Mild-moderate Stroke Research Articles

Early Mobilisation Post-Thrombolysis is Safe and Improves Outcomes in Mild-Moderate Acute-Stroke Patients

Abstract Background Thrombolysis (tPA) is the delivery of a clot-lysing agent used in acute ischemic stroke, typically followed by ≥24-hour bed rest. This study aimed to compare the safety and effectiveness of early mobilisation (≤24 hours post-tPA) versus ≥24-hour bed rest in patients with mild-moderate stroke. Methods A literature review was conducted leading to the development of an early mobilisation protocol post-tPA. Retrospective (January-July 2023: pre-early mobilisation protocol) and prospective (July 2023-April 2024: post-early mobilisation protocol) data were analysed. Baseline demographics and outcomes were compared between the two groups. Primary outcome was physical function (Modified Rankin Scale (mRS) at hospital discharge. Secondary outcomes included adverse effects, length of stay (LOS) and discharge destination. Results 11 patients met the criteria for early mobilisation in both groups. There were no significant differences in age, the National Institutes of Health Stroke Scale (NIHSS) pre-tPA and mRS at baseline between the two groups (p>0.05). 8 patients in the early mobilisation protocol were male (72.73%), the median (IQR) age was 61 (54-78) years, and NIHSS was 6 (3-8) pre-tPA and 1 (0-2) post-tPA. Patients had a median (IQR) mRS score of 0 (0-0) pre-stroke and time to early mobilisation was 12 (12-17) hours. Patients in the early mobilisation group had significantly lower mRS on discharge (p=0.007), shorter LOS (Median (IQR) 5 (4-7) days, P=0.13) and higher rates of discharge directly home compared to those mobilised post ≥24-hour bed rest. No adverse effects of early mobilisation occurred. Conclusion Compared with 24-hour bed rest, early mobilisation for mild-moderate stroke patients was safe and associated with significantly better physical function.

Sleep-disordered breathing in the acute phase of ischemic stroke

Objective. Sleep-disordered breathing (SDB) is a common cardiovascular risk factor. The aim of our study was to assess the occurrence and features of SDB in patients with acute supratentorial ischemic stroke. Design and methods. Patients 18-89 years of age with acute ischemic stroke admitted to the stroke intensive care unit within 24 hours after the symptom onset underwent respiratory monitoring during the first day of hospitalization. 1616 patients were screened between 2018 and 2021 years, respiratory monitoring was performed in 583 patients, and data from 281 patients [mean age 67 (30; 89) years, 146 males (52 %)] were included in the final analysis. Results. The mean respiratory disturbance index was 11,8 (0; 88)/h. SDB was detected in 182 patients (69,2 %), with mild severity in 28,6 %, moderate in 24,2 %, and severe in 47,2 %. Prevalent obstructive apnea type was observed in 71,1 %, central type in 14,2 %, and mixed type in 14,7 %. The TOAST stroke subtype distribution was the following: unspecified etiology was diagnosed in 52 %, cardioembolic in 26 %, atherothrombotic in 11 %, lacunar in 9 %, and other established etiology in 2 %. The majority of patients had mild stroke severity (89,4 %), moderate and severe stroke was diagnosed in 10,5 %. No significant differences in the main indices of the type and severity of sleep apnea were found in the groups based on severity and pathogenetic type of stroke. Conclusions. Our results correlate with the worldwide prevalence of SDB in patients with ischemic stroke (69,2 % and 71,1 %). Further analysis with inclusion of more patients with moderate and severe stroke is required, as well as a prospective study to assess the prognostic impact of SDB.

