Recovery Phase Of Stroke Research Articles

Beyond Pharmacology: The Biological Mechanisms of Remote Ischemic Conditioning in Cerebrovascular Disease

Cerebrovascular diseases (CVDs), comprising predominantly ischemic stroke and chronic cerebral hypoperfusion (CCH), are a significant threat to global health, often leading to disability and mortality. Remote ischemic conditioning (RIC) has emerged as a promising, non-pharmacological strategy to combat CVDs by leveraging the body’s innate defense mechanisms. This review delves into the neuroprotective mechanisms of RIC, categorizing its effects during the acute and chronic phases of stroke recovery. It also explores the synergistic potential of RIC when combined with other therapeutic strategies, such as pharmacological treatments and physical exercise. Additionally, this review discusses the pathways through which peripheral transmission can confer central neuroprotection. This review concludes by addressing the challenges regarding and future directions for RIC, emphasizing the need for standardized protocols, biomarker identification, and expanded clinical trials to fully realize its therapeutic potential.

Improvements in upper extremity isometric muscle strength, dexterity, and self-care independence during the sub-acute phase of stroke recovery: an observational study on the effects of intensive comprehensive rehabilitation.

Stroke often impairs upper extremity motor function, with recovery in the sub-acute phase being crucial for regaining independence. This study examines changes in isometric muscle strength, dexterity, and self-care independence during this period, and evaluates the effects of a comprehensive intensive rehabilitation (COMIRESTROKE). Individuals in sub-acute stroke recovery and age- and sex-matched controls were assessed for pre- and post-rehabilitation differences in primary outcomes (grip/pinch strength, Nine Hole Peg Test [NHPT], Action Research Arm Test [ARAT]). COMIRESTROKE's effects on primary and secondary outcomes (National Institute of Health Stroke Scale [NIHSS], Modified Rankin Scale [MRS], Functional Independence Measure [FIM]) were evaluated. Outcomes were analyzed for dominant and non-dominant limbs, both regardless of impairment and with a focus on impaired limbs. Fifty-two individuals with stroke (NIHSS 7.51 ± 5.71, age 70.25 ± 12.66 years, 21.36 ± 12.06 days post-stroke) and forty-six controls participated. At baseline, individuals with stroke showed significantly lower strength (dominant grip, key pinch, tip-tip pinch, p adj < 0.05), higher NHPT scores (p adj < 0.05), and lower ARAT scores (p adj < 0.001). COMIRESTROKE led to improvements in dominant key pinch, non-dominant tip-tip pinch, NHPT, and both dominant and non-dominant ARAT (p adj < 0.05). Notably, non-dominant key pinch improved significantly when considering only impaired hands. Pre- and post-test differences between groups were significant only for ARAT (both limbs), even after adjustment (p adj < 0.05). All secondary outcomes (NIHSS, MRS, FIM) showed significant improvement post-COMIRESTROKE (p adj < 0.001). Individuals with stroke exhibit reduced muscle strength and dexterity, impairing independence. However, comprehensive intensive rehabilitation significantly improves these functions. Data are available from the corresponding author upon request and are part of a sub-study of NCT05323916.

Early robotic gait training after stroke (ERA Stroke): study protocol for a randomized clinical trial

