Post Stroke Research Articles

390 Real World Analysis of Outcomes After Revascularization Surgery for Symptomatic Non-stenotic Carotid (SyNC) Artery Disease

INTRODUCTION: Symptomatic non-stenotic carotid (SyNC) artery disease is emerging as one of the primary causes of embolic stroke of unknown source. The optimal secondary prevention strategies including medical therapy and revascularization (Carotid Endarterectomy (CEA) versus Carotid Artery Stenting (CAS)) continue to be controversial. METHODS: The National Surgical Quality Improvement Program (NSQIP) targeted dataset for CEA and CAS was queried for symptomatic patients with <50% stenosis of the ipsilateral carotid artery undergoing CEA and CAS between 2012-2019. Data analysis for continuous and categorical variables was carried out. RESULTS: A total of 363 symptomatic patients with <50% stenosis of the ipsilateral carotid artery were identified of which 22 underwent CAS and 341 underwent CEA. Statistical analysis showed that patients undergoing CEA were more likely to be male as compared to those undergoing CAS (68% vs 54.5%, p < 0.001). Additionally, patients in the CAS group were more likely to present with high-risk anatomy features compared to patients in the CEA group (31.8% vs 11.7%, p = 0.007) whereas patients undergoing CEA were more likely to have <50% stenosis contralateral ICA stenosis when compared to patients undergoing CAS (65.1% vs 36.4%, p = 0.001). Furthermore, patients undergoing CAS were more likely to experience post procedural stroke at 30 days compared to those undergoing CEA (13.6% vs 3.8%, p = 0.03). Upon multivariable analysis, CEA was associated with lower odds of post procedural stroke as compared to CAS (OR = 0.17, 95% CI 0.033-0.82, p = 0.027). CONCLUSIONS: Carotid revascularization for SyNC is being performed despite current guidelines and CEA is associated with lower odds of post-procedural stroke compared to CAS.

Efficacy of Nardostachys jatamansi (D.Don) DC in post stroke depression: A randomized, double blind, controlled trial

BackgroundPost-stroke Depression (PSD) is a frequent neuropsychiatric manifestation of high clinical importance as it adversely affects recovery and quality of life, interferes with rehabilitation, and is a significant source of burden to caregivers. Prevalence rates of PSD range from 25% to 79%. The reason for treatment failure in patients of PSD includes the timing of intervention or the side effects of medications. Nardostachys jatamansi (D.Don) DC is commonly used in traditional medicine systems for neuropsychiatric and psychosomatic disorders with the least or no side effects. However, its clinical efficacy in PSD remains unraveled. The study aimed to evaluate the efficacy of Nardostachys jatamansi in PSD. MethodsPresent study was a double-blind randomized placebo-controlled trial with 20 patients in each test and control group. Participants were randomly allocated to receive Nardostachys jatamansi 3gms (powder) in the test group or placebo in the control group for six weeks. Participants were asked to follow up fortnightly for the assessment of subjective parameters. Objective parameters (Hamilton Depression Rating Scale (HDRS17) score and 36-Item Short Form Survey (SF-36) were assessed at baseline and end of the trial. ResultsAfter 6 weeks of treatment, there was a statistically significant reduction in HDRS17 score and SF-36 (p < 0.001), whereas there was no significant difference in the control group (P = 0.108, and 0.29 respectively). Comparison between baseline and post-treatment scores in the test group showed a positive reduction in all subjective parameters however, in the control group there was no statistically significant change. The intergroup analysis revealed that the reduction in HDRS17 score and improvement in SF-36 score was statistically significant in the test group than the control group (P < 0.001). ConclusionThe study revealed that the test drug is effective in the management of PSD. There was no adverse effect observed during the trial.

Efficacy of Baishao Luoshi decoction on synaptic plasticity in rats with post stroke spasticity.

