Post-stroke Recovery Research Articles

Post-Stroke Recovery in Relation to Parvalbumin-Positive Interneurons and Perineuronal Nets.

There is a critical time window of post-stroke neuroplasticity when spontaneous behavioral recovery occurs. Potential factors responsible for this heightened plasticity are the reduction of parvalbumin-immunoreactive (PV+) interneuron inhibitory signaling and the disappearance of extracellular matrix synaptic stabilizers called perineuronal net(s; PNN/PNNs). This study investigated whether behavioral recovery during this critical period following stroke is associated with changes in densities of PV+ interneurons and PNNs. Male, Sprague-Dawley rats received forelimb motor cortex stroke (n = 43) using endothelin-1, or vehicle injections (n = 44). Cohorts of rats underwent a battery of motor tests and were sacrificed within the post-stroke critical window on day 1, and 1, 2, 4, and 6 weeks. Using immunofluorescent labeling, PNNs (wisteria floribunda agglutinin; WFA+ cells), PV+ interneurons, and cells expressing both PV and PNNs were quantified in contra- and ipsilesional cortices to elucidate their spatial-temporal profiles following stroke. PV+ interneuron density decreased significantly at 1-day post-stroke in the lateral ipsilesional cortex, while the density of PNNs was significantly lower up to 4 weeks post-stroke in the lateral ipsilesional cortex and at 1 and 2 weeks post-stroke in the medial ipsilesional cortex. Reduction of combined PV+/PNN signaling coincided with spontaneous behavioral recovery. These results suggest that post-stroke behavioral recovery corresponds to an early reduction in PV+/PNN co-labeled cells in conjunction with an early temporally-dependent reduction in PV+ interneuron signaling and chronic disappearance of PNNs. Interventions targeting PNNs or PV+ interneuron signaling have significant potential for extending the critical window of recovery following stroke.

The impact of reduced skeletal muscle mass at stroke onset on 3-month functional outcomes in acute ischemic stroke patients.

Sarcopenia, characterized by reduced skeletal muscle mass (RMM), is increasingly recognized as a significant factor influencing outcomes in various health conditions, including stroke. Although most studies focus on sarcopenia developing during stroke rehabilitation, the impact of sarcopenia present at the onset of acute ischemic stroke remains underexplored. This study aims to evaluate the effect of RMM at stroke onset on 3-month functional outcomes in acute ischemic stroke patients. We prospectively enrolled acute ischemic stroke patients admitted between May 2019 and December 2019. Muscle mass was accessed early during hospitalization using whole-body dual-energy X-ray absorptiometry (DXA), and patients were categorized into RMM and normal muscle mass (NMM) groups based on the Asian Working Group for Sarcopenia (AWGS) criteria. Functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS), with unfavorable outcomes defined as mRS scores 2-5. Multivariable logistic regression and SHAP (Shapley Additive exPlanations) analyses were used to evaluate the independent impact of RMM on 3-months functional outcomes. A total of 99 patients were analyzed. The RMM group had a significantly higher prevalence of unfavorable outcomes at 3 months compared to the NMM group (p < 0.001). Patients with RMM were older and presented with more severe strokes. Multivariable analysis confirmed RMM as an independent predictor of unfavorable outcomes (adjusted OR: 8.07, 95% CI: 1.603-40.66, p = 0.011), even after adjusting for age and initial stroke severity. SHAP analysis ranked RMM as the second most influential predictor of unfavorable outcomes, following NIHSS on admission. These findings indicate that RMM not only worsens initial stroke severity but also independently hinders post-stroke recovery. Reduced muscle mass at the onset of acute ischemic stroke is a significant, independent predictor of unfavorable outcomes at 3 months. In addition to its impact on recovery, RMM is linked to older age and more severe strokes, worsening prognosis. Maintaining muscle mass is also crucial for stroke prevention, as it supports cardiovascular health and resilience. Early identification and intervention for sarcopenia can improve recovery and reduce future stroke risk.

Resting-State Cortico-Cerebellar Connectivity Correlates with Post-Stroke Motor Recovery - A Prospective Functional MRI Study.

