Post-stroke Patients Research Articles

Analysis of related factors related to the quality of life of post-stroke patients at Royal Prima Hospital Medan

Stroke is a severe global health problem and is ranked the third leading cause of death after heart disease and cancer. According to WHO data, about 15 million people have a stroke each year, with more than 5 million suffering from permanent disability. In Indonesia, the prevalence of stroke increases with the increase in risk factors such as hypertension and unhealthy lifestyles. This study aims to analyze the factors that affect the quality of life of post-stroke patients at Royal Prima Hospital Medan. The method used is non-experimental quantitative research with a descriptive approach and associative analysis. The study was conducted at the Royal Prima Hospital Medan, a population of patients undergoing post-stroke rehabilitation in the last three months. A sample of 60 patients was taken using the Slovin formula, and data analysis was carried out univariate, bivariate using the Chi-Square test, and multivariate with logistic regression analysis. The results of the study showed a significant relationship between age factors (p-value = 0.002), gender (p-value = 0.001), psychological condition (p-value = 0.002), physical condition (p-value = 0.004), and family support (p-value = 0.000) on the quality of life of patients. Family support was the most significant factor, with an odds ratio (OR) of 11,686, indicating that patients who received family support were likelier to achieve a good quality of life. These findings are expected to provide insights into designing more effective rehabilitation programs and raise awareness about the importance of support for post-stroke patients.

Analysis of the effect of range of motion exercises on the quality of life of post-stroke patients at royal prima hospital Medan in 2024

Stroke is a severe medical condition that occurs due to the interruption of blood supply to the brain, either through blockage (ischemic stroke) or rupture of blood vessels (hemorrhagic stroke). With more than 15 million cases each year worldwide, stroke is a leading cause of disability and death, with a significant impact on patients' quality of life. In Indonesia, the prevalence of stroke is very high, especially among adult patients, which contributes to the high mortality and disability rates. This study aims to evaluate the effect of Range of Motion Exercises on the physical condition and quality of life of post-stroke patients at the Rehabilitation Polyclinic of Royal Prima Hospital Medan. Using a correlational descriptive research design with the One Group Pretest-Posttest approach, this study involved 30 respondents who underwent a range of motion exercises. The results of the analysis showed that before the intervention, the majority of patients were in the poor quality of life category. However, after undergoing a rehabilitation program, there was a significant improvement in the patient's quality of life, where 50% of the respondents reported an excellent quality of life. This study indicates that range of motion exercises are effective in improving the quality of life of stroke patients, which has the potential to make an essential contribution to the development of stroke rehabilitation programs in Indonesia.

Does acupuncture combined with MOTOmed movement therapy have a better rehabilitation effect on post-stroke hemiplegia patients? A systematic review and meta-analysis

ABSTRACT Background Combinations of rehabilitation therapies are widely used in patients with post-stroke hemiplegia. A combination of acupuncture and MOTOmed had been shown to promote the recovery of post-stroke hemiplegia patients. We conducted a systematic review of evidence from studies that investigated the use of acupuncture combined with MOTOmed for rehabilitation of patients with post-stroke hemiplegia. Objective To estimate the rehabilitation effect of acupuncture combined with MOTOmed movement therapy in patients with post-stroke hemiplegia. Methods Randomized controlled trials (RCTs) of acupuncture combined with MOTOmed movement therapy in patients with post-stroke hemiplegia were retrieved from nine databases. Risk-of-bias assessments were conducted using the Cochrane Risk-of-bias Tool. Meta-analysis of outcome measures was performed using RevMan 5.4 software. And we followed the PRISMA 2020 guidelines. Results Eighteen studies involving 1637 participants were included. Compared with conventional rehabilitation, acupuncture, or MOTOmed movement therapy alone, acupuncture combined with MOTOmed movement therapy increased the scores of Fugl-Meyer Assessment Scale-lower extremity (FMA-LE), Berg Balance Scale (BBS), Functional Ambulation Categories scale (FAC), Maximal Walking Speed test (MWS), gait parameters of 3D gait analysis, Barthel Index (BI), Modified Barthel Index (MBI), total effective rate, and the levels of neurotrophic factors (NGF, BDNF and NT-3) in serum, while reduced the scores of Clinic Spasticity Index (CSI) and National Institutes of Health Stroke Scale-Lower Extremity (NIHSS-LE) (p < 0.05 for all). Conclusion Acupuncture combined with MOTOmed movement therapy has better efficacy than conventional rehabilitation, acupuncture, or MOTOmed alone in patients with post-stroke hemiplegia. This combination therapy can promote the rehabilitation of these patients.

