Post Stroke Research Articles

Mobile Health delivered physical activity after mild stroke or transient ischaemic attack. Is it feasible and acceptable?

Physical activity is a key component of secondary stroke prevention. Mobile health (mHealth) interventions show promise for enhancing post-stroke physical activity, but most studies have combined mHealth with onsite services. This study evaluated the feasibility and acceptability of a fully digitalised mHealth intervention for physical activity among individuals post stroke or transient ischemic attack (TIA) in Sweden. In this two-arm feasibility randomised controlled trial, adults with stroke or TIA were randomised to one of the following six month interventions: i) the experiment group, receiving mHealth delivered supervised exercise (two sessions weekly during months one to three, one session weekly during months four to six) and behavioural change techniques for physical activity (including two individual counselling and six follow-up sessions) or, ii) the control group, receiving two mHealth delivered individual counselling and three follow-up sessions. Feasibility (reach, retention, adherence, fidelity, safety) and acceptability were assessed according to pre-specified progression criteria. Of 114 participants, 105 (92%) completed the 6-month intervention and 102 (89%) completed the 12-month follow-up assessment. The intervention reached individuals from 20 of 21 Swedish regions. Sixty-eight percent of participants had a stroke (of which 96% were mild), 64% were female, and average age was 71 years (SD 9). Ninety-five percent were born in Sweden, had a high level of education (61%) and an average daily step count of 6451 steps. Completion of outcome measures included digital questionnaires (98%), sensor-derived physical activity (92%), and blood pressure monitoring (97%). A total of 1781 supervised exercise sessions were delivered to the experiment group, with an adherence rate of 76%, and adherence to individual counselling and follow-up sessions was 96%. Ninety-five adverse events were recorded, of which 16 were related to the intervention (predominantly pain or muscle soreness) but non-serious. Overall satisfaction with the mobile app was 71%, and 76% of the experiment group believed the app could partly replicate in-person visits. The mHealth intervention was overall feasible and acceptable, however there is a need to develop recruitment procedures to increase diversity of included participants regarding socioeconomic status and physical activity level, prior to a Phase 3 trial. ClinicalTrials.gov (NCT05111951)Keywords: physical activity, mHealth, stroke, TIA, feasibility.

Multimodality cardiac imaging in ischemic stroke: insights into the heart-brain interaction.

Annually, approximately 7.6 million individuals experience a new ischemic stroke, and roughly 25% of all ischemic strokes are cardiogenic in origin, carrying a high risk of recurrence, death and disability. To prevent future ischemic strokes, especially in younger individuals, it is crucial to detect and treat direct and indirect cardioembolic sources. Cardiac imaging is a rapidly evolving field, and post-stroke cardiac imaging is no longer limited to echocardiography, but also includes other imaging techniques, such as cardiac magnetic resonance imaging and cardiac computed tomography. Clinicians must be familiar with numerous cardiac and systemic disorders related to stroke and consider the possibilities that imaging diagnostics have to offer. Additional diagnostics tests, such as pre- and transcranial ultrasound with a bubble test, can also increase the diagnostic accuracy for detecting right-left shunt embolisms. Moreover, a patent foramen ovale (PFO) has traditionally been indicated as a minor or uncertain risk factor for ischemic stroke. However, PFO-associated strokes are a distinct category among the cardioembolic sources as in most cases we do not assume that the thrombus has been developed in-situ in the PFO-structure or elsewhere intracardial, but that PFO merely is acting as a mediator for a paradoxical, venous embolism. The article has two parts: Part I, the heart-brain axis, describes multimodality cardiac imaging in the assessment of cardioembolic sources of ischemic stroke, with a special focus on disorders that traditionally have received little attention in the literature. Part II discusses the brain-heart axis, namely when acute cerebrovascular events lead to cardiac dysfunction, for example neurogenic stunned myocardium and Takotsubo syndrome. Advances in cardiovascular imaging have significantly enhanced the detection of cardiac disorders associated with stroke. Clinicians involved in post stroke work-up need to be aware of the capabilities of different imaging modalities for higher individual diagnostic accuracy in order to effectively treat and prevent stroke recurrence.

Associative brain-computer interface training increases wrist extensor corticospinal excitability in patients with subacute stroke.