BackgroundWalking impairment after stroke is associated with substantial limitations in functional independence, quality of life, and long-term survival. People in the subacute phase after stroke who are unable to walk are most likely to benefit the greatest from use of overground robotic gait training (RGT). This study will provide preliminary evidence regarding the clinical use and efficacy of RGT during the subacute phase of stroke recovery as well as observational findings associated with the safety, tolerability, feasibility, and cost of delivering RGT during inpatient stroke rehabilitation.MethodsThis prospectively registered randomized controlled trial will enroll 54 patients admitted to inpatient rehabilitation within six months of stroke. Admitted patients will be screened at admission to inpatient rehabilitation for eligibility. Consented patients will be randomized based on stroke severity to receive either RGT or usual care for 90 minutes per week of gait training intervention during inpatient rehabilitation length of stay. Patients will complete assessments on walking and health outcomes at admission and discharge from inpatient rehabilitation and at 1- and 3-month follow-up. Intent-to-treat and per protocol analysis will be performed to evaluate safety [rate of adverse events, visual analog scale, and treatment completion rate], walking function [gait speed via 10-Meter Walk Test, Functional Ambulation Category, gait endurance via 6-Minute Walk Test] and health outcomes [Modified Rankin Scale, Stroke Rehabilitation Assessment of Movement, Continuity Assessment Record and Evaluation Tool, 5 Times Sit-to-Stand Test, Berg Balance Scale, and Stroke Impact Scale–16], and cost-analysis.DiscussionThis study will provide foundational evidence regarding the clinical use and efficacy of a RGT program during the subacute phase of stroke recovery with specific findings associated with the safety, tolerability, feasibility, and cost-analysis of delivering RGT during inpatient stroke rehabilitation.Trial registrationNCT06430632.

Study on correlation between Chinese medicine syndromes in stroke and neurological deficits during recovery phase: Perspective.

Stroke is a leading cause of long-term disability and mortality worldwide, necessitating effective rehabilitation strategies for successful recovery. Traditional Chinese medicine (TCM) has gained recognition as a complementary and alternative approach in stroke rehabilitation, owing to its unique syndromes that offer valuable insights for personalized treatment plans. This study aims to elucidate the correlation between TCM syndromes observed during the recovery phase of stroke and the associated neurological deficits. Syndromes such as Blood stasis, Phlegm-dampness, Qi deficiency, and Yin deficiency were systematically examined, while standardized neurological assessments, encompassing motor function, sensory perception, and cognitive abilities, were employed to evaluate the extent of neurological impairment. Rigorous statistical analyses were conducted to discern potential correlations between TCM syndromes and the severity of neurological deficits. The results revealed statistically significant positive associations between certain TCM syndromes, particularly Blood stasis and Phlegm-dampness, and heightened neurological deficits during the recovery phase post-stroke. These findings suggest that these syndromes may serve as indicators of more severe brain injury post-stroke, thereby guiding the development of tailored rehabilitation strategies. By establishing robust connections between TCM syndromes and neurological deficits, this study contributes to advancing our understanding of stroke recovery through an integrated approach that incorporates TCM principles. Moreover, it underscores the potential benefits of integrating TCM into conventional rehabilitation protocols, offering valuable insights for healthcare professionals and potentially improving patient outcomes.

Acute nicotine exposure attenuates neurological deficits, ischemic injury and brain inflammatory responses and restores hippocampal long-term potentiation in ischemic stroke followed by lipopolysaccharide-induced sepsis-like state

Ischemic stroke is followed by an increased susceptibility to bacterial infections, which exacerbate histological stroke outcome, neurological deficits and memory impairment due to increased neuroinflammation and neurotransmitter dysfunction. Pharmacological activation of nicotinic acetylcholine receptors was suggested to mitigate brain inflammatory responses in ischemic stroke. The functional responses associated with nicotinic acetylcholine receptor activation were unknown. In this study, male NMRI mice subjected to transient intraluminal middle cerebral artery occlusion (MCAO) were intraperitoneally exposed to vehicle treatment or Escherichia coli lipopolysaccharide (LPS; 4 mg/kg)-induced sepsis-like state 24 h post-MCAO, followed by intraperitoneal administration of vehicle or nicotine (0.5 mg/kg) 30 min later. Over 96 h, rectal temperature, neurological deficits, spontaneous locomotor activity, working memory, ischemic injury, synaptic plasticity, and brain inflammatory responses were evaluated by temperature measurement, behavioral analysis, infarct volumetry, electrophysiological recordings, and polymerase-chain reaction analysis. LPS-induced sepsis induced hypothermia, increased general and focal neurological deficits, reduced spontaneous exploration behavior, reduced working memory, and increased infarct volume post-MCAO. Additional treatment with nicotine attenuated LPS-induced hypothermia, reduced neurological deficits, restored exploration behavior, restored working memory, and reduced infarct volume. Local field potential recordings revealed that LPS-induced sepsis decreased long-term potentiation (LTP) in the dentate gyrus post-MCAO, whereas concomitant nicotine exposure restored LTP in the contralateral dentate gyrus. LPS-induced sepsis increased microglial/ macrophage Iba-1 mRNA and astrocytic GFAP mRNA levels post-MCAO, whereas add-on nicotine treatment reduced astrocytic GFAP mRNA. Taken together, these findings indicate that acute nicotine exposure enhances functional stroke recovery. Future studies will have to evaluate the effects of (1) chronic nicotine exposure, a clinically relevant vascular risk factor, and (2) the cessation of nicotine exposure, which is widely recommended post-stroke, but might have detrimental effects in the early stroke recovery phase.