Application of Isokinetic Dynamometry Data in Predicting Gait Deviation Index Using Machine Learning in Stroke Patients: A Cross-Sectional Study

Background: Three-dimensional gait analysis, supported by advanced sensor systems, is a crucial component in the rehabilitation assessment of post-stroke hemiplegic patients. However, the sensor data generated from such analyses are often complex and challenging to interpret in clinical practice, requiring significant time and complicated procedures. The Gait Deviation Index (GDI) serves as a simplified metric for quantifying the severity of pathological gait. Although isokinetic dynamometry, utilizing sophisticated sensors, is widely employed in muscle function assessment and rehabilitation, its application in gait analysis remains underexplored. Objective: This study aims to investigate the use of sensor-acquired isokinetic muscle strength data, combined with machine learning techniques, to predict the GDI in hemiplegic patients. This study utilizes data captured from sensors embedded in the Biodex dynamometry system and the Vicon 3D motion capture system, highlighting the integration of sensor technology in clinical gait analysis. Methods: This study was a cross-sectional, observational study that included a cohort of 150 post-stroke hemiplegic patients. The sensor data included measurements such as peak torque, peak torque/body weight, maximum work of repeated actions, coefficient of variation, average power, total work, acceleration time, deceleration time, range of motion, and average peak torque for both flexor and extensor muscles on the affected side at three angular velocities (60°/s, 90°/s, and 120°/s) using the Biodex System 4 Pro. The GDI was calculated using data from a Vicon 3D motion capture system. This study employed four machine learning models—Lasso Regression, Random Forest (RF), Support Vector regression (SVR), and BP Neural Network—to model and validate the sensor data. Model performance was evaluated using mean squared error (MSE), the coefficient of determination (R2), and mean absolute error (MAE). SHapley Additive exPlanations (SHAP) analysis was used to enhance model interpretability. Results: The RF model outperformed others in predicting GDI, with an MSE of 16.18, an R2 of 0.89, and an MAE of 2.99. In contrast, the Lasso Regression model yielded an MSE of 22.29, an R2 of 0.85, and an MAE of 3.71. The SVR model had an MSE of 31.58, an R2 of 0.82, and an MAE of 7.68, while the BP Neural Network model exhibited the poorest performance with an MSE of 50.38, an R2 of 0.79, and an MAE of 9.59. SHAP analysis identified the maximum work of repeated actions of the extensor muscles at 60°/s and 120°/s as the most critical sensor-derived features for predicting GDI, underscoring the importance of muscle strength metrics at varying speeds in rehabilitation assessments. Conclusions: This study highlights the potential of integrating advanced sensor technology with machine learning techniques in the analysis of complex clinical data. The developed GDI prediction model, based on sensor-acquired isokinetic dynamometry data, offers a novel, streamlined, and effective tool for assessing rehabilitation progress in post-stroke hemiplegic patients, with promising implications for broader clinical application.

Abstract 4136916: Indobufen: A Viable Alternative to Aspirin for Antiplatelet Therapy in patients with Aspirin Intolerance