Cerebellar functional and structural connectivity are likely related to motor function after stroke. Less is known about motor recovery, which is defined as a gain of function between two time points, and about the involvement of the cerebellum. Fifteen patients who were hospitalized between 2018 and 2020 for a first cerebral ischemic event with persistent upper limb deficits were assessed by resting-state functional MRI (rsfMRI) and clinical motor score measurements at 3, 9 and 15 weeks after stroke. Age- and sex-matched healthy subjects (n = 15) were assessed once. The objectives were (1) to study whether the level of connectivity between the contralesional cerebellum (lobules IV-V-VI and lobule VIII) and the ipsilesional motor regions on rsfMRI is predictive of motor recovery and (2) to compare these connectivities with those of healthy subjects. Upper limb motor recovery was positively correlated with functional connectivity between contralesional cerebellar lobule VIII and the ipsilesional supplementary motor area (SMA). The greater the connectivity between these regions, the better the motor recovery. In patients, the corticocerebellar network between lobule IV-V-VI and the ipsilesional M1 and SMA showed weaker synchronization at rest than in healthy subjects. Cortico-cortical connectivity was not associated with recovery. Resting-state functional connectivity, including contralesional cerebellar lobule VIII, could be a tool for studying and predicting recovery in stroke patients. Our study highlights the role of the cerebellum in motor recovery after stroke, enabling us to consider new therapeutic targets in neuromodulation.

Early changes in spatiotemporal dynamics of remapped circuits and global networks predict functional recovery after stroke in mice.

Stroke is the leading cause of chronic disability in the United States. How stroke size affects post-stroke repair and recovery is poorly understood. We aim to investigate the effects of stroke size on early repair patterns and determine how early changes in neuronal circuits and networks predict functional outcomes after stroke. We used wide-field optical imaging, photothrombosis, and the cylinder-rearing assay to examine changes in neuronal circuit and network activity in the context of functional recovery after stroke. Larger strokes ablating caused diffuse and widespread forepaw stimulus-evoked cortical activation, including contralesional regions evolving within 4 weeks post-stroke; smaller strokes resulted in more focused ipsilesional activation. Larger strokes decreased neuronal fidelity and bilateral coherence during stimulation of either the affected or unaffected forepaw within this 4-week period. Mice in the larger lesion group demonstrated hyperconnectivity within the contralesional hemisphere at the resting state. Greater degrees of remapping diffusivity, neuronal fidelity degradation, and hyperconnectivity predicted worse 8-week recovery after statistically controlling for the effect of infarct size. These results suggest that diffuse patterns of remapping, and desynchronization and hyperconnectivity of cortical networks, evolving early after stroke may reflect maladaptive plasticity, predicting poor long-term functional recovery.

Cerebellar activity and functional connectivity in subacute subcortical aphasia: Association with language recovery

Loss of language function (aphasia) is a common complication after stroke, and post-stroke recovery remains highly unpredictable due to the absence of reliable neurobiomarkers. Growing evidence points to involvement of the cerebellum in language processing; however, it is unclear if abnormal cerebellar activity and altered functional connectivity (FC) to language-related regions of cerebral cortex are underlying neural mechanisms for subcortical aphasia. In this longitudinal observational study, we used resting-state functional magnetic resonance imaging to examine potential abnormalities in spontaneous cerebellar activity and resting-state (rs)FC with language networks among post-stroke patients with subacute subcortical aphasia (n = 19) compared to healthy controls (HCs, n = 18).In addition, correlations between rsFC variables and language performance metrics were examined at post-stroke baseline and at follow-up. Compared to HCs, patients with subacute subcortical aphasia exhibited significantly reduced fractional amplitude of low frequency fluctuations, a measure of spontaneous activity, in the right cerebellar Crus II (rCrus II) region and reduced rsFC between rCrus II and left inferior frontal gyrus (LIFG), left angular gyrus (LAG), and left middle temporal gyrus (LMTG). Both rCrus II–LAG and rCrus II–LMTG rsFC values were positively correlated with Aphasia Battery of Chinese scores at baseline. Baseline rCrus II–LIFG rsFC was also positively correlated with spontaneous speech and naming scores at follow-up. A stronger baseline rCrus II–LIFG rsFC predicted superior recovery of language function post-stroke. We conclude that the right cerebellum may be an effective therapeutic target for subcortical aphasia.