Exploring Intra-Individual Cognitive Variability Phenotypes After Stroke Using Ecological Momentary Assessment

<h3>Research Objectives</h3> To describe variability in cognitive complaints and associations with functional outcomes in individuals with stroke. <h3>Design</h3> Longitudinal observational study using ecological momentary assessment (EMA) to assess cognitive complaints. PROMIS and NeuroQoL short forms, including participation and satisfaction with social roles, depression, anxiety, and pain interference and intensity, were also completed in a lab setting. We used Latent class analysis (LCA) to determine phenotypic profiles of cognitive variability (CV) and ANOVA to test associations between functional outcomes and variability profiles. <h3>Setting</h3> Home and community. <h3>Participants</h3> Individuals (N = 201) with mild-moderate stroke and greater than three months post-stroke were recruited. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Participants responded EMA surveys five times a day for 14 days. We derived five variability indicators to quantify the patterns of cognitive complaints experienced by each participant. <h3>Results</h3> The LCA converged on a three-profile model (BIC= 1398, entropy = 0.994, VLMR p = .177, k − 1 LRT=367.89, p < .001). Inspection of the profiles revealed a low, moderate, and high CV profile. The moderate and high CV group demonstrated significantly greater functional challenges than the low CV group (all domains p < .05). The high CV group had the worst performance in all domains. Further, over 65% of the participants with moderate CV reported meaningfully worse pain interference and participation in and satisfaction with social roles. <h3>Conclusions</h3> Findings suggest that EMA assessment of intra-individual variability may be a useful tool to identify a subgroup of at-risk stroke survivors with cognitive issues impacting daily function in natural environments. This tool offers real-world monitoring and screening for post-stroke health after transitioning to home and community settings. <h3>Author(s) Disclosures</h3> None.

A cohort study on longitudinal changes in postural balance during the first year after stroke

IntroductionMany patients with strokes report increased incidence of fall that can be due to impaired postural balance. The recovery of balance in patients with varying degrees of impairments and activity limitations is less studied, and whether individuals with mild paresis can recover their balance faster is unclear. Better knowledge about factors influencing the recovery of postural balance can be used to guide clinical management after stroke to provide the right rehabilitation to the right person at the right time, and thus to avoid potential fall incidences.ObjectiveThis study aims to examine longitudinal changes in postural balance during the first year after stroke.MethodsPostural balance was assessed using the Berg Balance Scale (BBS) within 5 days, 1, 2, and 3 months and 1-year post-stroke. Stroke severity was stratified using a cluster analysis by including multidimensional baseline measures. A longitudinal mixed-effect model was constructed to analyze changes in proportional balance impairment by stroke severity over time. Individuals with a cut-off of BBS below 45 scores were identified through a classification algorithm using baseline predictors.ResultsA total of 135 patients were stratified to mild stroke (77 [57%] patients) or moderate stroke (58 [43%] patients). Ninety-three patients were included in the longitudinal analysis. Significant recovery was found at 1-year for moderate stroke (48% recovery from the initial impaired postural balance, adjusted P < 0.001), but not for mild stroke, after adjusting for age and cognition. Both stroke severities had a maximal recovery in postural balance at 3 months post-stroke, but the moderate stroke group deteriorated after that. Patients with higher age and worse cognition had more severe balance impairments. The classification model achieved a sensitivity of 0.95 (95% confidence interval [CI]: 0.91–0.98) and a specificity of 0.99 (95% CI: 0.98–1.0) for classifying individuals with BBS below 45 points.ConclusionsThis study indicates that continuous improvements in postural balance ends at 3 months regardless for mild or moderate stroke groups, and patients with moderate stroke significantly deteriorate in postural balance after 3 months.

Does dual task merged in a mixed physical exercise protocol impact the mobility under dual task conditions in mild impaired stroke survivors? A feasibility, safety, randomized, and controlled pilot trial

Purpose To investigate the feasibility, safety, and effects of dual task (DT) in a mixed physical exercise protocol on mobility under DT in stroke survivors. Materials and methods Twenty-six chronic mild-impaired stroke survivors (age 51.57 ± 12.55; men= 13, women= 13) were randomly assigned into Experimental Group participating in a 15-week mixed (aerobic and resistance exercises performing a cognitive DT condition simultaneously) physical exercise protocol (30 sessions, 2x/week, duration of 60–90 min), and Control Group engaged in the same protocol without DT. Feasibility and outcome measures were assessed before and after the intervention and in a 5-week follow-up. Results DT physical exercise protocol was viable and safe. This protocol also improved mobility and gait when performed under DT, which was not found in the control group. DT does not influence aerobic resistance, strength, and balance responsiveness. It does not present any improvement in cognition, self-efficacy for falls, and quality of life. Conclusion The results indicate that mixed physical exercise under DT is feasible and safe for mild-impaired stroke survivors. Stroke survivors demonstrate more significant improvement in the mobility performance under DT when submitted to a DT mixed physical exercise protocol than the standard physical exercise intervention. Trial registration Brazilian clinical trials registry (RBR-4mvzz6); WHO trial record (U1111-1198-7173) IMPLICATIONS FOR REHABILITATION DT training can be prescribed by using clear and precise parameters for stroke survivors. Physical Exercise without DT requirements did not improve mobility performing and cognitive tasks simultaneously in stroke survivors. Clinicians are encouraged to incorporate DT requirements into the exercise routines to enhance mobility under DT to mild-moderate stroke survivors.