Introduction: Antiplatelet therapy with aspirin has been recommended for patients with stroke and myocardial infarction (MI). Clinicians face challenges when they come across aspirin hypersensitivity in their clinical practice. Therefore, potential alternative drugs can help avoid the omission of anti-thrombotic therapy. Indobufen is a cyclooxygenase-1 inhibitor studied as an alternative to aspirin. Hypothesis: Compared to aspirin, indobufen will be equally effective in preventing cardiovascular events in patients needing antiplatelet therapy but will cause fewer bleeding complications. Methods: We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing antiplatelet therapy with indobufen vs. aspirin. The efficacy outcomes of interest were composite vascular events, MI, and ischemic stroke. The safety outcomes of interest were major bleeding and any bleeding. Heterogeneity was assessed using I 2 statistics. Analysis followed the PRISMA guideline and was registered in the PROSPERO database (CRD42024540911). Results: The systematic review identified 4 studies, including 11,495 patients (indobufen n=5,728, 49.83%), with two studies in patients post-MI and two post-stroke patients. Composite vascular events at 90 days (RR 1.03; 95%CI 0.58-1.86; p=0.911; I 2 =46%) and 1 year (RR 1.10; 95%CI 0.96-1.27; p=0.184; I 2 =0%) did not show any difference between the groups. MI (RR 0.67; 95%CI 0.36-1.23; p=0.197; I 2 =0%) and ischemic stroke (RR 1.17; 95%CI 0.99-1.38; p=0.064; I 2 =0%) at 1 year did not show any significant difference between the groups. Major (RR 0.68; 95%CI 0.36-1.27; p=0.225; I 2 =74%) and any bleeding (RR 0.62; 95%CI 0.36-1.06; p=0.079; I 2 =91%) at 1 year were also comparable between the groups. Conclusion: Antiplatelet therapy with indobufen was comparable with aspirin in efficacy and safety. Indobufen can be considered an alternative to aspirin in patients with intolerance or hypersensitivity. However, more trials with a larger population are needed to confirm the clinical applicability.

Effects of Non-Pharmacological Interventions on the Swallowing Function of Patients With Post-Stroke Dysphagia: A Systematic Review and Network Meta-Analysis.

Post-stroke dysphagia can lead to serious complications and appropriate rehabilitation can significantly improve swallowing function. However, the best rehabilitation method for post-stroke dysphagia patients is not clear at the present stage, so it is necessary to conduct a comprehensive network meta-analysis and systematic review of different interventions for dysphagia. To compare the effectiveness and ranking of different interventions for improving swallowing function, and feeding and daily function in patients with post-stroke dysphagia. Seven databases were searched from the date of inception to September 1, 2022. Two investigators independently conducted literature searches, selected randomized controlled trials on dysphagia interventions, and assessed study quality. Network meta-analysis was conducted by using Stata software. A total of 33 studies involving 1,341 patients were included. According to the ranking probabilities, acupuncture was rated as the most effective of all interventions to enhance patients' swallowing function (surface under cumulative ranking curve values [SUCRCV]: 99.0%, standardized mean difference [SMD]: -2.40, 95% confidence interval [CI]: -3.38 to -1.43), followed by the chin tuck against resistance exercise (CTAR, SUCRA: 89.9%, SMD: -1.83, 95% CI: -2.69 to -0.97). Among all the interventions, acupuncture was the most effective for feeding and daily function (SUCRCV: 88.4%, SMD: -1.62, 95% CI: -2.94 to -0.30). The results showed that acupuncture was the most effective in the rehabilitation of patients with post-stroke dysphagia, followed by CTAR. Considering that CTAR is a low-cost and highly feasible intervention, we suggest that CTAR should be selected as a rehabilitation measure for patients with post-stroke dysphagia to improve their swallowing function.

Communication Prototype for Post-Stroke Patients Using Electrooculography (EOG)

Background this prototype is intended for post-stroke patients experiencing disabilities in their daily activities, particularly in communication with others. The challenge they face is difficulty in communication, leading to a diminished quality of life for post-stroke patients. The purpose of innovating this communication aid prototype is to facilitate communication between post-stroke patients and caregivers. The method employed in the post-stroke communication aid prototype utilizes Electrooculography (EOG) signals generated from eye muscle movements during eye gazes, captured by the MaM Sense sensor. The variation in Analog-to-Digital Converter (ADC) values in the MaM Sense sensor is exploited to produce various forms of EOG signals. The resultant command signals from this method are processed by a microcontroller and displayed on a 20 x 4 Character LCD. Testing was conducted on 9 healthy individuals, comprising 5 males and 4 females. To ensure the prototype's functionality, testing was also performed on 1 post-stroke patient. The success rate of MaM Sense sensor readings was 80.5% for the 4 communication modes employed, involving 4 eye gaze movements: right gaze, left gaze, upward gaze, and downward gaze. Thus, the post-stroke communication aid prototype proves effective in assisting communication for post-stroke patients and aiding caregivers in understanding the patients' desires. In the future, a wireless system may be implemented for the acquisition of EOG signals attached to the face to minimize the use of cables.