In a recently developed associative rehabilitative brain-computer interface (BCI) system, electroencephalography (EEG) is used to identify the most active phase of the motor cortex during attempted movement and deliver precisely timed peripheral stimulation during training. This approach has been demonstrated to facilitate corticospinal excitability and functional recovery in patients with lower limb weakness following stroke. The current study expands those findings by investigating changes in corticospinal excitability following the associative BCI intervention in patients with post stroke with upper limb weakness. In a randomized controlled trial, 24 patients with subacute stroke, subdivided into an intervention group and a "sham" control group, performed 30 wrist extensions. The intervention comprised 30 pairings of single peripheral nerve stimulation at the motor threshold, timed so that the generated afferent volley arrived at the motor cortex during the peak negativity of the movement-related cortical potential (MRCP), which was identified with EEG. The sham group underwent the same intervention, though the intensity of the nerve stimulation was below the perception threshold. Immediately after training, patients in the associative group exhibited significantly larger amplitudes of muscular-evoked potentials, compared with pretraining measurements in response to transcranial magnetic stimulation. These changes persisted for at least 30 min and were not observed in the sham group. We demonstrate that motor-evoked potential amplitudes increased significantly following paired associative BCI training targeting upper limb muscles in patients with subacute stroke, which is in line with results from lower limb studies.NEW & NOTEWORTHY We have demonstrated that a single training session with an associative brain-computer interface increased corticospinal excitability in patients suffering from upper limb weakness following stroke. This is the first time such an effect is described in the upper limb, which paves the way for effect augmentation of existing upper limb rehabilitation protocols.

Delayed Cortical Responses During Reactive Balance After Stroke Associated With Slower Kinetics and Clinical Balance Dysfunction

Background Slowed balance and mobility after stroke have been well-characterized. Yet the effects of unilateral cortical lesions on whole-body neuromechanical control is poorly understood, despite increased reliance on cortical resources for balance and mobility with aging. Objective. We tested whether individuals post stroke show impaired cortical responses evoked during reactive balance, and the effect of asymmetrical interlimb contributions to balance recovery and the evoked cortical response. Methods Using electroencephalography, we assessed cortical N1 responses evoked over fronto-midline regions (Cz) during backward support-surface perturbations loading both legs and posterior-lateral directions that preferentially load the paretic or nonparetic leg in individuals’ post-stroke and age-matched controls. We tested relationships between cortical responses and clinical balance/mobility function, as well as to center of pressure (CoP) rate of rise (RoR) during balance recovery. Results Cortical N1 responses were smaller and delayed after stroke (P < .047), regardless of perturbation condition. In contrast to controls, slower cortical response latencies associated with lower clinical function in stroke (Mini Balance Evaluation Systems Test: r = −.61, P = .007; Timed-Up-and-Go: r = .53, P = .024; walking speed: r = −.46, P = .055). Paretic-loaded balance recovery revealed slower CoP RoR (P = .012) that was associated with delayed cortical response latencies (r = −.70, P = .003); these relationships were not present during bilateral and nonparetic-loaded conditions, nor in the older adults control group. Conclusions Individuals after stroke may be limited in their balance ability by the slowed speed of their cortical responses to destabilization. In particular, paretic leg loading may reveal cortical response impairments that reflect reduced paretic motor capacity.

Improving nutrition knowledge and nutrient intake through nutrition education for post-stroke survivors and their families

Background: Malnutrition among post-stroke survivors is 14-52%. Nutrition knowledge reinforcement will be beneficial for the survivors and family/caregivers to maintain their nutritional status and improve quality of life.Objectives: To examine the improvement of nutrition knowledge about nutrition management for post-stroke survivors, family, and caregivers as well as the improvement of nutrient intake and nutritional status among post-stroke survivors.Materials and Methods: This study used pre-experimental design and was conducted in Embung Tambak Boyo, Sleman District during August 2018. The subjects were post-stroke survivors, being members of Happy Embung, and signing the informed consent. Total subjects were 27 post stroke survivors with 27 family/caregivers of them. This study consisted of a series of activities, as follows: pre-test and baseline assessment, i.e., anthropometry, blood pressure, physical function, and dietary were measured in the 1st week, a series of nutrition education in the 2nd and 3rd week, post-test and endline assessment in the 4th week. The paired sample T-test was employed to compare the differences between baseline data collected during the first week of intervention, and endline data, gathered in the final week of intervention.Results: Most participants were male (89%) and aged 60 or older (82%). After two series of nutrition education, there were notable increases in nutritional knowledge score of the survivor and family/caregivers, body weight, BMI, HGS, and energy intake of the survivor (baseline vs. endline, mean ± SE: 6.5±0.6 vs. 7.0±0.6; 8.8±0.3 vs. 9.3±0.3; 67.8±1.9 vs. 68.6±1.9; 29.5±0.8 vs. 29.8±0.7; 26.1±2.0 vs. 26.8±2.0; and 1334.5±75.7 vs. 1389.1±95.0, all p&lt;0.05). However, there was no significant improvement on MUAC, body fat total, protein, fat, and carbohydrate intake among the survivors.Conclusion: Nutrition education might enforce nutrition knowledge of post-stroke survivors and family/caregivers, as well as nutritional status improvement among the survivors.Keywords: Nutrition education; nutrient intake; nutrition status; post-stroke survivors

