Post-stroke Patients Research Articles

CLINICAL FEATURES OF MOTOR DEFICIT AND COGNITIVE DISORDERS IN POST-STROKE PATIENTS

The aim of the study – to determine the clinical features of motor deficits and cognitivedisorders in post-stroke patients.Materials and methods. The examination of 39 post-stroke patients included: clinicalneurological, psychodiagnostic methods using the National Institutes of Health StrokeScale (NIHSS), Action Reserch Arm test (ARAT), Modified Ashworth Scale (MAS), MontrealCognitive Assessment Scale (MoCA), Hospital Anxiety and Depression Scale (HADS).Results. Movement disorders with spasticity syndrome of varying severity were diagnosedin all examined patients. Severe and moderate degree of motor dysfunctions of the upperlimbs were revealed in 76.92 % of patients from the 1-st group and remained in 56.41 %of patients from the 2nd group. Violations of muscle tone in the affected limbs variedfrom an increase of a moderate degree to an increase of a mild degree in 74.36 % ofpatients. An increase in cognitive dysfunction, symptoms of anxiety and depression wereobserved in a 12 months after stroke. A higher degree of motor disorders correlated withthe expression of anxiety- depressive disorders.Conclusions. The number of patients with motor deficits of mild and moderate severitydegrees has increased over time. At the same time, the number of patients with moderateand severe degrees of movement disorders has decreased, which correlates with theseverity of anxiety and depression, as well as cognitive dysfunctions.

Impaired oral health associations with cognitive and motor decline in activities of daily living independence during hospitalization: insights from a post-stroke cohort

PurposeEvidence is scarce on the associations between impaired oral health and cognitive level related to independence in activities of daily living (ADLs) among hospitalized older patients. We aimed to evaluate the associations between baseline oral problems and changes in cognitive level in post-stroke patients. MethodsA retrospective cohort study was conducted, encompassing consecutively hospitalized post-stroke patients. Revised Oral Assessment Guide (ROAG) as a measure of oral health and function was assessed at admission. Primary outcomes included discharge scores for cognitive function assessed by the cognitive domain of the Functional Independence Measure (FIM-cognition) and the corresponding change in FIM-cognition during hospitalization. Another outcome measure was the motor domain of FIM (FIM-motor). Multivariate linear regression analyses were employed to assess the association between baseline ROAG and the designated outcomes, adjusting for potential confounding factors. ResultsData from 955 patients (mean age 73.2 years; 53.6% men) were included in the analysis. The median ROAG was 10 [9, 12], with 811 patients (84.9%) presenting oral problems. After fully adjusting for confounding factors, the ROAG was significantly and negatively associated with FIM-cognition at discharge (β = -0.107, p = 0.031) and FIM-cognition gain (β = -0.093, p = 0.018). Further, the ROAG was independently and negatively associated with FIM-motor at discharge (β = -0.043, p = 0.013) and FIM-motor gain (β = -0.065, p = 0.013). ConclusionOral problems were associated with compromised cognitive levels and a decline in physical function during the hospitalization in post-stroke patients. These results underscore the critical importance of addressing oral health in this patient population.

Using Dual-Target rTMS, Single-Target rTMS, or Sham rTMS on Post-Stroke Cognitive Impairment.

The clinical application of 10 Hz repetitive transcranil magnetic stimulation (rTMS) remains limited despite its demonstrated effectiveness in enhancing cortical excitability and improving cognitive function. The present study used a novel stimulus target [left dorsolateral prefrontal cortex + primary motor cortex] to facilitate the enhancement of cognitive function through the bidirectional promotion of cognitive and motor functions; Methods: Post-stroke cognitive impairment patients (n = 48) were randomly assigned to receive either dual-target, single-target, or sham rTMS for 4 weeks. Before and after 4 weeks of treatment, participants were asked to complete the Montreal Cognitive Assessment (MoCA) test, the Modified Barthel Index (MBI), the Trail-making Test (TMT), and the Digital Span Test (DST). In addition, the levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) in serum were also measured. After adjusting for pre-intervention (baseline) MoCA scores, the post-intervention MoCA scores varied significantly. After post-hoc analysis, differences existed between the post-treatment scores of the dual-target rTMS group and the sham rTMS group (the experimental group scores were significantly higher), and between those of the dual-target rTMS group and the single-target rTMS group (the dual-target rTMS scores were significantly higher). The serum VEGF levels of the dual-target rTMS group were significantly higher those that of the sham rTMS group. The present study presented data showing that a dual-target rTMS therapy is effective for Post-stroke cognitive impairment (PSCI). The stimulation exhibited remarkable efficacy, suggesting that dual-target stimulation (left dorsolateral prefrontal cortex+motor cortex (L-DLPFC+M1)) holds promise as a potential target for TMS therapy in individuals with cognitive impairment after stroke. No: ChiCTR220066184. Registered 26 November, 2022, https://www.chictr.org.cn.

