Post-stroke Patients Research Articles

Effects of continuous theta burst stimulation on contralateral primary motor cortex: a concurrent TMS-EEG study.

Continuous theta burst stimulation (cTBS) is a noninvasive brain stimulation technique. cTBS modulation is an effective treatment for motor dysfunction rehabilitation in post-stroke patients. However, there's currently a lack of research on the effects of cTBS stimulation on the contralesional hemisphere. To better understand the role of cTBS in motor rehabilitation, we investigated the neuroregulatory mechanisms of cTBS in the contralateral cortex using transcranial magnetic stimulation-evoked electroencephalography (TMS-EEG). In this randomized, sham-controlled, single-blind study, 18 healthy subjects received two separate stimulation conditions: cTBS or sham stimulation applied to the left primary motor cortex (M1). TMS-EEG measurements were taken before and immediately after stimulation. We investigated the TMS-evoked potentials (TEPs), evoked oscillatory responses (EOR), and phase synchronization index (PSI) of TMS-EEG. The effects of cTBS were analyzed using two-way repeated-measures analysis of variance (RMANOVA). There was a significant "cTBS condition × time" interaction effect on the theta and gamma bands of EOR, and on interhemisphere PSI (inter-PSI) and global PSI in both cTBS stimulation conditions. (theta: F = 4.526, P = 0.041; gamma: F = 5.574, P = 0.024; inter-PSI: F = 5.028, P = 0.032; global PSI: F = 5.129, P = 0.030). After real cTBS modulation, the energy in the theta and gamma frequency bands was significantly higher than before (theta: F = 5.747, P = 0.022; gamma: F = 5.545, P = 0.024). The inter-PSI and global PSI significantly increased after real cTBS modulation (inter-PSI: F = 6.209, P = 0.018; global PSI: F = 6.530, P = 0.015). cTBS modulation significantly increased EOR and PSI in contralateral brain regions, thereby enhancing cortical excitability and cortical functional connectivity throughout the brain. This provides a theoretical basis for cTBS neuromodulation in patients with stroke.NEW & NOTEWORTHY In right-handed individuals, the left hemisphere exhibits higher excitability. According to hemispheric competition theory, applying continuous theta burst stimulation (cTBS) to inhibit excitability in the left hemisphere can reduce its inhibitory effect on the right, thereby promoting neural excitability. This study applied cTBS to the left M1 of healthy individuals and, for the first time, recorded transcranial magnetic stimulation-evoked electroencephalography (TMS-EEG) from the right M1 to analyze the effects of cTBS on cortical oscillations and network connectivity in the contralateral cortex.

Malnutrition Diagnosis and Food Consumption in Subacute Post-Stroke Patients During Rehabilitation.

Stroke survivors frequently encounter malnutrition, adversely impacting clinical outcomes. Nevertheless, malnutrition and food consumption in post-stroke patients have not been frequently assessed, and their correlation with rehabilitation outcomes remains inadequately explored. The objective of this observational study was to evaluate malnutrition at admission in these patients, assess food consumption during a six-week rehabilitation program, and analyze their correlation with rehabilitation outcomes. Subacute post-stroke patients were evaluated at admission (T0) and after a six-week rehabilitation treatment (T1). At T0, we assessed clinical and demographic characteristics, and we diagnosed malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Weight, BMI, hematochemical parameters, and activities of daily living with the modified Barthel Index (mBI) were evaluated at both T0 and T1; recovery was registered as a change in the mBI (ΔmBI = mBIT1 - mBIT0). Patients' food consumption was recorded through visual plate waste estimation of three meals a day, 5 days a week, for six weeks of hospitalization for rehabilitation. A total of 109 patients completed the study (51 women, mean age 69 ± 11). According to the GLIM criteria, 105 of these patients were at risk of malnutrition, while 43 were malnourished, with 15 severely malnourished. Malnourished patients wasted more food, with respect to non-malnourished patients, as measured by visual plate waste of total meals (25 ± 17% vs. 15 ± 14%; p = 0.001) and reached a lower ΔmBI. A linear regression analysis found a significant correlation between the ΔmBI, the waste of a "second dish", which contained mainly protein, and serum albumin at admission, even after controlling for age. Malnutrition assessed with the GLIM criteria at admission and food consumption are two important nutritional parameters to evaluate in post-stroke patients hospitalized for rehabilitation due to their association with recovery.