A Randomized Control Trial of a Virtually Delivered Program for Increasing Upper Limb Activity After Stroke.

Upper limb activity following stroke is low, which may limit recovery. We investigated whether a virtually-delivered upper limb program, that included a wearable device with reach-to-grasp feedback, would increase upper limb activity after stroke. This was a parallel-group, assessor-blinded, randomized control trial conducted at 6 sites across 5 provinces of the CanStroke Recovery Trials Platform between 2020 to 2022. Participants (n = 73) were community-living, less than 1 year post stroke, and had residual arm movement and upper limb use limitations. Participants were randomized via a central web-based randomization service to receive a virtually delivered program (Virtual Arm Boot Camp [V-ABC], n = 36) or waitlist control (n = 37) receiving usual care. V-ABC consisted of a home exercise program, feedback from a wrist-worn device to monitor reach-to-grasp counts, and 6 virtual sessions with a trained therapist over 3 weeks. The primary outcome was the average daily reach-to-grasp counts over 3 days at 4 weeks post baseline assessment. Secondary outcomes included upper limb function, self-reported use, and quality of life. Within-subject changes between pre, post treatment, and 2 months follow up for all participants were also examined as a tertiary analysis. The V-ABC group demonstrated greater average daily reach-to-grasp counts (primary outcome) at 4 weeks compared to control (mean difference = 368, 95% confidence interval = 6-730, P = .046). This study provided evidence that a virtually delivered upper limb program that consists of exercise, feedback from a wearable device, and therapist support can increase real-world upper limb activity following stroke. NCT04232163.

Prediction of Central Post-Stroke Pain by Quantitative Sensory Testing.

Among patients with acute stroke, we aimed to identify those who will later develop central post-stroke pain (CPSP) versus those who will not (non-pain sensory stroke [NPSS]) by assessing potential differences in somatosensory profile patterns and evaluating their potential as predictors of CPSP. In a prospective longitudinal study on 75 acute stroke patients with somatosensory symptoms, we performed quantitative somatosensory testing (QST) in the acute/subacute phase (within 10 days) and on follow-up visits for 12 months. Based on previous QST studies, we hypothesized that QST values of cold detection threshold (CDT) and dynamic mechanical allodynia (DMA) would differ between CPSP and NPSS patients before the onset of pain. Mann-Whitney U-tests and mixed analysis of variances with Bonferroni corrections were performed to compare z-normalized QST scores between both groups. In total, 26 patients (34.7%) developed CPSP. In the acute phase, CPSP patients showed contralesional cold hypoesthesia compared to NPSS patients (p = 0.04), but no DMA differences. Additional exploratory analysis showed NPSS patients exhibit cold hyperalgesia on the contralesional side compared to the ipsilesional side, not seen in CPSP patients (p = 0.011). A gradient-boosting approach to predicting CPSP from QST patterns before pain onset had an overall accuracy of 84.6%, with a recall and precision of 75%. Notably, both in the acute and the chronic phase, approximately 80% of CPSP and NPSS patients showed bilateral QST abnormalities. Cold perception differences between CPSP and NPSS patients appear early post stroke before pain onset. Prediction of CPSP through QST patterns seems feasible. ANN NEUROL 2024.