Efficacy observation of combined transcutaneous vagus nerve stimulation and transcranial direct current stimulation on gait in 169 subacute stroke patients.

To investigate the combined effect of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation on improving lower limb function in stroke patients. Randomized controlled trial. Subacute stroke patients. 169 post-stroke hemiplegia patients were randomly divided into 4 groups (control, transcranial direct current stimulation, transcutaneous auricular vagus nerve stimulation, and transcutaneous auricular vagus nerve stimulation combined with transcranial direct current stimulation) and evaluated using the Fugl-Meyer Assessment-Lower Extremity (FMA-LL), Timed Up-and-Go (TUG) test, Modified Barthel Index (MBI), Berg Balance Scale (BBS), gait parameters, and surface electromyography (sEMG). Significant improvements in FMA-LL, MBI, BBS, TUG, gait parameters, and sEMG were noted in the intervention groups compared with the control, with the transcutaneous auricular vagus nerve stimulation combined with transcranial direct current stimulation group showing the most pronounced improvements. Differences in some outcomes were also notable between the transcutaneous auricular vagus nerve stimulation and transcranial direct current stimulation groups. The combination of transcutaneous auricular vagus nerve stimulation and transcranial direct current stimulation effectively enhances gait, balance, and daily living activities in subacute stroke patients. These benefits are likely due to transcutaneous auricular vagus nerve stimulation activating the solitary and trigeminal nuclei and transcranial direct current stimulation stimulating the motor cortex. Wearable gait analysis systems and electromyography are valuable in clinical gait assessment for these patients.

Diminished sense of agency inhibits paretic upper-limb use in patients with post-stroke motor deficits

Post-stroke motor deficits often disrupt the voluntary control of body movements, leading to abnormal feelings. Among these, alterations in the sense of agency (SoA), the feeling of controlling one’s movement, are notable because SoA facilitates actions. However, whether patients with more severe motor deficits experience poorer SoA and SoA’s clinical impact on motor activity remain unclear. To address these questions, this longitudinal study quantified SoA in 156 post-stroke patients through factor analyses with multiple question items to differentiate SoA from potentially confounding discomfort. Structural equation modeling revealed that SoA decreased significantly with upper-limb motor deficit severity and that reduced SoA correlated significantly with decreased paretic upper-limb use. Notably, this effect persisted after controlling for motor deficit severity, suggesting a direct clinical impact of SoA on motor activity. Further, improvements in SoA were significantly associated with increased upper-limb use in patients with moderate or severe motor deficits, emphasizing the role of SoA in maintaining or increasing paretic upper-limb activity. These findings highlight the importance of rehabilitation treatments that consider patients' subjective experiences, particularly agency attribution.

Deep Learning-Driven Analysis of a Six-Bar Mechanism for Personalized Gait Rehabilitation

Abstract Recent advances in robotics and artificial intelligence have highlighted the potential for the integration of computational intelligence in enhancing the functionality and adaptability of robotic systems, particularly in rehabilitation. Designing robotic exoskeletons for the lower limb rehabilitation of post-stroke patients requires frequent adjustments to accommodate individual differences in leg anatomy. This complex engineering challenge necessitates a deep understanding of human physiology, robotics, and optimization to develop adaptive robotic systems and also to swiftly quantify the required adjustments and implement them for each patient. The conventional approaches, which mostly rely on heuristics and manual tuning, often struggle to achieve optimal results. This paper presents a novel method that integrates a genetic algorithm with a deep learning approach to generate a gait trajectory of the ankle joint from a six-bar linkage mechanism of fixed dimensions. Later, using the same approach, the inverse kinematics solution for this mechanism is also devised whereby, the set of the link dimensions of the six-bar linkage mechanism is obtained for the given gait trajectory of an individual to achieve customization. We simulated the kinematic behavior of the six-bar linkage mechanism within defined mechanical constraints and utilized the generated data for training a feedforward neural network and long short-term memory models. The proposed model, when trained, can produce accurate lengths for the desired gait trajectories in the sagittal plane and vice versa, which further validates our proposed approach for inverse kinematics solution. Moreover, to evaluate the efficiency of deep learning models, we have conducted an extensive error-based, comparative, and sensitivity analysis using different performance indices. The results highlight the potential of the proposed deep-learning-driven approach in the design analysis of gait rehabilitation robots.