Brain-movement relationship during upper-limb functional movements in chronic post-stroke patients

BackgroundFollowing a stroke, brain activation reorganisation, movement compensatory strategies, motor performance and their evolution through rehabilitation are matters of importance for clinicians. Two non-invasive neuroimaging methods allow for recording task-related brain activation: functional near-infrared spectroscopy (fNIRS) and electroencephalography (fEEG), respectively based on hemodynamic response and neuronal electrical activity. Their simultaneous measurement during movements could allow a better spatiotemporal mapping of brain activation, and when associated to kinematic parameters could unveil underlying mechanisms of functional upper limb (UL) recovery. This study aims to depict the motor cortical activity patterns using combined fNIRS-fEEG and their relationship to motor performance and strategies during UL functional tasks in chronic post-stroke patients.MethodsTwenty-one healthy old adults and 21 chronic post-stroke patients were recruited and completed two standardised functional tasks of the UL: a paced-reaching task where they had to reach a target in front of them and a circular steering task where they had to displace a target using a hand-held stylus, as fast as possible inside a circular track projected on a computer screen. The activity of the bilateral motor cortices and motor performance were recorded simultaneously utilizing a fNIRS-fEEG and kinematics platform.Results and conclusionsKinematic analysis revealed that post-stroke patients performed worse in the circular steering task and used more trunk compensation in both tasks. Brain analysis of bilateral motor cortices revealed that stroke individuals over-activated during the paretic UL reaching task, which was associated with more trunk usage and a higher level of impairment (clinical scores). This work opens up avenues for using such combined methods to better track and understand brain-movement evolution through stroke rehabilitation.

Prevalence and Management of Oral Intake Restrictions in Critically Ill Patients: Insights from a Multicenter Point Prevalence Study.

Oral intake restrictions due to dysphagia in the intensive care unit (ICU) can increase morbidity, mortality, and negatively impact quality of life. The current oral intake practice and clinical management strategies for addressing dysphagia in the ICU are not well-defined. This study aimed to elucidate the clinical practices surrounding oral intake restrictions due to dysphagia and its management strategies in the ICU. A multicenter, prospective, cross-sectional, 2-day point prevalence study was conducted in Japan. Relevant data on the clinical circumstances surrounding oral intake practice and the implementation of strategies to prevent dysphagia for patients admitted to the ICU on November 1, 2023, and December 1, 2023, were collected. The primary outcome was the prevalence of oral intake restrictions in patients, defined by a Functional Oral Intake Scale score of less than 7 among eligible patients for oral intake. Out of 326 participants, 187 were eligible for the final analysis after excluding 139 patients who were not eligible for oral intake, primarily due to tracheal intubation. Among those eligible, 69.0% (129/187) encountered oral intake restrictions. About 52.4% (98/187) of patients underwent swallowing screenings; 36.7% (36/98) of these were suspected of having dysphagia. Compensatory and behavioral swallowing rehabilitation were provided to 21.9% (41/187) and 10.6% (20/187) of patients, respectively, from ICU admission to the survey date. Only 27.4% (14/51) of post-extubation and 9.3% (3/32) of post-stroke patients received swallowing rehabilitation. Notably, no ICUs had dedicated speech and language therapists, and most (85.7%, 18/21) lacked established swallowing rehabilitation protocols. This 2-point prevalence survey study revealed that oral intake restrictions due to dysphagia are common in ICUs, but few patients are screened for swallowing issues or receive rehabilitation. More clinical studies are needed to develop effective protocols for identifying and managing dysphagia, including screenings and rehabilitation in the ICU.