To evaluate the efficacy of Baishao Luoshi decoction (, BD) on synaptic plasticity in rats with post stroke spasticity (PSS), and to study the mechanism behind the action. The PSS model of rat was established by middle cerebral artery occlusion (MCAO). The neurological deficit symptoms were evaluated by modified neurological deficit score (mNSS). Muscle tension were evaluated by Modified Ashworth score (MAS). Transmission electron microscopy (TEM) was used to observe the synaptic ultrastructure. The expression of synaptic plasticity-related protein brain derived neurotrophic factor (BDNF), growth associated protein-43 (GAP43), synaptophysin (p38) and microtubule-associated protein 2 (MAP2) in the brain tissue around the infarct were detected by Western blotting. We found that mNSS were significantly improved and limb spasticity was ameliorated treated by BD. The thickness of postsynaptic density and the synaptic curvature increased significantly. The expression of synaptic plasticity-related protein BDNF, GAP43, p38, MAP2 in the brain tissue around the infarct were raised remarkably after treated by BD. Alleviating PSS by BD may be related to rescuing the synaptic plasticity, which provides a probable new therapeutic method for PSS.

Mobile health to promote physical activity in people post stroke or transient ischemic attack – study protocol for a feasibility randomised controlled trial

BackgroundPhysical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND– Let’s get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden.MethodsOne hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments.DiscussionWe hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA.Trial registrationClinicalTrials.gov Identifier: NCT05111951. Registered November 8, 2021.

Impact of post stroke depression and anxiety on health-related quality of life in young Filipino adults

BackgroundHealth-related quality of life (HRQoL) is important to assess in young adults who suffer from various physical and mental consequences after stroke. We aimed to evaluate the HRQoL of young adults after ischemic or hemorrhagic stroke and to determine the association of anxiety and depression with poor HRQoL in this special population.MethodsWe administered the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) to assess the HRQoL in our study population. This tool describes health outcomes in five dimensions. Socio-demographic and clinical data including modified Rankin scale (mRS), Barthel Index and Hospital Anxiety and Depression Scale scores were available from our previous cross-sectional study on young adults with stroke. We performed bivariate analyses to assess the association of psychiatric comorbidities with categorical characteristics and determined risk factors for poor HRQoL using multivariable logistic regression analysis.ResultsWe evaluated HRQoL, psychiatric and functional outcomes in 114 young adult stroke patients. CVD infarct was more common than hemorrhage (58.8 vs. 41.2%). Patients with both anxiety and depression were found to have the lowest ratings on the HRQoL scales, with an EQ VAS of 60 vs. 90 (p = 0.01) and an EQ Index of 0.64 vs. 0.89 (p &amp;lt; 0.01) when compared to those without both conditions. Anxiety and depression were significantly correlated with poor quality of life on all dimensions of the EQ-5D-5L. Similarly, Barthel Index was a significant predictor for problems in HRQoL (OR 0.17, 95% CI 0.03–1.02 on the mobility dimension and OR 0.08, 95% CI 0.01–0.55 on the self-care dimension). Cerebral hemorrhage was an independent predictor for poorer self-care dimension scores (OR 4.99, 95% CI 1.42–17.56).ConclusionsOur study showed that anxiety, depression and poor functional status are associated with poorer HRQoL in young adult Filipinos after stroke. Screening for psychiatric conditions and evaluating mobility are crucial in the management of this special population after stroke.

Comparison of Effects of NDT Vs BWSTT On Lower Extremity Among Chronic Stroke Patients