Assessment of Language Impairment Management of Post Stroke at Erbil Public Hospitals

Background: Stroke is the most common cause of aphasia which need to be managed because it postpones stroke recovery and causes psychological and social problems for the patients and their families. Researchers have observed that the issue of language disorder in post-stroke patients has been poorly addressed in Kurdistan Region. Objective: This neurolinguistic study aims at presenting a comprehensive scale study about the demography of stroke and aphasic patients at Rizgary hospital over a period of TWO months in2024. Patients and Methods: This cross-sectional study is carried out at Rizgary Public hospital in Erbil-Kurdistan Region. Demographic for all the patients who were registered at Erbil hospitals during the TWO months in 2024. Then the process of diagnosing aphasia and dysarthria as language impairments are carried out. Results: Among 234 subjects, the mean age of post stroke patients is 33.4 ± 22.038001years .15.3% of patients were not paralyzed, meanwhile 44.8% got right side body paralysis, followed by left side 38%, and both side 1.7%. The highest risk factor is Hypertension (68.8%), followed by Diabetes mellitus (41.4%), and Ischemic heart disease (21.7%). Conclusion: Language disorders is about (71.4%) which is a high range among post-stroke patients. Language disorders does not only affect stroke management but it also impair the individual’s quality of life. If language impairments are screened earlier in patients, it is possible to intervene in language skills and work through speech therapy. Keywords: Language impairment, stroke, dysarthria.

Enhancing Heart Rate-Based Estimation of Energy Expenditure and Exercise Intensity in Patients Post Stroke.

Indirect calorimetry is the gold standard field-testing technique for measuring energy expenditure and exercise intensity based on the volume of oxygen consumed (VO2, mL O2/min). Although heart rate is often used as a proxy for VO2, heart rate-based estimates of VO2 may be inaccurate after stroke due to changes in the heart rate-VO2 relationship. Our objective was to evaluate in people post stroke the accuracy of using heart rate to estimate relative walking VO2 (wVO2) and classify exercise intensity. Moreover, we sought to determine if estimation accuracy could be improved by including clinical variables related to patients' function and health in the estimation. Sixteen individuals post stroke completed treadmill walking exercises with concurrent indirect calorimetry and heart rate monitoring. Using 70% of the data, forward selection regression with repeated k-fold cross-validation was used to build wVO2 estimation equations that use heart rate alone and together with clinical variables available at the point-of-care (i.e., BMI, age, sex, and comfortable walking speed). The remaining 30% of the data were used to evaluate accuracy by comparing (1) the estimated and actual wVO2 measurements and (2) the exercise intensity classifications based on metabolic equivalents (METs) calculated using the estimated and actual wVO2 measurements. Heart rate-based wVO2 estimates were inaccurate (MAE = 3.11 mL O2/kg/min) and unreliable (ICC = 0.68). Incorporating BMI, age, and sex in the estimation resulted in improvements in accuracy (MAE Δ: -36.01%, MAE = 1.99 mL O2/kg/min) and reliability (ICC Δ: +20, ICC = 0.88). Improved exercise intensity classifications were also observed, with higher accuracy (Δ: +29.85%, from 0.67 to 0.87), kappa (Δ: +108.33%, from 0.36 to 0.75), sensitivity (Δ: +30.43%, from 0.46 to 0.60), and specificity (Δ: +17.95%, from 0.78 to 0.92). In people post stroke, heart rate-based wVO2 estimations are inaccurate but can be substantially improved by incorporating clinical variables readily available at the point of care.

Predicting independent walking ability using the Simplified Stroke Rehabilitation Assessment of Movement, Berg Balance Scale, and Barthel Index for Activities of Daily Living in individuals post-stroke: an observational preliminary study

IntroductionThe purpose of this study was to determine cut scores to predict independent ambulation for the Simplified Stroke Rehabilitation Assessment of Movement (S-STREAM), Berg Balance Scale (BBS), Barthel Index (BI) for Activities of Daily Living for patients with time after stroke up to 1 year. The study’s second goal was to establish statistical dependence between the tests the S-STREAM, BBS, BI, and the Functional Ambulation Category (FAC).MethodsCohort observational retrospective pilot study by design. Twenty-four people who suffered a stroke within the past year were enrolled in the study. The FAC was used to classify patients into independent walking and non-walking groups (scores 0–2 are non-walking patients, scores 4–5 are independent walking patients). Receiver operating characteristic (ROC) curve analysis was performed for the S-STREAM, BBS, BI selected according to the multiple logistic regression analysis with dichotomy on groups independent walking patients and not.ResultsROC analysis of scores at admission were used to determine cut scores for the independent waking ability for each of the listed measures. The cut score for S-STREAM was 19 points, for BBS was 27 points and for BI was 65 points. Based on this analysis it appears there is sufficient evidence to conclude a significant linear relationship between all tests the S-STREAM, BBS, BI, and FAC.ConclusionsIn patients who were ambulators, less than one year post stroke, this pilot study established a cut score for standardized assessment tools S-STREAM, BBS, BI for Activities of Daily Living.