Abstract 6: A Comparison Of The Modified Rankin Scale And Stroke Impact Scale-ADL For Measuring Function After Stroke

Introduction: The modified Rankin Scale (mRS) of clinician-rated global disability is commonly used to measure functional outcome after stroke but has limitations such as low granularity and ceiling effects. Measures of functional outcomes with higher resolution could provide improved insights into outcomes and therapeutic efficacy. Here we evaluated the performance of the mRS in relation to the Stroke Impact Scale v2.0 Activities of Daily Living score (SIS-ADL), a valid, reliable, patient-reported measure of post-stroke function. Methods: Patients in the STRONG Study were examined 90 d post-stroke. In addition to the mRS, exam included the SIS-ADL, which asks patients to rate the difficulty of performing 10 ADLs using a 5-level Likert Scale. SIS-ADL scores range from 0-40; higher scores indicate better function. Results: For 499 patients, age = 61.5±14.8 (mean±SD), acute NIHSS = 4 [2-9] (median [IQR], day 90 mRS median = 2 [1-3], and day 90 SIS-ADL median = 35 [26-39]. The d90 SIS-ADL correlated with d90 mRS (r = -0.74, p&lt;.0001). The mean SIS-ADL value decreased with increasing mRS scores, as expected, but there was substantial overlap in SIS-ADL scores across mRS levels (Figure) to a degree beyond the minimal clinically important difference (5.9 points). The SIS-ADL was sensitive to mild deficits, identifying persistent ADL problems in 30/66 (45.5%) patients with a perfect mRS score of 0. Conclusions: In a population of mild-moderate stroke, the SIS-ADL identified a wide range of patient-reported functional deficits within each mRS level and was sensitive to functional deficits not identified by the mRS. The SIS-ADL complements the mRS for measuring functional outcome after stroke and may be useful for study design and sample size estimates for acute stroke and stroke recovery trials.

Abstract WMP38: The Functional Significance Of Distal Arm Motor Deficits After Stroke

Background: Much of human behavior revolves around use of the hand, yet distal arm motor deficits are not part of the NIH Stroke Scale (NIHSS), and so their measurement is omitted from many guidelines and care pathways. We examined the frequency of distal arm motor deficits and their functional implications. Methods: Patients in the STRONG Study were examined 1-10d and again 90 d post-stroke. Grip force, expressed as the ratio of paretic/nonparetic hands, and the NIHSS were measured serially. The modified Rankin (mRS) and Fugl-Meyer arm motor (FM) scales were measured at d90. Results: There were 763 patients, with age = 62.5±15.0 (mean±SD), acute NIHSS = 4 [2-9] (median [IQR]), and day 90 mRS median = 2 [1-3]. Grip force was available in 748 acutely and in 439 at d90. Weakness in grip strength was present in 60.2% acutely and 52.2% at d90. Acutely, grip force was not related to NIHSS total score (r=.04, p=.3) after accounting for proximal motor deficits (NIHSS Q5); at d90, there was a weak relationship (r= -0.15, p&lt;.0001). Proximal weakness was only partially related to distal motor deficits at both timepoints (r = -0.48 to -0.53, p&lt;.0001). At d90, grip force explained 24.6% of the variance in mRS score (p&lt;.0001). D90 grip force showed convergent validity, correlating strongly with the distal arm motor FM score (r=.64, p&lt;.0001). Conclusions: In this mild-moderate stroke population, distal arm motor deficits were common, were poorly captured by the NIHSS total score, and did not simply echo proximal arm motor deficits. Distal arm motor deficits were strongly related to level of global disability at d90. These findings argue that measurement of distal arm motor deficits should be included in guidelines and care pathways after stroke.