The Turkish version of the cognitive assessment scale for stroke patients (CASP-TR): a reliability and validity

ABSTRACT Background Stroke, a prevalent neurological condition globally, is associated with a high mortality and often affects cognitive function. The Cognitive Assessment Scale for Stroke Patients (CASP) was developed to quickly identify and measure primary cognitive deficits, focusing particularly on stroke survivors. Within the Turkish context, there is a limited availability of validated cognitive screening tests for use after stroke. Aims The study aimed to translate CASP into Turkish (CASP-TR) and validate it in stroke patients. Methods and procedures After the translation of the CASP items into culturally appropriate Turkish versions, a pilot testing of the pre-final version was administered to post-stroke patients and healthy controls by two raters. Following completion of the final version of CASP-TR, 40 stroke patients were consecutively enrolled in validation process. Three blinded raters conducted all assessments with intervals of 1- or 2 days between evaluation sessions. The accuracy of CASP-TR was assessed using sensitivity, specificity, predictive values, likelihood ratios, and area under curve. CASP-TR performance in post-stroke patients with and without cognitive dysfunction was compared using the Mini-Mental State Examination (MMSE). CASP-TR data obtained by two raters were compared based on the presence of aphasia. Outcomes and results The study assessed inter-rater agreement using intraclass correlation coefficient (ICC), yielding a score of 0.92 (95% CI 0.85–0.96) between raters. Across subtests, moderate to good agreement was observed in most domains. Correlation analyses showed a strong positive relationship (r = 0.80) between mean CASP-TR and MMSE scores. CASP-TR and MMSE scores were stratified based on the presence of aphasia. CASP-TR scores from both raters were notably lower in the aphasia group compared to the non-aphasia group (p < 0.001). Similarly, MMSE scores were significantly lower in the aphasia group (p < 0.001). The patients were also classified into cognitive dysfunction and non-cognitive dysfunction groups based on MMSE scores. No statistically significant score differences were found between examiners in the cognitive dysfunction group (p = 0.267) or non-cognitive dysfunction group (p = 0.156) (p > 0.05). CASP-TR demonstrated a sensitivity of 82.4%, specificity of 78.6%, positive predictive value of 87.5%, negative predictive value of 68.7%, a positive likelihood ratio of 3.77, a negative likelihood ratio of 0.25, and an area under curve of 0.88. Conclusions This study proposes that CASP-TR is a valuable cognitive screening tool for assessing cognitive deficits in stroke patients, and it also demonstrates sensitivity to cognitive deficits in stroke patients with aphasia. The thorough validation within the acute post-stroke Turkish population demonstrates remarkably good accuracy and very good Area Under Curve (AUC) values.

Inertial measurement units to evaluate the efficacity of Equino Varus Foot surgery in post stroke hemiparetic patients: a feasibility study

IntroductionThis study evaluates the gait analysis obtained by Inetial Measurement Units (IMU) before and after surgical management of Spastic Equino Varus Foot (SEVF) in hemiplegic post-stroke patients and to compare it with the functional results obtained in a monocentric prospective cohort.MethodsPatients with post-stroke SEVF, who underwent surgery in a single hospital between November 2019 and December 2021 were included. The follow-up duration was 6 months and included a functional analysis using Goal Attainment Scaling (GAS) and a Gait analysis using an innovative Multidimensional Gait Evaluation using IMU: the semiogram.Results20 patients had a gait analysis preoperatively and at 6 months postoperatively. 90% (18/20) patients had a functional improvement (GAS T score ≥ 50) and 50% (10/20) had an improvement in walking technique as evidenced by the cessation of the use of a walking aid (WA). In patients with functional improvement and modification of WA the change in the semiogram area was + 9.5%, sd = 27.5%, and it was + 15.4%, sd = 28%. In the group with functional improvement without change of WA. For the 3 experiences (two patients) with unfavorable results, the area under the curve changed by + 2.3%, -10.2% and − 9.5%. The measurement of the semiogram area weighted by average speed demonstrated very good reproducibility (ICC(1, 3) = 0.80).DiscussionIMUs appear to be a promising solution for the assessment of post-stroke hemiplegic patients who have undergone SEVF surgery. They can provide a quantified, objective, reliable in individual longitudinal follow up automated gait analysis solution for routine clinical use. Combined with a functional scale such as the GAS, they can provide a global analysis of the effect of surgery.