Depression and anxiety at 1- and 12-months post ischemic stroke: methods for examining individual change over time.

Background Depression is commonly studied post stroke, while anxiety is less studied. This study presents prevalence of depression and anxiety at 1- and 12-months post ischemic stroke alongside three methods for examining within-subjects change over time. Methods Participants were ischemic stroke patients of the Auckland Regional Community Stroke Study (ARCOS-V) with Hospital Anxiety and Depression Scale data at 1- (n =343) and 12-months (n =307). Change over time was examined using within-subjects repeated measures ANOVA, calculation of the Reliable Change Index, and a Sankey diagram of those meeting cut-off scores (>7) for caseness over time. Results Using repeated measures ANOVA, depression scores didn't change significantly over time, while anxiety symptoms decreased significantly. When reliable change was calculated, 4.2% of individuals had reliable decreases in anxiety symptoms, while 5.7% had reliable decreases in depression symptoms. Those who had a reliable decrease in one tended to have a reliable decrease in the other. In the Sankey, the proportion of those meeting the cut-off score for anxiety did not change over time (12.8 and 12.7% at 1- and 12-months), while those meeting the cut-off for depression increased slightly (3.7-4.5%) and those meeting cut-offs for both decreased from 10.4 to 8.1%. Conclusion The three methods produced very different findings. Use of cut-off scores is common but has limitations. Calculation of clinically reliable change is recommended. Further work is needed to ensure depression and anxiety are monitored over time post-stroke, and both should be the subject of intervention efforts in both acute and late stages post-stroke.

Labeling and isolating cell specific neuronal mitochondria and their functional analysis in mice post stroke.

Dendritic and axonal plasticity, which mediates neurobiological recovery after a stroke, critically depends on the mitochondrial function of neurons. To investigate, in vivo, neuronal mitochondrial function at the stroke recovery stage, we employed Mito-tag mice combined with cerebral cortical infection of AAV9 produced from plasmids carrying Cre-recombinase controlled by two neuronal promoters, synapsin-I (SYN1) and calmodulin-kinase IIa to induce expression of a hemagglutinin (HA)-tagged enhanced green fluorescence protein (EGFP) that localizes to mitochondrial outer membranes of SYN1 positive (SYN+) and CaMKIIa positive (CaMKIIa+) neurons. These mice were then subjected to permanent middle cerebral artery occlusion (MCAO) and sacrificed 14days post stroke. Neuronal mitochondria were then selectively isolated from the fresh brain tissues excised from the ischemic core (IC), ischemic boundary zone (IBZ), as well as from the homologous contralateral hemisphere (CON) by anti-HA magnetic beads for functional analyses. We found that the bead pulled neuronal specific mitochondria were co-precipitated with GFP and enriched with mitochondrial markers, e.g. voltage-dependent anion channel, cytochrome C, and COX IV, but lacked the Golgi protein RCAS1 as well as endoplasmic reticulum markers: Heme‑oxygenase 1 and Calnexin, indicating that specific neuronal mitochondria have been selectively isolated. Western-blot data showed that oxidative phosphorylation (OXPHOS) components in SYN+ and CAMKII+ neuronal mitochondria were significantly decreased in the IBZ and further decreased in the IC compared to the contralateral tissue, which was associated with the significant reductions of mitochondrial function indicated by oxygen consumption rate (OCR) (p<0.05, respectively, for both neuron types). These data suggest dysfunction of neuronal mitochondria post stroke is present during the stroke recovery stage. Collectively, for the first time, we demonstrated that using a Mito-tag mouse line combined with AAV9 carrying Cre recombinase approach, neuronal specific mitochondria can be efficiently isolated from the mouse brain to investigate their functional changes post stroke.

Surgical repair of post infarct ventricular septal rupture in Peshawar Institute of cardiology: Experience in a newly established tertiary care hospital.