Quantification of stroke lesion volume using epidural EEG in a cerebral ischaemic rat model

Precise monitoring of the brain after a stroke is essential for clinical decision making. Due to the non-invasive nature and high temporal resolution of electroencephalography (EEG), it is widely used to evaluate real-time cortical activity. In this study, we investigated the stroke-related EEG biomarkers and developed a predictive model for quantifying the structural brain damage in a focal cerebral ischaemic rat model. We enrolled 31 male Sprague–Dawley rats and randomly assigned them to mild stroke, moderate stroke, severe stroke, and control groups. We induced photothrombotic stroke targeting the right auditory cortex. We then acquired EEG signal responses to sound stimuli (frequency linearly increasing from 8 to 12 kHz with 750 ms duration). Power spectral analysis revealed a significant correlation of the relative powers of alpha, theta, delta, delta/alpha ratio, and (delta + theta)/(alpha + beta) ratio with the stroke lesion volume. The auditory evoked potential analysis revealed a significant association of amplitude and latency with stroke lesion volume. Finally, we developed a multiple regression model combining EEG predictors for quantifying the ischaemic lesion (R2 = 0.938, p value < 0.001). These findings demonstrate the potential application of EEG as a valid modality for monitoring the brain after a stroke.

IMAGINE study protocol of a clinical trial: a multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors

BackgroundRehabilitation pathways are crucial to reduce stroke-related disability. Motivational Interviewing (MI), as a person-centered complex intervention, aimed to empower and motivate, and could be a resource to improve rehabilitation outcomes for older stroke survivors. The IMAGINE project aims to assess the impact of MI, as a complement to standard geriatric rehabilitation, on functional improvement at 30 days after admission, compared to standard geriatric rehabilitation alone, in persons admitted to geriatric rehabilitation after a stroke. Secondary objectives include assessing the impact of MI on physical activity and performance, self-efficacy, safety, cost-utility, participants’ experiences and functional status at 3 months.MethodsWe will conduct a multicenter randomized clinical trial in three geriatric rehabilitation hospitals in Spain. Older adults after mild-moderate stroke without previous severe cognitive impairment or disability will be randomized into the control or intervention group (136 per group, total N = 272). The intervention group will receive 4 sessions of MI by trained nurses, including the design of a personalized rehabilitation plan agreed between stroke survivors and nurses based on stroke survivors´ goals, needs, preferences and capabilities. Main outcome will be the Functional Independence Measure (FIM). In-hospital physical activity will be measured through accelerometers and secondary outcomes using validated scales. The study includes a process evaluation and cost-utility analysis.DiscussionFinal results are expected by end of 2020. This study will provide relevant information on the implementation of MI as a rehabilitation reinforcement tool in older stroke survivors. A potential reduction in post-stroke disability and dependence would increase person’s health-related quality of life and well-being and reduce health and social care costs. IMAGINE has the potential to inform practice and policymakers on how to move forward towards shared decision-making and shared responsibilities in the vulnerable population of older stroke survivors.Trial registrationClinicalTrials.gov: NCT03434938, registered on January 2018.

FEASIBILITY OF MOBILE HEALTH FOR LOW-INCOME MINORITY HISPANIC PATIENTS WITH A STROKE

Stroke is a leading cause of death and functional impairment that disproportionately impacts Hispanics. Several studies have supported the feasibility of mobile health interventions (mHealth) to provide health monitoring and patient education for improving chronic disease management, but none have focused on Latino stroke patients. The Hispanic Secondary Stroke Prevention Initiative is a randomized study of 200 stroke patients designed to evaluate the impact of a 12-month multi-modal Community Health Worker (CHW) and mHealth intervention on blood pressure control. Eligible participants were Latinos who experienced a mild-moderate stroke within the last five years. The CHW component included home visits, telephone calls, and daily text messages to obtain home blood pressure readings and provide patient navigation and health education. Feasibility was defined as the proportion of patients that responded to at least half the messages. Pre-post paired t-tests assessed improvements in question accuracy while correlation coefficients highlighted improvements in response rates. Among the 65 participants randomized to the intervention, the response rate was as follows: 37% - >50% response, 21% - 25-50%, 19% - 10-25%, and 23% - <10%, This finding suggests that mHealth interventions may be challenging in this population. However, the proportion of questions answered correctly increased from 63% to 84% in the intervention period’s last two months (p<0.05). There was a positive correlation between increased response rates and response accuracy to patient education assessments (r=0.82, p<0.05). These improvements in health knowledge suggest that a subset of patients may benefit from mHealth interventions, and the benefit correlates with use.