Applications of Near Infrared Spectroscopy and Mirror Therapy for Upper Limb Rehabilitation in Post-Stroke Patients: A Brain Plasticity Pilot Study.

Objectives: The aim of this study was to identify the neural pattern activation during mirror therapy (MT) and explore any cortical reorganization and reducing asymmetry of hemispheric activity for upper limb rehabilitation in post-stroke patients. Methods: A box containing a mirror was placed between the arms of the patients to create the illusion of normal motion in the affected limb by reflecting the image of the unaffected limb in motion. We measured the cerebral hemodynamic response using near-infrared spectroscopy (NIRS). We enrolled ten right-handed stroke patients. They observed healthy hand movements in the mirror (MT condition) while performing various tasks (MT condition), and then repeated the same tasks with the mirror covered (N-MT condition). Results: Significant activation of some brain areas was observed in the right and left hemiparesis groups for the MT condition, while lower levels of activation were observed for the N-MT condition. The results showed significant differences in hemodynamic response based on oxygenated (HbO) concentrations between MT and N-MT conditions across all tasks in sensorimotor areas. These neural circuits were activated despite the motor areas being affected by the brain injury, indicating that the reflection of movement in the mirror helped to activate them. Conclusions: These results suggest that MT promotes cortical activations of sensory motor areas in affected and non-affected brain sides in subacute post-stroke patients, and it encourages the use of these tools in clinical practice.

An international survey of optometric management of stroke survivors

Objectives A survey was conducted to describe the current status of optometric awareness and involvement regarding post-stroke management as literature suggests that visual impairment often goes undiagnosed and unmanaged in stroke survivors. Materials and methods A questionnaire was developed by the researchers, pilot tested by 5 other optometric researchers and 15 optometrists and modified based on the feedback. Practicing optometrists were invited to complete the anonymous online survey through optometric organizations in Canada, Hong Kong, India, UK, and US. Results Results showed that the majority of optometrists (61%) see 1–5 post-stroke patients per month, although 15% report seeing none. In all cases, optometrists referred stroke patients to other health care professionals more often than receiving incoming referrals from them. About 21% of all respondents were already fully involved in post-stroke vision care and 57% were interested in being more involved. Limiting factors to seeing more post-stroke patients included resources (29.8%), funding (25.8%), awareness (25.1%), and interest (9.8%). There was consensus among respondents in all countries that optometrists should be members of post-stroke care teams. Conclusion Optometrists are well suited to provide post-stroke visual rehabilitation but are often not included in care teams for these patients. As a result, the visual management of post-stroke patients often is unaddressed.

Empowering Post-Stroke Patients to Improve Self-Care and Prevent Recurrent Stroke Using Stroke Empowerment Education

Aims: Stroke can lead to varying outcomes, ranging from recovery with disability, death, to surviving with recurrent strokes. Post-stroke patients require special attention to improve self-care behaviors. Stroke empowerment education is an educational approach given to stroke patients with an empowerment-focused approach centered on the patient. This study aimed to determine the effect of stroke empowerment education on the self-care of post-stroke patients as an effort to prevent recurrent strokes at RSUD Gambiran Kota Kediri. Methods: The research design used was a Quasi-Experiment with a pre-post test design with a control group. Sampling was done using accidental sampling technique, resulting in 98 respondents. Data collection on self-care was conducted using the modified version of The Subjective Self-Care Performance Scale questionnaire. Results: The results of the Wilcoxon Signed Ranks Test showed significant improvement (p = 0.000) in self-care among post-stroke patients after Stroke Empowerment Education. Conclusion: This study concluded that there was an effect of stroke empowerment education on improving self-care among post-stroke patients as an effort to prevent recurrent strokes at RSUD Gambiran Kota Kediri. As a recommendation, the results of this study can be continued as an intervention in hospitals to enhance services for post-stroke patients to improve self-care as an effort to prevent recurrent strokes.