One-year budget impact of InTandem™: a novel neurorehabilitation system for individuals with chronic stroke walking impairment.

Aim: Chronic stroke walking impairment is associated with high healthcare resource utilization (HCRU) costs. InTandem™ is a neurorehabilitation system that autonomously delivers a rhythmic auditory stimulation (RAS)-based intervention for the at-home rehabilitation of walking impairment in adults in the chronic phase of stroke recovery. This study was conducted to estimate the budget impact of InTandem in comparison with currently available intervention strategies for improvement of gait/ambulation in individuals with chronic stroke walking impairment. Methods & materials: A budget impact analysis (BIA) for InTandem was conducted based on a 1-million-member US third-party payer perspective over a 1-year time horizon. Key inputs for the budget impact model were: costs for each intervention strategy (InTandem, physical therapy, self-directed walking and no treatment), HCRU costs for persons with chronic stroke and anticipated HCRU cost offsets due to improvements in gait/ambulatory status as measured by self-selected comfortable walking speed (based on functional ability). In addition to the reference case analysis, a sensitivity analysis was conducted. Results: Based on the reference case, introduction of InTandem was projected to result in overall cost savings of $439,954 in one year. Reduction of HCRU costs (-$2,411,778) resulting from improved walking speeds with InTandem offset an increase in intervention costs (+$1,971,824). Demonstrations of cost savings associated with InTandem were robust and were consistently evident in nearly all scenarios evaluated in the sensitivity analysis (e.g., with increased/decreased patient shares, increased HCRU costor increased InTandem rental duration). Conclusion: The InTandem system is demonstrated to improve walking and ambulation in adults in the chronic phase of stroke recovery after a five-week intervention period. The BIA predicts that introduction of InTandem will be associated with overall cost savings to the payer.

Multidisciplinary Delphi Panel on Rehabilitation Approaches and Unmet Needs for Chronic Stroke Walking Impairment and the Role of Rhythmic Auditory Stimulation.

Walking or gait impairment is a common consequence of stroke that persists into the chronic phase of recovery for many stroke survivors. The goals of this work were to obtain consensus from a multidisciplinary panel on current practice patterns and treatment options for walking impairment after stroke, to better understand the unmet needs for rehabilitation in the chronic phase of recovery and to explore opportunities to address them, and to discuss the potential role of rhythmic auditory stimulation (RAS) in gait rehabilitation. A panel of eight experts specializing in neurology, physical therapy, and physiatry participated in this three-part, modified Delphi study. Survey 1 focused on gathering information to develop statements that were discussed and polled during Survey 2 (interactive session), after which revised and new statements were polled in Survey 3. Consensus was defined as ≥75% (6/8 of panelists) agreement or disagreement with a statement. Consensus agreement was ultimately reached on all 24 statements created and polled during this process. The panelists agreed that individuals with gait or walking impairment in the chronic phase of stroke recovery can achieve meaningful improvement in walking by utilizing various evidence-based interventions. Barriers to treatment included cost, access, participation in long-term treatment, and safety. Consensus was achieved for interventions that have the following features challenging, personalized, accessible, and engaging. Improvement of gait speed and quality, durability of effect, safety, affordability, and ability for home or community use also emerged as important treatment features. In addition to conventional treatments (e.g., physical therapy, including mobility-task training and walking/exercise therapy), RAS was recognized as a potentially valuable treatment modality. Discussion: This panel highlighted limitations of current treatments and opportunities to improve access, participation, and outcomes through a consideration of newer treatment strategies and patient/healthcare provider education and engagement.