Objective: The purpose of the study is to determine the effect of Neurodevelopment Treatment Vs Body Weight Supported Treadmill Training along with conventional therapy on lower extremity among chronic stroke patients. Study Design: Randomized Controlled Trial (RCT). Place and Duration of study: This study took place n Lahore, Pakistan and the duration of the study was 6 months. Method: This study is a Randomized Controlled Trial utilized a non-probability purposive sampling technique, the primary outcome measure was Berg Balance Scale and Functional Gait Assessment which were used to check the balance and gait. The findings were then statistically analysed by non parametric tests Mann Whitney U Test and Friedman Test were used for between group and within the group comparisons respectively. Results: A total of 46 patients participated in the study among which after randomized allocation of 23(50%) in NDT and 23(50%) in BWSTT group. NDT group showed better results than the BWSTT group and the p value is 0.000 which is less than 0.05 when compared between the groups for balance at 12 weeks. NDT group showed better results than the BWSTT group and the p value is 0.001 which is less than 0.05 when compared between the groups for mobility at 12 weeks. Therefore, NDT is better than BWSTT for the improvement of both balance and mobility. Conclusion: Both of the treatment approaches have proven to be effective in treatment of balance and gait among chronic stroke patients but Neurodevelopmental Treatment has proven to be significantly more effective than Body Weight Supported Treadmill Training and has more significant results. Discussion: In the current study where NDT and BWSTT are compared to each other shows that NDT is highly effective for the treatment of balance in post stroke patients as compared to BWSTT that is only effective within the group but not as effective as NDT. Similarly Grozdek Covcic et.al in 2021 did a research on “Effects of Bobath treatment and specific mobilizations on gait in stroke patients” which indicated that Bobath technique in combination with soft tissue mobilization shows better results for the maintenance of balance and mobility in post-stroke patients. Also the Bobath treatment helped with increased AROM of the patient [1].

Trunk training following stroke.

Trunk training following stroke.

A case of Pathological Laughter in a patient with recurrent stroke

Introduction Stroke survivors frequently deal with neuropsychiatric sequelae - depression, anxiety and apathy being the most common ones. Pathological laughing and crying (PLC) is a post stroke condition characterized by brief, intense uncontrollable crying and/or laughing due to a neurological disorder. Prevalence of PLC post stroke has been reported to be 15-20%. Pathological laughter (PL) is commonly associated with bilateral or diffuse cerebral lesions. Ischemic injury involving the internal capsule and basal ganglia seems to be associated with emotional disorders. Objectives To discuss an uncommon case of pathological laughter developing after recurrent infarct. Methods A 32-year-old male patient presented to the medical emergency for complaints of slurring of speech since 7 hours. On examination, patient was alert, oriented, with blood pressure 150/90 mmHg. He had a history of similar stroke 2 years prior to current complaints and was on treatment for hypertension since then. Baseline investigations were done. MRI brain revealed acute lacunar infarcts in bilateral ganglio-capsular region, chronic small vessel ischaemic changes in B/L periventricular white matter (Fazeka grade 2) and micro-haemorrhages in various brain regions. Patient was managed conservatively (antiplatelets, statins, antihypertensives). Patient was then referred to Psychiatry department for uncontrollable laughing spells, which started few hours after onset of above complaints. These occurred without any provocation, every 1-2 hours, lasting for several seconds to a minute, and relieved spontaneously. Patient was aware of episodes and found them embarrassing socially. Mental status examination revealed no mood features or other abnormalities. Patient was prescribed Escitalopram, but shifted to homeopathic medicine and was lost to follow up. Telephonic interview one year later revealed that while other complaints have remitted, patient still has laughing spells of similar quality and frequency. Results Discussion: In post stroke PLC, pathological crying represents about 80% cases, while Pure Pathological Laughing, as in the present case, is uncommon. It is generally seen in diffuse CNS pathologies (eg. multiple sclerosis) or bilateral – ischaemic or degenerative. In case of strokes, PL may herald symptom onset, or may immediately follow focal deficits. The aetiology of PLC is unknown; monoaminergic neurotransmission may be altered in post stroke PLC. SSRIs are regarded as first choice treatment agents, given their greater tolerability overall. Conclusions Pathological laughter is a comparatively uncommon but recognisable and treatable post stroke sequela, more commonly seen in bilateral lesions. Patients often describe PL as distressing and socially disabling, but awareness about this condition and available treatments is lacking. Disclosure of Interest None Declared

Effect of Dual Task Training, Gait Training and Vestibular Rehabilitation on Balance and Quality of Life in Post Stroke Adults

