Post-stroke Survivors Research Articles

The burden of executive dysfunction after ischemic stroke (Bulgaria, 2019-2021)

Abstract Background Executive dysfunctions have great impact on behavior and quality of life in elderly. They also play important role for post-stroke functional outcome. The aim of our study was to examine the frequency, severity and types of executive dysfunctions at the third month after the ischemic stroke. Methods We examined 108 patients 3 months after ischemic stroke (66.67±9.03 years old, 66 males and 42 females) via 128-Wisconsin Card Sorting Test (WCST). WCST is a standardized instrument for detecting various executive dysfunctions. It is applicable for patients after stroke, because the test doesn’t require preserved arm motor functions. It measures global executive functioning (GEF), inhibitory control system (ICS), executive attention (EA), cognitive flexibility (CF) and working memory (WM). Our patients’ results were compared to the normal population test results. SPSS 24 was used for statistical analysis. Results Impaired GEF were found in 46% of our patients, most of them had mild or moderate impairment. One fourth of them showed impaired ICS, although the impairment in most of the cases was mild. EA deficits were found in 43% of our cases (17% had mild, 15% mild to moderate, 7% moderate and 4% severe impairment). WM dysfunction was found in 1/3 of them (the average result was about 27 percentiles; 29% had mild and 5% had mild to moderate deficits) and about ¼ of our patients had borderline results. CF was impaired in 68% of our patients (11% had mild, 28% mild to moderate, 16% moderate and 13% severe impairment). Conclusions GEF impairment is frequent after stroke. Patients had problems in ICS, EA, CF and WM. However, in most of the cases the dysfunction is mild or moderate and can be found only if it is actively searched and accessed. The most impaired functions were CF and EA. Patients with executive dysfunction require cognitive rehabilitation and specific social support. Key messages • Executive dysfunctions are frequent after ischemic stroke. The impairment is mild or moderate, but however it impacts the quality of life, behavior, prognosis and outcome of post-stroke survivors. • Patients with executive dysfunctions require specific cognitive rehabilitation and social support.

Effectiveness of website-based education program on activities of daily living and fear of falls among sub-acute stroke survivors: a pilot study in South Gujarat Region of India

BackgroundStroke survivors and their caregivers have numerous and diverse educational needs, many of which are unmet because of inadequate training from healthcare professionals. As stroke recovery and rehabilitation can continue for years post-stroke, it is critical that stroke survivors are provided with and have access to a range of support options and evidence-based information. Website-based education programs (WEP) have been adopted in recent years to manage health problems. The present pilot study aims to evaluate the effect of WEP on activities of daily living (ADLs) and the fear of falls among sub-acute stroke survivors.MethodsA total of 16 eligible post-stroke survivors were recruited from multiple study settings across Surat City of Gujarat state in western India and were randomly assigned using a lottery method to either the experimental group (n = 8) receiving WEP or the control group (n = 8) receiving conventional physiotherapy for 4 weeks. Outcome measures were the Indian Stroke Scale (ISS), Modified Barthel Index (MBI), and Falls Efficacy Scale-International (FES-I).ResultsBoth groups showed statistically significant improvements in all outcomes but the experimental group showed more significant improvements in ADLs and fear of falls among sub-acute stroke survivors (p < 0.05).ConclusionWEP for sub-acute stroke survivors is an effective intervention. It improves the performance of ADLs for stroke survivors and helps in better fall management indicating that web-based education programs shall be implemented on a regular basis to improve patient care.

Clinical Implication of Time of Ischaemic Stroke Among Post-Stroke Survivors from Eastern India: A Circadian Perspective.