Triad of rehabilitation, nutrition support, and oral management improves activities of daily living and muscle health in hospitalized patients after stroke

The triad approach combining rehabilitation, nutrition support, and oral management has garnered increasing interest for improving outcomes in older adults. However, evidence is limited regarding its effectiveness in post-stroke patients, who are at high risk for malnutrition, sarcopenia, oral problems, and dysphagia. This study aims to investigate the association between the triad approach and improvement in activities of daily living (ADL), muscle strength, and skeletal muscle mass in these patients. A retrospective cohort study was conducted using post-stroke patients. Patients were divided into groups based on their exposure to the triad approach, defined as a combination of intensive chair-stand exercise (rehabilitation), personalized food prescriptions (nutrition support), and oral management by dental professionals. We investigated the association between the triad approach and outcomes using multiple linear regression analysis adjusted for covariates. Primary outcome was Functional Independence Measure motor score (FIM-motor) at discharge and its gain. Secondary outcomes were handgrip strength (HGS) and skeletal muscle mass index (SMI) at discharge. The study included 1,012 post-stroke patients (median age 75.6 years; 54.1% men). Multiple linear regression analysis revealed that the triad approach had the strongest association with higher FIM-motor at discharge (β=0.262, p<0.001) and FIM-motor gain (β=0.272, p<0.001) compared to the individual or combined interventions. The triad also showed the strongest associations with higher HGS (β=0.090, p=0.017) and SMI (β=0.041, p=0.028) at discharge. The triad approach of intensive rehabilitation, personalized nutrition support, and oral management by dental professionals is strongly associated with improved ADL, muscle strength, and skeletal muscle mass in post-stroke rehabilitation patients. Implementing this multidisciplinary strategy may maximize functional and muscle health recovery.

Pneumatic Plantar Stimulation Device Replicating Manual Therapy Improves Lateral Stability in Standing Posture

Strokes are a widespread condition characterized by motor paralysis and sensory impairment, and they significantly hinder daily activities. Hence, rehabilitation aimed at improving motor function is crucial for post-stroke patients. Manual therapy, which involves the manual stimulation of the limbs to provide sensory input and enhance motor function, is commonly employed for rehabilitation. However, the limited duration of inpatient rehabilitation highlights the need for devices that can provide similar rehabilitation interventions at home. Here we elucidate the skills employed by physical therapists during intervention through interviews and measurements of the force applied to the plantar surface of the foot. Subsequently, we develop a device capable of replicating these intervention skills. The investigation of physical-therapist skills revealed the importance of stimulating the muscles involved in forming the longitudinal and transverse arches and the flexor muscles of the toes during manual therapy. The required force for stimulation was also noted. Using our device, which utilized pneumatic actuation to replicate therapist skills, intervention on the plantar surface of the feet of healthy adults demonstrated improved stability in their standing posture, particularly in the lateral direction. These devices can enhance the sensory-motor connection from the plantar surface, thereby improving motor abilities, such as preventing falls.

A predictive score for atrial fibrillation in poststroke patients.

Atrial fibrillation (AF) is a risk factor for cerebral ischemia. Identifying the presence of AF, especially in paroxysmal cases, may take time and lacks clear support in the literature regarding the optimal investigative approach; in resource-limited settings, identifying a higher-risk group for AF can assist in planning further investigation. To develop a scoring tool to predict the risk of incident AF in the poststroke follow-up. A retrospective longitudinal study with data collected from electronic medical records of patients hospitalized and followed up for cerebral ischemia from 2014 to 2021 at a tertiary stroke center. Demographic, clinical, laboratory, electrocardiogram, and echocardiogram data, as well as neuroimaging data, were collected. Stepwise logistic regression was employed to identify associated variables. A score with integer numbers was created based on beta coefficients. Calibration and validation were performed to evaluate accuracy. We included 872 patients in the final analysis. The score was created with left atrial diameter ≥ 42 mm (2 points), age ≥ 70 years (1 point), presence of septal aneurysm (2 points), and score ≥ 6 points at admission on the National Institutes of Health Stroke Scale (NIHSS; 1 point). The score ranges from 0 to 6. Patients with a score ≥ 2 points had a fivefold increased risk of having AF detected in the follow-up. The area under the curve (AUC) was of 0.77 (0.72-0.85). We were able structure an accurate risk score tool for incident AF, which could be validated in multicenter samples in future studies.