OBJECTIVE: To investigate the effectiveness of dual task training, gait training and vestibular rehabilitation on balance and quality of life in post stroke adults. MATERIALS AND METHODS: This Pilot study was carried out on 45 post stroke participants both male and female who fulfilled the inclusion criteria were recruited for the study with age group between 40 to 60 years from out-patient physiotherapy department of Dr. M.G.R. Educational and Research Institute, Deemed to beUniversity. The subjects were randomly assigned into 3 groups, each group consisting of 15 subjects. Group A received dual task training for thrice a week of 45 minutes per session for 4 weeks. Group B received gait training program for thrice a week of 30 minutes per session for 6 weeks. Group C received Cawthorne and Cooksey exercises of vestibular rehabilitation for thrice a week of 60 minutes per session for 8 weeks. The outcome measures used were Global Quality of Life Scale (GQOL) and Berg Balance Scale (BBS). RESULT: When the mean values of GroupA, Group B and Group C were compared on GQOL and BBS scale revealed significant increase in the post test mean value with Group C showing 87 and 55 on GQOL and BBS respectively, which was higher than Group A mean values 84.1, 52.33 and followed by Group B mean value 80, 53.3 at p ≤ 0.001. Hence, Group C which received vestibular rehabilitation was more effective than other groups.

Relationship between upper extremities functional recovery with speech recovery among post stroke patients - an observational study

Globally stroke is one of the most common neurological disease, frequently causing death and disability. The survivors suffer from various impairments among which upper and lower limb motor deficits, visuo-spatial neglect and speech impairments are most common. The aim of the study is to find out the association between upper extremity functional recovery and speech recovery in acute stroke patients and to predict the recovery of upper extremity functions based on recovery of speech. Twenty-eight eligible and willing subjects diagnosed with dominant hemisphere supratentorial stroke were taken for the study. The objectives were achieved with Fugl- Meyer assessment: upper extremity (FMA-UL), Western Aphasia Battery (WAB) scale and Wolf motor function scales (WMFT), that were administered by the tester on the eligible subjects within a week after acute stroke and follow up measurements were carried out post one month. A moderate positive correlation was found in between WMFT and WAB. Strength component of WMFT was found to show better correlation with WAB as compared to functional ability and time components. Since initial recovery is mostly seen within (90-120) days, a long term follow up of the same study may provide more information regarding return of upper extremity function with respect to speech. Hence, recovery of speech can predict upper extremity functional recovery.

An evaluation of 3D printable elastics for post stroke dynamic hand bracing: a pilot study

ABSTRACT The rise of 3D printing allows unprecedented customization of rehabilitation devices, and with an ever-expanding library of 3D printable (3DP) materials, the spectrum of attenable rehabilitation devices is likewise expanding. The current pilot study explores feasibility of using 3DP elastic materials to create dynamic hand orthoses for stroke survivors. A dynamic orthosis featuring a replaceable finger component was fabricated using 3DP elastic materials. Duplicates of the finger component were printed using different materials ranging from low stiffness (low elastic modulus) to relatively high stiffness (high elastic modulus). Five stroke survivors with predominantly moderate hand impairment were recruited to evaluate usability and impact of orthoses on upper extremity function and biomechanics. No significant differences in usability were found between 3D-printed orthoses and a commercial orthosis. Increases in stiffness of the 3DP material reduced pincer force (p = .0041) and the BBT score (p = .043). In comparison, the commercial orthosis did not reduce pincer force but may reduce BBT score to a degree that is clinically significant (p = .0002). While preliminary, these findings suggest that a dynamic orthosis is a feasible clinical application of 3DP elastic materials, and future study is warranted.

Neurotoxicity of ischemic astrocytes involves STAT3-mediated metabolic switching and depends on glycogen usage.