Electrophysiological evidence of dry needling efficacy on spasticity in poststroke patients: A randomized control trial

Abstract: CONTEXT: Therapists use dry needling (DN) to treat myofascial trigger points and various pain conditions. Need for study: A gap analysis showed that more information about how DN works on spastic muscles through alpha motor neurofiring and what role it plays in clinical and functional outcomes. Currently, the objective evidence for the usefulness of DN in neurological diseases is required. AIMS: The purpose of this research was to examine how DN affects spasticity in stroke patients using the H reflex and a Modified Tardieu Scale (MTS). SETTINGS AND DESIGN: We conducted a randomized controlled trial. We randomly assigned 81 stroke survivors to one of two groups: one group underwent six sessions of DN over the muscles with conventional treatment, whereas the other group received conventional care. We assessed spasticity using the H reflex and the MTS. We analyzed all outcome measures before, after, and 2 weeks later names as H1, H2, H3 and T1, T2, and T2 receptivity. RESULTS: After the intervention, people who received DN had improvement in spasticity. H3-H1 is statistically significant (P = 0.42) in the experimental group against the control group. T3-T1 and T2-T3 are statistically significant (P = 0.00) in the experimental group compared to the control group. CONCLUSIONS: The DN is effective for lowering spastic muscle tone and local muscle stiffness. This could be because DN diminishes the nodular zone of spastic muscle and reduces the firing of alpha motor neurons. These findings are very promising in terms of lowering spasticity.

Efficacy of manual lymphatic drainage combined with repetitive transcranial magnetic stimulation in post-stroke complex regional pain syndrome: a pilot study

Purpose The aim of this study was to investigate the efficacy of manual lymphatic drainage (MLD) combined with repetitive transcranial magnetic stimulation (rTMS) on the recovery of upper limb in patients with post-stroke complex regional pain syndrome (CRPS). Methods This pilot study was conducted with 54 patients with post-stroke CRPS. Patients were randomized into three groups: the MLD combined with rTMS group (MLD + rTMS group), the rTMS group and the sham-rTMS group. The results of numeric rating scale (NRS), volumetric measurement, Fugl-Meyer assessment of upper extremity (FMA-UE), CRPS severity score (CSS), generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) before and after the intervention were analyzed. Results Fifty-four participants (37 males, 17 females; mean age 66.11 ± 8.43 years; range, 18 to 85) were included in the study. Among groups, improvements were statistically significant with superiority of rTMS + MLD group after treatment (p < 0.05). NRS, GAD-7, and PHQ-9 in the rTMS + MLD group improved more significantly than those in the rTMS group (p < 0.05). Conclusion MLD combined with rTMS has an add-on efficacy on the basis of rTMS therapy in post-stroke patients, especially in pain. MLD could also have an effect on anxiety and depression.