Objective: To share our experience of post infarct closure of ventricular septal rupture in newly established cardiac center. Study Design: Retrospective study. Setting: Department of Cardiac Surgery, Peshawar Institute of Cardiology, Peshawar. Period: Jan 2021 to August 2024. Methods: All VSR repair cases done during this period were included which were 10. Results: A total of 10 cases of surgical repair of VSR were included in the study. 50 % were males. Mean age was 65 years (IQR 14.7). 40 % were diabetic while 80% were hypertensive. 20% patients had thrombolysis while 60% had PPCI. 50 % patients presented with NYHA IV symptoms. 10% patients were in pre operative AKI. 40% were in cardiogenic shock. 10 % had pre operative IABP passed while 50 % were stabilized with preoperative ionotropic support. 90% of VSR were anterior while 10% posterior. Median VSR size was 13.5 mm (IQR 12.2mm). 20 % VSR were multiple. Median time from onset of symptoms to VSR was 4 days (IQR 2.5). Median time from hospital presentation to VSR repair was 15 days (IQR 20.7). Concomitant CABG was performed in 90% cases. Post operative median ICU stay was 4 days (IQR 4.7) while hospital stay was 7 days (IQR 7.2). Residual VSR, pleural effusion, reopening, post Operative AKI, stroke and heart failure each were present in 10% cases. In hospital mortality was 10%. Conclusion: Optimal timing of surgery and preoperative status of patients are important determinant to decrease postoperative complications and mortality.

IMU Calibration Effect on Lower Limbs Kinematics Against Optical Motion Capture in Post-Stroke Gait

BackgroundStroke is the most common cause of disabilities worldwide. Rehabilitation is central to restore functions. Inertial measurement units (IMU) can be used to ease goal settings and monitor progression. Contrary to optical motion capture (OMC), IMU are less expensive, portable, and allow large scale data collections in ambulatory settings. Although Xsens MVN system validity has been demonstrated in healthy participants, its validity among post-stroke (PS) patients is yet to be proven. Research questionComputation methods being affected by the calibration type; the goal of this study is to compare lower limbs kinematics from Xsens system, after two calibrations against OMC in slow PS walkers exhibiting reduced ranges of movements. MethodsData was collected for six PS patients. They were equipped with 29 reflective markers and seven IMU. A minimum of two walks with a dynamic calibration and four walks with a static calibration were performed. All trials were accomplished at a self-selected walking speed and PS used their usual walking aids. ResultsFew interactions between the calibration type and side were found for the ankle abduction/adduction (A/A) bias, root mean square error (RMSE), and range of motion difference (ROMd) (p = 0.011, p = 0.048, p = 0.039). Few effects of the side on errors' values were found. We noticed some effects of the calibration type on errors' values, the dynamic calibration showing better results. In the sagittal plane, we reported RMSE values from 3.6 to 4.8°, 5.2 to 6.5°, and 5.0 to 5.9° for the hip, knee, and ankle dynamic calibration. SignificanceThe calibration type, reduced range of movement, and slow walking speed does not seem to impact Xsens' accuracy to a great extent. Nevertheless, dynamic calibration provides slightly better results. Considering the patient's walking ability, we recommend using this calibration.

Are aquatic exercises feasible post stroke? What do we know after an overview of systematic reviews?

Background Aquatic exercises might be considered a safe modality for the treatment of individuals after stroke. Objective To assess the effectiveness of aquatic exercise (AE) compared to land-based conventional therapy or no intervention. Methods This overview of systematic reviews (SR) followed the recommendations of the Cochrane Collaboration, the protocol was registered on PROSPERO, and the risk of bias was assessed by AMSTAR-2. The databases Medline, Embase, Web of Science, SportDiscus, Cinahl, Scopus, Scielo, and PEDro, from 1945 to 2024, were used. Results In total, 15 SRs were included. All reviews showed methodological failure according to the AMSTAR-2 classification, being shown to be critically low. The domains that presented the worst performance were related to the registration of the protocol, assessment of the risk of bias of the primary studies, and adequate conduction of the meta-analysis. Conclusions According to the included reviews, aquatic exercise can be effective, especially in improving balance, however, caution is needed to interpret these findings due to their critically low methodological quality. No adverse effects were reported in any of the reviews.