A molecular brain atlas reveals cellular shifts during the repair phase of stroke.

Ischemic stroke triggers a cascade of pathological events that affect multiple cell types and often lead to incomplete functional recovery. Despite advances in single-cell technologies, the molecular and cellular responses that contribute to long-term post-stroke impairment remain poorly understood. To gain better insight into the underlying mechanisms, we generated a single-cell transcriptomic atlas from distinct brain regions using a mouse model of permanent focal ischemia at one month post-injury. Our findings reveal cell- and region-specific changes within the stroke-injured and peri-infarct brain tissue. For instance, GABAergic and glutamatergic neurons exhibited upregulated genes in signaling pathways involved in axon guidance and synaptic plasticity, and downregulated pathways associated with aerobic metabolism. Using cell-cell communication analysis, we identified increased strength in predicted interactions within stroke tissue among both neural and non-neural cells via signaling pathways such as those involving collagen, protein tyrosine phosphatase receptor, neuronal growth regulator, laminin, and several cell adhesion molecules. Furthermore, we found a strong correlation between mouse transcriptome responses after stroke and those observed in human nonfatal brain stroke lesions. Common molecular features were linked to inflammatory responses, extracellular matrix organization, and angiogenesis. Our findings provide a detailed resource for advancing our molecular understanding of stroke pathology and for discovering therapeutic targets in the repair phase of stroke recovery.

Early poststroke clinically significant fatigue predicts functional independence: a prospective longitudinal study.

Poststroke fatigue is a prevalent issue among stroke survivors, significantly impeding functional recovery and diminishing their quality of life. This prospective cohort study aims to investigate the association between poststroke fatigue and the extent of functional recovery in survivors of ischemic and hemorrhagic strokes. Additionally, it seeks to delineate the temporal progression of poststroke fatigue in these two stroke subtypes. We assessed a cohort of 79 patients recovering from acute ischemic or hemorrhagic strokes. Poststroke fatigue was quantified using the Fatigue Severity Scale (FSS) and the Numeric Rating Scale (NRSfatigue). Patients' condition was evaluated using the National Institute of Health Stroke Scale (NIHSS), and functional independence levels were determined using the Barthel Index for Activities of Daily Living (BIADL) and the Modified Rankin Scale (MRS). Depressive mood and pain were measured using the Beck Depression Inventory (BDI) and the Numeric Rating Scale for pain (NRSpain), respectively. Our primary findings indicate that the early manifestation of clinically significant fatigue (CSF) is predictive of a poorer trajectory in functional independence levels during recovery. Furthermore, we observed differing patterns of fatigue progression between ischemic and hemorrhagic strokes. Fatigue tends to ameliorate over time in hemorrhagic stroke cases, paralleling functional recovery, while it remains stable over time in ischemic stroke cases. Our results underscore the detrimental impact of early poststroke fatigue on long-term outcomes. Furthermore, they highlight the imperative of managing poststroke fatigue, particularly during the subacute phase of stroke recovery.

Peripheral vascular function in stroke: systematic review and meta-analysis.