The circadian variation in stroke occurrence is a well-documented phenomenon. However, the circadian effect on stroke outcome, particularly on post-stroke cognition, has not yet been fully elucidated. We aim to evaluate the influence of diurnal variation of stroke onset upon post-stroke cognition and development of post-stroke depression. Based on 4-hourly time period of stroke occurrence, 249 recruited cohorts were categorized into 6 groups. Several clinical and cognitive parameters were compared among the groups. Then, the mRNA expression of core clock genes in Peripheral Blood Mononuclear Cells were quantified and correlated with post-stroke outcomes among 24 acute phase cases with day-time or night-time stroke occurrence. Furthermore, the genetic susceptibility towards a higher number of cases in the morning was examined by genotyping CLOCK (rs1801260T/C, rs4580704G/C) and CRY2 (rs2292912C/G) genes variants in cases and 292 controls. In our study, the peak for highest incidence although observed during the early morning from 4 to 8 am, the nocturnal-onset stroke cases showed more severity (12.2 ± 5.67) at the time of admission irrespective of arterial territory involved. The night onset cases were also found to be more susceptible to develop language impairment and post-stroke depression in due course of time. Upon transcript analysis, circadian genes (BMAL1 and CRY1) were found to be downregulated in night-time cases than day-time ones during the acute phase of onset. In addition, those mRNA levels also showed a correlation with raw scores for language and depression. However, the difference in incidence frequency along a day did not reveal any genetic correlation. Therefore, we suggest night-time stroke to be positively associated with higher immediate severity and poor cognitive outcome than day-time injury and propose downregulation of circadian genes during the acute phase could be the underlying molecular mechanism for this.

Establishing the convergent and divergent validity of the Return-to-Work Assessment Scale among poststroke survivors

ABSTRACT Background: Stroke is a leading cause of disability worldwide, for which the concept of return to work (RTW) plays a crucial role in rehabilitation. The RTW Assessment Scale (RAS) was first developed to assess RTW among poststroke survivors; however, its validity requires further investigation. This cross-sectional study therefore aimed to determine the convergent and divergent validity of the RAS among poststroke survivors in Southeastern Nigeria. Methods: This cross-sectional study in Southeast Nigeria evaluated the convergent and divergent validity of the RAS in 101 poststroke survivors. The purposive sampling technique was used to select eligible individuals from several randomly selected locations. Consecutive participants who met the inclusion criteria were enrolled in this study. Descriptive statistics, correlation analysis, and Spearman’s rank correlation coefficients were used for data analysis. Results: The RAS exhibited strong convergent validity with the World Health Organization Disability Assessment Schedule scores (r = −0.874 to −0.529), indicating a significant relationship between RTW and overall disability. We further observed a weak negative correlation between the RAS scores and the Visual Analog Scale (VAS) scores, with correlation coefficients (r) ranging from r = −0.371 to −0.235, indicating a lesser association between RTW and pain perception of VAS, suggesting divergent validity of RAS. Conclusion: The study concluded that the RAS demonstrated strong convergent and divergent validity, affirming its reliability in assessing RTW among poststroke survivors.

Gastric myoelectric activity changes in post-stroke survivors with dysphagia under different feeding routes

Gastric myoelectric activity changes in post-stroke survivors with dysphagia under different feeding routes

Cross-linguistic dissociations in Kannada-English bilingual persons with aphasia and alexia

Individuals with alexia manifest reading impairments comparable to spoken language impairments. With escalating dependency on communication through texts, emails, and other social media sources, these individuals express their interest in improving written language skills as well. Alexia in bilinguals in the Indian scenario is of special interest, owing to diverse geographical, cultural, traditional, and linguistic demarcations in India. Although substantial research is reported on bilingual aphasia, evidence on bilingual alexia is scarce. The study aimed to explore the cross-linguistic dissociations in Kannada-English bilingual individuals with alexia in post-stroke survivors. Thirteen Kannada-English bilingual individuals (10 males and 3 females) with reading and language impairments post ictus, above 18 years of age were recruited. Participants were subjected to neurobehavioral linguistic and reading tasks in both Kannada and English. The performance of linguistic tasks and reading tasks were analysed for cross-linguistic distinctions, linguistics versus reading, and correlation between linguistics and reading abilities. Results revealed evident cross-linguistic dissociations, wherein participants outperformed in Kannada (L1) in both linguistics and reading domains. All performed superior in the linguistics domain compared to reading. In both languages, semantic abilities were best performed within the linguistic domains. Oral reading abilities fared poor scores relative to reading comprehension. The correlation analysis revealed strong correlation between oral reading and semantics &gt; phonology &gt; syntax. Reading comprehension strongly correlated to syntax &gt; phonology &gt; semantics. The study proved convincing linguistic influences on reading abilities in Kannada- English bilingual context. Most investigations have predominantly centred on case observations, and have often lacked thorough pre- and post-rehabilitation assessments of linguistic and reading impairments using equivalent tests in a bilingual context. This study proves to be a preliminary attempt in this context. A much larger bilingual alexia cohort would aid in substantiating the reading impairments in a variant of subgrouping of aphasia.