The Effectiveness of the Bobath Technique in Improving Balance Levels among Post-Stroke Patients

The Effectiveness of the Bobath Technique in Improving Balance Levels among Post-Stroke Patients

Brain activation patterns in patients with post-stroke cognitive impairment during working memory task: a functional near-infrared spectroscopy study.

To explore the activation patterns in the frontal cortex of patients with post-stroke cognitive impairment during the execution of working memory tasks. 15 patients with post-stroke cognitive impairment, 17 patients without cognitive impairment, and 15 healthy controls of similar age and sex were included. All participants under-went immediate recall task testing and near-infrared spectroscopy imaging to measure frontal cortex activation during the task. The healthy control group performed the best in the immediate recall task, followed by the post-stroke non-cognitive impairment group. The post-stroke cognitive impairment group had the poorest performance. The near-infrared spectroscopy results revealed that during the immediate recall task, the healthy control group primarily activated the left frontal lobe region. In contrast, post-stroke patients exhibited reduced activation in the left frontal lobe and increased activation in the right frontal cortex, particularly in the right frontopolar and orbitofrontal regions, with the post-stroke cognitive impairment group displaying the most pronounced changes. Patients with post-stroke cognitive impairment exhibit reduced activation in the left prefrontal cortex during the working memory tasks. They rely on compensatory activation in the right prefrontal cortex, particularly in the frontopolar and orbitofrontal cortex, to successfully complete the task.

Establishing and evaluating the gradient of item naming difficulty in post-stroke aphasia and semantic dementia

Anomia is a common consequence following brain damage and a central symptom in semantic dementia (SD) and post-stroke aphasia (PSA), for instance. Picture naming tests are often used in clinical assessments and experience suggests that items vary systematically in their difficulty. Despite clinical intuitions and theoretical accounts, however, the existence and determinants of such a naming difficulty gradient remain to be empirically established and evaluated. Seizing the unique opportunity of two large-scale datasets of semantic dementia and post-stroke aphasia patients assessed with the same picture naming test, we applied an Item Response Theory (IRT) approach and we (a) established that an item naming difficulty gradient exists, which (b) partly differs between patient groups, and is (c) related in part to a limited number of psycholinguistic properties - frequency and familiarity for SD, frequency and word length for PSA. Our findings offer exciting future avenues for new, adaptive, time-efficient, and patient-tailored approaches to naming assessment and therapy.

Impact of Social Support and Self-Efficacy on Activity of Daily Living among Post-Stroke Patients in Saudi Arabia: A Cross-Sectional Study.

This study employed a cross-sectional design to explore the impact of social support and self-efficacy on activity of daily living (ADL) among post-stroke patients in Saudi Arabia and investigate the mediating role of self-efficacy. Data were collected from 158 post-stroke patients across six healthcare facilities in three regions of Saudi Arabia using convenience sampling, between February 2023 and July 2023. The analysis included descriptive statistics, variance analysis, and linear regression using bootstrap methods. PROCESS Macro was used for the mediation model. This study revealed that most participants had high ADL, social support, and self-efficacy levels. Significant negative associations were found between ADL and age (p < 0.001), time since stroke (p = 0.009), and stroke history (p < 0.001), while significant positive associations were observed with educational background (p = 0.049), employment status (p < 0.001), and self-efficacy (p < 0.001). ADL in post-stroke patients was significantly influenced negatively by age (p = 0.025), time since stroke (p = 0.027), and stroke history (p < 0.001), while self-efficacy (p < 0.001) had a positive impact and moderated the relationship between social support and ADL. This study highlights the physical and psychosocial aspects affecting post-stroke patients, identifies key areas for enhancing their experiences, and informs the development of targeted interventions to address their comprehensive needs.