Peripheral vascular dysfunction, measured as flow-mediated dilation (FMD), is present across all phases of stroke recovery and elevates the risk for recurrent cardiovascular events. The objective of this systematic review and meta-analysis was to characterize baseline FMD in individuals' poststroke, with consideration for each phase of stroke recovery. Three databases (PubMed, CINAHL, and Embase) were searched between January 1, 2000 and October 12, 2023 for studies that examined baseline FMD in stroke. Three reviewers conducted abstract and full-text screening, data extraction, and quality assessment. A random effects model was used to estimate FMD across studies. Meta-regression was used to examine the impact of age and time since stroke (acute, subacute, chronic) on FMD. Twenty-eight studies with ischemic and hemorrhagic stroke were included. Descriptive statistics for the demographics and FMD values of each study are presented. For the meta-analysis, average estimate FMD was 3.9% (95% CI: 2.5-5.3%). We report a large amount of heterogeneity (Cochrane's Q P value <0.001, and I2 = 99.6%). Differences in average age and the time poststroke between studies were not significantly associated with differences in FMD values. Despite the large heterogeneity for FMD values across studies, our primary finding suggests that FMD remains impaired across all phases of stroke.NEW & NOTEWORTHY This systematic review and meta-analysis offers invaluable insight into poststroke vascular function. Despite the inherent heterogeneity among the 28 studies analyzed, we report that peripheral vascular dysfunction, as quantified by flow-mediated dilation, exists across all stages of stroke recovery. This finding underscores the importance for interventions that focus on improving vascular health and secondary stroke prevention.

Abstract TP93: A Bayesian Hierarchical Time Series Model to Forecast Patient Recovery Outcomes After an Acute Stroke When Activity Monitor Data is Incomplete

Background: Activity monitor data is a useful tool in clinical trials to monitor patient recovery after stroke. These data offer important information on activity, sedentary and sleep behaviors throughout recovery. However, not all participants wear activity monitors, or their activity data may be incomplete. The purpose of this study was to develop a model-based approach to obtain individual patient-level longitudinal forecast estimates of activity and sleep behaviors for both those with and without complete activity data. Methods: Participants wore an ActivPal (steps/day) and Actigraph (total sleep/day) monitors for 3-7 days at 10-60-90 days post stroke. We developed a Bayesian hierarchical time series model to forecast daily steps and sleep time by participant. We included a logistic growth curve in which we use predictors comprising age, sex, race, marital status, smoking, BMI, cognition, gait speed, depression, self-reported sleep, and patients’ previous time trends to forecast patient specific future time trends during the first 90 days following stroke. Results: Data were collected on a total sample of 114 participants. Out of the 114 participants, 73 participants had recorded sleep data, and 76 participants had step data reported, which are not mutually exclusive groups. Out of 114 total participants, 41 participants did not have any sleep or step data recorded. We obtained patient-specific time trends for both patients with and without monitor data. To assess model predictive performance, we compared predicted estimates to observed data using a validation study and found that on average, there was a difference of 0.52 daily steps (counts). Additionally, on average, there was a difference of 0.46 between observed and estimated daily sleep count (minutes). Discussion: The contribution of our study is a model-based approach to accurately predict patient-specific longitudinal step and sleep behaviors based on predictor variables and previous time trends for patients in the subacute stroke recovery phase. Our approach may be extended to other applications using activity monitor data. A limitation of this study is the increased uncertainty surrounding forecast estimates for periods/days without data, which will be addressed in future work.

Maintaining moderate levels of hypochlorous acid promotes neural stem cell proliferation and differentiation in the recovery phase of stroke.

JOURNAL/nrgr/04.03/01300535-202503000-00029/figure1/v/2024-06-17T092413Z/r/image-tiff It has been shown clinically that continuous removal of ischemia/reperfusion-induced reactive oxygen species is not conducive to the recovery of late stroke. Indeed, previous studies have shown that excessive increases in hypochlorous acid after stroke can cause severe damage to brain tissue. Our previous studies have found that a small amount of hypochlorous acid still exists in the later stage of stroke, but its specific role and mechanism are currently unclear. To simulate stroke in vivo, a middle cerebral artery occlusion rat model was established, with an oxygen-glucose deprivation/reoxygenation model established in vitro to mimic stroke. We found that in the early stage (within 24 hours) of ischemic stroke, neutrophils produced a large amount of hypochlorous acid, while in the recovery phase (10 days after stroke), microglia were activated and produced a small amount of hypochlorous acid. Further, in acute stroke in rats, hypochlorous acid production was prevented using a hypochlorous acid scavenger, taurine, or myeloperoxidase inhibitor, 4-aminobenzoic acid hydrazide. Our results showed that high levels of hypochlorous acid (200 μM) induced neuronal apoptosis after oxygen/glucose deprivation/reoxygenation. However, in the recovery phase of the middle cerebral artery occlusion model, a moderate level of hypochlorous acid promoted the proliferation and differentiation of neural stem cells into neurons and astrocytes. This suggests that hypochlorous acid plays different roles at different phases of cerebral ischemia/reperfusion injury. Lower levels of hypochlorous acid (5 and 100 μM) promoted nuclear translocation of β-catenin. By transfection of single-site mutation plasmids, we found that hypochlorous acid induced chlorination of the β-catenin tyrosine 30 residue, which promoted nuclear translocation. Altogether, our study indicates that maintaining low levels of hypochlorous acid plays a key role in the recovery of neurological function.