Clinical Symptom Profiles After Mild-Moderate Stroke.

BackgroundThere is heterogeneity in the severity of domains affected in patients with stroke, resulting in differences in health‐related quality of life (hrQoL). Identifying different clinical profiles of stroke patients may provide a means for selecting patients for tailored interventions to improve hrQoL.Methods and ResultsThis was an observational study of 496 patients with ischemic stroke or intracerebral hemorrhage seen in a cerebrovascular clinic from October 12, 2015, through June 11, 2018, who completed patient‐reported outcome measures using Patient‐Reported Outcome Measurement Information System (PROMIS) tools within 1 month of stroke. Latent profile analysis identified groups based on PROMIS domain scores—pain, depression, cognitive function, fatigue, social role satisfaction, and physical function—as well as clinician‐reported modified Rankin Scale (mRS). Five distinct profiles were identified. Group 1 (“excellent hrQoL,” n=106) had fewer symptoms in all domains than the general population. Group 2 (“disabled with mixed hrQoL,” n=17) had fewer symptoms than the general population in all domains except social role satisfaction and physical function, despite having moderate disability (median mRS score: 3). Group 3 (“mild limitations with average hrQoL,” n=189) had scores similar to the general population for all domains and minimal disability (median mRS score: 1). Group 4 (“mild limitations with poor hrQoL,” n=152) also had a median mRS score of 1 but had worse scores than group 3 on all domains. Group 5 (“disabled with poor hrQoL,” n=32) had worse symptoms than patients in the other profiles and a median mRS score of 3.ConclusionsPatients with recent stroke have distinct clinical symptom profiles, even with similar levels of clinician‐reported disability. Symptom profiles provide a means of understanding patterns of outcomes in patients with stroke.

PARAMETERS AFFECTING STROKE SEVERITY AND OUTCOME IN ACUTE STROKE PATIENTS TREATED WITH IV THROMBOLYSIS

Aim: Our aim is to evaluate vascular risk factors and laboratory findings in patients treated with IV thrombolysis, to compare these parameters according to neurological findings scored by a National Institutes of Health Stroke Scale (NIHSS) at admission, after 7 days and to investigate the impact of these parameters on stroke severity and outcome at 3rd month.&#x0D; Methods: We reviewed 53 consecutive acute ischemic stroke patients admitted within 0-4.5 h after stroke onset and treated with IV thrombolysis between 2014 March-2018 May. Patients with acute posterior circulation stroke, and who underwent endovascular intervention after thrombolysis were excluded. Demographic features, vascular risk factors, laboratory findings and hemorrhagic transformation, and NIHSS scores of patients at admission and after 7 days, and also 3rd month mRS scores were recorded.&#x0D; Results: The mean age of patients was 64.79±12.26 and 60.37 % of them were male. Mean NIHSS score at admission was 10.60±5.16 and one week after IV r-tPA treatment, the mean score was 7.07±5.39. Hemorrhagic transformation was 18.9%. The male ratio was significantly higher in mild-moderate stroke group (p=0.008), the prevalence of hypertension, diabetes, hemorrhagic transformation and blood urea levels were also significantly higher in severe stroke group than mild-moderate group (p≤ 0.05). In addition neutrophil levels was higher in severe group, but not statistically significant. Creatine levels were significantly higher in the poor outcome group (NIHSS difference &lt;6) after one week.&#x0D; &#x0D; Conclusion: Female gender, hemorrhagic transformation and high neutrophil levels were found to have impact on stroke severity towards poor prognosis independently.