THE EFFECT OF THE REHABILITATION AND PHYSICAL THERAPY PROGRAM ON THE FUNCTIONAL STATUS OF POST-STROKE PATIENTS

The article examines the impact of a physical rehabilitation program on the functional state of the musculoskeletal system in elderly patients who have suffered an intracerebral stroke and are in the conditions of a neurorehabilitation center in the early post-stroke period. Before the implementation of the program, post-stroke patients have pronounced walking disorders and a pronounced dependence on external assistance. The aim of the articale is to reveal the effectiveness of the physical rehabilitation program for post-stroke patients in the early recovery period. Results. Features of hemodynamic adaptation in post-stroke patients in the conditions of the rehabilitation center were revealed. Conclusion. As a result of the research, it was found that post-stroke patients had concomitant diseases: chronic heart failure and arterial hypertension in all studied patients, diabetes – in 20% of patients. All these conditions were taken into account during the selection of optimal means of the program physical rehabilitation. After completing the program, patients became more independent and needed less daily assistance, and also mastered such a vital and necessary skill as walking. This is confirmed by tests of functional status (Bartel index, Rivermead) and assessment of independent walking (Hauser walking index). The level of disability according to the Rankin scale decreased by 20%, the Rivermead mobility index increased by 50.6%, the Barthel index of daily activity increased by 13.5%, the Hauser walking index increased by 31.8%, the range of motion in the joints of the limbs also increased, the level of spasticity according to the modified Ashworth scale decreased by 22.5% in the in the upper and lower extremities, the strength according to the MRCS scale increased, in the extremities by 20%. Thus, after completing the rehabilitation program, all patients observed a increase in paretic muscle strength, decreased muscle spasticity tone, and improved range of motion in the joints. Implementation of the physical rehabilitation program resulted in a significant increase in MRCS muscle strength in the limbs by 20% (p &lt; 0.01). After completing the program, patients became more independent and needed less daily assistance, as well as mastered such a vital and necessary skill as walking. This is confirmed by tests of functional status (Bartel index, Rivermead) and assessment of independent walking (Hauser walking index). The level of disability according to the Rankin scale decreased by 20%, the Rivermead mobility index increased by 50.6%, the Barthel daily activity index increased by 13.5%, the Hauser walking index increased by 31.8%, the range of motion in the joints of the upper and of the lower limbs also increased, the level of spasticity according to the modified Ashworth scale decreased by 22.5% in the upper limb and by 20% in the upper and of the lower limbs, the strength according to the MRCS scale increased, in the limbs by 20%. Patients were able to move with little resistance. The effect of the rehabilitation program and physical therapy is evident in the increase in paretic muscle strength, reduction in spasticity, and increase in joint range of motion. Most patients regained the ability to walk, which contributed to increasing their level of independence. In general, the research results obtained after the implementation of the selected means of physical rehabilitation indicate the effectiveness of such a program.

РЕАБИЛИТАЦИОННАЯ РОЛЬ ПАТОЛОГИЧЕСКИХ РЕФЛЕКСОВ

In most post-stroke patients, an increase in muscle tone on the hemiplegic side is accompanied by a revival of tendon reflexes and an expansion of their reflexogenic zone, as well as the appearance of specific abnormal reflexes. All these signs have long been considered when diagnosing damage to the pyramidal system in diseases of the spinal cord and brain, but their rehabilitation significance has not yet been considered. Based on literature data, the clinical and neurophysiological characteristics of known abnormal reflexes were assessed. It is concluded that it is possible to use lively tendon reflexes, as well as tonic reflexes of the foot and hand (Babinsky and its analogues, Mayer's, Klippel – Feil, Larry`s reflexes) in rehabilitation practice. The role of phasic abnormal hand and foot reflexes (Rossolimo's sign and its analogues) in the rehabilitation process is considered insignificant due to their short duration.

A greedy assist-as-needed controller for end-effect upper limb rehabilitation robot based on 3-DOF potential field constraints.

It has been proven that robot-assisted rehabilitation training can effectively promote the recovery of upper-limb motor function in post-stroke patients. Increasing patients' active participation by providing assist-as-needed (AAN) control strategies is key to the effectiveness of robot-assisted rehabilitation training. In this paper, a greedy assist-as-needed (GAAN) controller based on radial basis function (RBF) network combined with 3 degrees of freedom (3-DOF) potential constraints was proposed to provide AAN interactive forces of an end-effect upper limb rehabilitation robot. The proposed 3-DOF potential fields were adopted to constrain the tangential motions of three kinds of typical target trajectories (one-dimensional (1D) lines, two-dimensional (2D) curves and three-dimensional (3D) spirals) while the GAAN controller was designed to estimate the motor capability of a subject and provide appropriate robot-assisted forces. The co-simulation (Adams-Matlab/Simulink) experiments and behavioral experiments on 10 healthy volunteers were conducted to validate the utility of the GAAN controller. The experimental results demonstrated that the GAAN controller combined with 3-DOF potential field constraints enabled the subjects to actively participate in kinds of tracking tasks while keeping acceptable tracking accuracies. 3D spirals could be better in stimulating subjects' active participation when compared to 1D and 2D target trajectories. The current GAAN controller has the potential to be applied to existing commercial upper limb rehabilitation robots.