Robotic solutions for post-stroke recovery – literature review

Robotic solutions for post-stroke recovery – literature review

Rehabilitation With Bridging Exercise In Stroke Patients: Systematic Review

Background: Stroke is a neurological disease that can result in weakness in part or all of the body, emphasizing the importance of early mobilization in post-stroke recovery. One of the fundamental physical exercises recommended is the bridging exercise. This article evaluates the impact of bridging exercises on stroke patients through a systematic review approach, focusing on their potential to improve rehabilitation outcomes. Methods: The methodology involved a systematic review of studies from 2020 to 2024, using journal databases such as Google Scholar, Science Direct, and PubMed. Keywords like "Bridging exercise," "Stroke," "Stroke patients," "Rehabilitation," "Muscle strength," and "Body balance" guided the search. Articles included in the review were in English and selected based on PRISMA guidelines, resulting in seven eligible studies for analysis. Results: The results of this review highlight that bridging exercises significantly improve muscle strength and body balance among stroke patients. The exercises demonstrated a positive influence on patients' rehabilitation progress, contributing to better physical and functional health outcomes. Conclusion: In conclusion, bridging exercises serve as an effective intervention in stroke rehabilitation, promoting early mobilization and improving post-stroke recovery. Encouraging stroke patients to incorporate these exercises into their rehabilitation routines could enhance overall health and functional capabilities.

Stroke survivor and caregiver experiences of virtual reality gaming to promote social participation: A qualitative study.

Virtual reality (VR) gaming is a promising technology that can be applied in stroke rehabilitation to increase survivors' social engagement, though its optimal usage and effects on stroke recovery are not fully understood. This qualitative study aimed to investigate stroke survivors' and caregivers' perspectives of VR-based gaming rehabilitation modules for supporting post-stroke recovery and social participation. Twenty-eight participants (18 stroke survivors and 10 caregivers) were recruited through purposive sampling from acute hospitals in Hong Kong. Two rounds of semi-structured interviews were carried out, with the first round exploring participants' previous knowledge of VR, views about its relevance to stroke rehabilitation, and expected benefits. The second round of interviews was conducted immediately post-intervention to investigate participants' experience, satisfaction, and areas for improvement. Resulting data were thematically analysed. Most participants were female (75%) with secondary education or above (82%). For stroke survivors, the average duration since stroke was 9.39 (SD = 10.48) years and most were first-time survivors (89%). Main themes identified included (1) Shift in attitudes towards VR technology; (2) Perceptions of VR effectiveness; and (3) Practical drawbacks and design recommendations. Participants reported positive experiences with the VR-based gaming modules, including increased confidence in mobility and heightened awareness regarding outdoor safety and accessibility. Despite concerns regarding hygiene and discomfort with gaming equipment, participants found VR gaming to be engaging and conducive to their recovery. The VR-based gaming modules were well-received by survivors and their caregivers and considered as an appealing and useful method of post-stroke rehabilitation. Improvements in survivors' attitudes towards VR technology, and self-observed benefits to their physical and psychosocial health, were noted. Areas for optimisation included expansion of game length and contents, options for alternative gaming equipment, and enhanced design elements.

Dual role of vascular endothelial growth factor-C in post-stroke recovery.

Cerebrospinal fluid (CSF), antigens, and antigen-presenting cells drain from the central nervous system (CNS) into lymphatic vessels near the cribriform plate and dura, yet the role of these vessels during stroke is unclear. Using a mouse model of ischemic stroke, transient middle cerebral artery occlusion (tMCAO), we demonstrate stroke-induced lymphangiogenesis near the cribriform plate, peaking at day 7 and regressing by day 14. Lymphangiogenesis is restricted to the cribriform plate and deep cervical lymph nodes and is regulated by VEGF-C/VEGFR-3 signaling. The use of a VEGFR-3 inhibitor prevented lymphangiogenesis and led to improved stroke outcomes at earlier time points, with no effects at later time points. VEGF-C delivery after tMCAO did not further increase post-stroke lymphangiogenesis, but instead induced larger brain infarcts. Our data support the damaging role of VEGF-C acutely and a pro-angiogenic role chronically. This nuanced understanding of VEGFR-3 and VEGF-C in stroke pathology advises caution regarding therapeutic VEGF-C use in stroke.