Inhibitory effect of Transcranial Magnetic Stimulation (TMS) in the case of stroke: literature study

Background: Transcranial Magnetic Stimulation (TMS) is a form of non-invasive brain stimulation with the capacity to modulate cortical excitability. Low-frequency TMS (1 Hz) inhibits regional brain activity and allows contralateral cortical excitability through modulation of interhemispheric inhibition. Until now, research on low-frequency TMS that shows its inhibition on regional brain and the possibility of contralateral cortical stimulation is still very limited and not widely known. The purpose of this study was to determine the inhibitory effect of Transcranial Magnetic Stimulation (TMS) in post-stroke patients. Methods: Literature review was conducted to identify all articles that discuss the use of low-frequency TMS to determine the inhibitory effect of post-stroke patients on non-lesion areas. Databases from Hindawi, PubMed, Science Direct, and Cochrane with research types of pilot studies and randomized controlled trials published in the last 10 years by entering the keywords “Transcranial Magnetic Stimulation”, “Inhibition”, and “Stroke”. The research was conducted by systematically collecting, processing, and analyzing data. Results: Of the 505 articles identified, then selected according to the title there were 57 articles, obtained 10 articles that had abstracts according to the study. After that, the selection of articles according to the inclusion and exclusion criteria by reading the full article, there were 4 studies selected for review. 4 articles were included in this study showing motor improvement, increased functional ability, and cognitive improvement in post-stroke patients. Conclusion: TMS has beneficial effects on motor recovery in post-stroke patients with lasting effects.

Factors associated with recurrent stroke in Sikhio District, Nakhon Ratchasima Province, Thailand

Background: Stroke survivors can experience residual disability and are at risk for subsequent strokes that might cause further damage or even death. The objective of this study was to identify factors associated with recurrent stroke in Sikhio District, Nakhon Ratchasima Province, Thailand. Method: We used gender and age characteristics to match our study participants in a ratio of 1 case patient to 2 controls. The total sample size was 111 participants, 37 participants with recurrent stroke were considered as the case group and 74 participants without recurrent stroke were the control group. The case group was diagnosed by a physician along with a computerized tomography (CT) scan and received treatment at Sikhio Hospital in the period of 1 October 2021 - 30 September 2022. Face-to-face data were collected by a structured questionnaire and compared to the medical record. Results: The study revealed that risk factors associated with recurrent stroke in Sikhio District were comorbidities (AOR = 4.64, 95% CI = 1.35-15.86, p &lt; 0.014) and systolic blood pressure (AOR = 2.41, 95% CI = 1.10-5.78, p &lt; 0.049). Conclusion: Comorbidities and systolic blood pressure represented a risk to recurrent stroke among post-stroke patients. Therefore, hospitals should find effective methods to care for patients with co-morbidities and promote knowledge about blood pressure control.

Effectiveness of Propioceptive Neuromuscular Facilitation in Improving Walking Quality in Post-Stroke Patients at Haji General Hospital Medan

