Post-stroke Conditions Research Articles

Do Orally Disintegrating Tablets Facilitate Medical Adherence and Clinical Outcomes in Patients with Post-stroke Dysphagia?

Orally disintegrating tablets (ODTs) dissolve rapidly in contact with saliva and have been reported to facilitate oral administration of medications in swallowing difficulties. However, their clinical benefits remain unclear because no previous studies have examined whether ODTs facilitate medication adherence and clinical outcomes in patients with post-stroke dysphagia. This study evaluated the association between ODT prescriptions and clinical benefits using high-dimensional propensity score (hd-PS) matching to adjust for confounding factors. Using a large Japanese commercial medical and dental claims database, we identified patients aged ≥ 65years with post-stroke dysphagia between April 2014 and March 2021. To compare 1-year outcomes of medication adherence, cardiovascular events, and aspiration pneumonia between patients taking ODTs and non-ODTs, we performed hd-PS matching. We identified 11,813 patients without ODTs and 3178 patients with ODTs. After hd-PS matching, 2246 pairs were generated. Medication adherence for 1year, based on the proportion of days covered, was not significantly different between the non-ODT and ODT groups before (0.887 vs. 0.900, P = 0.999) and after hd-PS matching (0.889 vs. 0.902, P = 0.977). The proportion of cardiovascular events (0.898 vs. 0.893, P = 0.591) and aspiration pneumonia (0.380 vs. 0.372, P = 0.558) were also not significantly different between the groups. This study found no significant differences in medication adherence, cardiovascular diseases, or aspiration pneumonia between the non-ODT and ODT groups in patients with post-stroke dysphagia. Both groups achieved a proportion of days covered exceeding 80%. Clinicians may consider prescribing ODTs or non-ODTs based on patient preferences rather than solely on post-stroke conditions.

Comprehensive immune modulation mechanisms of Angong Niuhuang Wan in ischemic stroke: Insights from mass cytometry analysis.

Angong Niuhuang Wan (AGNHW, ), is a classical medicinal formula in Traditional Chinese Medicine (TCM) that has been appreciated for its neuroprotective properties in ischemic cerebral injuries, yet its intricate mechanisms remain only partially elucidated. This study leverages advanced Mass cytometry (CyTOF) to analyze AGNHW's multifaceted immunomodulation effects in-depth, emphasizing previously underexplored areas. AGNHW mitigated monocyte-derived macrophages (MoDM) infiltration in the brain, distinguishing its effects on those from microglia. While the vehicle group exhibited elevated inflammatory markers like CD4, CD8a, and CD44 in ischemic brains, the AGNHW-treated group attenuated their expressions, indicating AGNHW's potential to temper the post-ischemic inflammatory response. Systemically, AGNHW modulated fundamental immune cell dynamics, notably augmenting CD8+ T cells, B cells, monocytes, and neutrophil counts in the peripheral blood under post-stroke conditions. Intracellularly, AGNHW exhibited its targeted modulation of the signaling pathways, revealing a remarked inhibition of key markers like IκBα, indicating potential suppression of inflammatory responses in ischemic brain injuries. This study offers a comprehensive portrait of AGNHW's immunomodulation effects on ischemic stroke, illuminating its dual sites of action-both cerebral and systemic-and its nuanced modulation of cellular and molecular dynamics.

The Comorbidity and Associations between Depression, Cognitive Impairment, and Sleep after Stroke and How They Affect Outcomes: A Scoping Review of the Literature

