Low Alberta Stroke Program Early Computed Tomography Score: Is Modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 Superior to mTICI 2b?

Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2-5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT. This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke. Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0-3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18-4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07-4.41; P=0.04). In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.

Burr Hole Hemispherotomy-Modification of Trans-Sylvian Peri-Insular Technique: 2-Dimensional Operative Video.

Trans-sylvian peri-insular hemispherotomy represents a functional hemispherectomy with minimal brain removal used for treatment of refractory hemispheric epilepsy.1 Exposure for this procedure is achieved by craniotomy. Refinement in the hemispherotomy technique, including trends toward minimizing cortical resection, has contributed to a substantial drop in complication rates.2 We present a refinement of this technique, allowing for complete hemispheric disconnection through a single burr hole. In this instance, this technique was applied in the case of a 4-year-old girl who presented with medically refractory epilepsy, which had developed on the first day of life due to a perinatal incomplete left middle cerebral artery stroke. Postoperatively, the patient experienced no worsening of her preexisting right-sided hemiparesis and remains seizure-free 18 months postoperatively, now off medication. While the trans-sylvian peri-insular hemispherotomy represents an established surgical technique, this is the first report of this procedure performed in a minimally invasive fashion through a single burr hole. Beyond the minimal incision and small aperture in the skull, seldom appreciated nuances of hemispheric disconnection are described and demonstrated, including amygdala disconnection, hippocampal tail disconnection directly into splenium disconnection, concomitant intermediate disconnection and callosotomy, and frontobasal disconnection landmarks. Consent was obtained from the patient's parents for the surgical procedure, use of outcome videos, and for publication of this video and associated materials. The participants and patient's parents consented to publication of their images and that of the patient.

Surgical Exploration and Endarterectomy for Symptomatic Carotid Web With Retained Thrombus

Background Symptomatic carotid web with retained thrombus represents a potential source of embolic strokes. However, the absence of diagnostic guidelines contributes to heterogeneity in management recommendations. Methods We present a patient with a right middle cerebral artery stroke attributable to carotid web with retained thrombus. Confirmation was obtained through surgical exploration, given the inconclusive imaging but strong index of suspicion. Results The presence of carotid web with retained thrombus was confirmed through surgical exploration. Cervical endarterectomy was performed and a carotid web with an associated thrombus was successfully resected. Conclusion We highlight the importance of having a high index of suspicion and prompt treatment to mitigate the risk of recurrent strokes when suspecting carotid web with retained thrombus.

Effectiveness of Task Oriented Training and Swiss Ball Exercise on Balance among Middle Cerebral Artery Stroke Patients: A Comparative Study

Background: This study was developed to determine the effectiveness of task oriented training and swiss ballexercise on balance among middle cerebral artery stroke patients.Purpose: To compare the effectiveness of task oriented training and swiss ball exercise on balance among middlecerebral artery stroke patients.Materials and Methods: This research is an experimental study. The 30 subjects obtained from SaiCharan PhysioCentre were split into two distinct groups as Group A (15 Subjects) and Group B (15 subjects). All the 30 subjectswere assessed with Trunk Impairment Scale as a pre test and the same test was performed for post test at the endof 4 weeks following the intervention protocol. Group A received task oriented training and Group B receivedSwiss ball exercise along with convention therapy given for both the groups. Exercise were given for 4 weeks, 5days per week, 10 repetition * 3 sets. Pre test and post test values were calculated and tabulated. The entire periodwas performed from November 2022 to March 2023.Result: Statistical analysis of Trunk Impairment Scale Examination post values revealed the constantly significantdifferences, With the P value of &lt;0.0001.Conclusion: Task oriented training with conventional therapy is more effective on enhancing the trunk balanceamong MCA Stroke patients than either using Swiss ball exercise with conventional therapy.

Assessment of the effectiveness of the reconstraction of social-everyday skills on the hardware-training complex of audio-visual reconstruction of the environment of patients after acute cerebrovascular accident

BACKGROUND: Motor disorders as a result of аcute cerebrovascular accident are the most common cause of disability and not only significantly reduce the quality of life of patients, but also cause restriction of social and household independence of patients in a familiar environment.&#x0D; AIM: the evaluation of the effectiveness for restoring the social and domestic activity skill ― shopping in the supermarket in patients undergoing stroke in the right middle cerebral artery after course of the special apparat trainings with audio-visual reconstruction of the environment.&#x0D; MATERIALS AND METHODS: The study included 65 participants, they were divided into 3 groups, the first and the second group ― the patients who undergoing the stroke (main and control groups): the main group of patients received a base standard rehabilitation program (kinesiotherapy, mechanotherapy on cyclic apparatгs, massage) and additional the social and domestic trainings with audio-visual reconstruction of the environment. The control group ― a base standard rehabilitation program. The duration of the rehabilitation course was 21 days. The third comparison group are the healthy participants, who were necessary for defining "etalon" options for training of socially important skill.&#x0D; RESULTS: As a result of the study in both groups (main and control) as compared with the initial findings the lowering of the heaviness ischemic stroke outcome (NIHSS): 6.2±0.4 in the first group and 6.8±0.7 in the second group vs. 4.2±0.2 and 5.9±0.8 (р ≤0.05). By comparison the first and the second groups with the health participants were defined the statistically significant changes of the studing time options in the main group during making these skills: take the bag and sling it through the shoulder, open the pockets of the bag (2 pockets), take the jacket from the clothes hanger and put on. Although in patients of the first group after restoring threatment course with using method of functional spatially-oriented rehabilitation it was authentic lesser disturbance of everyday life activity: in estimating Bartel Index 61.3±4.9 vs. 43.75±5.1 (initial) (р ≤0.05), what was signuficantly higher be comparison with control group results. In estimating functional independence by Modified Scale FIM: 71.4±4.9 in the main group vs. 53.7±3.1 (initial) (р ≥0.05), what was although significantly higher in comparison with the second group. By HADS it was lowering of the anxiety symptoms in the first group from 13.02±1.9 till 10.12±1.2 (р ≤0.05) as compared with the control group where the level of anxiety was staying quietly high and was 12.6±0.6 by comparison the initial findings 13.14±1.5 (р ≥0.05).&#x0D; CONCLUSION: The obtained resalts point at the effectiveness of using functional spatially-oriented rehabilitation in restoring threatment programs for patient undergoing stroke for elevation of the independence level in real life terms. An additional point is that this kind training promote significantly positive influence on the patient’s motivation for actualization of active movement to improvement of the social and domestic adaptation.