Astrocytic responses are critical for the maintenance of neuronal networks in health and disease. In stroke, reactive astrocytes undergo functional changes potentially contributing to secondary neurodegeneration, but the mechanisms of astrocyte-mediated neurotoxicity remain elusive. Here, we investigated metabolic reprogramming in astrocytes following ischemia-reperfusion in vitro, explored their role in synaptic degeneration, and verified the key findings in a mouse model of stroke. Using indirect cocultures of primary mouse astrocytes and neurons, we demonstrate that transcription factor STAT3 controls metabolic switching in ischemic astrocytes promoting lactate-directed glycolysis and hindering mitochondrial function. Upregulation of astrocytic STAT3 signaling associated with nuclear translocation of pyruvate kinase isoform M2 and hypoxia response element activation. Reprogrammed thereby, the ischemic astrocytes induced mitochondrial respiration failure in neurons and triggered glutamatergic synapse loss, which was prevented by inhibiting astrocytic STAT3 signaling with Stattic. The rescuing effect of Stattic relied on the ability of astrocytes to utilize glycogen bodies as an alternative metabolic source supporting mitochondrial function. After focal cerebral ischemia in mice, astrocytic STAT3 activation was associated with secondary synaptic degeneration in the perilesional cortex. Inflammatory preconditioning with LPS increased astrocytic glycogen content, reduced synaptic degeneration, and promoted neuroprotection post stroke. Our data indicate the central role of STAT3 signaling and glycogen usage in reactive astrogliosis and suggest novel targets for restorative stroke therapy.

Predicting later categories of upper limb activity from earlier clinical assessments following stroke: an exploratory analysis

BackgroundAccelerometers allow for direct measurement of upper limb (UL) activity. Recently, multi-dimensional categories of UL performance have been formed to provide a more complete measure of UL use in daily life. Prediction of motor outcomes after stroke have tremendous clinical utility and a next step is to explore what factors might predict someone’s subsequent UL performance category.PurposeTo explore how different machine learning techniques can be used to understand how clinical measures and participant demographics captured early after stroke are associated with the subsequent UL performance categories.MethodsThis study analyzed data from two time points from a previous cohort (n = 54). Data used was participant characteristics and clinical measures from early after stroke and a previously established category of UL performance at a later post stroke time point. Different machine learning techniques (a single decision tree, bagged trees, and random forests) were used to build predictive models with different input variables. Model performance was quantified with the explanatory power (in-sample accuracy), predictive power (out-of-bag estimate of error), and variable importance.ResultsA total of seven models were built, including one single decision tree, three bagged trees, and three random forests. Measures of UL impairment and capacity were the most important predictors of the subsequent UL performance category, regardless of the machine learning algorithm used. Other non-motor clinical measures emerged as key predictors, while participant demographics predictors (with the exception of age) were generally less important across the models. Models built with the bagging algorithms outperformed the single decision tree for in-sample accuracy (26–30% better classification) but had only modest cross-validation accuracy (48–55% out of bag classification).ConclusionsUL clinical measures were the most important predictors of the subsequent UL performance category in this exploratory analysis regardless of the machine learning algorithm used. Interestingly, cognitive and affective measures emerged as important predictors when the number of input variables was expanded. These results reinforce that UL performance, in vivo, is not a simple product of body functions nor the capacity for movement, instead being a complex phenomenon dependent on many physiological and psychological factors. Utilizing machine learning, this exploratory analysis is a productive step toward the prediction of UL performance.Trial registration NA

Normative Data of Fugl Meyer Assessment on Upper Extremity in Post Stroke Population

Background: Stroke is clinically diagnosed as an acute, localized neurological impairment that is caused by vascular damage (infarction, hemorrhage) to the central nervous system. This main leading cause of demise and dysfunction worldwide resulting in frequent deficit, hemiplegia, which briefly affects upper limb. This multicentered study is the first to provide updated normative reference values for FMA-UE in post stroke adults in wide range of age in Pakistan’s population.&#x0D; Objective: To determine Pakistani normative values of Fugl-Meyer Assessment on upper extremity in post Stroke Population.&#x0D; Methods: Descriptive cross-sectional study on 1260 post-stroke patients was conducted in various public and private physiotherapy centers of country using Fugl-Meyer Assessment (Upper-Extremity) FMA-UE scale after ethical approval. Hemiplegic survivors of both genders aged 45-75 years were taken using convenience sampling technique, informed consent was taken. Statistics was done using SPSS version25.&#x0D; Results: Patients included were 88.3% ischemic and 11.7% hemorrhagic. 44.1% were in acute phase (less than 2 weeks) while 55.9% were in sub-acute (2 weeks to 6 months) phase. Mean score of FMA-UE was 88.63±30.09. The cutoff score/mean value for motor impairment and sensation was recorded as 41.49 ±19.7 and 8.6±3.9 while passive joint motion and pain were calculated 18.93±5.47 and 19.57±5.1 respectively.&#x0D; Conclusion: The scoring, in acute and subacute phases, accentuate the need to follow Pakistani specific modified norms in Asian inhabitants instead of reference values applicable on western population.&#x0D; Keywords: Fugl-Meyer scale, Hemiplegia, Motor control, Post Stroke, Upper extremity.