Objectives: post-stroke depression (PSD), cognitive impairment, and sleep disturbances are the most common post-stroke conditions. To aid clinical practice for a highly confounded clinical problem, a clearer understanding of the associations between comorbid PSD, post-stroke cognitive impairment, and sleep disturbances is necessary. Materials and Methods: a scoping review of the literature was conducted according to the recommended guidelines using the search term [“stroke (mesh term) AND depression (in the abstract) AND cognitive (in the abstract) AND sleep (in the abstract)”]. Results: 10 studies met the criteria for inclusion. Only one study reported a co-occurrence of post-stroke emotional distress and sleep disturbances at a rate of 10.7%. Poor sleep and cognitive impairment are independent risk factors for PSD. The relationship between post-stroke poor sleep and cognitive impairment is ambiguous. None of the studies examined how PSD, cognitive impairment, and sleep disturbances interact to influence stroke outcomes. Conclusions: the dearth of studies indicates either a lack of awareness of the potential relationship between the three outcomes and the possible range of inter-related non-motor outcomes after stroke or the practical challenges in designing appropriate studies. The included studies had methodological weaknesses in their observational design and use of imprecise, subjective outcome measurements. Important knowledge gaps are identified for future research.

Determining Diagnostic Utility of EEG for Assessing Stroke Severity using Deep Learning Models

Stroke has become a leading cause of disability worldwide. Early medication and rehabilitation is the key to help post-stroke survivors recover faster. Presently, doctors rely on imaging modalities like CT/MRI for diagnosing stroke patients. The diagnosis done using these modalities can be highly subjective. Apart from this, these imaging modalities are very costly, time taking and inconvenient for the patients. So there is a need of faster, portable and an automated diagnostic system for assessing post-stroke conditions so that right measures can be taken in the right time. To cater to this need EEG comes in handy because of its portable nature. So, in this work, utility of EEG has been studied to diagnose three aspects of stroke: 1) type of stoke, 2) affected artery and 3) severity of stroke. To achieve this, one-minute resting state EEG data was used to extract 57 features. The features were ranked and selected using ranking algorithm and deep learning (DL) models were trained with supervision from information extracted using MRI data. To find out type of stroke and affected artery DWI, SWI and MRA images were used, and severity of stroke was recorded in terms of NIHSS score. Three different DL models were trained for each task i.e. type of stroke, affected artery and severity of stroke. For classifying type of stroke an accuracy of 97.74% was obtained using 37 features. For stroke severity, the model gave RMSE of 2.1955 with a high correlation value (r = 0.91). The DL model for classifying affected artery used 33 features and gave accuracy of 95.7%. It was also found that less complex time domain features and QEEG features were frequently selected out of 57 features for all the DL models. Features in delta and theta sub-bands were frequently selected along with QEEG features. The work presented here established that EEG can act as a reliable modality for faster diagnosis of stroke specifics and hence can help medical professionals in speeding the decision making process.

Protective effects of fecal microbiota transplantation against ischemic stroke and other neurological disorders: an update.

The bidirectional communication between the gut and brain or gut-brain axis is regulated by several gut microbes and microbial derived metabolites, such as short-chain fatty acids, trimethylamine N-oxide, and lipopolysaccharides. The Gut microbiota (GM) produce neuroactives, specifically neurotransmitters that modulates local and central neuronal brain functions. An imbalance between intestinal commensals and pathobionts leads to a disruption in the gut microbiota or dysbiosis, which affects intestinal barrier integrity and gut-immune and neuroimmune systems. Currently, fecal microbiota transplantation (FMT) is recommended for the treatment of recurrent Clostridioides difficile infection. FMT elicits its action by ameliorating inflammatory responses through the restoration of microbial composition and functionality. Thus, FMT may be a potential therapeutic option in suppressing neuroinflammation in post-stroke conditions and other neurological disorders involving the neuroimmune axis. Specifically, FMT protects against ischemic injury by decreasing IL-17, IFN-γ, Bax, and increasing Bcl-2 expression. Interestingly, FMT improves cognitive function by lowering amyloid-β accumulation and upregulating synaptic marker (PSD-95, synapsin-1) expression in Alzheimer's disease. In Parkinson's disease, FMT was shown to inhibit the expression of TLR4 and NF-κB. In this review article, we have summarized the potential sources and methods of administration of FMT and its impact on neuroimmune and cognitive functions. We also provide a comprehensive update on the beneficial effects of FMT in various neurological disorders by undertaking a detailed interrogation of the preclinical and clinical published literature.