Predictive Markers of Post-Stroke Cognitive Recovery and Depression in Ischemic Stroke Patients: A 6-Month Longitudinal Study.

The growing number of stroke survivors face physical, cognitive, and psychosocial impairments, making stroke a significant contributor to global disability. Various factors have been identified as key predictors of post-stroke outcomes. The aim of this study was to develop a standardized predictive model that integrates various demographic and clinical factors to better predict post-stroke cognitive recovery and depression in patients with ischemic stroke (IS). We included IS patients during both the acute phase and six months post-stroke and considered neuropsychological measures (screening scales, individual tests, functional cognitive scales), stroke severity and laterality, as well as functional disability measures. The study identified several key predictors of post-stroke cognitive recovery and depression in IS patients. Higher education and younger age were associated with better cognitive recovery. Lower stroke severity, indicated by lower National Institutes of Health Stroke Scale (NIHSS) scores, also contributed to better cognitive outcomes. Patients with lower modified Rankin Scale (mRS) scores showed improved performance on cognitive tests and lower post-stroke depression scores. The study concluded that age, education, stroke severity and functional status are the most critical predictors of cognitive recovery and post-stroke emotional status in IS patients. Tailoring rehabilitation strategies based on these predictive markers can significantly improve patient outcomes.

Haptic Technology: Exploring Its Underexplored Clinical Applications-A Systematic Review.

Haptic technology has transformed interactions between humans and both tangible and virtual environments. Despite its widespread adoption across various industries, the potential therapeutic applications of this technology have yet to be fully explored. A systematic review of randomized controlled trials (RCTs) and randomized crossover trials was conducted, utilizing databases such as PubMed, Embase, Cochrane Library, and Web of Science. This review included studies reporting clinical applications of haptic technology in rehabilitation, cognition, wellness, and mental health among adult subjects. This systematic review included 34 studies, of which 20 focused on clinical outcomes and 14 on learning clinical skills. The results showed that haptic devices, both robotic and non-robotic, enhance sensorimotor performance and motor function in rehabilitation settings, especially in post-stroke recovery, with reported effect sizes ranging from 0.2 to 0.7. The majority of the haptic technologies reported were integrated into robotic systems (40%). Haptic devices were also reported to improve clinical skills training by providing tactile feedback that enhances procedural performance and trainee self-efficacy. In fact, surgical simulations accounted for 79% of all the modalities used for medical training. This review underscores the potential yet underexplored applications of haptic technology in healthcare, including medical education, rehabilitation, cognition, and mental health. The key limitations of this review include heterogeneity across studies, small sample sizes, and a scarcity of comprehensive, long-term investigations. Therefore, future research should aim to validate these findings further and expand the applications of haptic technology to maximize its utility in the healthcare industry and clinical practice.

Deep brain stimulation combined with morroniside promotes neural plasticity and motor functional recovery after ischemic stroke.

Until now, there has been an unmet need for treatments promoting chronic-phase post-stroke functional recovery. We previously found that morroniside promoted endogenous neurogenesis in ischemic stroke, but its therapeutic window was limited to the first 48h. Here, we aimed to explore whether deep brain stimulation (DBS) combined with morroniside could enhance neurogenesis in rats subjected to focal ischemic stroke and contributes to functional recovery. Beginning 2weeks after the endothelin-1-induced stroke, rats were administered DBS of lateral cerebellar nucleus consecutively for 14days, followed by morroniside for 7 consecutive days post-stimulation. Behavioral tests were used for assessing motor function. Local field potentials were recorded to evaluate neuronal excitability. Nissl staining was used to assess infarct volume. Immunofluorescence staining and Western blotting were carried out to uncover the stroke recovery mechanisms of DBS combined with morroniside treatment. The results showed that this combined treatment improved behavioral outcomes, enhanced cortical local field potentials, and diminished infarct volumes at 35days post-stroke. Moreover, it notably amplified neurogenic responses post-stroke, evidenced by the proliferation of BrdU/SOX2 and BrdU/DCX in the subventricular zone, and their subsequent differentiation into BrdU/NeuN and BrdU/VgulT1 in the ischemic penumbra. Moreover, the combined treatment also elevated the amount of BrdU/Olig2 and the level of axonal sprouting-related proteins in the perilesional cortex. Our results demonstrated that the combined treatment extended the neurorestorative efficacy of morroniside, reduced infarct size, enhanced neuronal excitability and accelerated sensorimotor function recovery. This therapeutic approach may emerge as a potential clinical intervention for chronic ischemic stroke.