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 (GA) 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.

Gait speed after mild stroke/transient ischemic attack was associated with long-term adverse outcomes: A cohort study.

The association between gait speed and adverse outcomes after stroke has not been fully illustrated. This study aimed to explore the association of gait speed on long-term outcomes in minor stroke or transient ischemic attack (TIA). We performed a longitudinal study with acute minor stroke or TIA based on a subgroup of the Third China National Stroke Registry data. The gait speed was evaluated using a 10-meter walking test at discharge and 3 months after the stroke onset. The primary outcomes were poor functional outcomes at 1 year, defined by a modified Rankin Score (mRS) of 2-6. Additional outcomes included all-cause death, ambulate dependency (mRS score 4-6), cognitive impairment (Montreal Cognitive Assessment <26), stroke recurrence, and composite vascular events. The study sample included a total of 1542 stroke patients with a median age of 60 (53-68). At 1-year follow-up, 140 (9.20%) patients experienced poor functional outcomes. Faster gait speed at discharge was associated with lower incidence of poor functional outcome (OR = 0.89; 95% CI, 0.84-0.94), cognitive impairment (OR = 0.93; 95% CI, 0.89-0.96), ischemic stroke recurrence (HR = 0.92; 95% CI, 0.87-0.98), and composite vascular events (HR =0.94; 95% CI, 0.89-0.99) at 1 year. Faster gait speed at 3 months was associated with lower incidence of poor functional outcome (OR = 0.90; 95% CI, 0.85-0.95), ambulate dependency (OR = 0.86; 95% CI, 0.77-0.97), and cognitive impairment (OR = 0.92; 95% CI, 0.88-0.95) at 1 year. Our findings indicated that slow gait speed after minor stroke or TIA may be an independent predictor for long-term poor outcomes. Gait speed may be considered as a vital sign during follow-up in post-stroke patients.

Effectiveness Of Visual Feedback Balance Training On Equiboard Versus Traditional Balance Training In Post Stroke Patients- A Comparative Study

Background: A Stroke is classically characterized as a neurological deficit attributed to an acute focal injury of the central nervous system by a vascular cause and is a major cause of disability and death worldwide.(1) Balance problems are thought to be common after stroke and they have been implicated in the poor recovery of activities of daily living and mobility and increased risk of falls.(2) Postural sway for patients with hemiplegia can be twice that of their age matched peers. Many balance training are used but No general physiotherapy approach has proven to be superior for promoting balance recovery from stroke.(3)Novel biofeedback devices based on Virtual reality (VR)technology are now being used for neuromotor rehabilitation. Traditional balance training is based on the automatic repetition of specific movements. These methods can become repetitive and thus reduce the motivation of the patient and adherence to treatment. So the need of my study is to compare the effectiveness of visual feedback balance training on equiboard and traditional balance training in post stroke patients. Aims and objectives-To study and compare the effectiveness of visual feedback balance training on equiboard versus traditional balance training in post stroke patients. Methodology- 30 patients with stroke were equally divided into two groups. patients in group A received the conventional physiotherapy while the patients in group B received visual feedback balance training on equiboard. All the subjects were treated for 1 month, 5 days a week. BBS-Berg Balance Scale and step test was used as the outcome measure at the beginning and end of study. Results-Results showed significant improvement within both the groups for both the outcome measure(p,0.05), while there was no significant difference between two groups in BBS(p&gt;0.5), but there was significant difference in the step test of experimental group(p&lt;0.5) Conclusion-It can be concluded that visual feedback balance training is more effective than the traditional balance training alone in stroke patients.