Effectiveness of the 30-Degree Lateral Sleeping Position on Sleep Quality in Elderly Individuals Post-Stroke

Background: Post-stroke conditions can have an impact on the sleep quality of the elderly. Sleep disorders are a common health problem for the elderly, requiring serious attention. Poor sleep quality in the elderly is caused by increased sleep potential, reduced sleep efficiency, and early awakenings due to the ageing process.
 Objective: This research aims to determine the effectiveness of a 30-degree lateral sleeping position compared to a supine sleeping position on the sleep quality of elderly individuals post-stroke.
 Method: The design of this research uses a quasi-experiment design with a non-equivalent control group design approach. The study will be conducted in 2023 in Ekasari Village, Jembrana Regency, Bali. The total research population is 126 elderly individuals, and the sample size meeting the criteria is 64 respondents, divided into 32 respondents in the intervention group and 32 respondents in the control group. Data analysis in this study uses the Mann-Whitney U Test.
 Results: The Mann-Whitney U Test shows a difference between the intervention and control groups (p = 0.000, Z score = -4.830), which means that the 30-degree lateral sleep position is better at helping older people who have had a stroke sleep better than the supine sleep position.
 Conclusion: Post-stroke elderly individuals tend to experience an improvement in sleep quality when they sleep in the lateral position of 30 degrees. Therefore, elderly people who are having sleep quality issues can adopt this sleeping position to improve their sleep.

Effectiveness of Mirror Therapy on Post Stroke Functional Ability: A Meta-Analysis

Background: Stroke is the third leading cause of death after heart disease and cancer. One of the impacts of stroke is it causes a decrease in the functional ability to carry out daily activities, therefore mirror therapy is carried out to restore the functional ability. The study aims to determine the effect of mirror therapy on the functional ability of post-stroke patients based on previous primary studies. Subjects and Method: It was a systematic review and meta-analysis study with PICO as follows: P= post-stroke patients, I= mirror therapy, C= conventional therapy, and O= functional ability. Data collection was conducted from databases, namely: Google Scholar and PubMed. The inclusion criteria used were full-text articles in English, with randomized control trial design, published in 2006-2021. The keywords used were "stroke" AND "mirror therapy" AND "functional independence measure" OR "FIM" AND "randomized control trial". The inclusion criteria of the study were articles using a randomized control trial study design, the effect size used was the Mean SD, the subjects of the study were patients with poststroke conditions, the intervention given was mirror therapy, the comparison was conventional therapy, with the outcome was increased functional ability. The articles were analyzed using Review Manager 5.3. application. Results: The meta-analysis was conducted on 9 primary studies from several countries such as Turkey, South Korea, India, and Italy. The results of the study showed that there was an effect of mirror therapy on the functional ability of post-stroke patients. Patients who obtained mirror therapy had a functional ability of 0.92 units higher than conventional therapy. The results were statistically significant (SMD= 0.92; 95% CI= 0.67 to 1.17; p<0.001). Conclusion: mirror therapy can improve the functional ability of post-stroke patients. Keywords: mirror therapy, functional ability, post-stroke Correspondence: Galang Aji Samudera. Master’s Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: ghalangsamudera@gmail.com. Mobile: +6287836783209. Indonesian Journal of Medicine (2023), 08(01): 1-11 https://doi.org/10.26911/theijmed.2023.08.01.01

Validity & Reliability of a Korean-version of Eating Assessment Tool (K-EAT-10): Predicting the Risk of Aspiration in Stroke Patients