Mobility related confidence level in chronic stroke patients through task oriented walking intervention

Introduction&#x0D; Stroke is a neurological insufficiency caused by cerebrovascular injury resulting in major motor deficits in lower limbs. Different therapeutic interventions are being used for stroke rehabilitation. Task oriented walking intervention is a unique approach used for stroke rehabilitation. This research work was planned to study the effects of Task-Oriented walking Interventions on improving the mobility related confidence level in chronic stroke patients.&#x0D; Method&#x0D; This randomized control trial study was conducted on 48 stroke patients in hospital settings. Informed consent was taken from all the study participants before inclusion in the study population and the data from the study subjects was collected through a specially designed questionnaire, 06 minutes-walk test (6MWT), Timed "Up and Go" test (TUG), and Activity-specific Balance Confidence (ABC) Scale. The study population was randomly divided into two groups as experimental group and control group. Experimental group received Task-Oriented Walking Interventions and conventional treatment while control group received conventional interventions only.&#x0D; Results&#x0D; On statistical analysis, significant improvement in mobility related confidence level for all the three scales TUG, ABC and 6MWT was observed on experimental group as compared to the control group after six weeks of interventions.&#x0D; Conclusion&#x0D; The study concluded that task oriented walking interventions is an effective approach for improving mobility related confidence level in post stroke patients.&#x0D; Keywords: Task oriented training, Mobility related confidence, Stroke, Activity-specific Balance Confidence Scale

Characterization of the influence of the dominant tract on hand closing post stroke based on the Fugl-Meyer score

While stroke survivors with moderate or mild impairment are typically able to open their hand at will, those with severe impairment cannot. Abnormal synergies govern the arm and hand in stoke survivors with severe impairment, so hand opening, which is required to overcome the working synergy, is an extremely difficult task for them to achieve. It is universally accepted that alternative tracts including the cortico-reticulospinal tract (CRST), employed in the case that the corticospinal tract (CST) is damaged by stroke, brings about such abnormal synergies. Here we note that hand closing is enabled by alternative tracts as well as the CST, and a research question arises: Does motor characteristics while closing the hand depend on the integrity of the CST? In this study, we evaluate the abilities of 17 stroke survivors to flex and relax the metacarpophalangeal (MCP) joints and investigate whether motor characteristics can be distinguished based on CST integrity which is estimated using upper-extremity Fugl-Meyer (UEFM) scores. UEFM scores have been perceived as an indirect indicator of CST integrity. We found that participants with the UEFM score above a certain value, who are assumed to use the CST, moves the MCP joints more smoothly (P < 0.05) and activates the flexors to flex the joints faster (P < 0.05), in comparison to participants with low UEFM scores, who are assumed to preferentially use alternative tracts. The results imply that use of alternative tracts (i.e. the CRST) results in a degradation in movement smoothness and slow activation of MCP flexors. We present evidence that responses of flexors of the MCP joints following stroke depend on the degree of impairment which is hypothesized to originate from preferentially use of different neural motor pathways.