A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After Stroke.

Functional electrical stimulation (FES) is a common neuromotor intervention whereby electrically evoked dorsiflexor muscle contractions assist foot clearance during walking. Plantarflexor neurostimulation has recently emerged to assist and retrain gait propulsion; however, safe and effective coordination of dorsiflexor and plantarflexor neurostimulation during overground walking has been elusive, restricting propulsion neuroprostheses to harnessed treadmill walking. We present an overground propulsion neuroprosthesis that adaptively coordinates, on a step-by-step basis, neurostimulation to the dorsiflexors and plantarflexors. In 10 individuals post-stroke, we evaluate the immediate effects of plantarflexor neurostimulation delivered with different onset timings, and retention to unassisted walking (NCT06459401). Preferred onset timing differed across individuals. Individualized tuning resulted in a significant 10% increase in paretic propulsion peak (Δ: 1.41 ± 1.52%BW) and an 8% increase in paretic plantarflexor power (Δ: 0.27 ± 0.23 W/kg), compared to unassisted walking. Post-session unassisted walking speed, paretic propulsion peak, and propulsion symmetry all significantly improved by 9% (0.14 ± 0.09 m/s), 28% (2.24 ± 3.00%BW), and 12% (4.5 ± 6.0%), respectively, compared to pre-session measurements. Here we show that an overground propulsion neuroprosthesis can improve overground walking speed and propulsion symmetry in the chronic phase of stroke recovery. Future studies should include a control group to examine the efficacy of gait training augmented by the propulsion neuroprosthesis compared to gait training alone.

Validating the Safe and Effective Use of a Neurorehabilitation System (InTandem) to Improve Walking in the Chronic Stroke Population: Usability Study.

Persistent walking impairment following a stroke is common. Although rehabilitative interventions exist, few exist for use at home in the chronic phase of stroke recovery. InTandem (MedRhythms, Inc) is a neurorehabilitation system intended to improve walking and community ambulation in adults with chronic stroke walking impairment. Using design best practices and human factors engineering principles, the research presented here was conducted to validate the safe and effective use of InTandem. In total, 15 participants in the chronic phase of stroke recovery (≥6 months after stroke) participated in this validation study. Participants were scored on 8 simulated use tasks, 4 knowledge assessments, and 7 comprehension assessments in a simulated home environment. The number and types of use errors, close calls, and operational difficulties were evaluated. Analyses of task performances, participant behaviors, and follow-up interviews were conducted to determine the root cause of use errors and difficulties. During this validation study, 93% (14/15) of participants were able to successfully complete the critical tasks associated with the simulated use of the InTandem system. Following simulated use task assessments, participants' knowledge and comprehension of the instructions for use and key safety information were evaluated. Overall, participants were able to find and correctly interpret information in the materials in order to answer the knowledge assessment questions. During the comprehension assessment, participants understood warning statements associated with critical tasks presented in the instructions for use. Across the entire study, 3 "use errors" and 1 "success with difficulty" were recorded. No adverse events, including slips, trips, or falls, occurred in this study. In this validation study, people in the chronic phase of stroke recovery were able to safely and effectively use InTandem in the intended use environment. This validation study contributes to the overall understanding of residual use-related risks of InTandem in consideration of the established benefits.