Objectives: This study aims to investigate the reliability and validity of a Korean version of the Eating Assessment Tool (EAT-10) as a clinical evaluation tool for dysphagia with stroke patients and determine its clinical usefulness as a screening tool. Methods: A total of 50 patients with stroke (15 without dysphagia, and 35 with dysphagia, identified through a videofluoroscopic swallowing study (VFSS) participated in this study. The internal consistency, test-retest reliability, and concurrent validity of the adapted Korean version of EAT-10(K-EAT-10) were evaluated. In addition, the K- EAT-10 scores were compared between two groups according to demographic characteristics, post-stroke conditions, and swallowing function. Moreover, K-EAT-10 scores were compared with the VFSS findings to estimate the sensitivity, specificity, and positive and negative predictions of aspiration. Results: The internal consistency of the K-EAT-10 questionnaire showed a Cronbach α coefficient of .091, and the correlation coefficient of the test- retest reliability was .988. In addition, when correlation analysis was performed between the total score of K-EAT-10 and the K-DHI, the correlation coefficient was .904. In the receiver operating characteristic (ROC) curve analysis of K-EAT-10, a cut-off point for the K-EAT-10 questionnaire was set at 10 points with a sensitivity of 86.7% and specificity of 77.1%, and the area under the curve was shown to be 0.86. In addition, the positive predictive value (PPV) for the K-EAT-10 was 91%, and the negative predictive value (NPV) was 60%. Conclusion: Korean version of EAT-10 revealed excellent internal consistency, test-retest reliability, concurrent validity and positive predictive value for aspiration. The results suggest that the Korean adaptation of EAT-10 can be useful as a clinical screening test for dysphagia, especially predicting aspiration risk in patients with stroke.

The Effect of Early Mobilization and Body Positioning on Functional Ability in Patients with Acute Ischemic Stroke

There are many physical problems in post-stroke conditions which is decreased functional ability. This study aimed to determine the effect of early mobilization and body positioning on functional ability in acute stroke patients. The study design used a single blinding, randomized, and controlled trial. The sample consisted of 20 acute ischemic stroke patients selected randomly and equal distribution between the group of early mobilization and body positioning (ages 45-70, MMT 2+ and given exercises ranging from 24-48 after the attack) and the control group (age 45-70, MMT 2+ and given passive exercises 24-48 after the attack) for seven days in hospital care. All patients were evaluated with Glasgow Coma Scale, Mini-Mental State Exam, and Barthel Index. Paired t-tests and independent t-tests have been used to evaluate and differentiate between groups. The study results showed the treatment group (early mobilization and body position training) to a level of functional ability p<0.05 (p=0.000) and the mean -65. The control group (passive exercise) to the level of functional ability p<0.05 (p=0.000) and the mean-28. The difference effect between the group (early mobilization and body position training) with the control group (passive exercise) on the level of functional ability p<0.05 (p=0.000) with a mean difference was 36.9. Early mobilization and body position training are other approaches that can improve functional abilities in patients with acute ischemic stroke

Supervised Myoelectrical Hand Gesture Recognition in Post-Acute Stroke Patients with Upper Limb Paresis on Affected and Non-Affected Sides.