Evaluating the Efficacy of Artificial Intelligence Using Machine Learning Models in Predicting Functional Recovery Post-Stroke

Abstract Background: Stroke is a significant health problem in India, with an uneven prevalence and high early mortality rates. Worldwide, stroke is the second leading cause of death. In the initial months post-stroke, motor impairment is a primary concern, in addition to various other deficits. Predicting recovery after a stroke is crucial for optimizing resource allocation. Utilizing machine learning offers the potential to enhance therapeutic decision-making and predict individual recovery outcomes in stroke rehabilitation. Objectives: We aimed to employ machine learning algorithms to predict functional recovery after stroke by estimating Barthel Index scores, identifying patterns and correlations within the dataset, and determining the most effective machine learning model among the five algorithms that were tested. Materials and Methods: Participants were screened for eligibility before enrollment, and demographic information, stroke characteristics, and Barthel Index scores were recorded. The dataset was split into training and testing subsets for analysis. Five machine learning algorithms were trained using the initial dataset to develop predictive models. Results: High alcohol and tobacco use potentially influenced Barthel Index scores and stroke recovery. The recovery process varied based on stroke type, with ischemic and hemorrhagic strokes. The Random Forest model exhibited the highest predictive accuracy among the models. Conclusion: The study highlights the role of demographics, lifestyle habits, comorbidities, and stroke type in functional recovery poststroke. The Random Forest model demonstrated the most reliable predictive capability, indicating artificial intelligence’s potential in stroke recovery prediction. Furthermore, research studies are needed to develop and evaluate robust prediction models.

Brain and muscle derived features to discriminate simple hand motor tasks for a rehabilitative BCI: comparative study on healthy and post-stroke individuals

Objective.Brain-Computer Interfaces targeting post-stroke recovery of the upper limb employ mainly electroencephalography to decode movement-related brain activation. Recently hybrid systems including muscular activity were introduced. We compared the motor task discrimination abilities of three different features, namely event-related desynchronization/synchronization (ERD/ERS) and movement-related cortical potential (MRCP) as brain-derived features and cortico-muscular coherence (CMC) as a hybrid brain-muscle derived feature, elicited in 13 healthy subjects and 13 stroke patients during the execution/attempt of two simple hand motor tasks (finger extension and grasping) commonly employed in upper limb rehabilitation protocols.Approach. We employed a three-way statistical design to investigate whether their ability to discriminate the two movements follows a specific temporal evolution along the movement execution and is eventually different among the three features and between the two groups. We also investigated the differences in performance at the single-subject level.Main results. The ERD/ERS and the CMC-based classification showed similar temporal evolutions of the performance with a significant increase in accuracy during the execution phase while MRCP-based accuracy peaked at movement onset. Such temporal dynamics were similar but slower in stroke patients when the movements were attempted with the affected hand (AH). Moreover, CMC outperformed the two brain features in healthy subjects and stroke patients when performing the task with their unaffected hand, whereas a higher variability across subjects was observed in patients performing the tasks with their AH. Interestingly, brain features performed better in this latter condition with respect to healthy subjects.Significance.Our results provide hints to improve the design of Brain-Computer Interfaces for post-stroke rehabilitation, emphasizing the need for personalized approaches tailored to patients' characteristics and to the intended rehabilitative target.