Nationally, the prevalence of stroke in Indonesia in 2018 was 10.9 per mile, an increase compared to 2013 which was 7 per mile. Stroke is the second leading cause of death and the third leading cause of disability in the world. Two-thirds of stroke events occur in developing countries. Weakness and decreased muscle strength in stroke sufferers occur on one side of the limb, however, in the trunk muscles, weakness occurs on both sides, resulting in limited trunk rotation and difficulty in maintaining balance and gait). Propioceptive Neuromuscular Facilitation (PNF) is a physiotherapy intervention method that can be used to improve the quality of walking in stroke patients. This method can improve proprioceptor function by stimulating it in muscles and tendons. PNF also improves muscle strength, flexibility, and balance). Description of respondent data was carried out using univariate analysis to determine the frequency of age, weight, height, gender, paralyzed side and Wisconsin values ??before and after the intervention for both groups. Bivariate test to compare the average WGS value after treatment with before treatment in both the PNF group and the conventional group and compare the average difference between the PNF group and the conventional group. The average value of the difference before and after the intervention in the PNF group was 1.75 with a standard deviation of ± 0.463, while in the conventional group the average value of the difference before and after the intervention was 0.63 with a standard deviation of ± 0.518. Statistical tests using the Wilcoxon rink test between the two groups obtained a p-value of 0.024, which is smaller than 0.05, which means there is a significant difference between the PNF intervention group and the Conventional intervention group.

A Concept Analysis: Tenacity of Post-Stroke Patients in Rehabilitation Programs

Stroke is a major global health issue, with rehabilitation offering significant benefits. However, adherence is often compromised. Tenacity, defined by persistence and determination, is essential for effective rehabilitation but is often overlooked and poorly evaluated in clinical settings. This analysis aims to clarify the concept of tenacity in post-stroke rehabilitation and assess its impact on outcomes. Walker and Avant's eight-step framework is used to examine tenacity, drawing data from relevant stroke rehabilitation literature. The analysis reveals that tenacity has several key attributes, including adaptability, self-motivation, determination, perseverance, resilience, and persistence. Antecedents of tenacity include factors such as the severity of the stroke, family support, and access to rehabilitation resources. High levels of tenacity lead to improved rehabilitation outcomes, such as enhanced mobility and quality of life. Tenacity is an essential component in the rehabilitation of post-stroke patients that can significantly improve rehabilitation outcomes. A better understanding of tenacity can aid healthcare professionals in designing more effective interventions to support patients in their rehabilitation programs. Further research is needed to develop valid and reliable tools for assessing tenacity and to evaluate interventions that can enhance patient tenacity.

The Kinetic and Kinematic Efficacy of Posterior Leaf Spring Ankle-foot Orthosis in Patients with Drop foot

Background: Dorsi flexor weakness is one of the common consequences of stroke with a negative impact on normal walking. Posterior leaf spring (PLS) Ankle Foot Orthosis (AFO) is the most frequent prescription to assist foot clearance and leg propulsion in these patients. However, the real efficacy of this AFO needs more attention. This study aimed to investigate the efficacy of PLS AFO on gait outcomes as the most common AFO in drop foot post-stroke patients. Methods: The study design was a pre–post-test experiments in which twenty drop foot patients with a mean age of 65 years with a mean age of 58.45 (±5.23) years who were 4/5 years post-stroke. They walked at self-selected walking speed on a 10 meters walk away in two conditions of with their own shoes and PLS AFO. The 3D motion capture gait analysis system including 6 vicon cameras and a Kistler force plate were used in order to measure gait kinetic and kinematic variables. For each trial, each joints (ankle, knee and hip) angle, moment and power were averaged over one-minute walking. Results: Walking with PLS showed a statistically significant improve kinetic and kinematic variables in hip, knee and ankle joints included power, moments and angles at entire gait cycle. P&lt;0.05. Conclusions: In our study of stroke patients who were fitted with a PLS AFO, immediate significant improvements occurred in most kinetic and kinematic than shoes only in sacrifice some others.

Machine learning to predict incident atrial fibrillation in patients with acute stroke: FIND-AF STROKE