In clinical practice, acute post-stroke paresis of the extremities fundamentally complicates timely rehabilitation of motor functions; however, recently, residual and distorted musculoskeletal signals have been used to initiate feedback-driven solutions for establishing motor rehabilitation. Here, we investigate the possibilities of basic hand gesture recognition in acute stroke patients with hand paresis using a novel, acute stroke, four-component multidomain feature set (ASF-4) with feature vector weight additions (ASF-14NP, ASF-24P) and supervised learning algorithms trained only by surface electromyography (sEMG). A total of 19 (65.9 ± 12.4 years old; 12 men, seven women) acute stroke survivors (12.4 ± 6.3 days since onset) with hand paresis (Brunnstrom stage 4 ± 1/4 ± 1, SIAS 3 ± 1/3 ± 2, FMA-UE 40 ± 20) performed 10 repetitive hand movements reflecting basic activities of daily living (ADLs): rest, fist, pinch, wrist flexion, wrist extension, finger spread, and thumb up. Signals were recorded using an eight-channel, portable sEMG device with electrode placement on the forearms and thenar areas of both limbs (four sensors on each extremity). Using data preprocessing, semi-automatic segmentation, and a set of extracted feature vectors, support vector machine (SVM), linear discriminant analysis (LDA), and k-nearest neighbors (k-NN) classifiers for statistical comparison and validity (paired t-tests, p-value < 0.05), we were able to discriminate myoelectrical patterns for each gesture on both paretic and non-paretic sides. Despite any post-stroke conditions, the evaluated total accuracy rate by the 10-fold cross-validation using SVM among four-, five-, six-, and seven-gesture models were 96.62%, 94.20%, 94.45%, and 95.57% for non-paretic and 90.37%, 88.48%, 88.60%, and 89.75% for paretic limbs, respectively. LDA had competitive results using PCA whereas k-NN was a less efficient classifier in gesture prediction. Thus, we demonstrate partial efficacy of the combination of sEMG and supervised learning for upper-limb rehabilitation procedures for early acute stroke motor recovery and various treatment applications.

Advancement of epigenetics in stroke.

A wide plethora of intervention procedures, tissue plasminogen activators, mechanical thrombectomy, and several neuroprotective drugs were reported in stroke research over the last decennium. However, against this vivid background of newly emerging pieces of evidence, there is little to no advancement in the overall functional outcomes. With the advancement of epigenetic tools and technologies associated with intervention medicine, stroke research has entered a new fertile. The stroke involves an overabundance of inflammatory responses arising in part due to the body’s immune response to brain injury. Neuroinflammation contributes to significant neuronal cell death and the development of functional impairment and even death in stroke patients. Recent studies have demonstrated that epigenetics plays a key role in post-stroke conditions, leading to inflammatory responses and alteration of the microenvironment within the injured tissue. In this review, we summarize the progress of epigenetics which provides an overview of recent advancements on the emerging key role of secondary brain injury in stroke. We also discuss potential epigenetic therapies related to clinical practice.

Racial disparities in post-stroke aphasia: A need to look beyond the base analysis

IntroductionRacial disparities have been reported in post-stroke conditions such as aphasia, yet findings have been inconsistent. Prior studies have generally included small numbers of people of color for comparisons of outcome. Consequently, it is unclear if the racial disparities that are consistently observed in stroke, the primary cause of aphasia, parallel disparities in aphasia outcomes. MethodsIn this study we examined aphasia outcomes among Black and White persons with aphasia (PWA) based on data from the Moss Aphasia Psycholinguistics Project Database (MAPPD). ResultsIn initial comparisons of the measures of aphasia impairment (Western Aphasia Battery-Revised Aphasia Quotient; WAB-R AQ), White PWA exhibited greater impairment than Black PWA. However, after adjusting for aphasia type, age, sex, estimates Blacks exhibited lower average WAB AQs. ConclusionsThis study illustrates how more sophisticated statistical methods should be used to examine racial differences in aphasia and other communication outcomes particularly given differences commonly observed sociodemographic characteristics that are present in the primary cause of the disorders. Without careful analysis of data and consideration of its implications, researchers and clinicians will continue to ignore key differences in clinical populations that influence aphasia outcomes. More importantly, in order to grow knowledge in the field and a continue to improve clinical outcomes, the field must fully exploit tools of empirical analysis and focus their research on discovering, adapting and improving the lives of all individuals with aphasia.