Physiotherapy provision to hospitalised stroke patients: Analysis from the UK Sentinel Stroke National Audit Programme.

The purpose of this study is to investigate which factors are associated with physiotherapy provision to hospitalised stroke patients. Data were analysed for stroke patients admitted to hospital in England and Wales between April 2013 and March 2017 recorded on the Sentinel Stroke National Audit Programme (SSNAP) national stroke register. Associations between different patient factors, and applicability for and intensity of physiotherapy were measured using multi-level logistic and regression models.Findings: Data from 306,078 patients were included on the SSNAP register. Median age was 77 years (IQR 67-85) and 84.7% of patients with completed stroke severity data had a mild-moderate stroke. In all, 85.2% of patients recorded on SSNAP were deemed applicable for physiotherapy. Applicability for physiotherapy was 47% higher among thrombolysed patients (aOR 1.47, 95% CI 1.40-1.54), 36% lower in those with severe pre-morbid disability (aOR 0.64, 95% CI 0.58-0.71) and more than 2.5-fold higher among patients admitted to hospitals with greater availability of early supported discharge (aOR 2.62, 95% CI 1.28-5.37). Patients who were younger, male, had less pre-morbid disability, lower stroke severity, sustained an infarction, received thrombolysis, and had fewer medical complications were more likely to receive more intensive physiotherapy post-stroke. Several patient and service organisational factors are associated with physiotherapy provision to stroke patients, some of which may not be justifiable. Physiotherapists should be aware of these factors when planning and delivering physiotherapy as well as any possible biases associated with physiotherapy provision to patients post-stroke.

The clinical utility of a 30-minute neuropsychological assessment battery in inpatient stroke rehabilitation

Cognitive assessment is an important component of inpatient stroke rehabilitation. Few studies have empirically evaluated the clinical utility of specific neuropsychological measures in this setting. We investigated the psychometric properties and clinical utility of a 30-minute neuropsychological battery developed by the National Institute of Neurologic Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN). Clinical data were analyzed from 100 individuals with mild-moderate stroke severity on an acute inpatient rehabilitation unit who completed the NINDS-CSN battery at admission. The battery comprised the Symbol-Digit Modalities Test (SDMT), Trail Making Test, Controlled Oral Word Association Test, Animal Naming, and the Hopkins Verbal Learning Test-Revised. We evaluated the battery's distribution of scores, frequency of impaired performance, internal consistency, and ability to predict rehabilitation gain and independence in cognitively-based instrumental activities of daily living (IADL) at discharge. Results indicated that the NINDS-CSN battery was sensitive to cognitive impairment, demonstrated moderately strong internal consistency, and predicted discharge IADL. The SDMT demonstrated the strongest sensitivity to impairment and predictive validity. The NINDS-CSN battery is a clinically useful assessment battery in acute inpatient stroke rehabilitation. Complex attention and processing speed performance may be most informative in predicting amount of rehabilitation gain and IADL functioning at discharge.

Extraction of corticospinal tract microstructural properties in chronic stroke

BackgroundInformation about the structural integrity of the corticospinal tract (CST) from diffusion-weighted imaging can improve our ability to understand motor outcomes in people with upper limb impairment after stroke, especially those with severe impairment. Yet, there is no consensus on which method of CST generation most accurately represents function and impairment in individuals with chronic stroke. New methodThe aim of the study was to compare different methods of CST reconstruction and resulting microstructural properties, as well as the relationship between these properties and motor function and impairment. Fifteen individuals with mild-moderate impairment and 15 with severe impairment who were in the chronic phase post-stroke underwent a diffusion-weighted imaging scan and motor function and impairment assessments. ResultsDifferent relationships existed between reconstruction methods, microstructural properties, and impairment and function. In severe stroke, fractional anisotropy (FA) emerged over and above apparent diffusion coefficient (ADC) and tract number to index CST integrity; FA correlated with impairment and function, whereas ADC and tract number did not correlate. No significant differences between methods or microstructural properties were found in mild-moderate stroke. Comparison with existing methodsOur study demonstrates that CST reconstruction method influences the extraction of microstructural integrity in individuals with chronic severe stroke, with FA appearing to be the most representative method. A similar line of investigation is warranted earlier post-stroke. ConclusionDifferences in this data set highlight the need to establish a common methodology for CST reconstruction and analysis which may eliminate discrepancies in interpreting DWI and enhance biomarker use post-stroke for motor function.