Factors influencing limb movements in post-stroke patients

BackgroundStroke is the leading cause of long-term disability impacting patients’ daily lives. Adequate and ongoing rehabilitation is a necessity. Due to disability problems, rehabilitation in the health care system is limited. Traditional medicine has been promoted in Thailand for stroke rehabilitation, with physical therapy as the primary treatment plan. However, despite more options, many patients still receive inadequate rehabilitation. The development of an appropriate rehabilitation model is still necessary. This study aims to study factors influencing limb movements in post-stroke patients.MethodsThis cross-sectional study comprised 120 ischemic stroke patients obtained by multi-stage sampling in Muang district, Phitsanulok province. The data were collected using questionnaires with Cronbach’s alpha coefficient of 0.89. The ability to move the muscles of the limbs of the patients was assessed using the motor power assessment form, and binary logistic regression statistics analyzed the factors influencing limb movements.ResultData analysis shows that 76% of the stroke patients were female, 39.3% aged 61–70 years had a mean of 62 years and a standard deviation (S.D.) of 8.9, 4.6% of stroke patients had a duration of illness of 6–12 months, and 94.2% had a caregiver. 53.1% received rehabilitation once a week, and 92.5% received Thai massage. Thai traditional medicine utilization methods consist of Thai massage, herbal compresses, herbal steam, and taking herbal medicines. There are two factors influencing the ability to move the limb muscles of stroke patients as follows: (1) the massage with the Thai traditional medicine rehabilitation method (Adj OR = 28.917, p-value = 0.006) and (2) the number of rehabilitation sessions per week (Adj OR = 2.465, p-value < 0.001). These two variables explain the variance of regaining limb movement among post-stroke patients of 42.5% at a significance level of 0.05. In this analysis, the predictive accuracy was 70%.ConclusionRehabilitation using Thai massage, together with the number of rehabilitation sessions per week, influenced the ability of limb movement in post-stroke patients. In other words, increasing the number of rehabilitation times per week and using Thai massage in rehabilitation will help stroke patients move their limbs better.

Association Between Frequency of Rehabilitation Therapy and Long-Term Mortality After Stroke: A Nationwide Cohort Study.

Previous studies have demonstrated conflicting results regarding the effects of rehabilitation therapy on poststroke mortality. We aimed to investigate the association between rehabilitation therapy, including both inpatient and outpatient treatment, within the first 6 months after stroke and long-term all-cause mortality in patients with stroke using the Korean National Health Insurance System data. A total of 10 974 patients newly diagnosed with stroke using the International Classification of Diseases, Tenth Revision, codes (I60-I64) between 2003 and 2019 were enrolled and followed up for all-cause mortality until 2019. Follow-up for mortality began 6 months after the index event. Poststroke patients were categorized into 3 groups according to the frequency of rehabilitation therapy: no rehabilitation therapy, ≤40 sessions and >40 sessions. Cox proportional hazards models were used to assess the mortality risk according to rehabilitation therapy stratified by disability severity measured based on activities of daily living 6 months after stroke onset. Within 6 months after stroke, 6738 patients (61.4%) did not receive rehabilitation therapy, whereas 2122 (19.3%) received ≤40 sessions and 2114 (19.3%) received >40 sessions of rehabilitation therapy. Higher frequency of rehabilitation therapy was associated with significantly lower poststroke mortality in comparison to no rehabilitation therapy (hazard ratio [HR], 0.88 [95% CI, 0.79-0.99]), especially among individuals with severe disability after stroke (mild to moderate: HR, 1.02 [95% CI, 0.77-1.35]; severe: HR, 0.74 [95% CI, 0.62-0.87]). In the context of stroke type, higher frequency of rehabilitation therapy was associated with reduced mortality rates compared with no rehabilitation therapy only in patients with hemorrhagic stroke (ischemic: HR, 1.04 [95% CI, 0.91-1.18]; hemorrhagic: HR, 0.60 [95% CI, 0.49-0.74]). We found a positive association between rehabilitation therapy within 6 months after stroke onset and long-term mortality in patients with stroke. A higher frequency of rehabilitation therapy would be recommended for poststroke patients, especially those with hemorrhagic stroke and severe disability.