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.

Appraising Linguistic and Reading Impairments in Kannada-Speaking Persons With Central Alexia.

Alexia is an acquired condition resulting in impaired abilities to comprehend and/or read aloud written scripts secondary to lesions in the brain involved in reading processes. Just as how linguistic aspects are multi-faceted in persons with aphasia (PWAs), the reading impairments also vary extensively across each PWA depending on the type and nature of the language deficits. Each language has its unique linguistic properties. Whether the impairment is in the spoken form or written form, the dissociations in both aspects across the linguistic distinctions are paramount. Given the diverse orthographic features of Kannada, alongside inquiries into the impairment in oral language skills among individuals with acquired reading difficulties, the study emphasizes distinguishing the concurrent language processes associated with reading impairment. The study aimed to explore the relationship between spoken language and reading abilities in Kannada-speaking post-stroke survivors with acquired alexia. The study recruited 15 Kannada-speaking adults with complaints of reading impairment post-ictus through convenient sampling. The enrolled participants included both males and females with a mean age of 42.2 years (SD=15.58; range=20-68) with 16 years of formal education. The study performed three primary investigations; a) linguistic, b) oral reading, and c) reading comprehension. Linguistic tasks entailed semantics, syntax, and phonological tasks. Oral reading entailed real word and non-word reading tasks. Reading comprehension tasks entailed single-word level, sentence-level, and paragraph-level tasks. Results of overall domain performance across linguistics, oral reading, and reading comprehension revealed superior performance in linguistics (M=71.77, SD=19.18) followed by reading comprehension (M=70.55, SD=24.10) and oral reading (M=41.55, SD=24.66), which was significant (p<0.05). Performance in phonology was weakest (M=58.06, SD=12.44) compared to syntax (M=71.13) and semantics (M=85.33) on comparing PWAs' abilities within the linguistic domain. Reading abilities were compared across oral reading and reading comprehension, which significantly varied (p<0.05), and reading comprehension abilities were superior (M=72.65, SD=24.10). Task-specific variabilities were significant (p<0.05) in both oral reading and reading comprehension, wherein, real word reading (M=58.22) and comprehension at a single level (M=80.22) were better performed. Results of correlation analysis revealed semantics (r=0.494, p<0.05) and phonology (r=0.428, p>0.05) were highly positively correlated to oral reading abilities. Syntax (r=0.412, p>0.05), and semantics (r=0.377, p>0.05) were strongly positively correlated to reading comprehension abilities. The study has convincingly shown that performance on reading-related tasks reflects the functionality of central semantic, phonological, and syntactic processing elements. The literate adults routinely interact with both spoken and written language and a comprehensive assessment framework of language processing must encompass both modalities (linguistic and reading) for individuals with alexia, specific to Indian languages. Owing to the transparent writing system of the Kannada language, a multimodal phonological and lexical-based reading treatment may prove to be beneficial in remediating reading impairments among adult post-stroke survivors.

The relationship between rehabilitation motivation and upper limb motor function in stroke patients.