Time-course for acquiring transfer independence in patients with subacute stroke: a prospective cohort study.

To clarify the time-course of longitudinal changes in the independence level of subtasks composing bed-wheelchair transfer among patients with stroke. Single-institution prospective cohort study. A total of 137 consecutive post-stroke patients using wheelchair on admission to the subacute rehabilitation wards. The independence degree in each of the 25transfer-related subtasks was assessed using the Bed-Wheelchair Transfer Tasks Assessment Form on a three-level scale every two weeks, from admission to the endpoint (either discharge or when achieving independent transfer). Patients were classified based on admission and endpoint assessment form scores using two-step cluster analysis. Patients were classified into three clusters. The first cluster included 50 patients who exhibited a greater independence level in all subtasks on admission (52.0-100% of patients performed each subtask independently) and at the endpoint (64.0-100%). The second included 30 patients who showed less independence on admission (0-27.8%) but achieved greater independence levels at the endpoint (44.4-97.2%). The third included 51 patients whose independence level remained low in many subtasks from admission (0-5.8%) until the endpoint (0-29.4%). The independence level and its changing process during transfer were categorized into three time-courses, each requiring different intervention strategies.

The role of artificial intelligence in optimizing management of atrial fibrillation in acute ischemic stroke.

Atrial fibrillation (AF) is a severe condition associated with high morbidity and mortality, including an increased risk of stroke and poor outcomes poststroke. Our understanding of the prognosis in AF remains poor. Machine learning (ML) has been applied to the diagnosis, management, and prognosis of AF in the context of stroke but remains suboptimal for clinical use. This article endeavors to provide a comprehensive overview of current ML applications to AF patients at risk of stroke, as well as poststroke patients without AF. Strategies to develop effective ML involve the validation of a variety of ML algorithms across internal and external datasets as well as exploring their predictive powers in hypothetical and realistic settings. Recent literature of this rapidly evolving field has displayed much promise. However, further testing and innovation of medical artificial intelligence are required before its imminent introduction to ensure complete patient trust within the community. Prioritizing this research is imperative for advancing the optimization of ongoing care for AF patients, as well as the management of stroke patients with AF.

Factors Predicting the Ability to Perform Activities of Daily Living among Stroke Patients in Rural Community Southern Thailand.

The aim of this study was to explore the factors associated with the ability to perform activities of daily living (ADL) among post-stroke patients participating in outpatient physical rehabilitation programmes in community hospital in southern Thailand. In this cross-sectional study, data were collected from 258 patients diagnosed with stroke through the HOSxP programme from 2018 to 2022. Patients' ADL were assessed using the Barthel Index measurement. Characteristics were described by percentages and medians (IOR). Associations of categorical variables were examined using the chi-squared test, and multiple logistic regressions were employed to identify factors predicting Barthel Index scores among stroke patients. Patients' capacity levels were categorised based on Barthel Index scores and rehabilitation criteria, and unadjusted and adjusted odds ratios (OR/AOR) were presented, with a significance level of 0.05. Of the 258 stroke patients, 59.30% were male, with a median age of 67 years old. Significant differences in Barthel Index scores were found with respect to gender, age, marital status, comorbidities and duration of rehabilitation (P < 0.05). Binary logistic regression analysis indicated that male stroke patients (AOR = 1.89; 95% confidence interval [CI]: 1.10, 3.26), individuals with single marital status (AOR = 4.62; 95% CI: 1.58, 13.49), absence of comorbidities (AOR = 0.53; 95% CI: 0.29, 0.98), and rehabilitation duration of less than five days (AOR = 4.38; 95% CI: 2.14, 8.96) were more likely to achieve independence in ADL with higher Barthel Index scores (P < 0.05). Several factors contribute to the effective planning of care and rehabilitation for stroke patients in rural area. Stroke rehabilitation programmes in this region should consider various elements, including patient characteristics, family involvement and clinical factors, to improve ADL performance.

Assessment of Motor Imagery and Its Relationship to Functional Impairment in Post-Stroke Patients: A Descriptive Cross-Sectional Study.