The Effectiveness of Physical Exercise in Stroke Patient Recovery: A Systematic Review

Background: Stroke is a leading cause of disability worldwide, significantly affecting motor function, mobility, and patients’ quality of life. Physical exercise is often recommended as part of rehabilitation programs to enhance recovery after a stroke. Objective: This study aims to systematically review the literature on the effectiveness of physical exercise in accelerating post-stroke recovery, particularly in improving motor function, mobility, and independence. Methods: A systematic search was conducted across electronic databases such as PubMed, Scopus, and ScienceDirect using keywords like "stroke rehabilitation," "physical exercise," "motor recovery," and "systematic review." Inclusion criteria covered articles published in the last 10 years, in English or Indonesian, involving post-stroke patients undergoing physical exercise programs. The articles were analyzed to evaluate the type of exercise, frequency, duration, and clinical outcomes. Results: Fifteen articles met the inclusion criteria. Aerobic exercise, strength training, and task-oriented therapy were found effective in improving motor function and mobility in stroke patients. Exercise programs performed intensively for a minimum of 4 weeks showed significant results compared to conventional therapy. Positive effects were also observed in patients’ quality of life. Conclusion: Physical exercise has been proven effective in facilitating stroke recovery, especially when individually tailored and performed regularly. This study recommends implementing standardized physical exercise-based rehabilitation programs to support post-stroke recovery.

Exploring physiotherapy staff's perceptions of physiotherapy delivery in acute stroke rehabilitation.

To explore physiotherapists' perspectives on current and alternative models of physiotherapy delivery in acute stroke rehabilitation. Qualitative service evaluation. An acute stroke rehabilitation unit within a London teaching hospital in the UK. A purposive sample of 17 physiotherapy staff (qualified physiotherapists and physiotherapy support staff) working in the acute stroke rehabilitation unit at the time of, or in the previous 3 months of the study were recruited to participate. Three themes were identified: barriers to effective physiotherapy delivery, enablers of effective physiotherapy delivery, and alternative models of physiotherapy delivery. Themes were framed by the concept of providing effective and efficient physiotherapy guided by reflection. Main barriers included patients not being ready for and underutilisation of time within physiotherapy sessions. Use of timetabling and access to senior therapy support enabled more effective and efficient physiotherapy delivery. Alternative models to optimise physiotherapy delivery included different staff to patient ratios, group therapy, opportunistic physiotherapy delivery and self-management. Several enablers of and barriers to providing effective and efficient physiotherapy post-stroke exist. Physiotherapists should consider implementing alternative models of physiotherapy delivery to increase the amount of physiotherapy provided to patients' post-stroke, thereby facilitating post-stroke functional recovery.

Gut Microbe-Generated Metabolite Trimethylamine-N-Oxide and Ischemic Stroke.

Trimethylamine-N-oxide (TMAO) is a gut microbiota-derived metabolite, the production of which in vivo is mainly regulated by dietary choices, gut microbiota, and the hepatic enzyme flavin monooxygenase (FMO), while its elimination occurs via the kidneys. The TMAO level is positively correlated with the risk of developing cardiovascular diseases. Recent studies have found that TMAO plays an important role in the development of ischemic stroke. In this review, we describe the relationship between TMAO and ischemic stroke risk factors (hypertension, diabetes, atrial fibrillation, atherosclerosis, thrombosis, etc.), disease risk, severity, prognostic outcomes, and recurrence and discuss the possible mechanisms by which they interact. Importantly, TMAO induces atherosclerosis and thrombosis through lipid metabolism, foam cell formation, endothelial dysfunction (via inflammation, oxidative stress, and pyroptosis), enhanced platelet hyper-reactivity, and the upregulation and activation of vascular endothelial tissue factors. Although the pathogenic mechanisms underlying TMAO's aggravation of disease severity and its effects on post-stroke neurological recovery and recurrence risk remain unclear, they may involve inflammation, astrocyte function, and pro-inflammatory monocytes. In addition, this paper provides a summary and evaluation of relevant preclinical and clinical studies on interventions regarding the gut-microbiota-dependent TMAO level to provide evidence for the prevention and treatment of ischemic stroke through the gut microbe-TMAO pathway.

Family's Caregiving Status and Post-Stroke Functional Recovery During Subacute Period from Discharge to Home: A Retrospective Study.