The Place of Botulinum Toxin in Spastic Hemiplegic Shoulder Pain after Stroke: A Scoping Review

Stroke is a common pathology worldwide, with an age-standardized global rate of new strokes of 150.5 per 100,000 population in 2017. Stroke causes upper motor neuron impairment leading to a spectrum of muscle weakness around the shoulder joint, changes in muscle tone, and subsequent soft tissue changes. Hemiplegic shoulder pain (HSP) is the most common pain condition in stroke patients and one of the four most common medical complications after stroke. The importance of the appropriate positioning and handling of the hemiplegic shoulder for prevention of HSP is therefore of high clinical relevance. Nevertheless, HSP remains a frequent and disabling problem after stroke, with a 1-year prevalence rate up to 39%. Furthermore, the severity of the motor impairment is one of the most important identified risk factors for HSP in literature. Spasticity is one of these motor impairments that is likely to be modifiable. After ruling out or treating other shoulder pathologies, spasticity must be assessed and treated because it could lead to a cascade of unwanted complications, including spastic HSP. In clinical practice, Botulinum toxin A (BTA) is regarded as the first-choice treatment of focal spasticity in the upper limb, as it gives the opportunity to target specifically selected muscles. It thereby provides the possibility of a unique patient tailored focal and reversible treatment for post stroke spasticity. This scoping review aims to summarize the current evidence of BTA treatment for spastic HSP. First, the clinical manifestation and outcome measures of spastic HSP will be addressed, and second the current evidence of BTA treatment of spastic HSP will be reviewed. We also go in-depth into the elements of BTA application that may optimize the therapeutic effect of BTA. Finally, future considerations for the use of BTA for spastic HSP in clinical practice and research settings will be discussed.

Abstract TMP109: Labeling And Isolating Cell Specific Neuronal Mitochondria And Their Functional Analysis In Mice Post Stroke

Introduction: In vivo neuronal mitochondria dysfunction post stroke has not been well investigated. Methods: Using Mito-tag mice in combine with local infection of AAV9 produced from plasmids carrying Cre-recombinase controlled by neuronal promoters, we generated reporter mice expressing a hemagglutinin (HA)-tagged EGFP that localizes to mitochondrial outer membranes in synaptophysin (SYN) and calmodulin-kinase II (CaMKII) glutamatergic neurons localized to cerebral cortex. These mice were subjected to permanent middle cerebral artery occlusion and sacrificed 14 days post stroke. Fresh brain tissues were excised from the ischemic core (IC), ischemic boundary zone (IBZ) as well as from the homologous contralateral hemisphere, and the crude mitochondrial fractions (CMF) were extracted. Neuronal mitochondria were then isolated from the CMF by anti-HA magnetic beads (Thermo Scientific) and their specificity and oxidative phosphorylation (OXPHOS) complexes were confirmed by means of Western-blot. Seahorse assay was employed to measure oxygen consumption rate (OCR) of the isolated mitochondria as an indicator of mitochondrial function. Results: The bead pulled components 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 OXPHOS components in SYN + and CAMKII + neuronal mitochondria were significantly downregulated in the IBZ and further decreased in the IC compared to the contralateral tissue, which was associated with the significant reductions of mitochondrial function measured by OCR (p&lt;0.05, respectively, for both neuron types). These data suggesting dysfunction of neuronal mitochondria post stroke. Conclusions: We, for the first time, measure mitochondrial function in 2 types of neurons post stroke. By introducing specific neuronal promoter controlled Cre recombinase to Mito-tag mouse, mitochondria from individual neuronal linage cells can be efficiently labeled and isolated to investigate functional change post stroke.

Abstract HUP9: Racial Disparities In Acute Ischemic Stroke At A Large Metropolitan Stroke Center