Cerebral Small Vessel Disease Burden Is Associated With Poststroke Depressive Symptoms: A 15-Month Prospective Study.

Objective: All types of cerebral small vessel disease (SVD) markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds, and perivascular spaces were found to be associated with poststroke depressive symptoms (PDS). This study explored whether the combination of the four markers constituting an overall SVD burden was associated with PDS.Methods: A cohort of 563 patients with acute ischemic stroke were followed over a 15-month period after the index stroke. A score of ≥7 on the 15-item Geriatric Depression Scale was defined as clinically significant PDS. Scores of the four SVD markers ascertained on magnetic resonance imaging were summed up to represent total SVD burden. The association between SVD burden and PDS was assessed with generalized estimating equation models.Results: The study sample had a mean age of 67.0 ± 10.2 years and mild-moderate stroke [National Institutes of Health Stroke Scale score: 3, interquartile, 1–5]. PDS were found in 18.3%, 11.6%, and 12.3% of the sample at 3, 9, and 15 months after stroke, respectively. After adjusting for demographic characteristics, vascular risk factors, social support, stroke severity, physical and cognitive functions, and size and locations of stroke, the SVD burden was associated with an increased risk of PDS [odds ratio = 1.30; 95% confidence interval = 1.07–1.58; p = 0.010]. Other significant predictors of PDS were time of assessment, female sex, smoking, number of acute infarcts, functional independence, and social support.Conclusion: SVD burden was associated with PDS examined over a 15-month follow-up in patients with mild to moderate acute ischemic stroke.

Abstract WP325: Designing Patient-centered Solutions for Enhanced Home-based Recovery After Mild-moderate Stroke

Introduction: After discharge from a structured rehabilitation setting, mild-moderate stroke patients report feeling unprepared to manage their home recovery plan. Through Design for America, we worked with undergraduate students to develop prototypes to empower patients in their post-stroke home-based recovery. Methods: “User centered design”, a six step process, was applied over a 6-week summer program, with design and process experts’ mentorship. We obtained qualitative data from patients, caregivers and healthcare professionals through focus groups, interviews and web-based surveys (N=60). The insights gained from users were utilized to design solutions. Results: Insights gained include: 1) 96% of patients reported they were unable to follow home rehabilitation schedules; 2) 66.7% reported being “comfortable” with technology and 10% having previously used Apps for exercise; 3) often insurance does not cover rehabilitation in mild strokes cases; and 4) patients like to hear from others and often develop their own exercises. Solutions designed included:1) a wearable device (Figure 1A) for stroke survivors to alert them of exercise schedule, track activity, appointments, and medication reminders, 2) a website (Figure 1B) that provides patients an online community to find user-submitted therapeutic exercises, share stories, and motivate others. Conclusion: In partnership with Design for America, we created unique solutions that fill a gap in the continuity of stroke recovery: community-based, patient-centered, and self-empowering tools. In the coming months, we plan to build and pilot test these products in a clinical setting.

Interhemispheric Pathways Are Important for Motor Outcome in Individuals with Chronic and Severe Upper Limb Impairment Post Stroke.

Background Severity of arm impairment alone does not explain motor outcomes in people with severe impairment post stroke. Objective Define the contribution of brain biomarkers to upper limb motor outcomes in people with severe arm impairment post stroke. Methods Paretic arm impairment (Fugl-Meyer upper limb, FM-UL) and function (Wolf Motor Function Test rate, WMFT-rate) were measured in 15 individuals with severe (FM-UL ≤ 30/66) and 14 with mild–moderate (FM-UL > 40/66) impairment. Transcranial magnetic stimulation and diffusion weight imaging indexed structure and function of the corticospinal tract and corpus callosum. Separate models of the relationship between possible biomarkers and motor outcomes at a single chronic (≥6 months) time point post stroke were performed. Results Age (ΔR20.365, p = 0.017) and ipsilesional-transcallosal inhibition (ΔR20.182, p = 0.048) explained a 54.7% (p = 0.009) variance in paretic WMFT-rate. Prefrontal corpus callous fractional anisotropy (PF-CC FA) alone explained 49.3% (p = 0.007) variance in FM-UL outcome. The same models did not explain significant variance in mild–moderate stroke. In the severe group, k-means cluster analysis of PF-CC FA distinguished two subgroups, separated by a clinically meaningful and significant difference in motor impairment (p = 0.049) and function (p = 0.006) outcomes. Conclusion Corpus callosum function and structure were identified as possible biomarkers of motor outcome in people with chronic and severe arm impairment.