The Relationship Between Self-Concept and Post-Stroke Depression in Stroke Patients

Stroke is when something goes wrong with the blood vessels in your brain, and it can cause serious problems like not being able to move or talk. The are two main types of strokes – one where the blood vessels get blocked (called ischemic) and another where they burst (called hemorrhagic). The blocked kind is more common and happens most often (almost 90% of strokes are ischemic). Meanwhile, hemorrhagic stroke is caused by a leak or rupture of blood vessels in or around the brain, thereby blocking blood flow to brain tissue. Based on preliminary studies, it was found that there was still a high incidence of depression in post-stroke patients at RSU ANNA Medika Madura. The research aims to determine whether there is a relationship between self-concept and post-stroke depression in stroke patients. This research method uses cross-sectional. The independent variable is self-concept, while the dependent variable is post-stroke depression. The total population was 94 stroke patients with a sample of 76 respondents. The sampling technique uses purposive sampling. The instruments used were self-concept questionnaires and HDRS. The statistical test uses the Spearman rank correlation test with a 0.05. The results of the Spearman rank test for the self-concept variable with post-stroke depression obtained a p-value of 0.000 &lt; α 0.05. This research concludes that there is a relationship between self-concept and post-stroke depression in stroke patients. It is hoped that the researchers' suggestions can increase understanding about stroke, improve self-concept to avoid depression.

Oral Health in Patients Hospitalized Because of Ischemic Stroke.

Background/Objectives: Maintenance of good oral health is relevant to overall health and quality of life. Results of many analyses showed that stroke patients had worse oral health than the control population. The aim of this study was a clinical assessment of oral condition in post-stroke patients and a healthy population. Methods: Oral health was assessed in stroke patients on the first day of ischemic stroke, and in a control group of healthy subjects. The number of teeth, the presence of active carious foci, fillings, and prosthetic restorations were evaluated. To assess oral hygiene, the Approximal Plaque Index (API) was used. In periodontal examinations, the presence of dental deposits, the depth of the existing periodontal pockets, tooth mobility, and the Sulcus Bleeding Index (SBI) during probing were assessed. Results: Significantly higher mean values of Decayed Teeth (DT), Missing Teeth (MT), and Decayed, Missing, and Filled Teeth (DMFT) indices were recorded in the study group. The incidence of dental caries, API, and SBI was also significantly higher in the study group. The study and control groups did not differ significantly in the average number of pockets 3 mm deep and deeper and in the frequency of having prosthetic restorations. Conclusions: Oral health and the level of oral hygiene in patients hospitalized because of ischemic stroke, in comparison with that in a healthy population, is not satisfactory. Active interdisciplinary collaboration between various medical specialists in the therapy of patients with general illnesses, including stroke, is strongly recommended.

Exploring the impact of anticholinergic burden on urinary independence: insights from a post-stroke cohort of older adults.

Anticholinergic burden is associated with adverse events in the older adults. However, there is a lack of evidence regarding its effect on urinary independence in stroke patients. This study examined the association between increased anticholinergic burden during hospitalization and urinary independence in post-stroke patients undergoing rehabilitation. This observational cross-sectional study included stroke patients admitted to a post-acute rehabilitation hospital between 2020 and 2022 who were not independently urinating. The degree of urinary independence was assessed using the Functional Independence Measure-Bladder (FIM-Bladder), a subscale of the motor domain of the FIM, and urinary independence was defined as FIM-Bladder ≥ 6. Anticholinergic burden was assessed using the anticholinergic risk scale (ARS), and changes in ARS during hospitalization were calculated by subtracting the value at admission from the value at discharge. The study outcome was urinary independence at discharge. Logistic regression analysis was used to examine whether change in ARS score was independently associated with the outcome. Statistical significance was set at P < 0.05. Of the 573 patients enrolled, 312 patients (mean age 77.5years, 51.9% male) were included in the analysis. ARS increased during hospitalization in 57 patients (18.3%). Change in ARS score was independently associated with urinary independence (odds ratio: 0.432, 95% confidence interval: 0.247-0.756, P = 0.003). Increased anticholinergic burden in post-stroke patients who require assistance with urination is significantly associated with less independent urination. Anticholinergic agents may need to be introduced cautiously in patients who require assistance with urination.

Network Reorganization for Neurophysiological and Behavioral Recovery Following Stroke.

Stroke continues to be the main cause of motor disability worldwide. While rehabilitation has been promised to improve recovery after stroke, efficacy in clinical trials has been mixed. We need to understand the cortical recombination framework to understand how biomarkers for neurophysiological reorganized neurotechnologies alter network activity. Here, we summarize the principles of the movement network, including the current evidence of changes in the connections and function of encephalic regions, recovery from stroke and the therapeutic effects of rehabilitation. Overall, improvements or therapeutic effects in limb motor control following stroke are correlated with the effects of interhemispheric competition or compensatory models of the motor supplementary cortex. This review suggests that future research should focus on cross-regional communication and provide fundamental insights into further treatment and rehabilitation for post-stroke patients.