Insufficient motivation among post-stroke survivors may be an important factor affecting their motor function recovery. This study seeks to investigate the relationship between motivation and functional recovery in stroke patients undergoing rehabilitation training. 103 stroke patients with upper limb impairments were studied during their hospital stays. Assessments were done before and after rehabilitation training to measure motivation, emotional state, motor function, and independence in daily activities. Data analysis was conducted to examine the distribution of these factors among the participants. Pearson and Spearman correlation analyses were used to study the relationships between motivation, emotional state, and motor function. Patients were divided into high and low motivation groups based on the Rehabilitation Motivation Scale (RMS), and chi-square and rank-sum tests were used to compare functional differences before and after treatment among patients with varying levels of motivation. 66 participants were found to have low motivation in the initial assessment of the RMS (64.08%). Consistency in motivation levels was observed among patients with high motivation (r = 0.648, P<0.001). Apathy was identified as the main factor affecting motivation in patients with low motivation (p = 0.027), while depression and anxiety were not significantly correlated. Motivation was strongly linked to improvements in upper limb motor function, daily living activities, and self-exercise duration (p < 0.001) for stroke patients undergoing rehabilitation. Post-training, there was a notable increase in motivation, motor function, and independence in daily activities (p < 0.001). Increased rehabilitation motivation was linked to better upper limb motor function and daily independence in patients, particularly those with low motivation. This correlation was significant for both the FMA-UE and FIM scores. Old patients with poor upper limb motor function often have low motivation, which hinders their recovery. Using strategies to boost motivation in stroke patients with impaired upper limb function could greatly improve their rehabilitation and motor skills. It is crucial to prioritize these intervention strategies. Enhancing rehabilitation motivation in stroke patients with low motivation and upper limb motor impairments can foster the restoration of their functional capabilities.

Current implications of EEG and fNIRS as functional neuroimaging techniques for motor recovery after stroke

Abstract Persistent motor deficits are highly prevalent among post-stroke survivors, contributing significantly to disability. Despite the prevalence of these deficits, the precise mechanisms underlying motor recovery after stroke remain largely elusive. The exploration of motor system reorganization using functional neuroimaging techniques represents a compelling yet challenging avenue of research. Quantitative electroencephalography (qEEG) parameters, including the power ratio index, brain symmetry index, and phase synchrony index, have emerged as potential prognostic markers for overall motor recovery post-stroke. Current evidence suggests a correlation between qEEG parameters and functional motor outcomes in stroke recovery. However, accurately identifying the source activity poses a challenge, prompting the integration of EEG with other neuroimaging modalities, such as functional near-infrared spectroscopy (fNIRS). fNIRS is nowadays widely employed to investigate brain function, revealing disruptions in the functional motor network induced by stroke. Combining these two methods, referred to as integrated fNIRS-EEG, neural activity and hemodynamics signals can be pooled out and offer new types of neurovascular coupling-related features, which may be more accurate than the individual modality alone. By harnessing integrated fNIRS-EEG source localization, brain connectivity analysis could be applied to characterize cortical reorganization associated with stroke, providing valuable insights into the assessment and treatment of post-stroke motor recovery.

Mitigating Trunk Compensatory Movements in Post-Stroke Survivors through Visual Feedback during Robotic-Assisted Arm Reaching Exercises.

Trunk compensatory movements frequently manifest during robotic-assisted arm reaching exercises for upper limb rehabilitation following a stroke, potentially impeding functional recovery. These aberrant movements are prevalent among stroke survivors and can hinder their progress in rehabilitation, making it crucial to address this issue. This study evaluated the efficacy of visual feedback, facilitated by an RGB-D camera, in reducing trunk compensation. In total, 17 able-bodied individuals and 18 stroke survivors performed reaching tasks under unrestricted trunk conditions and visual feedback conditions. In the visual feedback modalities, the target position was synchronized with trunk movement at ratios where the target moved at the same speed, double, and triple the trunk's motion speed, providing real-time feedback to the participants. Notably, trunk compensatory movements were significantly diminished when the target moved at the same speed and double the trunk's motion speed. Furthermore, these conditions exhibited an increase in the task completion time and perceived exertion among stroke survivors. This outcome suggests that visual feedback effectively heightened the task difficulty, thereby discouraging unnecessary trunk motion. The findings underscore the pivotal role of customized visual feedback in correcting aberrant upper limb movements among stroke survivors, potentially contributing to the advancement of robotic-assisted rehabilitation strategies. These insights advocate for the integration of visual feedback into rehabilitation exercises, highlighting its potential to foster more effective recovery pathways for post-stroke individuals by minimizing undesired compensatory motions.