The effectiveness of robotic rehabilitation for the functional recovery of the upper limb in post-stroke patients: a systematic review

Stroke is a significant contributor to global mortality and disability, and it is typically classified as a neurological disorder. A key component of stroke rehabilitation is improving upper limb function to reduce impairments and disabilities and their impact on activities of daily living. In the last few years, robot-assisted therapy (RT) arises as a novel and expanding approach in poststroke rehabilitation, which utilizes robotic devices to facilitate the recovery of motor function and task-oriented training. The aim of this systematic review, conducted through MEDLINE, CINAHL and EMBASE consultation, was to investigate the association between functional outcomes of the upper limb in patients with stroke after-effects and the use of robotic rehabilitation.The results of the included studies have highlighted the impact of robot-assisted rehabilitation, whether integrated with traditional physiotherapy, on several clinical outcomes such as pain, spasticity, motor function, hand and finger function and cognitive abilities. The introduction of the robot-assisted intervention, coupled with traditional treatment, maybe a valuable approach to improving quality of life and enhance not only motor function but also the cognitive ability of stroke patients, especially whether focusing on the early phase of stroke recovery with a high potential impact on clinical practice. Keywords: Stroke; Upper limb; Robotic rehabilitation; Neurological disorders; robot-assisted therapy;

Exploring facilitators and barriers associated with oral care for inpatients with dysphagia post-stroke.

To explore the attitudes, facilitators and barriers in providing oral care for inpatients with dysphagia post-stroke as perceived by healthcare professionals. Dysphagia is a common complication of stroke and is associated with a higher incidence of aspiration pneumonia, malnutrition and dehydration. In the acute phase of stroke recovery, a dental professional is not usually part of the multidisciplinary team caring for the patient and oral care is the responsibility of the healthcare professionals in the stroke unit. There is a lack of high-quality evidence to demonstrate the most effective method of providing oral care for patients with dysphagia post-stroke. This was a single-site study conducted with healthcare professionals working in the Stroke Unit of Cork University Hospital in Ireland, using focus groups and a qualitative thematic analysis approach. A total of three focus groups were conducted in the Stroke Unit with 17 healthcare professionals. The focus groups included representation from all healthcare professional groups providing direct clinical care to patients on the Stroke Unit including geriatric medicine, dietetics, speech and language therapy, healthcare assistance, nursing, occupational therapy and physiotherapy. A qualitative thematic analysis was carried out and seven overarching themes emerged from the data. Three themes related to facilitators to providing oral care for this patient group: (i) a focus on oral care in both policy and practice, (ii) expanding professional roles in the provision of oral care, (iii) perceived importance of oral care in recovery and rehabilitation. Four themes related to barriers to the provision of oral care for this patient group: (i) lack of confidence and concerns related to the perceived risk for patients with dysphagia, (ii) unique challenges of patient and stroke-related factors, (iii) lack of resources and time and (iv) perceived importance of oral care in recovery and its relative importance with competing demands. Members of the stroke multidisciplinary team believe that they all have a part to play in the delivery of oral care for patients with dysphagia post-stroke. Opportunities exist for the development of multidisciplinary interventions to improve the oral cavity assessment and oral care provided in the Stroke Unit.

Sensitivity to Change and Responsiveness of the Upper Extremity Fugl-Meyer Assessment in Individuals With Moderate to Severe Acute Stroke.