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

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

Comparison of dry needling with exercise and exercise alone on spasticity, range of motion, and function of post-stroke chronic spastic patients

IntroductionStroke is a common cause of disability and death in adults, with spasticity being a common post-stroke complication that can significantly affect patients' quality of life. This study aimed to investigate the impact of exercise therapy alone versus exercise therapy combined with dry needling on clinical outcomes in patients with chronic spasticity after stroke. MethodsForty patients were randomly assigned to either a control or intervention group. The control group received a standard exercise program consisting of two sessions per week for six weeks. The intervention group received the same exercise program in addition to dry needling of the hip and leg muscles. Clinical outcomes were assessed using the Modified Modified Ashworth Scale, Timed Up & Go Test, and goniometer in four separate examination sessions. ResultsThe findings of this study suggest that the addition of dry needling to exercise therapy led to faster and longer-lasting improvements in clinical outcomes. The intervention group showed significant improvements in spasticity, range of motion, and function in the second through fourth examination sessions, while the control group's improvements decreased over time. Between-group comparisons revealed significantly greater improvements in the intervention group than the control group. ConclusionsThe findings suggest that combining dry needling with exercise therapy may be beneficial in managing post-stroke spasticity. Dry needling may lead to faster and more significant improvements in clinical outcomes, ultimately improving function and quality of life for patients with chronic spasticity after stroke.

Unraveling stroke gait deviations with movement analytics, more than meets the eye: a case control study.

This study aimed to identify and quantify the kinematic and kinetic gait deviations in post-stroke hemiplegic patients with matched healthy controls using Statistical Parametric Mapping (SPM). Fifteen chronic stroke patients [4 females, 11 males; age 53.7 (standard deviation 12.2) years; body mass 65.4 (10.4) kg; standing height 168.5 (9.6) cm] and 15 matched healthy controls [4 females, 11 males; age 52.9 (11.7) years; body weight 66.5 (10.7) years; standing height 168.3 (8.8) cm] were recruited. In a 10-m walking task, joint angles, ground reaction forces (GRF), and joint moments were collected, analyzed, and compared using SPM for an entire gait cycle. Generally, when comparing the stroke patients' affected (hemiplegic) and less-affected (contralateral) limbs with the control group, SPM identified significant differences in the late stance phase and early swing phase in the joint angles and moments in bilateral limbs (all p < 0.005). In addition, the vertical and anteroposterior components of GRF were significantly different in various periods of the stance phase (all p < 0.005), while the mediolateral component showed no differences between the two groups. SPM was able to detect abnormal gait patterns in both the affected and less-affected limbs of stroke patients with significant differences when compared with matched controls. The findings draw attention to significant quantifiable gait deviations in the less-affected post-stroke limb with the potential impact to inform gait retraining strategies for clinicians and physiotherapists.

Perceived social support, self-management, perceived stress, and post-traumatic growth in older patients following stroke: Chain mediation analysis.

Stroke is a potentially traumatic event that can lead to both positive changes associated with post-traumatic growth (PTG) and enduring mental distress. This study aimed to investigate the association between perceived stress and PTG among older postsurvivors, as well as to explore the potential mediating role of perceived social support and self-management in this relationship. A cross-sectional study was conducted to recruit 354 older poststroke survivors from 2 tertiary hospitals in Shenyang, China, between January 2022 and October 2023. Various multidimensional scales were utilized to measure perceived stress, perceived social support, self-management, and PTG. Structural equation modeling was employed by Amos 24.0 to analyze the mediating pathways. The average score of PTG was 50.54 ± 22.69 among older poststroke patients. Pearson analysis revealed significant associations between perceived stress, perceived social support, self-management, and PTG (all P < .01). The mediation model showed that perceived stress could both direct influence PTG (Effect = -0.196, 95% CI = [-0.259, -0.129]), and indirectly impact PTG through perceived social support (Effect = -0.096, 95% CI = [-0.157, -0.044]), through self-management (Effect = -0.033, 95% CI = [-0.064, -0.012]), and sequentially through perceived social support and self-management (Effect = -0.007, 95% CI = [-0.017, -0.002]), accounting for 58.9%, 28.8%, 9.9%, and 2.1% of the total effect, respectively. These findings confirmed the mediating roles of perceived social support and self-management between perceived stress and PTG among older poststroke survivors. This provides valuable insights into developing targeted social intervention programs to improve stroke management among older survivors.