Abstract 4119129: PREDICTING 30-DAY ALL-CAUSE READMISSION AFTER STROKE: THE APPLICATION OF MACHINE LEARNING TO LINKED REGISTRY DATA

Background: Thirty-day readmission following hospital discharge for stroke is an important quality measure for US hospitals. Current US prediction models for post stroke readmission based on electronic medical records from single healthcare systems or hospitals have modest discrimination (AUC range 0.64 - 0.74). Aim: To develop 30-day all-cause readmission prediction model using a machine learning (ML) based method trained on linked stroke registry and administrative claims data. Methods: Using probabilistic linking, we matched acute stroke (ICD-10 I61-I63) discharges from 31 hospitals participating in the Michigan Acute Stroke registry between 2016-2020 to multipayer administrative claims data provided by the Michigan Value Collaborative for Medicare and Blue Cross Blue Shield of Michigan commercial beneficiaries. Stroke registry data included patient demographics, clinical characteristics, past medical history, and treatments. Claims data was used to identify readmissions within 30 days of discharge. We used multivariable LASSO logistic regression- a simple ML technique to predict 30-day all-cause-readmission and evaluated the prediction accuracy using a hospital-split internal validation scheme to generate hospital-specific and pooled AUC estimates with 95% confidence intervals (Figure 1). Results: Of 19,382 linked stroke discharges, 2,724 (14.1%) were readmitted within 30-days. Readmitted patients were older, more likely to be male, black, and have higher stroke severity (NIHSS &gt;5). Registry hospitals were either primary (64%) or comprehensive (26%) stroke centers. Hospital-specific 30-day readmission ranged between 9.9%-23.1% ( P &lt;.001) with an average of 14.1% (95% CI:13.6%-14.5%) (Figure 2). Hospital specific AUC estimates ranged between 0.60-0.80 with a pooled AUC of 0.68 (95% CI:0.65-0.70) (Figure 2). Conclusions: ML prediction model fitted to linked registry data can be used to predict hospital-specific and statewide readmissions post stroke.

Sexual Function and Quality of Life in Individuals Post Stroke.

Sexual function is commonly affected post stroke and impacts an individual's quality of life. This study aimed to determine the factors associated with sexual function in an individual post stroke and the association with quality of life. This cross-sectional study included 56 participants who had a stroke between three and 24months prior. The participants were assessed for: level of disability with the Modified Rankin Scale (MRS); quality of life with the Stroke Specific Quality of Life scale (SSQOL); and sexual function with the Changes in Sexual Functioning Questionnaire (CSFQ-14), and an open-ended questionnaire was administered. The average age of the participants was 51.32 (SD=±13.24) years, with 32 (57.1%) males and 24 (42.9%) females. According to the CSFQ-14, the majority of the study participants (n=35, 62.5%) had sexual dysfunction after their stroke. The factors associated with sexual dysfunction post stroke included age, disability, comorbidities, psychosocial factors such as self-esteem, role changes, and depression. Those with sexual dysfunction were found to have a lower mean SSQOL score (139.94±33.89) than those without sexual dysfunction (149.76±33.77), however, there was no significant difference (p=0.298) between the groups. Majority of the participants (n=37; 66.1%) did not know that healthcare professionals can assist with sexual dysfunction. The majority of participants experienced sexual dysfunction after their stroke. Factors such as pain, difficulty with positioning, self-esteem issues, lack of motivation, and change in desire, are important considerations for the multidisciplinary team in the rehabilitation of a patient's sexual function post stroke. This cross-sectional study did not require study registration.

A modified intensive, comprehensive aphasia program (mICAP) has better reported outcomes than usual care: a randomized controlled trial