Cerebral disease of small vessels: morphological, neuropsychological and neurovisualization comparisons

The term "cerebrovascular disease of small vessals" (CDSV) includes neuropathological, clinical and neuroimaging manifestations lesions of small perforating arteries, arterioles, capillaries, venules and small veins. CDSV, according to the pathogenetic classification of L. Pantoni, is divided into 6 types: sporadic non-amyloid microangiopathy (SNAMA); sporadic and hereditary cerebral amyloid angiopathy (CAA); hereditary CDSV (CADASIL, CARASIL, MELAS, Fabry disease, CDSV in mutations of COL4A1 gene and others); CDSV, mediated by inflammation and immune processes; venous collagenosis; other options. In 4 chapters of the review the following are considered: morphological and neuroimaging characteristics of CDSV; cognitive impairment and CDSV: morphological, neuropsychological and neuroimaging comparisons; natural aging of the brain: morphological, neuroimaging and neuropsychological comparisons; the influence of modified risk factors (hypertension, type 2 diabetes mellitus, radiation exposure) on the course of CDSV. Conclusions. Despite the threatening consequences of CDSV, its early clinical and instrumental diagnosis has not attracted proper attention of researchers. The subject of the vast majority of studies were: CDSV of moderate and severe degree, post-stroke conditions; neuroimaging criteria for the prognosis of acute cerebrovascular disease, Alzheimer's disease and dementia in the elderly and senile persons; age differences of CDSV and cognitive impairments (CI) in terms of the overall disease duration, and not in terms of the peculiarities of its manifestation in middle or avanced age. There are objective prerequisites for establishing a methodological framework for early diagnosis of CDSV that takes into account the age of patients and the presence of modifiable risk factors. These include: the existence of consensus on the definition, classification and neuroimaging features of CDSV; availability of effective cognitive scales, which are designed to screen and determine the domain affiliation of non-dementia CD; introduction of new neuroimaging technologies that allow molecular (diffusion) research and obtain images with submillimeter resolution. Two clinical observations serve as convincing evidence of the conclusions reached on the basis of the analysis of the scientific literature.

The Level of Knowledge, Motivation, and Self Efficacy of Post-Stroke Patients in Lumajang

Post-stroke conditions can be stressful and unpredictable. Knowledge, motivation, and self-efficacy are essential to the long-term care of post-stroke patients. This study aimed to analyze the correlation between the level of knowledge, motivation, and self-efficacy of post-stroke patients in Lumajang. This study used a cross-sectional design. The population of this study was post-stroke patients in Lumajang. The sampling technique used consecutive sampling with the number of samples obtained, namely 55 samples. The variables of this study were the level of knowledge, motivation, and self-efficacy. The data collection was carried out by using a questionnaire. The data analysis was performed by using the Spearman Rank test. The results showed a correlation between knowledge and motivation with self-efficacy in post-stroke patients, with p-values of 0.004 (r: 0.383) and 0.000 (r: 0.581). A person who had high knowledge and motivation would show positive results in managing his disease; for example, in the stroke concept, the patient will actively participate in the rehabilitation program, treatment program, and schedule visits to health care facilities.

U-Limb: A multi-modal, multi-center database on arm motion control in healthy and post-stroke conditions.

BackgroundShedding light on the neuroscientific mechanisms of human upper limb motor control, in both healthy and disease conditions (e.g., after a stroke), can help to devise effective tools for a quantitative evaluation of the impaired conditions, and to properly inform the rehabilitative process. Furthermore, the design and control of mechatronic devices can also benefit from such neuroscientific outcomes, with important implications for assistive and rehabilitation robotics and advanced human-machine interaction. To reach these goals, we believe that an exhaustive data collection on human behavior is a mandatory step. For this reason, we release U-Limb, a large, multi-modal, multi-center data collection on human upper limb movements, with the aim of fostering trans-disciplinary cross-fertilization.ContributionThis collection of signals consists of data from 91 able-bodied and 65 post-stroke participants and is organized at 3 levels: (i) upper limb daily living activities, during which kinematic and physiological signals (electromyography, electro-encephalography, and electrocardiography) were recorded; (ii) force-kinematic behavior during precise manipulation tasks with a haptic device; and (iii) brain activity during hand control using functional magnetic resonance imaging.