The impact of ankle–foot orthoses on mobility of dual-task walking in stroke patients? A cross-sectional two-factor factorial design clinical trial

ABSTRACT To assess the impact of ankle-foot orthoses (AFOs) on mobility and gait during dual-task walking in post-stroke survivors. In this cross-sectional, factorial design trial, stroke survivors performed four randomized tasks: (1) dual-task walking with AFOs, (2) single-task walking with AFOs, (3) dual-task walking without AFOs, and (4) single-task walking without AFOs. Primary outcome was the Timed Up and Go (TUG) test, with secondary outcomes including gait metrics, Tinetti scores, and auditory N-back tests. In the results, 48 subjects (38 males and 10 females; 19-65 years) completed the trial. Patients had a greater TUG score with AFOs compared with non-AFOs conditions (95% CI: 7.22–14.41, P < 0.001) in single-task and dual-task conditions. Secondary outcomes showed marked enhancement with AFOs during dual-task walking, with significant interaction effects in gait metrics, balance, and cognitive function (P < 0.05). Although not statistically significant, dual-task effects of TUG and walking speed were more pronounced during dual-task walking. In conclusion, AFOs enhance mobility and gait during both single and dual-task walking in post-stroke survivors.

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

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

Effect of functional electrical stimulation of interscapular muscles on trunk performance and balance in post-stroke elderly patients

BackgroundDisability in the upper limb in post-stroke survivors may have a variety of effects, particularly in the elderly, that require planning therapeutic actions to restore function. Thirty-four patients were randomly assigned to the control group (CON) and the Functional Electrical Stimulation (FES) group. For 12 weeks, the CON group received core stabilization exercises (CSEs). The FES group received (FES) for the interscapular muscles with CSEs for the first six weeks and completed the following six weeks with only CSEs. Patients were assessed at baseline, 6 and 12 weeks post-intervention. The trunk impairment scale (TIS) and the Postural Assessment Scale for Stroke (PASS) were used to assess trunk performance. A palpation meter was used to measure the scapular horizontal position (SP). Balance was assessed by the Berg Balance Scale (BBS), and the Timed Up-and-Go test (TUG). Function was assessed with Barthel Index (BI).ResultsBoth groups improved significantly (P < 0.001 for both groups, d = 1.1–3.7 for control group and d = 1.9–6.1 for FES group) post-treatment (at 6 and 12 weeks) in all outcomes except SP in the control group (P < 0.05 at both times, d = 0.6 at 6 weeks and 0.8 at 12 weeks).ConclusionFES for interscapular muscles may have positive effects on trunk performance, scapular position, balance, and function in stroke patients. Also, additional improvements were observed post-intervention compared to baseline. FES is recommended to be part of the rehabilitation program of elderly post-stroke patients.

Effects of robot-assisted gait training on motor performance of lower limb in poststroke survivors: a systematic review with meta-analysis.

This study aimed to investigate the effects of robot-assisted gait training (RAGT) on improving walking ability, and to determine the optimal dosage of task-specific training based on RAGT for stroke patients. Two investigators independently searched electronic databases, including PubMed, Embase, Cochrane Library, and Physiotherapy Evidence Database (PEDro) from inception to 31 January 2020. The study design was a systematic review with meta-analysis of randomized controlled trials (RCTs), comparing the intervention of RAGT plus conventional therapy to conventional therapy alone. RCTs mainly focus on lower limb motor function as the primary outcomes, while the secondary outcomes involve gait speed, walking distance, cadence, balance, and activities of daily living (ADL). Pooled effect estimates were calculated by comparing the change from baseline to the end of the study in each group. Twenty-eight RCTs were included. The pooled analysis showed that RAGT had a significantly short-term effect on improving lower limb function [standardized mean difference (SMD) 0.32, 95% CI 0.10 to 0.55]. Additionally, there were significant improvements in gait speed (MD 0.10, 95% CI 0.06 to 0.14) and ADL (SMD 0.17, 95% CI 0.02 to 0.32). Subgroup analyses indicated that RAGT lasting for 30-60 minutes per day over 4 weeks yielded a moderate effect size (SMD 0.53, 95% CI 0.16 to 0.90). Additionally, RAGT significantly promoted lower limb function recovery in the early stage after a stroke (SMD 0.33, 95% CI 0.07 to 0.58) or in non-ambulatory patients (SMD 0.35, 95% CI 0.10 to 0.59). RAGT demonstrated significant positive effects on lower limb function post-stroke. Our results provide additional evidence to support that RAGT is a potentially appropriate intervention to promote lower limb recovery in individuals who have had a stroke.