Background: Motor and cognitive sequelae are common in patients who have experienced a stroke. Recent advances in neuroscience have enabled the development of novel therapeutic approaches, such as motor imagery, which facilitate motor learning. The objective of this study is to examine the relationship between implicit and explicit motor imagery abilities and their correlation with functional impairment in post-stroke patients. Methods: A descriptive cross-sectional study was conducted with 36 patients who had experienced a stroke between March 2008 and March 2023. The capacity to generate both implicit and explicit motor imagery and to perform physical functions was evaluated. The relationship between implicit and explicit motor imagery measures was investigated using Pearson's correlation coefficient. The factorial structure, which encompasses the capacity to generate motor imagery, whether implicit or explicit, and physical function, was subjected to analysis. Results: A correlation was identified between the time taken to identify images and the accuracy of this process, with the right hand (R = 0.474), the left hand (R = 0.568), and the left foot (R = 0.344) all demonstrating significant associations. Additionally, a notable correlation was observed between the two subscales of the KVIQ-10 scale (R = 0.749). No association was identified between the capacity to generate implicit and explicit motor imagery. Two- and three-factor solutions were obtained for the right and left hemibodies, respectively. On both sides, accuracy in identifying images and physical function constituted a single factor, while time to generate images for both hands and feet constituted a second factor. Conclusions: In conclusion, no significant data were reported regarding the association between the capacity to generate implicit and explicit motor imagery in the studied sample. However, the ability to generate implicit motor imagery was related to physical function, suggesting that it may serve as a screening criterion for implementing specific therapeutic approaches in post-stroke patients.

A Systematic Search and Review of Registered Pharmacological Therapies Investigated to Improve Outcomes after a Stroke

Introduction: Stroke burden is largely due to long-term impairments requiring prolonged care and loss of productivity. We aim to identify and assess studies of different registered pharmacological therapies as treatments for improving post-stroke impairments and/or disabilities. Methods: In a systematic search and review (PROSPERO registration: CRD42022376973), studies of treatments that have been investigated as recovery-enhancing or recovery-promoting treatments in adult patients who had suffered a stroke will be searched for, screened, and reviewed based on the following: participants (P): adult humans, aged 18 years or older, diagnosed with stroke; interventions (I): registered or marketed pharmacological therapies that have been investigated as recovery-enhancing or recovery-promoting treatments in stroke; comparators (C): active or placebo or no comparator; outcomes (O): stroke-related neurological impairments and functional/disability assessments. Data will be extracted from included papers, including patient demographics, study methods, keystroke inclusion criteria, details of intervention and control, and the reported outcomes. Result: “The best available studies” based on study design, study size, and/or date of publication for different therapies and stroke subtypes will be selected and graded for level of evidence by consensus. Conclusion: There are conflicting study results of pharmacological interventions after an acute stroke to enhance recovery. This systematic search and review will identify the best evidence and knowledge gaps in the pharmacological treatment of post-stroke patients as well as guide clinical decision-making and planning of future studies.

Relationship between Family Support and Quality of Life in Stroke Patients

Stroke is a disease of the brain in the form of impaired local nerve function that appears suddenly, progressively, and quickly. Family support is very influential on stroke patients, because family support is very instrumental in a form of assistance provided by family members to provide physical and psychological comfort when someone experiences illness and provides social support. This article review aims to determine the relationship between family support and quality of life in stroke patients. This study used the literature review method with the Preferred Reporting Items for Systematic Reviews &amp; Meta-Analyses (PRISMA) protocol. Scientific articles or journals were downloaded from PubMed, Garuda Portal, and Google Scholar with SINTA IV and V standards within 2020-2024. In this literature, it was found that family support is an aspect that plays an important role in the quality of life of stroke patients. Family support itself includes emotional support, appreciation support, instrumental support and information support. The family is the closest person who always interacts with post-stroke patients, so the role of the family is very important in an effort to provide various supports that create a sense of security for patients.