COGNITIVE BEHAVIOURAL THERAPY TO REDUCE DEPRESSION IN POST STROKE PATIENTS: A SCOPING REVIEW

Background: Post-stroke depression is one of the psychological disorders that is often experienced by post-stroke patients. Depression is more than just sadness. People with post-stroke depression will experience a lack of interest and pleasure in daily activities, weight loss or excessive sleep, lack of energy, inability to concentrate, feelings of worthlessness or guilt and recurring thoughts of death or suicide. Based on several types of post-stroke depression management, psychosocial interventions have been shown to reduce the likelihood of developing post-stroke depression. One of the interventions to reduce post-stroke depression is cognitive behavioral therapy.&#x0D; Objective: This scoping review aims to identify the effectiveness of cognitive behavioral therapy to reduce depression in post-stroke patients.&#x0D; Design: This study used a scoping review through a review of articles on cognitive behavioral therapy that has been used to reduce depression in post-stroke patients.&#x0D; Data Sources: Search for articles accessed through a database, including: CINAHL, MEDLINE, Academic search ultimate, PubMed, and google scholar with a range of search years 2011-2020.&#x0D; Review Methods: Quality appraisal assessment for each selected study was conducted using the Preferred Reporting Items for scoping review (PRISMA) method.&#x0D; Results: The results of this literature review show that cognitive behavioral therapy to reduce depression in post-stroke patients can change thoughts, feelings and behaviors to influence each other. The relationship between thoughts, feelings and behavior greatly influences respondents in dealing with post-stroke conditions with a positive way of thinking so that it will accelerate or help the post-stroke recovery process. The way to implement cognitive behavioral therapy is to be given as many as 12 sessions in 25-35 minutes each session. Cognitive behavioral therapy can be done in a hospital and has a significant post-stroke depression rate with p &lt;0.01.&#x0D; Conclusion: Cognitive behavioral therapy can be given as an intervention to reduce depression in post-stroke patients including cognitive behavioral therapy, duration of cognitive behavioral therapy and sessions in cognitive behavioral therapy.&#x0D; &#x0D; Keywords: Cognitive behavioral therapy, post stroke depression.

Strategies adopted to manage physical and psychosocial challenges after returning home among people with stroke: A qualitative study.

Stroke survivors encounter various physical and psychosocial challenges after hospital discharge. Systematic reviews consistently suggest the importance of self-management in promoting post-stroke recovery. However, stroke survivors’ performance of self-management behaviors after returning home is poorly understood. This study was conducted to explore how stroke survivors manage their life after returning home from the hospital. This was a qualitative study with individual, semi-structured interviews. We recruited a purposive sample of adults who had a first or recurrent ischemic or hemorrhagic stroke and currently lived at home. Participants were asked about their post-stroke experiences, challenges encountered, and strategies adopted for managing post-stroke conditions. Data were transcribed verbatim and analyzed using thematic analysis. A total of 30 stroke survivors (mean age = 61.97 years, SD = 10.20) were interviewed. Most were men (n = 18), married (n = 25), and retired (n = 21). Two-thirds had experienced an ischemic stroke. Five key themes emerged: pursuing lifelong learning to live well after a stroke; reinterpreting unpleasant experiences as new learning opportunities; engaging in life activities to better adapt to post-stroke challenges; being confident in oneself to persevere in self-management behaviors; and continuing to accept the current self and explore the new self. Participants regarded learning as a prerequisite for improving their affected functions and managing uncertainties in recovery. Learning requires self-participation, building self-efficacy and positive outcome expectations, testing and adapting strategies to one's own health conditions, and engaging in leisure or social activities. These findings will guide future development of interventions for enhancing stroke survivors’ recovery outcomes.

Apathy after stroke: Diagnosis, mechanisms, consequences, and treatment.