Effectiveness of dynamic neuromuscular stabilization, neurodevelopmental techniques and proprioceptive neuromuscular facilitation on trunk and gait parameters in patients with subacute stroke: A three-arm parallel randomised clinical trial

Background Today, stroke is the principal cause of demise in both developed and developing countries. There are different techniques used to treat patients with sub-acute stroke. Trunk muscles play a key role, i.e. in keeping the spine and trunk in place. This stabilization requires moving the head and extremities freely and selectively. The aim of this study is to compare the effectiveness of dynamic neuromuscular stabilization (DNS), neurodevelopmental techniques (NDT) and proprioceptive neuromuscular facilitation (PNF) on trunk and gait parameters in the subacute phase of stroke. This study is intended to ascertain the efficacy of all three approaches individually and to compare the effectiveness of DNS, NDT and PNF on trunk and gait parameters. Furthermore, the findings of this study could be used to assist post-stroke survivors in their early recovery and improve their level of independence. Methods In this interventional study, participants will be divided into three groups, and in each group, 20 patients will be assigned randomly to each group using the sequentially numbered opaque sealed envelope method. Group A patients will be given DNS, Group B will be given NDT, and Group C will be given PNF. The patients will be given treatment for five days for four consecutive weeks. Outcome measures that will be used are trunk impairment scale (TIS), dynamic gait index (DGI) and gait parameters. Data will be collected before and after the 4-week treatment period. Conclusions After the study, a conclusion will be drawn regarding which treatment technique is most suitable among all the three strategies for treating stroke patients if the hypothesis of the study is found valid. Clinical Trials Registry – India (CTRI) reference no. CTRI/2022/06/043037; date of registration 22/05/2022.

Characterizing Two Hybrid Exercise-Cognitive Training Interventions With Neurophysiological and Behavioral Indexes in Post-Stroke Patients With Cognitive Dysfunction: A Randomized Controlled Trial.

Combined exercise and cognitive training have been evidenced to be effective in cognitive and physical functions in post-stroke survivors. Recent interest has gradually shifted to technology-aided cognitive rehabilitation. However, clear neural makers or comprehensive behavioral indexes used for evaluating rehabilitation remain unexplored. The study aimed to examine the effects of two types of combined exercise-cognitive training on stroke patients with cognitive dysfunction, focusing on neural and behavioral markers. 39 patients were randomly assigned to sequential exercise-cognitive training, simultaneous exercise-cognitive training or active control groups and underwent 60 minutes/day training, 3 days/week, for 12 weeks. 29 patients ultimately completed the training. The markers/indexes included cognitive function, physical function, instrumental activities of daily living, and caregiver strain. Cognitive function included working memory task performance, neurophysiological markers, and cognitive indexes. The results indicated no d-prime difference between groups after the training. The simultaneous training demonstrated significant improvements in the neurophysiological marker of P300 and theta coherence compared to the other groups. Moreover, the simultaneous training also led to significant enhancements in physical function, as measured by the Rivermead Mobility Index, comparing to the other groups. Further analysis contrasting the two exercise-cognitive trainings revealed that improvements in cognition and multifaceted domains (i.e., instrumental activities of daily living and caregiver strain) were manifested in the simultaneous training. Together with the neural markers identified in the current interventions, the differential impacts of the two interventions indicates the potential of technology-driven and personalized rehabilitation in post-stroke patients.

The influence of eight cognitive training regimes upon cognitive screening tool performance in post-stroke survivors: a network meta-analysis.