ABSTRACT Background Intensive Comprehensive Aphasia Programs (ICAPs) are a new model of service delivery that show promising pre-post outcomes but have yet to be compared with usual care. Aim To compare the clinical effectiveness of a modified Intensive Comprehensive Aphasia Program (mICAP) to usual care in a parallel two arm study utilizing stratified block randomisation. Methods & Procedures Participants were a referred sample with post stroke aphasia from ten local speech pathology departments. Assessments were completed prior to, immediately after, and follow up at 3 months after the mICAP. While 269 participants with aphasia were approached for the study, only 52 were eligible to be randomised with 113 participants approached not meeting selection criteria and 99 of eligible participants declining to participate. Block randomization was based on matched moderate/mild versus severe aphasia pairs. Three of the 26 mICAP participants withdrew. In the experimental arm of the mICAP (the LIFT program), participants with aphasia and their family attended goal directed tailored therapy three times weekly for 8 weeks. Therapy included 14 hours each of impairment therapy, functional communication therapy, and computer therapy and 7 hours of group therapy and a challenge task. The main outcome measures were the self-reported Assessment for Living with Aphasia (ALA) and Content Information Units (#CIU’s) in connected speech. Outcomes & Results Linear Mixed Modelling was completed on the remaining 42 participants’ data and found a significant benefit for the mICAP on the ALA Total score (p= .014; 95% CI= −21.48- −2.57) ALA Aphasia domain (p = .027; 95% CI= −3.23 - −0.203), ALA Environment domain (p = .017; 95% CI= −4.70 - −0.493) immediately post intervention with maintenance of effects for the ALA Aphasia domain in the follow up period (p = .014; 95% CI= −3.64 - −0.438). Family members in the mICAP reported significant reduction in caregiving burden in the follow up period (p= .017; CI= −14.12 - −1.52.). There were no significant differences on the other main outcome measure of Content Information Units (95% CI= −34.94 – 55.15). Conclusions For those suitable and interested, the mICAP was more beneficial than usual care for participants with aphasia and their family members. However, lack of significant differences in discourse and other language functions, suggests that individual elements of mICAPs and their evaluation require review. Based on these results, the LIFT program has been refined to become the Comprehensive High-dose Aphasia Therapy (CHAT) program.

Effect of Unimanual Versus Bimanual Training on Impairment, Disability and Quality of Life Among Post Stroke Individuals: A Comparative Study

Background: Stroke is a significant global health issue caused by sudden interruptions in blood flow to the brain, leading to neurological dysfunction that can result in ischemic or hemorrhagic conditions. Effective rehabilitation approaches, such as unilateral and bilateral training, play a vital role in restoring upper limb function and overall recovery through targeted neural adaptations. Evaluation tools like the (SIS) provide critical insights into post-stroke recovery and improvements in quality of life, underscoring the need for comprehensive care and early intervention in managing this complex medical condition. Aim: To find out the effectiveness of unimanual and bimanual training on impairment, disability, and quality of life among post stroke individuals. Study design: comparative study Method: Firstly, ethical clearance was taken from the committee for comparative study. Samples were collected by lottery allotment sampling method. Thirty participants were selected based on inclusion and exclusion criteria. The details of the treatment were explained and written consent was taken from the participants. Experimental group treated with unimanual training and bimanual training for 5 days a week for 4 weeks. Outcome measure: Stroke impact scale Results: Data was analysed using SPSS Version29. According to statistical analysis, improvement seen in group B compared to group A. Conclusions: Bimanual training showed greater effective in impairment, disability and quality of life compared to unimanual training. KEYWORDS: Bimanual training, Unimanual training, stroke impact scale, quality of life, stroke.

Physical activity and influencing factors in people post stroke or transient ischemic attack across diverse regions in Sweden.

Physical activity (PA) and sedentary behavior are key targets for secondary stroke prevention, yet their characteristics and contributing factors are not well understood. This study aims to explore PA and sedentary behavior in individuals' post-stroke or transient ischemic attack (TIA) and identify factors linked to low PA (≤5,000 steps/day) and prolonged sedentary time (≥8 h/day). A cross-sectional study comparing sensor-derived (activPAL) PA and sedentary time among community-dwelling individuals post stroke or TIA residing in diverse geographical regions of Sweden. Multiple logistic regression models were performed to determine potential factors associated with low PA and prolonged sedentary time. The study included 101 participants post-stroke (n = 68) and TIA (n = 33), with a mean age of 70.5 years (65% female), mostly with no or mild disability (91%), living in metropolitan (69%) and rural (31%) areas of Sweden. Most participants (72%) had ≥ 8 h of sedentary time per day and 38% performed ≤5,000 steps per day. Using a walking aid (OR = 11.43, p = 0.002) was independently associated with low PA, whereas contextual factors; living alone (OR = 3.49, p = 0.029) and living in metropolitan areas (OR = 2.79, p = 0.036), were associated with prolonged sedentary time. In this study encompassing people post stroke or TIA from diverse geographical regions across Sweden, PA was associated with mobility status whereas sedentary behavior was associated with contextual factors. The results also showed a large variation in PA highlighting the need for tailored strategies to promote PA post stroke or TIA.