Abstract TP460: Dominant Imaging Markers for Post Stroke Cognitive Performance in the TABASCO Study

Introduction: Post-stroke patients are at high risk of developing cognitive decline. Previous studies have examined only limited magnetic resonance imaging (MRI) parameters for prediction of cognitive status following stroke Aim: To determine radiological markers associated with different cognitive domains in post-stroke patients. Materials and Methods: Patients from the TABASCO (Tel-Aviv Brain Acute Stroke Cohort), a prospective cohort of first-ever mild-moderate ischemic stroke patients, were Included (N=141). All patients underwent a 3T MRI and were cognitively assessed at admission and 2 later. Multiple regression models were used to assess which of the imaging measures best associated with cognitive scores 2 years after the index event. Results: After controlling for both age and education, the comparisons between cognitively intact and impaired patients revealed significant differences between the two groups in relative CSF volume, white matter lesion (WML) load and white matter microstructural integrity, reflected as mean diffusivity (MD), radial diffusivity (Dr) and axial diffusivity (Da) values ( p’s &lt;0.05). Multiple regression analyses demonstrated the significant role of hippocampi MD to serve as a common predictor for all three cognitive scores. Relative WML load significantly contributed to the global score and executive function. Discussion: Our results highlight the role of hippocampal MD and WML load as markers for cognitive performances. We suggest that these imaging markers best demonstrated "brain intergrity"

Factors related to therapeutic outcomes of intravenous thrombolysis in stroke patients with different severity

To investigate the factors related to therapeutic outcomes of intravenous thrombolysis in patients with acute ischemic stroke (AIS) of different severity. Clinical data of patients with AIS treated with intravenous thrombolysis in the Second Affiliated Hospital, Zhejiang University School of Medicine between June 2009 and December 2013 were retrospectively reviewed. According to National Institutes of Health Stroke Scale (NIHSS), patients were categorized as mild stroke (≤8, n=134), moderate stroke (9-15, n=121) and severe stroke(≥16, n=110). The good outcome was defined as modified Rankin Scale ≤ 2. The factors related to functional outcomes and hemorrhagic transformation (HT) were analyzed and compared among 3 groups. Among 365 enrolled patients, good outcomes in 3 groups were 78.4% (105/134), 47.9% (58/121) and 24.5%(27/110), respectively. In patients with mild stroke, age (OR=0.937, 95%CI: 0.898-0.978; P=0.003), baseline NIHSS (OR=0.732, 95%CI:0.564-0.950; P=0.019), onset to needle time (ONT) within 270 min (OR=4.109, 95%CI:1.441-11.719; P=0.008) independently predicted good outcome, while baseline glucose (OR=1.326, 95%CI:1.009-1.743; P=0.043) was independently associated with parenchymal hematoma (PH). In patients with moderate stroke, age (OR=0.954, 95%CI: 0.924-0.984; P=0.003) and baseline NIHSS (OR=0.760, 95%CI: 0.619-0.933; P=0.009) independently predicted good outcome, while atrial fibrillation (OR=3.307, 95%CI: 1.140~9.596; P=0.028) and systolic pressure (OR=0.967, 95%CI: 0.943~0.991; P=0.008) was independently associated with hemorrhagic infaction. Atrial fibrillation (OR=36.972, 95%CI: 1.770-772.462; P=0.02) was independently associated with PH. In patients with severe stroke, baseline NIHSS (OR=0.808, 95%CI:0.677-0.963; P=0.018) independently predicted good outcome, while no independent risk factors of HT was found. For different severity of AIS patients, the related factors of functional outcome and HT after thrombolysis were different.