Background/Objectives: Family members, often informal caregivers, play a crucial role in providing home care for stroke survivors. The period following discharge to home after receiving acute stroke management in a hospital includes the subacute phase of stroke and remains critical to the recovery of stroke patients. This study evaluated the association between family caregiving and post-stroke functional recovery after discharge to home. Methods: Data from 402 patients with stroke were obtained from the Korea University Ansan Hospital Stroke Center from January 2019 to May 2022. The family's caregiving status was evaluated for family burden and supportable environment in the home. This study's outcome of interest was the modified Rankin Scale (mRS) at discharge to home and three months after stroke onset. The repeated mRS scores were analyzed using the Linear Mixed Model. Results: Median days from discharge to 3 months after stroke onset was 81.0 days. The median score of mRS at discharge was 2.0, and the score at three months after stroke onset was 2.0. The distribution of mRS score 0-2 was 60.9% at discharge and 72.1% at three months after stroke onset. In Linear Mixed Models after adjustments with covariables, the family's caregiving status was positively associated with repeated mRS scores (β = 0.17; 95% confidence interval = 0.11, 0.23; p < 0.001). Conclusions: These findings suggest that family caregiving to patients with stroke might be associated with post-stroke functional recovery within the period from discharge to home until three months after stroke onset.

Cerebello-Cerebral Resting-State Functional Connectivity in Poststroke Aphasia.

Introduction: The influence of the cerebellum in poststroke aphasia recovery is poorly understood. Despite the right cerebellum being identified as a critical region involved in both language and cognitive functions, little is known about functional connections between the cerebellum and bilateral cortical hemispheres following stroke. This study investigated the relationship between chronic poststroke naming deficits and cerebello-cerebral resting-state functional connectivity (FC). Methods: Twenty-five cognitively normal participants and 42 participants with chronic poststroke aphasia underwent resting-state functional magnetic resonance imaging. Participants with aphasia also underwent language assessment. We conducted regions of interest (ROI)-to-ROI analyses to investigate the FC between the right cerebellar Crus I/II (seed ROI; Cereb1r/Cereb2r) and bilateral cortical language regions and compared these results to cognitively normal controls. Single-subject connectivity parameters were extracted and used as independent variables in a stepwise multiple linear regression model associating Boston Naming Test (BNT) score with FC measures. Results: FC analyses demonstrated correlations between the right cerebellar Crus I/II and both left and right cortical regions for both cognitively normal controls and stroke participants. Additionally, aphasia severity and lesion load had an effect on the cerebello-cerebral network connectivity in participants with aphasia. In a stepwise multiple linear regression, controlling for aphasia severity, time poststroke and lesion load, FC between the right Cereb2-left Cereb1 (standardized beta [std B]= -0.255, p < 0.004), right Cereb2-right anterior MTG (std B = 0.259, p < 0.004), and the right Cereb2-left anterior STG (std B = -0.208, p < 0.018) were significant predictors of BNT score. The overall model fit was R2 = 0.786 (p = 0.001). Conclusion: Functional connections between the right cerebellum and residual bilateral cerebral hemisphere regions may play a role in predicting naming ability in poststroke aphasia.

Suppressing the Inflammatory Prostaglandin Signaling after Thrombotic Stroke Ameliorates Ischemic Brain Injury and Facilitates Poststroke Recovery.

Acute cerebral ischemia is a leading cause of death and disability, particularly among old adults. The narrow therapeutic window and risk of hemorrhagic transformation largely limit patient eligibility for the current treatment. The neuroinflammatory signaling pathway involving the prostaglandin E2 (PGE2) receptor subtype EP2 has now been clarified to contribute to the secondary neurotoxicity following ischemic stroke. We previously demonstrated the feasibility of pharmacologically targeting EP2 for ischemic stroke using an EP2 antagonist in a mouse model of transient middle cerebral artery occlusion. Herein, we evaluated the effects of a second-generation EP2 antagonist with improved potency and selectivity in a mouse model of thrombotic stroke, the most common type of stroke. We found that the EP2 antagonist, when administered hours after an ischemic stroke induced within motor and somatosensory cortices by photoactivation of a light-sensitive dye Rose Bengal, reduced cortical infarction in a dose-dependent manner. EP2 inhibition also improved the poststroke body weight recovery and reduced neurological impairments in locomotor and cognitive functions, revealed by a panel of behavioral tests. These broad benefits support the feasibility of targeting the PGE2/EP2 axis-mediated neuroinflammatory pathway as a novel strategy to alleviate the ischemic brain injury caused by thrombotic occlusion and accelerate poststroke recovery.