The Fugl-Meyer Assessment-Upper Extremity (FMA-UE) is a widely used outcome measure for quantifying motor impairment in stroke recovery. Meaningful change (responsiveness) in the acute to subacute phase of stroke recovery has not been determined. Determine responsiveness and sensitivity to change of the FMA-UE from 1-week to 6-weeks (subacute) after stroke in individuals with moderate to severe arm impairment who received standard clinical care. A total of 51 participants with resulting moderate and severe UE hemiparesis after stroke had FMA-UE assessment at baseline (within 2 weeks of stroke) and 6-weeks later. Sensitivity to change was assessed using Glass's delta, standardized response means (SRM), standard error of measure (SEM), and minimal detectable change (MDC). Responsiveness was assessed with the minimal clinically important difference (MCID), estimated using receiver operating characteristic curve analysis with patient-reported global rating of change scales (GROC) and a provider-reported modified Rankin Scale (mRS) as anchors. The MCID estimates were 13, 12, and 9 anchored to the GROC Arm Weakness, GROC Recovery, and mRS. Glass's delta and the SRM revealed large effect sizes, indicating high sensitivity to change, (∆ = 1.24, 95% CI [0.64, 1.82], SRM = 1.10). Results for the SEM and MDC were 2.46 and 6.82, respectively. The estimated MCID for the FMA-UE for individuals with moderate to severe motor impairment from 1 to 6-weeks after stroke is 13. These estimates will provide clinical context for FMA-UE change scores by helping to identify the change in upper-extremity motor impairment that is both beyond measurement error and clinically meaningful.

Gait and Muscle Activity Changes in Patients in the Recovery Phase of Stroke with Continuous Use of Ankle-Foot Orthosis with Plantarflexion Resistance

Gait and Muscle Activity Changes in Patients in the Recovery Phase of Stroke with Continuous Use of Ankle-Foot Orthosis with Plantarflexion Resistance

Effect of Selective Serotonin Reuptake Inhibitors on Motor Recovery After Stroke: A Systematic Meta-analysis.

We conducted a meta-analysis to determine the effectiveness of SSRIs in improving motor outcomes after stroke. For accuracy, we only included studies in which SSRIs were administered to patients in the recovery phase after stroke (<6 months after stroke). Meta-analyses were conducted according to the tools used to measure motor function. We searched the SCOPUS, PubMed, Embase, and Cochrane Library databases for studies which compared motor recovery in patients who receive SSRI medication in the recovery phase after stroke with a control group that did not receive any SSRI. A total of 3,715 publications were assessed, and nine studies met the study criteria. The group which received SSRI showed improved Fugl-Meyer Motor Scale and Barthel index scores compared to the control group. However, there was no significant difference in the modified Rankin Scale scores between the SSRI and control groups. The incidence of adverse effects after the administration of SSRIs did not differ from that in the control group. Our study showed that the use of SSRI in the recovery phase of stroke improved motor function without significant increase in side effects.

Salt-induced maladaptive innate immune memory impedes stroke recovery

Abstract A high salt diet (HSD) is a top risk factor for human mortality. Beyond its heavily implicated role in hypertension, it is now linked to the development of inflammatory diseases before the onset of cardiovascular events. Even after salt reduction, HSD can induce prolonged tissue damage, yet the mechanisms by which HSD induces persistent negative effects on immune system are largely unexplored. While HSD is an established risk factor for stroke, its impact on long-term stroke recovery is unknown. Here, we model two major stroke types, intracerebral hemorrhage, and cerebral ischemia, to investigate how HSD induces unfavorable immune responses and subsequently impacts long-term tissue repair. We found HSD exclusively hampers alternative activation in monocytes-derived macrophages (MDMs) while sparing the major parenchymal macrophage—microglia—in the stroke brain. HSD induces innate immune memory in the hematopoietic stem and progenitor cells through downregulating mitochondrial oxidative phosphorylation and NR4a orphan nuclear receptors expression. This immunological memory was retained in the brain-infiltrating MDMs and restrained their reparative functions. Consequently lead to impaired tissue repair and neurobehavioral recovery during stroke recovery phase. Pharmacological treatment with NR4a1 activator and genetic overexpression of NR4a1 restored MDMs reparative phenotype suppressed by HSD and enabled stroke recovery. These findings establish a new mechanism linking HSD-induced maladaptive innate immune memory to a hindered macrophage alternative activation and delayed tissue recovery. Our data unveil innate immune memory and NR4a1 as potential therapeutic targets for treating HSD-associated diseases.