Traditional meta-analysis offers only direct comparative evidence. The optimal cognitive training for poststroke cognitive impairment (PSCI) remains largely undetermined. This study aims to assess and compare the effectiveness of selected cognitive training methods for PSCI patients and to identify and rank the most effective intervention programs. Searches were conducted in PubMed, Embase, Cochrane Library, Web of science, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and China Biomedical Database for randomized controlled trials up to September 30, 2023. Two researchers independently performed literature screening, data extraction, and quality assessment. Network meta-analysis was utilized to synthesize the main findings. The primary outcome focused on the intervention's impact on subjective cognitive function, with secondary outcomes including effects on activities of daily living, motor function, and functional independence. This study is registered with PROSPERO (CRD42023463282). Fifty eligible randomized controlled trials were identified, revealing eight distinct interventions. These interventions collectively demonstrate efficacy in enhancing cognition. Traditional cognitive training significantly improves overall cognitive function, daily living function, motor function, and functional independence. In Loewenstein Occupational Therapy Cognitive Assessment, Barthel Index, Fugl-Meyer Assessment, and Functional Independence Measure scales, a combination of computer-based and traditional cognitive training outperformed the conventional control group MD = 29.97 (95%CI: 16.3, 44.2), MD = 18.67 (95%CI: 9.78, 27.45), MD = 28.76 (95%CI: 5.46, 51.79) and MD = 42.2 (95%CI: 5.25, 78.99). In the MMSE scale, virtual reality cognitive training combined with traditional training was most effective MD = 8.01 (95%CI: 3.6, 12.4). On the MoCA scale, the combination of exercise and cognitive training showed superior results MD = 6.68 (95%CI: 2.55, 10.78). Only the combined computer-based and traditional cognitive training, as well as traditional cognitive training alone, significantly enhanced functional independence, with no notable differences in other pairwise interventions. The network meta-analysis suggests that augmenting traditional training with other modalities may enhance overall effectiveness. Specifically, interventions incorporating computer-based cognitive training appear to surpass other methods in improving cognition, daily living function, motor skills, and functional independence. The findings of this network meta-analysis provide evidence-based guidance for clinical decision-making. https://www.crd.york.ac.uk/PROSPERO/, identifier in PROSPERO (CRD42023463282).

POST-STROKE DEPRESSION AND ITS RISK FACTORS – CROSS-SECTIONAL STUDY

Introduction: Post-stroke depression (PSD) is one of the leading, although preventable complications, after ischemic stroke (IS). Our study aimed to examine PSD and the leading causes for its development Contingent and methods: In this cross-sectional study, we examined 107 post-stroke survivors (66.67±9.03years old, 65 males and 42 females) for PSD in a two-step model (at the acute stage and at the 3rd month after stroke) with 21 Hamilton Depression Rating Scale (HDRS). Results: 33% of examined patients showed depression at the acute and 30% at the chronicIS stage. 1/4 to 1/3 of the others had subclinical depression. The severity of depression in most of the cases was mild. Very few of our patients (2 at the acute tage and 1 at the chronic stroke stage) had severe depression. The main risk factors for PSD were stroke severity, subcortical localization of stroke, leukoaraiosis, ageing, loneliness and some comorbidities (that lead to systemic inflammation, changes in neurotransmission and impaired brain plasticity). Conclusion: PSD is one of the main complications of acute IS. It should be assessed, prevented and treated as soon as possible.

Exploring rehabilitation options and resources of support for stroke survivors in Eldoret, Kenya: qualitative study

BackgroundStroke is a major cause of death and disability in adults globally. Most post-stroke survivors experience various impairments which requires rehabilitation. Likewise, returning home after a stroke represents challenging moments full of struggle. This study, therefore, explores options of rehabilitation and resources of support for stroke survivors in Eldoret, Kenya.MethodA qualitative descriptive approach was used to conduct the study. The study utilised semi-structured interviews. Fifteen dyads of stroke survivors (10 men and 5 women; aged 40–75 years) were enrolled from a rehabilitation outpatient clinic (Medical Park Physical Therapy) in Eldoret, Kenya. Interviews were conducted at the patients’ house, and an inductive approach was used to enable thematic content analysis.ResultsTwo dominant themes and several categories emerged from the participants; these included the following: (1) rehabilitation services available for stroke survivors and (2) resources of support.ConclusionsThe study found that stroke units are only available at the national hospitals and not accessible to many. Patients receive physiotherapy and occupational therapy services during hospital stay but has poor access post discharge. Transport, distance, and lack of finances have been highlighted as the main challenges. There is scarcity of speech therapist as well as advanced orthotics for stroke rehabilitation. From a clinical perspective, healthcare system should be better structured to accommodate continuity of care post discharge for stroke survivors.