Abstract Background Atrial fibrillation (AF)-related strokes have a high rate of recurrence, and are associated with substantial morbidity, disability, healthcare expenditure, and mortality.(1-3) Detection of AF promises opportunity to prevent recurrent stroke through conversion of antiplatelet to anticoagulant therapy,(4,5) but use of extended monitoring has cost implications.(6) Thus accurately identifying patients with stroke at high risk for AF is important but previous previous models have been developed in small, unrepresentative cohorts.(7) Purpose To develop and validate a simple novel decision support tool for prediction of incident AF after hospitalisation with stroke through machine learning. Methods We developed the model (FIND-AF STROKE) in UK secondary care and death certificate-linked primary care health record data from individuals aged ≥30 years without known AF hospitalized with a stroke or transient ischaemic attack (Jan 2, 1998 to Feb 28, 2022), randomly divided into training (80%) and testing (20%) datasets. We evaluated logistic regression and random forest models for prediction of 2-year AF risk in the testing dataset with internal bootstrap validation, and compared against the CHA2DS2VASC score. Youden index was used to set a threshold for higher and lower risk. Results Of 35 530 UK individuals (mean age 72.1 (SD 12.7) years, 50.9% women), 1742 (4.8%) had developed incident AF at 2 years. Using feature importance a parsimonious version of the model was created requiring only age, sex, ethnicity (white versus other) and five comorbidities. In the testing dataset prediction performance for the random forest algorithm (area under the receiver operating characteristic (AUROC) 0.710, 95% CI 0.685 – 0.736) was superior to the CHA2DS2VASC score (0.645, 95% CI 0.617-0.672) (Figure 1). The threshold for higher risk using the Youden index was 4.81% which resulted in a negative predictive value of 97.6%, sensitivity 0.712, specificity 0.583. Of the post-stroke patients 44% were labelled at higher risk of AF, who were older, had a higher prevalence of comorbidities, and a 3.3-fold higher incidence of AF post-stroke, than those identified as lower risk (Table 1). Conclusions The machine learning FIND-AF STROKE decision support tool can accurately identify individuals at risk of incident AF after stroke to enable a targeted and cost-effective approach to extended monitoring. Validation within cohorts that have undergone extended monitoring post-stroke will give a more accurate estimation of yield at different risk thresholds.Figure 1

Integrated care using the ABC-stroke pathway improves cardiovascular outcomes and survival in patients with recent ischaemic stroke: a population-based cohort study

Abstract Background A recent European Society of Cardiology (ESC) Council on Stroke position paper proposed the ABC-stroke pathway, a holistic and integrated care approach to optimise the post-stroke management for patients with recent stroke, and associated heart disease. The ABC-stroke pathway is based on 3 pillars: "A" Appropriate Antithrombotic therapy; "B" Better functional and psychological status; and "C" Cardiovascular risk factors and Comorbidity optimisation (including lifestyle changes). There are limited data on the impact of adherence to the ABC-stroke pathway on post-stroke patient outcomes. Purpose We aimed to investigate the potential impact of ABC-stroke pathway adherence in the Clinical Data Analysis and Reporting System (CDARS) database in Hong Kong. Methods The analysis included patients with new-onset ischaemic stroke recorded in CDARS between 1st June 2006 and 31st May 2022. Multivariable Cox proportional hazards regression analyses were performed to evaluate the association between adherence to the ABC-stroke pathway and the primary outcome. The primary endpoint was a composite outcome of recurrent ischaemic stroke, transient ischaemic attack, haemorrhagic stroke, myocardial infarction, heart failure and all-cause death. Secondary outcomes were the individual components of the composite outcome, and cardiovascular death. Results Of the 9,669 included patients with ischaemic stroke (mean age 69.6 ± 13.4 years; 42.5% female), 58.1% were adherent to all 3 main ABC-stroke pillars. After 1 year of follow-up, adherence to the ABC-stroke pathway was associated with a lower risk of the primary composite endpoint (HR: 0.80; 95% CI: 0.72–0.88). Risk reductions increased progressively with a higher number of ABC-stroke criteria obtained (Figure 1). On multivariate analyses of the secondary outcomes, ABC-stroke pathway-adherent care was associated with a reduced risk of all-cause mortality (HR: 0.72; 95% CI: 0.62–0.85), cardiovascular death (SHR: 0.64; 95% CI: 0.45–0.90), haemorrhagic stroke (SHR: 0.50; 95% CI: 0.38–0.67) and heart failure (SHR: 0.771; 95% CI: 0.596-0.998) (Table 1). Conclusion In a large cohort of patients with ischaemic stroke, adherence to the ABC-stroke pathway was associated with a reduction of the risk of adverse outcomes.