Apathy is a reduction in goal-directed activity in the cognitive, behavioral, emotional, or social domains of a patient’s life and occurs in one out of three patients after stroke. Despite this, apathy is clinically under-recognized and poorly understood. This overview provides a contemporary introduction to apathy in stroke for researchers and practitioners, covering topics including diagnosis, neurobiological mechanisms, associated consequences, and potential treatments for apathy. Apathy is often misdiagnosed as other post-stroke conditions such as depression. Accurate differential diagnosis of apathy, which manifests as reductions in initiative, and depression, which manifests as negative emotionality, is important as it informs prognosis. Research on the neurobiology of apathy suggests that there are few consistent associations between stroke lesion location and the development of apathy. These may be resolved by adopting a network neuroscience approach, which models apathy as a pathology arising from structural or functional damage to brain networks underlying motivated behavior. Importantly, networks can be affected by physiological changes related to stroke, including the acute infarct but also diaschisis and neurodegeneration. Aside from neurobiological changes, apathy is also associated with other negative outcome measures such as functional disability, cognitive impairment, and emotional distress, suggesting that apathy is indicative of a worse prognosis following stroke. Unfortunately, high-quality trials aimed at treating apathy are scarce. Antidepressants may have limited effects on apathy. Acetylcholine and dopamine pharmacotherapy, behavioral interventions, and transcranial magnetic stimulation may be more promising avenues for treatment.

Measuring working memory usage on aphasic individuals and analysis of emotional valence through electroencephalography

Recent studies discuss the use of brain-computer interfaces (BCI) in medicine, more specifically in the treatment of post-stroke conditions. Those studies seek to develop therapeutic, diagnostic, and rehabilitation strategies to provide a better quality of life. One of those approaches consists of stimulating working memory (WM) usage, which is closely related to language-processing observed in individuals with aphasia. Aphasia is a health condition, usually developed from a stroke, that compromises both oral and written communication skills. In this work, a low-cost non-invasive signal acquisition system based on electroencephalography (EEG) was used to analyze short-term changes in the spectral properties of the brain. An n-back application was developed to attend specific demands stimulating the working memory load during the experiments. As a result, it was possible to explore brain activity by performing the power spectral density analysis of theta (4–8 Hz), alpha (8–12 Hz) and beta (13–29 Hz) waves. Wavelets were used to perform time-frequency analysis. It was possible to verify that working memory could be activated for a longer period of time through the sessions. Besides, the evaluation of users' emotional valence was simultaneously developed to identify whether the user has a positive or negative emotional state. Four aphasic volunteers, two non-aphasic individuals and a neuropsychologist participated in the experience. This study affords preliminary results to aphasia treatment based on electroencephalography, being a pioneer experience in Brazil.

Spreading Depressions and Periinfarct Spreading Depolarizations in the Context of Cortical Plasticity

Studies of cortical function-recovery require a comparison between normal and post-stroke conditions that lead to changes in cortical metaplasticity. Focal cortical stroke impairs experience-dependent plasticity in the neighboring somatosensory cortex and usually evokes periinfarct depolarizations (PiDs) – spreading depression-like waves. Experimentally induced spreading depressions (SDs) affect gene expression and some of these changes persist for at least 30 days. In this study we compare the effects of non-stroke depolarizations that impair cortical experience-dependent plasticity to the effects of stroke, by inducing experience-dependent plasticity in rats with SDs or PiDs by a month of contralateral partial whiskers deprivation. We found that whiskers’ deprivation after SDs resulted in normal cortical representation enlargement suggesting that SDs and PiDs depolarization have no influence on experience-dependent plasticity cortical map reorganization. PiDs and the MMP-9, -3, -2 or COX-2 proteins, which are assumed to influence metaplasticity in rats after stroke were compared between SDs induced by high osmolarity KCl solution and the PiDs that followed cortical photothrombotic stroke (PtS). We found that none of these factors directly caused cortical post-stroke metaplasticity changes. The only significant difference between stoke and induced SD was a greater imbalance in interhemispheric activity equilibrium after stroke. The interhemispheric interactions that were modified by stroke may therefore be promising targets for future studies of post-stroke experience-dependent plasticity and of recuperation studies.