Background: Race and ethnicity can have a major impact on the quality of care patients with acute ischemic stroke (AIS) receive. We sought to assess the impact of race and ethnicity on quality benchmarks of AIS therapy and clinical outcomes at a comprehensive stroke center (CSC). Methods: A retrospective analysis of AIS patients presenting to a CSC between 2015 to 2020 was performed. Data included demographics, NIH Stroke Scale scores, time to thrombolysis, discharge diabetic and hypertensive medications, length of stay (LOS), discharge functional status, 30-day readmission, and 30-day mortality. Quality benchmarks and outcomes were analyzed by the five most prevalent racial-ethnic groups including Non-Hispanic White (NHW), Hispanic, Black, Asian, Other and Unknown. Results: 3,735 AIS patients were identified. NHW represented 53.3% (n=1992),Black 21.3% (n=797), Hispanic 10.4% (n=390), Asian 7.2% (n=267), Other 4.6% (n=170) and Unknown 3.2% (n=119). There were no significant differences in door to needle (P=0.93), door to puncture time (P=0.98), intravenous thrombolysis (P=0.32) and mechanical thrombectomy utilization (P=0.19) by race-ethnicity. In univariable analysis, there was a higher rate of 30-day mortality in Unknown 23.5% vs NHW 7.3% (P&lt; 0.0001). A significantly (P&gt;0.05) higher rate of 30-day readmission was noted in NHW 20.3% vs Black 15.7%, Hispanics 15.6%, Others 11.8% and Unknown 8.4%. Black 67.6%, Hispanic 64.9% and Unknown 80.5% had a significantly (P&lt;0.05) higher rate of post stroke disability (mrs&gt;2) vs NHW 60.3%. A significant difference (P&lt;0.05) in LOS with Black patients staying 8.4, Hispanic 10.8, Asians 11.9 and Unknown 11.2 days vs NHW 7.7.Adjusting for age, sex, NIHSS and comorbidities, multivariable logistic regression continued to show differences in post stroke disability for Black (OR=1.40, P=0.003), Hispanic (OR=1.49, P=0.008) and Unknown (OR=2.03, P=0.016) vs NHW. Median LOS was 0.85 and 0.77 days longer for Asian and Hispanic (P=0.006, P=0.014) respectively vs NHW. Conclusions: Our analysis reveals persistent disparities in stroke outcomes, with Black and Hispanic patients suffering greater disability post stroke. Further investigation is needed to uncover how race-ethnicity mediates stroke care and outcomes.

Abstract WP233: Sex Differences In The Impact Of Focal Ischemia On Cognitive Impairment In Middle-aged Rats And The Effect Of Iv Mir20a-3p Treatment

Introduction: Our previous studies show that the small non-coding RNA, mir20a-3p, is neuroprotective for stroke in the acute phase (Branyan et al., 2021). Here we used a battery of tests to assess the integrated functioning of affective and cognitive circuits in the chronic phase of stroke and the impact of mir20a-3p. Methods: Middle-aged (12-month-old) female and male Sprague-Dawley rats were subject to middle cerebral artery occlusion (MCAo) using endothelin-1. Mir20a-3p mimic or scrambled oligo was administered i.v. 4h, 24h, and 60d after stroke. Cognitive changes (30-100d after stroke) were assessed by contextual fear conditioning (CFC) and the novel object recognition test (NORT). Blood samples were collected at 60 and 100d to assess cytokines and short chain fatty acids. Results: MCAo impaired sensory motor performance in the acute phase, which was ameliorated by Mir20a-3p treatment. At 30, 60 and 100d after stroke, retrieval of fear memory was significantly reduced over time in sham and stroke males and females. However, the rate of decline of fear memory was significantly accelerated in the scramble treated female stroke group, but not in the scramble treated male stroke group. Similarly, declarative memory (NORT) declined in all female groups at 30 days post stroke and continued to worsen only in the stroke+ scrambled treated group. Male rats did not show any change in performance due to stroke or its treatment at comparable time points of testing. Hyperintensities in the forebrain of T2 weighted MRI images were decreased in mir20a-3p treated stroke females compared to males. Correlation analysis showed that in females at 60d post stroke, the extent of Remote Fear memory recall was highly positively correlated with the levels of the SCFA butyric acid (+0.81) and valeric acid (+0.61), as well as the pro-inflammatory cytokine IL-12p70 (+0.64), and the serine hydrolase, butyrylcholinesterase (+0.71). Conclusion: Although acute sensory-motor impairment is seen to a similar extent in males and females, stroke significantly affected cognitive function in females but not males, and this was associated with alterations in inflammatory mediators. Mir20a-3p, which is predicted to repress inflammatory analytes, abrogated stroke effects in females.